Shuttle Risk Progression: Use of the Shuttle Probabilistic Risk Assessment (PRA) to Show Reliability Growth

NASA Technical Reports Server (NTRS)

Hamlin, Teri L.

2011-01-01

It is important to the Space Shuttle Program (SSP), as well as future manned spaceflight programs, to understand the early mission risk and progression of risk as the program gains insights into the integrated vehicle through flight. The risk progression is important to the SSP as part of the documentation of lessons learned. The risk progression is important to future programs to understand reliability growth and the first flight risk. This analysis uses the knowledge gained from 30 years of operational flights and the current Shuttle PRA to calculate the risk of Loss of Crew and Vehicle (LOCV) at significant milestones beginning with the first flight. Key flights were evaluated based upon historical events and significant re-designs. The results indicated that the Shuttle risk tends to follow a step function as opposed to following a traditional reliability growth pattern where risk exponentially improves with each flight. In addition, it shows that risk can increase due to trading safety margin for increased performance or due to external events. Due to the risk drivers not being addressed, the risk did not improve appreciably during the first 25 flights. It was only after significant events occurred such as Challenger and Columbia, where the risk drivers were apparent, that risk was significantly improved. In addition, this paper will show that the SSP has reduced the risk of LOCV by almost an order of magnitude. It is easy to look back afte r 30 years and point to risks that are now obvious, however; the key is to use this knowledge to benefit other programs which are in their infancy stages. One lesson learned from the SSP is understanding risk drivers are essential in order to considerably reduce risk. This will enable the new program to focus time and resources on identifying and reducing the significant risks. A comprehensive PRA, similar to that of the Shuttle PRA, is an effective tool quantifying risk drivers if support from all of the stakeholders is given.

Nigerian College Students: HIV Knowledge, Perceived Susceptibility for HIV and Sexual Behaviors

ERIC Educational Resources Information Center

Chng, Chwee Lye; Eke-Huber, Esther; Eaddy, Starr; Collins, John. R.

2005-01-01

This study examined HIV knowledge, perceived risk and sexual behavior of 370 undergraduate students in selected universities in southern Nigeria. MANOVA confirmed females to have significantly higher overall HIV knowledge than males ([p.bar] = .03). In addition, more females than males reported significantly higher knowledge on the risk of HIV…

Perceived risk of cervical cancer among pre-screening age women (18-24 years): the impact of information about cervical cancer risk factors and the causal role of HPV.

PubMed

Nadarzynski, Tomasz; Waller, Jo; Robb, Kathryn A; Marlow, Laura A V

2012-10-01

Current National Health Service cervical screening information does not explain that the cause of cervical cancer is a sexually transmitted infection (human papillomavirus (HPV)). This study aimed to consider the impact that providing this information, in addition to risk factor information, might have on women's perceived risk of cervical cancer. Female students aged 18-24 years (n=606) completed a web-based survey and were randomised to receive (1) control information about cervical cancer; (2) details of the link between HPV and cervical cancer; (3) risk factor information or (4) details about the link with HPV + risk factor information. Risk perceptions for cervical cancer were assessed before and after reading the information. There was a significant difference in perceived risk of cervical cancer between the four groups following information exposure (p=0.002). Compared with the control group, risk perceptions were significantly lower among women given risk factor information but not among those informed about HPV. There were significant group by risk factor interactions for smoking status (p<0.001), age of first sex (p=0.018) and number of sexual partners (p<0.001). Risk perceptions were lower among women considered at low risk and given risk factor information, but there was no association between information group and perceived risk for high-risk women. Providing risk factor information appears to reduce cervical cancer risk perceptions, but learning about the aetiological role of HPV appears to have no impact on risk perceptions. Incorporating brief information about HPV as the cause of cervical cancer should be in addition to, rather than in place of, risk factor information.

Additive treatment improves survival in elderly patients after non-curative endoscopic resection for early gastric cancer.

PubMed

Jung, Da Hyun; Lee, Yong Chan; Kim, Jie-Hyun; Lee, Sang Kil; Shin, Sung Kwan; Park, Jun Chul; Chung, Hyunsoo; Park, Jae Jun; Youn, Young Hoon; Park, Hyojin

2017-03-01

Endoscopic resection (ER) is accepted as a curative treatment option for selected cases of early gastric cancer (EGC). Although additional surgery is often recommended for patients who have undergone non-curative ER, clinicians are cautious when managing elderly patients with GC because of comorbid conditions. The aim of the study was to investigate clinical outcomes in elderly patients following non-curative ER with and without additive treatment. Subjects included 365 patients (>75 years old) who were diagnosed with EGC and underwent ER between 2007 and 2015. Clinical outcomes of three patient groups [curative ER (n = 246), non-curative ER with additive treatment (n = 37), non-curative ER without additive treatment (n = 82)] were compared. Among the patients who underwent non-curative ER with additive treatment, 28 received surgery, three received a repeat ER, and six experienced argon plasma coagulation. Patients who underwent non-curative ER alone were significantly older than those who underwent additive treatment. Overall 5-year survival rates in the curative ER, non-curative ER with treatment, and non-curative ER without treatment groups were 84, 86, and 69 %, respectively. No significant difference in overall survival was found between patients in the curative ER and non-curative ER with additive treatment groups. The non-curative ER groups were categorized by lymph node metastasis risk factors to create a high-risk group that exhibited positive lymphovascular invasion or deep submucosal invasion greater than SM2 and a low-risk group without risk factors. Overall 5-year survival rate was lowest (60 %) in the high-risk group with non-curative ER and no additive treatment. Elderly patients who underwent non-curative ER with additive treatment showed better survival outcome than those without treatment. Therefore, especially with LVI or deep submucosal invasion, additive treatment is recommended in patients undergoing non-curative ER, even if they are older than 75 years.

Additive effects of PNPLA3 and TM6SF2 on the histological severity of non-alcoholic fatty liver disease.

PubMed

Koo, Bo Kyung; Joo, Sae Kyung; Kim, Donghee; Bae, Jeong Mo; Park, Jeong Hwan; Kim, Jung Ho; Kim, Won

2017-11-29

We investigated the effects of PNPLA3 rs738409, TM6SF2 rs58542926, and MBOAT7-TMC4 rs641738 variants on metabolic phenotypes and their combined effects on the histological severity of non-alcoholic fatty liver disease (NAFLD). We genotyped rs738409, rs58542926, and rs641738 in biopsy-proven NAFLD patients (n = 416) and healthy controls (n = 109). Homeostasis model assessment of insulin resistance and adipose tissue insulin resistance were calculated. The rs738409 and rs58542926 variants, but not rs641738, were associated not only with non-alcoholic steatohepatitis (NASH) (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.46-2.73 and OR, 1.91; 95% CI, 1.04-3.51) but also with significant fibrosis (≥ F2) (OR, 1.53; 95% CI, 1.11-2.11 and OR, 1.88; 95% CI, 1.02-3.46) in NAFLD, even after adjustment for metabolic risk factors. Of both variants, only rs738409 was associated with homeostasis model assessment of insulin resistance and adipose tissue insulin resistance even in healthy controls (P = 0.046 and 0.002, respectively) as well as in the entire study cohort (P = 0.016 and 0.048, respectively). PNPLA3 and TM6SF2 risk variants additively increased the risk of NASH and significant fibrosis (OR per risk allele, 2.03; 95% CI, 1.50-2.73 and 1.61; 95% CI, 1.19-2.17). Even in subjects with low insulin resistance, the risk of NASH or significant fibrosis increased as the number of risk alleles increased (P = 0.008 and 0.020, respectively). PNPLA3 and TM6SF2 determine the risk of NASH and significant fibrosis, even after adjustment for insulin resistance, and exert an additive effect on NASH and significant fibrosis. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Spatial analysis of gastroschisis in Massachusetts and Texas

PubMed Central

Yazdy, Mahsa M.; Werler, Martha M.; Anderka, Marlene; Langlois, Peter H.; Vieira, Veronica M.

2014-01-01

Purpose Previous research has suggested gastroschisis, a congenital malformation, may be linked to environmental or infectious factors and cases can occur in clusters. The objective of this study was to identify geographic areas of elevated gastroschisis risk. Methods Cases of gastroschisis were identified from birth defect registries in Massachusetts and Texas. Random samples of live births were selected as controls. Generalized additive models were used to create a continuous map surface of odds ratios (OR) by smoothing over latitude and longitude. Maternal age, race/ethnicity, education, cigarette smoking, and insurance status (MA only) were assessed for confounding. We used permutation tests to identify statistically significant areas of increased risk. Results An area of increased risk was identified in north-central Massachusetts, but was not significant after adjustment (p-value=0.07; OR=2.0). In Texas, two statistically significant areas of increased risk were identified after adjustment (p-value=0.02; OR=1.3 and 1.2). Texas had sufficient data to assess the combination of space and time, which identified an increased risk in 2003 and 2004. Conclusion This study suggests there were areas of elevated gastroschisis risk in Massachusetts and Texas that cannot be explained by the risk factors we assessed. Additional exploration of underlying artifactual, environmental, infectious, or behavioral factors may further our understanding of gastroschisis. PMID:25454289

Usefulness of the addition of beta-2-microglobulin, cystatin C and C-reactive protein to an established risk factors model to improve mortality risk prediction in patients undergoing coronary angiography.

PubMed

Nead, Kevin T; Zhou, Margaret J; Caceres, Roxanne Diaz; Sharp, Stephen J; Wehner, Mackenzie R; Olin, Jeffrey W; Cooke, John P; Leeper, Nicholas J

2013-03-15

Evidence-based therapies are available to reduce the risk for death from cardiovascular disease, yet many patients go untreated. Novel methods are needed to identify those at highest risk for cardiovascular death. In this study, the biomarkers β2-microglobulin, cystatin C, and C-reactive protein were measured at baseline in a cohort of participants who underwent coronary angiography. Adjusted Cox proportional-hazards models were used to determine whether the biomarkers predicted all-cause and cardiovascular mortality. Additionally, improvements in risk reclassification and discrimination were evaluated by calculating the net reclassification improvement, C-index, and integrated discrimination improvement with the addition of the biomarkers to a baseline model of risk factors for cardiovascular disease and death. During a median follow-up period of 5.6 years, there were 78 deaths among 470 participants. All biomarkers independently predicted future all-cause and cardiovascular mortality. A significant improvement in risk reclassification was observed for all-cause (net reclassification improvement 35.8%, p = 0.004) and cardiovascular (net reclassification improvement 61.9%, p = 0.008) mortality compared to the baseline risk factors model. Additionally, there was significantly increased risk discrimination with C-indexes of 0.777 (change in C-index 0.057, 95% confidence interval 0.016 to 0.097) and 0.826 (change in C-index 0.071, 95% confidence interval 0.010 to 0.133) for all-cause and cardiovascular mortality, respectively. Improvements in risk discrimination were further supported using the integrated discrimination improvement index. In conclusion, this study provides evidence that β2-microglobulin, cystatin C, and C-reactive protein predict mortality and improve risk reclassification and discrimination for a high-risk cohort of patients who undergo coronary angiography. Copyright © 2013 Elsevier Inc. All rights reserved.

Cardiometabolic Risks in Polycystic Ovary Syndrome: Non-Traditional Risk Factors and the Impact of Obesity.

PubMed

Chiu, Wei-Ling; Boyle, Jacqueline; Vincent, Amanda; Teede, Helena; Moran, Lisa J

2017-01-01

Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with reproductive, metabolic, and psychological features and significantly increased cardiometabolic risks. PCOS is underpinned by inherent insulin resistance and hyperandrogenism. Obesity, more common in PCOS, plays an important role in the pathophysiology, exacerbating hyperinsulinaemia and hyperandrogenism, leading to recommended first-line lifestyle intervention. Significant traditional and non-traditional risk factors are implicated in PCOS in addition to obesity-exacerbated cardiometabolic risks and are explored in this review to promote the understanding of this common metabolic and reproductive condition. © 2016 S. Karger AG, Basel.

Spironolactone Add-on for Preventing or Slowing the Progression of Diabetic Nephropathy: A Meta-analysis.

PubMed

Hou, Jing; Xiong, Weiquan; Cao, Ling; Wen, Xiangqiong; Li, Ailing

2015-09-01

The aim of this meta-analysis was to evaluate the benefits and potential adverse effects of adding spironolactone to standard antidiabetic/renoprotective/antihypertensive (AD/RP/AHT) treatment in patients with diabetic nephropathy (DN). PubMed/MEDLINE and Web of Knowledge were searched for relevant randomized, controlled studies (RCTs) or quasi-RCTs of the effects of adding spironolactone to standard AD/RP/AHT treatment in patients with DN. Results were summarized with a random-effects model or a fixed-effects model. According to the outcomes measured (benefits and risks of adding spironolactone to standard AD/RP/AHT treatment), compared with controls, the addition of spironolactone significantly decreased end-of-treatment (EOT) 24-hour urinary albumin/protein excretion and significantly increased percentage reduction from baseline in urinary albumin/creatinine ratio (UACR), although it did not significantly affect EOT UACR. The addition of spironolactone further led to a significantly greater reduction from baseline in glomerular filtration rate (GFR)/estimated (e) GFR, although it did not significantly affect EOT GFR/eGFR. Further, the addition of spironolactone significantly reduced EOT in-office, 24-hour, and daytime systolic and diastolic blood pressure (SBP and DBP, respectively) and led to significantly greater reductions from baseline in in-office SBP and DBP, although it did not significantly affect nighttime SBP or DBP. Finally, the addition of spironolactone significantly increased mean serum/plasma potassium levels and the risk for hyperkalemia. Spironolactone could be added to preexisting AD/RP/AHT therapy in patients with DN to prevent or slow DN progression by reducing proteinuria. The addition of spironolactone would likely provide even more beneficial effect in patients with DN and hypertension due to the BP reduction associated with spironolactone use. However, the beneficial effects of spironolactone add-on should be weighed against its potential risks, especially hyperkalemia. The long-term effects of spironolactone add-on on renal outcomes and mortality need to be studied. Copyright © 2015. Published by Elsevier Inc.

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

PubMed

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

2013-01-01

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

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

PubMed

Heinrich, Katie M; Maddock, Jay

2011-01-01

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

Additive Effects of the Risk Alleles of PNPLA3 and TM6SF2 on Non-alcoholic Fatty Liver Disease (NAFLD) in a Chinese Population.

PubMed

Wang, Xiaoliang; Liu, Zhipeng; Wang, Kai; Wang, Zhaowen; Sun, Xing; Zhong, Lin; Deng, Guilong; Song, Guohe; Sun, Baining; Peng, Zhihai; Liu, Wanqing

2016-01-01

Recent genome-wide association studies have identified that variants in or near PNPLA3, NCAN, GCKR, LYPLAL1, and TM6SF2 are significantly associated with non-alcoholic fatty liver disease (NAFLD) in multiple ethnic groups. Studies on their impact on NAFLD in Han Chinese are still limited. In this study, we examined the relevance of these variants to NAFLD in a community-based Han Chinese population and further explored their potential joint effect on NAFLD. Six single nucleotide polymorphisms (SNPs) (PNPLA3 rs738409, rs2294918, NCAN rs2228603, GCKR rs780094, LYPLAL1 rs12137855, and TM6SF2 rs58542926) previously identified in genome-wide analyses, to be associated with NAFLD were genotyped in 384 NAFLD patients and 384 age- and gender-matched healthy controls. We found two out of the six polymorphisms, PNPLA3 rs738409 (OR = 1.52, 95%CI: 1.19-1.96; P = 0.00087) and TM6SF2 rs58542926 (OR = 2.11, 95%CI: 1.34-3.39; P = 0.0016) are independently associated with NAFLD after adjustment for the effects of age, gender, and BMI. Our analysis further demonstrated the strong additive effects of the risk alleles of PNPLA3 and TM6SF2 with an overall significance between the number of risk alleles and NAFLD (OR = 1.64, 95%CI: 1.34-2.01; P = 1.4 × 10(-6)). The OR for NAFLD increased in an additive manner, with an average increase in OR of 1.52 per additional risk allele. Our results confirmed that the PNPLA3 and TM6SF2 variants were the most significant risk alleles for NAFLD in Chinese population. Therefore, genotyping these two genetic risk factors may help identify individuals with the highest risk of NAFLD.

Implications of Bioremediation of Polycyclic Aromatic Hydrocarbon-Contaminated Soils for Human Health and Cancer Risk

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

Davie-Martin, Cleo L.; Stratton, Kelly G.; Teeguarden, Justin G.

Background: Bioremediation uses microorganisms to degrade polycyclic aromatic hydrocarbons (PAHs) in contaminated soils. Its success is largely evaluated through targeted analysis of PAH concentrations in soil and cancer risk (exposure) estimates. However, bioremediation often fails to significantly degrade the most carcinogenic PAHs and can initiate formation of more polar metabolites, some of which may be more toxic. Objectives: We aimed to investigate whether the cancer risk associated with PAH-contaminated soils was reduced post-bioremediation and to identify the most effective bioremediation strategies for degrading the carcinogenic and high molecular weight (≥MW302) PAHs. Methods: Pre- and post-bioremediation concentrations of eight B2 groupmore » carcinogenic PAHs in soils were collated from the literature and used to calculate excess lifetime cancer risks (ELCR) for adult populations exposed via non-dietary ingestion, per current U.S. Environmental Protection Agency (USEPA) recommendations. Due to the nature of the collated data (reported as mean concentrations ± standard deviations pre- and post-bioremediation), we used simulation methods to reconstruct the datasets and enable statistical comparison of ELCR values pre- and post-bioremediation. Additionally, we measured MW302 PAHs in a contaminated soil prior to and following treatment in an aerobic bioreactor and examined their contributions to cancer risk. Results: 120 of 158 treated soils (76%) exhibited a statistically significant reduction in cancer risk following bioremediation; however, 67% (106/158) of soils had post-bioremediation ELCR values over 10 fold higher than the USEPA health-based ‘acceptable’ risk level. Composting treatments were most effective at biodegrading PAHs in soils and reducing the ELCR. MW302 PAHs were not significantly degraded during bioremediation and dibenzo(a,l)pyrene, alone, contributed an additional 35% to the cancer risk associated with the eight B2 group PAHs in the same bioremediated soil. Conclusions: Bioremediation strategies often fail to reduce carcinogenic PAH concentrations in contaminated soils below USEPA acceptable cancer risk levels. Additionally, MW302 PAHs and ‘unknown’ metabolites (compounds not routinely measured) are not included in current cancer risk assessments and could significantly contribute to soil carcinogenicity.« less

Predictors of HIV-Risk Sexual Behavior: Examining Lifetime Sexual and Physical Abuse Histories in Relation to Substance Use and Psychiatric Problem Severity Among Ex-Offenders

PubMed Central

Majer, John M.; Rodriquez, Jaclyn; Bloomer, Craig; Jason, Leonard A.

2015-01-01

Predictors of HIV-risk sexual behavior were analyzed among a sample of ex-offenders who were completing inpatient treatment for substance dependence. Hierarchical linear regression was conducted to examine increases in participants’ number of sexual partners in relation to sociodemographic characteristics, recent substance use and current psychiatric problem severity in addition to lifetime histories of sexual and physical abuse. Gender, substance use, and psychiatric problem severity predicted increases in HIV-risk sexual behaviors beyond what was predicted by abuse histories. Proportionately more women than men reported abuse histories. In addition, significantly more unprotected sexual than safer sexual practices were observed, but differences in the frequency of these practices based on lifetime abuse histories and gender were not significant. Findings suggest recent substance use and current psychiatric problem severity are risk-factors for HIV-risk sexual behavior among ex-offenders with and without lifetime abuse histories. PMID:24717831

Adverse childhood experiences and sexual victimization in adulthood.

PubMed

Ports, Katie A; Ford, Derek C; Merrick, Melissa T

2016-01-01

Understanding the link between adverse childhood experiences (ACEs) and sexual victimization (SV) in adulthood may provide important information about the level of risk for adult SV and sexual re-victimization among childhood sexual abuse (CSA) survivors. In the present paper, we explore the relationship between ACEs, including CSA, and SV in adulthood. Data from the CDC-Kaiser ACE Study were used to examine the effect of experiences of early adversity on adult SV. Adult HMO members (n=7,272) undergoing a routine health exam provided detailed information about ACEs that occurred at age 18 or younger and their experiences of SV in adulthood. Analyses revealed that as ACE score increased, so did risk of experiencing SV in adulthood. Each of the ACE variables was significantly associated with adult SV, with CSA being the strongest predictor of adult SV. In addition, for those who reported CSA, there was a cumulative increase in adult SV risk with each additional ACE experienced. As such, early adversity is a risk factor for adult SV. In particular, CSA is a significant risk factor for sexual re-victimization in adulthood, and additional early adversities experienced by CSA survivors may heighten adult SV risk above and beyond the risk associated with CSA alone. Given the interconnectedness among various experiences of early adversity, adult SV prevention actions must consider how other violence-related and non-violence-related traumatic experiences may exacerbate the risk conferred by CSA on subsequent victimization. Published by Elsevier Ltd.

KIT polymorphisms were associated with the risk for head and neck squamous carcinoma in Chinese population.

PubMed

Hang, Dong; Yuan, Hua; Liu, Li; Wang, Lihua; Miao, Limin; Zhu, Meng; Du, Jiangbo; Dai, Juncheng; Hu, Zhibin; Chen, Ning; Shen, Hongbing; Ma, Hongxia

2017-01-01

KITLG/KIT pathway plays a vital role in multiple types of human cancer including head and neck squamous cell carcinoma (HNSCC). Genetic variations in KITLG and KIT may affect the expression or function of these genes, thereby modifying cancer risk. In this study, we evaluated the association of KITLG and KIT polymorphisms with HNSCC risk among Chinese population. Twenty-two tagging SNPs in KITLG and KIT genes were genotyped in a case-control study with 576 HNSCC patients and 1552 healthy controls. Logistic regression analyses revealed that an upstream SNP rs6554198 [additive model: adjusted odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.74-0.97, P = 0.019] and two intron SNPs rs2237025 (additive model: adjusted OR = 0.82, 95%CI = 0.70-0.95, P = 0.007), and rs17084687 (additive model: adjusted OR = 0.85, 95%CI = 0.73-0.99, P = 0.042) of KIT were significantly associated with the decreased risk of HNSCC. Combined analysis of the three SNPs showed that subjects carrying the protective alleles had decreased risk of HNSCC in a dose-response manner (P trend  = 0.001). Furthermore, interaction analyses revealed a significant multiplicative interaction between rs17084687 and drinking on HNSCC risk (P = 0.012). Luciferase activity assay indicated that the allele A of potentially functional rs6554198 led to significantly lower transcription activity of KIT compared to the risk allele G. Summarily, our findings suggested that SNPs in KIT gene may play a role in genetic susceptibility to HNSCC, which may improve our understanding of the pathogenic mechanisms of this disease. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Balance and Risk of Fall in Individuals with Bilateral Mild and Moderate Knee Osteoarthritis

PubMed Central

Khalaj, Nafiseh; Abu Osman, Noor Azuan; Mokhtar, Abdul Halim; Mehdikhani, Mahboobeh; Wan Abas, Wan Abu Bakar

2014-01-01

Balance is essential for mobility and performing activities of daily living. People with knee osteoarthritis display impairment in knee joint proprioception. Thus, the aim of this study was to evaluate balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis. Sixty subjects aged between 50 and 70 years volunteered in this study. They were categorized into three groups which were healthy (n = 20), mild (n = 20) and moderate (n = 20) bilateral knee osteoarthritis groups. Dynamic and static balance and risk of fall were assessed using Biodex Stability System. In addition, Timed Up and Go test was used as a clinical test for balance. Results of this study illustrated that there were significant differences in balance (dynamic and static) and risk of fall between three groups. In addition, the main (most significant) difference was found to be between healthy group and moderate group. Furthermore, on clinical scoring of balance, the “Timed Up and Go” test, all three groups showed significant difference. In conclusion, bilateral knee osteoarthritis impaired the balance and increased the risk of fall, particularly in people with moderate knee osteoarthritis. PMID:24642715

Balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis.

PubMed

Khalaj, Nafiseh; Abu Osman, Noor Azuan; Mokhtar, Abdul Halim; Mehdikhani, Mahboobeh; Wan Abas, Wan Abu Bakar

2014-01-01

Balance is essential for mobility and performing activities of daily living. People with knee osteoarthritis display impairment in knee joint proprioception. Thus, the aim of this study was to evaluate balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis. Sixty subjects aged between 50 and 70 years volunteered in this study. They were categorized into three groups which were healthy (n = 20), mild (n = 20) and moderate (n = 20) bilateral knee osteoarthritis groups. Dynamic and static balance and risk of fall were assessed using Biodex Stability System. In addition, Timed Up and Go test was used as a clinical test for balance. Results of this study illustrated that there were significant differences in balance (dynamic and static) and risk of fall between three groups. In addition, the main (most significant) difference was found to be between healthy group and moderate group. Furthermore, on clinical scoring of balance, the "Timed Up and Go" test, all three groups showed significant difference. In conclusion, bilateral knee osteoarthritis impaired the balance and increased the risk of fall, particularly in people with moderate knee osteoarthritis.

[Prevention of dyslexia – short-term and intermediate effects of promoting phonological awareness and letter-sound correspondence with at-risk preschool children].

PubMed

Höse, Anna; Wyschkon, Anne; Moraske, Svenja; Eggeling, Marie; Quandte, Sabine; Kohn, Juliane; Poltz, Nadine; von Aster, Michael; Esser, Günter

2016-09-01

This study assesses the short-term and intermediate effects of preschool training stimulating phonological awareness and letter-sound correspondence for children at risk of developing dyslexia. Moreover, we examined whether training reduced the frequency of subsequent dyslexic problems. 25 children at risk of developing dyslexia were trained with Hören, Lauschen, Lernen 1 und 2 (Küspert & Schneider, 2008; Plume & Schneider, 2004) by their kindergarten teachers and were compared with 60 untrained at-risk children. The training revealed a significant short-term effect: The phonological awareness of trained at-risk children increased significantly over that of untrained at-risk children. However, there were no differences in phonological awareness, spelling, and reading ability between the first-graders in the training and control group. Furthermore, reading problems were reduced in the training group. In the future, phonological awareness as well as additional predictors should be included when identifying children vulnerable to developing dyslexia. Moreover, in order to prevent dyslexia, additional prerequisite deficits need to be identified, alleviated, and their effects evaluated.

A genetic risk score based on direct associations with coronary heart disease improves coronary heart disease risk prediction in the Atherosclerosis Risk in Communities (ARIC), but not in the Rotterdam and Framingham Offspring, Studies.

PubMed

Brautbar, Ariel; Pompeii, Lisa A; Dehghan, Abbas; Ngwa, Julius S; Nambi, Vijay; Virani, Salim S; Rivadeneira, Fernando; Uitterlinden, André G; Hofman, Albert; Witteman, Jacqueline C M; Pencina, Michael J; Folsom, Aaron R; Cupples, L Adrienne; Ballantyne, Christie M; Boerwinkle, Eric

2012-08-01

Multiple studies have identified single-nucleotide polymorphisms (SNPs) that are associated with coronary heart disease (CHD). We examined whether SNPs selected based on predefined criteria will improve CHD risk prediction when added to traditional risk factors (TRFs). SNPs were selected from the literature based on association with CHD, lack of association with a known CHD risk factor, and successful replication. A genetic risk score (GRS) was constructed based on these SNPs. Cox proportional hazards model was used to calculate CHD risk based on the Atherosclerosis Risk in Communities (ARIC) and Framingham CHD risk scores with and without the GRS. The GRS was associated with risk for CHD (hazard ratio [HR] = 1.10; 95% confidence interval [CI]: 1.07-1.13). Addition of the GRS to the ARIC risk score significantly improved discrimination, reclassification, and calibration beyond that afforded by TRFs alone in non-Hispanic whites in the ARIC study. The area under the receiver operating characteristic curve (AUC) increased from 0.742 to 0.749 (Δ = 0.007; 95% CI, 0.004-0.013), and the net reclassification index (NRI) was 6.3%. Although the risk estimates for CHD in the Framingham Offspring (HR = 1.12; 95% CI: 1.10-1.14) and Rotterdam (HR = 1.08; 95% CI: 1.02-1.14) Studies were significantly improved by adding the GRS to TRFs, improvements in AUC and NRI were modest. Addition of a GRS based on direct associations with CHD to TRFs significantly improved discrimination and reclassification in white participants of the ARIC Study, with no significant improvement in the Rotterdam and Framingham Offspring Studies. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Several anthropometric measurements and breast cancer risk: results of the E3N cohort study.

PubMed

Tehard, B; Clavel-Chapelon, F

2006-01-01

To investigate the association between various anthropometric characteristics and breast cancer. Longitudinal prospective cohort study. Follow-up between 1995 and 2000. In total, 69 116 women (age: 45-70 years; mean follow-up: 3.6 years), 275 premenopausal and 860 postmenopausal incident invasive breast cancers. Self-reported height, weight, breast, thorax, waist and hip circumferences and calculated body mass index (BMI) and waist-to-hip ratio (WHR) at baseline. A slight increase in risk with increasing height was found. Weight, BMI, thorax and waist circumferences and WHR were negatively related to breast cancer risk among premenopausal women. The relationships became non significant after additional adjustment for BMI. An increased risk of premenopausal breast cancer with an android body shape (WHR>0.87) might possibly be confined to obese women. Among postmenopausal women, all anthropometric measurements of corpulence were positively associated with breast cancer risk but became non significant after additional adjustment for BMI. No difference in risk of postmenopausal breast cancer according to HRT use was observed. The study confirmed that adiposity was negatively associated to premenopausal breast cancer risk and positively associated to postmenopausal breast cancer risk. Further studies will be needed to specify clearly the association between WHR and breast cancer risk, particularly before menopause.

Microbiological Quantitative Risk Assessment

NASA Astrophysics Data System (ADS)

Dominguez, Silvia; Schaffner, Donald W.

The meat and poultry industry faces ongoing challenges due to the natural association of pathogens of concern (e.g., Salmonella, Campylobacter jejuni, Escherichia coli O157:H7) with a variety of domesticated food animals. In addition, pathogens such as Listeria monocytogenes pose a significant cross-contamination risk during further meat and poultry processing, distribution, and storage. Furthermore, the meat and poultry industries are constantly changing with the addition of new products, use of new raw materials, and targeting of new consumer populations, each of which may give rise to potential new risks. National and international regulations are increasingly using a “risk-based” approach to food safety (where the regulatory focus is driven by the magnitude of the risk), so risk assessment is becoming a valuable tool to systematically organize and evaluate the potential public health risk posed by food processing operations.

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

PubMed

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

2015-11-01

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

Impact of Individual and Neighborhood Factors on Cardiovascular Risk in White Hispanic and Non-Hispanic Women and Men.

PubMed

Cohn, Tanya; Miller, Arlene; Fogg, Louis; Braun, Lynne T; Coke, Lola

2017-04-01

Cardiovascular disease (CVD) is the leading cause of mortality for adults in the US, regardless of ethnicity. A cross-sectional correlational design was used to describe and compare CVD risk and cardiac mortality in White Hispanic and non-Hispanic women and men. Data from 3,317 individuals (1,523 women and 1,794 men) hospitalized for non-cardiac causes during 2012-2013, and data from the 2010 United States Census were included. The sex-specific 10-year Framingham General Cardiovascular Risk Score (FRS-10) was used to estimate long-term risk for major cardiac events. Approximately three-quarters of the sample was White Hispanic. FRS-10 scores were generally low, but a high prevalence of risk factors not included in the standard FRS-10 scoring formula was seen. White Hispanic women had significantly lower estimated CVD risk scores compared to White Hispanic and non-Hispanic men despite higher non-FRS-10 risks. Neighborhood median household income had a significant negative relationship and Hispanic neighborhood concentration had a significant positive relationship with cardiac mortality. Hispanic concentration was the only predictor of estimated CVD risk in a multilevel model. CVD risk assessment tools that are calibrated for ethnic groups and socioeconomic status may be more appropriate for Hispanic individuals than the FRS-10. Neighborhood-level factors should be included in clinical cardiac assessment in addition to individual characteristics and behavioral risks. Researchers should continue to seek additional risk factors that may contribute to or protect against CVD in order to close the gap between estimated CVD risk and actual cardiac mortality for Hispanics in the US. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Medication adherence, comorbidities, and health risk impacts on workforce absence and job performance.

PubMed

Loeppke, Ronald; Haufle, Vince; Jinnett, Kim; Parry, Thomas; Zhu, Jianping; Hymel, Pamela; Konicki, Doris

2011-06-01

To understand impacts of medication adherence, comorbidities, and health risks on workforce absence and job performance. Retrospective observational study using employees' medical/pharmacy claims and self-reported health risk appraisals. Statin medication adherence in individuals with Coronary Artery Disease was significant predictor (P < 0.05) of decreasing absenteeism. Insulin, oral hypoglycemic, or metformin medication adherence in type 2 diabetics was significant (P < 0.05) predictor of decreasing job performance. Number of comorbidities was found as significant (P < 0.5) predictor of absenteeism in five of nine subsamples. Significant links (P < 0.05) between high health risks and lower job performance were found across all nine subsamples. Results suggest integrated health and productivity management strategies should include an emphasis on primary and secondary prevention to reduce health risks in addition to tertiary prevention efforts of disease management and medication management.

Genetic predisposition to coronary heart disease and stroke using an additive genetic risk score: A population-based study in Greece

PubMed Central

Yiannakouris, N.; Katsoulis, M.; Dilis, V.; Parnell, L.D.; Trichopoulos, D.; Ordovas, J.M.; Trichopoulou, A.

2012-01-01

Objective To determine the extent to which the risk for incident coronary heart disease (CHD) increases in relation to a genetic risk score (GRS) that additively integrates the influence of high-risk alleles in nine documented single nucleotide polymorphisms (SNPs) for CHD, and to examine whether this GRS also predicts incident stroke. Methods Genotypes at nine CHD-relevant SNPs were determined in 494 cases of incident CHD, 320 cases of incident stroke and 1345 unaffected controls drawn from the population-based Greek component of the European Prospective Investigation into Cancer and nutrition (EPIC) cohort. An additive GRS was calculated for each study participant by adding one unit for the presence of each high-risk allele multiplied by the estimated effect size of that allele in the discovery samples. Statistical analysis was performed using logistic regression. Results The GRS was significantly associated with the incidence of CHD where the odds of CHD incidence in the highest quintile of the GRS were 1.74 times higher (95% confidence interval [CI] = 1.25–2.43, p for trend = 0.0004), compared to the lowest quintile. With respect to stroke, a weaker and non-significant positive association with GRS was apparent as the odds of stroke incidence in the highest quintile of the GRS were 1.36 times higher (95% CI = 0.90–2.06, p for trend = 0.188), compared to the lowest quintile. Conclusion A GRS relying on nine documented “CHD-specific” SNPs is significantly predictive of CHD but it was not found to be statistically significantly associated with incident stroke. PMID:22429504

National Kidney Foundation consensus conference on cardiovascular and kidney diseases and diabetes risk: an integrated therapeutic approach to reduce events.

PubMed

Bakris, George; Vassalotti, Joseph; Ritz, Eberhard; Wanner, Christoph; Stergiou, George; Molitch, Mark; Nesto, Richard; Kaysen, George A; Sowers, James R

2010-10-01

Cardiovascular disease (CVD) is the most common cause of death in industrialized nations. Type 2 diabetes is a CVD risk factor that confers risk similar to a previous myocardial infarction in an individual who does not have diabetes. In addition, the most common cause of chronic kidney disease (CKD) is diabetes. Together, diabetes and hypertension account for more than two-thirds of CVD risk, and other risk factors such as dyslipidemia contribute to the remainder of CVD risk. CKD, particularly with presence of significant albuminuria, should be considered an additional cardiovascular risk factor. There is no consensus on how to assess and stratify risk for patients with kidney disease across subspecialties that commonly treat such patients. This paper summarizes the results of a consensus conference utilizing a patient case to discuss the integrated management of hypertension, kidney disease, dyslipidemia, diabetes, and heart failure across disciplines.

Orthotopic Liver Transplantation in High-Risk Patients

PubMed Central

Gayowski, Timothy; Marino, Ignazio R.; Singh, Nina; Doyle, Howard; Wagener, Marilyn; Fung, John J.; Starzl, Thomas E.

2010-01-01

Background One of the most controversial areas in patient selection and donor allocation is the high-risk patient. Risk factors for mortality and major infectious morbidity were prospectively analyzed in consecutive United States veterans undergoing liver transplantation under primary tacrolimus-based immunosuppression. Methods Twenty-eight pre-liver transplant, operative, and posttransplant risk factors were examined univariately and multivariately in 140 consecutive liver transplants in 130 veterans (98% male; mean age, 47.3 years). Results Eighty-two percent of the patients had post-necrotic cirrhosis due to viral hepatitis or ethanol (20% ethanol alone), and only 12% had cholestatic liver disease. Ninety-eight percent of the patients were hospitalized at the time of transplantation (66% United Network for Organ Sharing [UNOS] 2, 32% UNOS 1). Major bacterial infection, posttransplant dialysis, additional immunosuppression, readmission to intensive care unit (P=0.0001 for all), major fungal infection, posttransplant abdominal surgery, posttransplant intensive care unit stay length of stay (P<0.005 for all), donor age, pretransplant dialysis, and creatinine (P<0.05 for all) were significantly associated with mortality by univariate analysis. Underlying liver disease, cytomegalovirus infection and disease, portal vein thrombosis, UNOS status, Childs-Pugh score, patient age, pretransplant bilirubin, ischemia time, and operative blood loss were not significant predictors of mortality. Patients with hepatitis C (HCV) and recurrent HCV had a trend towards higher mortality (P=0.18). By multivariate analysis, donor age, any major infection, additional immunosuppression, post-transplant dialysis, and subsequent transplantation were significant independent predictors of mortality (P<0.05). Major infectious morbidity was associated with HCV recurrence (P=0.003), posttransplant dialysis (P=0.001), pretransplant creatinine, donor age, median blood loss, intensive care unit length of stay, additional immunosuppression, and biopsy-proven rejection (P<0.05 for all). By multivariate analysis, intensive care unit length of stay and additional immunosuppression were significant independent predictors of infectious morbidity (P<0.03). HCV recurrence was of borderline significance (P=0.07). Conclusions Biologic and physiologic parameters appear to be more powerful predictors of mortality and morbidity after liver transplantation. Both donor and recipient variables need to be considered for early and late outcome analysis and risk assessment modeling. PMID:9500623

Comparison of 0.625-mm source computed tomographic images versus 5-mm thick reconstructed images in the evaluation for renal calculi in at-risk patients.

PubMed

Berkenblit, Robert; Hoenig, David; Lerer, Daniel; Moses, Melanie; Minsky, Lloyd

2013-02-01

CT has become a well-established modality in the evaluation of urinary calculi. The advent of multidetector CT (MDCT) scanners and submillimeter thick slice acquisitions has yielded CT images with even greater resolution. MDCT scanners allow for source data slice acquisition with submillimeter slice thickness. These source images can then be reconstructed to thicker slices for more convenient interpretation of the CT scan. Previous authors have looked at the effect of slice thickness on detection of urinary calculi. We investigated whether the thin slice source images yielded detection of additional stones and the potential significance of detecting these additional stones. Ninety-five consecutive patients who were referred to our outpatient imaging center for CT, with a clinical history placing them at risk for urinary calculi, were included in the study. In 49 (52%) of the 95 patients, more calculi were visualized using the 0.625-mm thick images than with the 5-mm thick images. In 34 (69%) of these 49 patients, the additional findings were thought to be "clinically significant," while in the remaining 15 (31%) patients, the additional findings were not thought to be clinically significant. In 46 (48%) of the 95 patients, there were no additional urinary calculi identified on the 0.625-mm thick images compared with that observed on 5-mm thick images. The results from this study encourage reviewing the thin slice source images of MDCTs in patients at risk for urinary calculi, because important clinical decisions may hinge on the additional findings made on these images.

Polygenic dissection of diagnosis and clinical dimensions of bipolar disorder and schizophrenia.

PubMed

Ruderfer, Douglas M; Fanous, Ayman H; Ripke, Stephan; McQuillin, Andrew; Amdur, Richard L; Gejman, Pablo V; O'Donovan, Michael C; Andreassen, Ole A; Djurovic, Srdjan; Hultman, Christina M; Kelsoe, John R; Jamain, Stephane; Landén, Mikael; Leboyer, Marion; Nimgaonkar, Vishwajit; Nurnberger, John; Smoller, Jordan W; Craddock, Nick; Corvin, Aiden; Sullivan, Patrick F; Holmans, Peter; Sklar, Pamela; Kendler, Kenneth S

2014-09-01

Bipolar disorder and schizophrenia are two often severe disorders with high heritabilities. Recent studies have demonstrated a large overlap of genetic risk loci between these disorders but diagnostic and molecular distinctions still remain. Here, we perform a combined genome-wide association study (GWAS) of 19 779 bipolar disorder (BP) and schizophrenia (SCZ) cases versus 19 423 controls, in addition to a direct comparison GWAS of 7129 SCZ cases versus 9252 BP cases. In our case-control analysis, we identify five previously identified regions reaching genome-wide significance (CACNA1C, IFI44L, MHC, TRANK1 and MAD1L1) and a novel locus near PIK3C2A. We create a polygenic risk score that is significantly different between BP and SCZ and show a significant correlation between a BP polygenic risk score and the clinical dimension of mania in SCZ patients. Our results indicate that first, combining diseases with similar genetic risk profiles improves power to detect shared risk loci and second, that future direct comparisons of BP and SCZ are likely to identify loci with significant differential effects. Identifying these loci should aid in the fundamental understanding of how these diseases differ biologically. These findings also indicate that combining clinical symptom dimensions and polygenic signatures could provide additional information that may someday be used clinically.

Modifiable Risk Factors in Primary Joint Arthroplasty Increase 90-Day Cost of Care.

PubMed

Schroer, William C; Diesfeld, Paul J; LeMarr, Angela R; Morton, Diane J; Reedy, Mary E

2018-04-19

Risk factors in demographics and health status have been identified that increase the risk of complications after joint arthroplasty, necessitating additional care and incurring additional charges. The purpose of this study was to identify the number of patients in a hospital network database who had one or more predefined modifiable risk factors and determine their impact on average length of stay, need for additional care during the 90-day postoperative period, and the 90-day charges for care. An electronic hospital record query of 6968 lower extremity joint arthroplasty procedures under Diagnosis-Related Group 469/470 performed in 2014-2015 was reviewed, and total 90-day charges were calculated. The case mean was compared to charges for patients with modifiable risk factors: anemia (Hgb < 10 g/dL), malnutrition (albumin < 3.4 g/dL), obesity (body mass index > 45 kg/m 2 ), uncontrolled diabetes (random glucose >180 mg/dL or A1C > 8), narcotic use (prescription filled), and tobacco use (documented within 30 days before surgery). Length of stay, emergency room visits, and hospital readmission were compared. Mean 90-day charges for Diagnosis-Related Group 469/470 were $36,647. Risk factors were associated with a significant increase in 90-day charges: anemia (+$ 15,869/126 patients), malnutrition (+$9270/592), obesity (+$2048/445), diabetes (+$5074/291), narcotic use (+$1801/1943), and tobacco use (+$2034/1882). Intensive care unit admission rate, emergency department visits, and hospital readmission were significantly increased for patients with each risk factor. Length of stay was higher in patients with anemia, malnutrition, diabetes, and tobacco use. When separated by elective vs fracture admission, 90-day charges were significantly higher for each risk factor. Medical strategies to optimize patients before joint arthroplasty are warranted to improve postoperative outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

Predictors of HIV-risk sexual behavior: examining lifetime sexual and physical abuse histories in relation to substance use and psychiatric problem severity among ex-offenders.

PubMed

Majer, John M; Rodriguez, Jaclyn; Bloomer, Craig; Jason, Leonard A

2014-01-01

Lifetime histories of sexual and physical abuse have been associated with increased HIV-risk sexual behavior, and some studies have identified other variables associated with these relationships. However, there is a dearth of literature that has critically examined abuse histories and HIV-risk sexual behavior in relation to these other variables. Predictors of HIV-risk sexual behavior were analyzed among a sample of ex-offenders who were completing inpatient substance dependence treatment to identify factors related to increases in HIV-risk sexual behavior beyond that of abuse histories. Hierarchical linear regression was conducted to examine sociodemographic characteristics, recent substance use, and current psychiatric problem severity in addition to lifetime histories of sexual/physical abuse in a cross-sectional design. Gender, substance use, and psychiatric problem severity predicted increases in HIV-risk sexual behavior beyond what was predicted by abuse histories. Proportionately more women than men reported abuse histories. In addition, significantly more unprotected sexual than safer sexual practices were observed, but differences in these practices based on lifetime abuse histories and gender were not significant. Findings suggest recent substance use and current psychiatric problem severity are greater risk factors for HIV-risk sexual behavior than lifetime abuse histories among persons who have substance use disorders.

Effect of dry period length on the effect of an intramammary teat sealant on the risk of mastitis in cattle treated with antibiotics at drying off.

PubMed

Laven, R A; Balcomb, C C; Tulley, W T; Lawrence, K E

2014-07-01

The aim of this study was to evaluate, under farm conditions, the use of a teat sealant in addition to whole herd dry cow antibiotic therapy on the risk of clinical mastitis in dairy cattle at pasture, and to evaluate the impact of dry period length on that risk and the impact of the teat sealant on that risk. Dairy cows in three herds which used routine whole herd antibiotic therapy were randomly assigned to receive either treatment with an internal teat sealant (n=322) or no additional treatment (n=313) at drying-off between March and May 2010. All clinical mastitis cases during the dry period and to the end of the subsequent lactation were recorded by farm staff; factors affecting risk of clinical mastitis were then analysed using a Cox proportional hazards model. Median duration of the dry period was 112 days with >25% of cows having a dry period >130 days. The incidence risk of mastitis during lactation for cows treated with teat sealant was 9.9 (95% CI=6.9-13.7) cases per 100 cows compared with 17.9 (95% CI=13.8-22.6) cases per 100 cows for cows treated with antibiotic alone. The addition of a teat sealant to dry cow antibiotic therapy decreased the risk of clinical mastitis only in the first 33 days after calving (Hazard risk 0.24 (95% CI=0.12-0.48)). Length of dry period did not significantly affect the risk of clinical mastitis, or the effect of adding teat sealant to dry cow antibiotic therapy on the risk of clinical mastitis. In these herds where, based on the mastitis history, whole herd antibiotic therapy had been recommended, the use of a teat sealant significantly reduced the risk of clinical mastitis. This effect was limited to the first 33 days after calving; subsequently there was no significant effect of treatment. There was no effect of dry period length on risk of clinical mastitis, nor any significant interaction with treatment. Combination therapy with teat sealant and antibiotic was effective under New Zealand conditions in herds using whole herd antibiotic treatment at drying off. Teat sealant reduced risk of clinical mastitis in cattle with dry periods substantially longer than 100 days, and there was no evidence that this effect changed as dry period length increased.

Low childhood high density lipoprotein cholesterol levels and subsequent risk for chronic inflammatory bowel disease.

PubMed

Voutilainen, Markku; Hutri-Kähönen, Nina; Tossavainen, Päivi; Sipponen, Taina; Pitkänen, Niina; Laitinen, Tomi; Jokinen, Eero; Rönnemaa, Tapani; Viikari, Jorma S A; Raitakari, Olli T; Juonala, Markus

2018-04-01

Several genetic and environmental risk factors have been linked to chronic inflammatory bowel disease (IBD). The incidence of IBD has significantly increased in developed countries during last decades. The aim of the present study was to examine childhood risk factors for subsequent IBD diagnosis in a longitudinal cohort study of children and adolescents. A Finnish study population consisting of 3551 children and adolescents originally evaluated as part of the Cardiovascular Risk in Young Finns study in 1980. At baseline, participant BMI, insulin, lipid, C-reactive protein and blood pressure levels, socioeconomic position, dietary habits, and physical activity, were evaluated. In addition, information was gathered on rural residency, severe infections, breast feeding, parental smoking and birth weight. Subsequent IBD diagnosis status was evaluated based on nationwide registries on hospitalisations and drug imbursement decisions. Altogether, 49 participants (1.4%) had IBD diagnosed during the 34 years of register follow-up, of which 31 had ulcerative colitis, 12 Crohn's disease and 6 undetermined colitis. In univariate analyses, significant correlations were observed between childhood HDL-cholesterol (risk ratio (95% CI) for 1-SD change (0.58 (0.42-0.79)) and CRP concentrations (1.20 (1.01-1.43)) with IBD. The inverse association between HDL-cholesterol and IBD remained significant (0.57 (0.39-0.82)) in a multivariable model including data on age, sex and CRP. In addition, a weighted genetic z-score of 71 single nucleotide polymorphisms associated with elevated HDL-cholesterol levels was significantly lower in IBD patients, P=0.01). Low childhood HDL-cholesterol levels are associated with subsequent IBD diagnosis. In addition, a genetic risk score associated with low HDL-cholesterol levels predict later IBD suggesting that HDL-cholesterol metabolism might have a role in the pathogenesis of IBD. Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Mapping habitat suitability for at-risk plants and its implications for restoration and reintroduction

Treesearch

E. Questad; J.R. Kellner; K. Kinney; S. Cordell; G.P. Asner; J. Thaxton; J. Diep; A. Uowolo; S. Brooks; N. Inman-Narahari; S. Evans; B. Tucker

2014-01-01

The conservation of species at risk of extinction requires data to support decisions at landscape to regional scales. There is a need for information that can assist with locating suitable habitats in fragmented and degraded landscapes to aid the reintroduction of at-risk plant species. In addition, desiccation and water stress can be significant barriers to the...

A Study of the Factors Associated with Risk for Development of Pressure Ulcers: A Longitudinal Analysis.

PubMed

Thomas, Elizebeth; Vinodkumar, Sudhaya; Mathew, Silvia; Setia, Maninder Singh

2015-01-01

Pressure ulcers (PUs) are prevalent in hospitalized patients; they may cause clinical, psychological, and economic problems in these patients. Previous studies are cross-sectional, have used pooled data, or cox-regression models to assess the risk for developing PU. However, PU risk scores change over time and models that account for time varying variables are useful for cohort analysis of data. The present longitudinal study was conducted to compare the risk of PU between surgical and nonsurgical patients, and to evaluate the factors associated with the development of these ulcers over a period of time. We evaluated 290 hospitalized patients over a 4 months period. The main outcomes for our analysis were: (1) Score on the pressure risk assessment scale; and (2) the proportion of individuals who were at severe risk for developing PUs. We used random effects models for longitudinal analysis of the data. The mean PU score was significantly higher in the nonsurgical patients compared with surgical patients at baseline (15.23 [3.86] vs. 9.33 [4.57]; P < 0.01). About 7% of the total patients had a score of >20 at baseline and were considered as being at high-risk for PU; the proportion was significantly higher among the nonsurgical patients compared with the surgical patients (14% vs. 4%, P = 0.003). In the adjusted models, there was no difference for severe risk for PU between surgical and nonsurgical patients (odds ratios [ORs]: 0.37, 95% confidence interval [CI]: 0.01-12.80). An additional day in the ward was associated with a significantly higher likelihood of being at high-risk for PU (OR: 1.47, 95% CI: 1.16-1.86). There were no significant differences between patients who were admitted for surgery compared with those who were not. An additional day in the ward, however, is important for developing a high-risk score for PU on the monitoring scale, and these patients require active interventions.

User Perceptions of a Dementia Risk Reduction Website and Its Promotion of Behavior Change

PubMed Central

2013-01-01

Background Several modifiable health and lifestyle factors are consistently associated with dementia risk and it is estimated that significantly fewer people would develop dementia if the incidence of risk factors could be reduced. Despite this, Australians’ awareness of the health and lifestyle factors associated with dementia risk is low. Within a national community education campaign, Alzheimer’s Australia developed a dementia risk reduction website providing information about modifiable risk or protective factors for dementia. Objective This study aimed to assess the usefulness of the website content in improving knowledge and enabling adoption of recommended strategies, and to examine what additional resources consumers need. Methods Visitors to the website over a 3 month period were invited to complete an online survey, which asked them to rate their knowledge of dementia risk reduction before and after visiting the site, how important monitoring their health related behavior was to them before and after visiting the site, their current behavior related to health and lifestyle factors associated with dementia risk, their intentions to change behavior, and the usefulness of potential additional resources to help them do so. Results For this study, 123 Australian adults responded to the survey. 44.7% (55/122) were aged over 60 and 82.1% (98/119) were female. Respondents’ ratings and comments indicated they generally found the content interesting, informative, and helpful to them. Respondents’ ratings of their knowledge about the links between health and lifestyle factors and dementia risk significantly increased after visiting the website (P<.001). Their ratings of how important monitoring what they do in relation to their health and lifestyle factors were also significantly increased after visiting the website (P<.001). Average ratings for how well respondents felt they were doing at the time in relation to specific risk or protective factors were generally high, suggesting many website visitors already had high levels of health motivation and healthy lifestyle behaviors. 55.6% (45/81) said that after visiting the website their intention to make lifestyle changes was strong. Only 27.1% (22/81) said their intention to visit their doctor to discuss dementia risk reduction was strong. Potential additional resources that would help people assess and address their personal dementia risk factors were rated as more helpful than general information resources. Conclusions A dementia risk reduction website providing information about the current evidence and practical strategies was of interest and was useful to the Australian community. Benefits for visitors included increased knowledge and increased motivation to address relevant behaviors. Many visitors to the site were already health conscious, indicating that more needs to be done to get dementia risk reduction messages to the wider community. More interactive and personalized resources in future interventions may offer additional benefits to individuals. PMID:23608480

Applying the reasoned action approach to understanding health protection and health risk behaviors.

PubMed

Conner, Mark; McEachan, Rosemary; Lawton, Rebecca; Gardner, Peter

2017-12-01

The Reasoned Action Approach (RAA) developed out of the Theory of Reasoned Action and Theory of Planned Behavior but has not yet been widely applied to understanding health behaviors. The present research employed the RAA in a prospective design to test predictions of intention and action for groups of protection and risk behaviors separately in the same sample. To test the RAA for health protection and risk behaviors. Measures of RAA components plus past behavior were taken in relation to eight protection and six risk behaviors in 385 adults. Self-reported behavior was assessed one month later. Multi-level modelling showed instrumental attitude, experiential attitude, descriptive norms, capacity and past behavior were significant positive predictors of intentions to engage in protection or risk behaviors. Injunctive norms were only significant predictors of intention in protection behaviors. Autonomy was a significant positive predictor of intentions in protection behaviors and a negative predictor in risk behaviors (the latter relationship became non-significant when controlling for past behavior). Multi-level modelling showed that intention, capacity, and past behavior were significant positive predictors of action for both protection and risk behaviors. Experiential attitude and descriptive norm were additional significant positive predictors of risk behaviors. The RAA has utility in predicting both protection and risk health behaviors although the power of predictors may vary across these types of health behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.

Genome-wide association analysis of age-at-onset in Alzheimer’s disease

PubMed Central

Kamboh, M. Ilyas; Barmada, M. Michael; Demirci, F. Yesim; Minster, Ryan L.; Carrasquillo, Minerva M.; Pankratz, V. Shane; Younkin, Steven G.; Saykin, Andrew J.; Sweet, Robert A.; Feingold, Eleanor; DeKosky, Steven T.; Lopez, Oscar L.

2011-01-01

The risk of Alzheimer’s disease (AD) is strongly determined by genetic factors and recent genome-wide association studies (GWAS) have identified several genes for the disease risk. In addition to the disease risk, age-at-onset (AAO) of AD has also strong genetic component with an estimated heritability of 42%. Identification of AAO genes may help to understand the biological mechanisms that regulate the onset of the disease. Here we report the first GWAS focused on identifying genes for the AAO of AD. We performed a genome-wide meta analysis on 3 samples comprising a total of 2,222 AD cases. A total of ~2.5 million directly genotyped or imputed SNPs were analyzed in relation to AAO of AD. As expected, the most significant associations were observed in the APOE region on chromosome 19 where several SNPs surpassed the conservative genome-wide significant threshold (P<5E-08). The most significant SNP outside the APOE region was located in the DCHS2 gene on chromosome 4q31.3 (rs1466662; P=4.95E-07). There were 19 additional significant SNPs in this region at P<1E-04 and the DCHS2 gene is expressed in the cerebral cortex and thus is a potential candidate for affecting AAO in AD. These findings need to be confirmed in additional well-powered samples. PMID:22005931

Genome-wide association analysis of age-at-onset in Alzheimer's disease.

PubMed

Kamboh, M I; Barmada, M M; Demirci, F Y; Minster, R L; Carrasquillo, M M; Pankratz, V S; Younkin, S G; Saykin, A J; Sweet, R A; Feingold, E; DeKosky, S T; Lopez, O L

2012-12-01

The risk of Alzheimer's disease (AD) is strongly determined by genetic factors and recent genome-wide association studies (GWAS) have identified several genes for the disease risk. In addition to the disease risk, age-at-onset (AAO) of AD has also strong genetic component with an estimated heritability of 42%. Identification of AAO genes may help to understand the biological mechanisms that regulate the onset of the disease. Here we report the first GWAS focused on identifying genes for the AAO of AD. We performed a genome-wide meta-analysis on three samples comprising a total of 2222 AD cases. A total of ~2.5 million directly genotyped or imputed single-nucleotide polymorphisms (SNPs) were analyzed in relation to AAO of AD. As expected, the most significant associations were observed in the apolipoprotein E (APOE) region on chromosome 19 where several SNPs surpassed the conservative genome-wide significant threshold (P<5E-08). The most significant SNP outside the APOE region was located in the DCHS2 gene on chromosome 4q31.3 (rs1466662; P=4.95E-07). There were 19 additional significant SNPs in this region at P<1E-04 and the DCHS2 gene is expressed in the cerebral cortex and thus is a potential candidate for affecting AAO in AD. These findings need to be confirmed in additional well-powered samples.

Egg consumption and risk of bladder cancer: a meta-analysis.

PubMed

Li, Fei; Zhou, You; Hu, Rui-ting; Hou, Li-na; Du, Yue-Jun; Zhang, Xin-ji; Olkkonen, Vesa M; Tan, Wan-long

2013-01-01

The findings of epidemiologic studies on the association between egg consumption and bladder cancer risk remain conflicting. We conducted a meta-analysis to clarify the potential association between egg consumption and bladder cancer risk. Four cohort studies and 9 case-control studies in the PubMed database through February 2012 were identified on egg consumption and risk of bladder cancer involving 2715 cases and 184,727 participants. Random-effects models were used to calculate the summary relative risk estimates (SRRE) based on the highest compared with the lowest category of egg consumption. In addition, we performed stratified analyses and sensitivity and dose-response analyses to examine the association. Overall, no significant association was observed between egg consumption and bladder cancer (SRRE = 1.11 95% CI: 0.90-1.35). However, increased risk of bladder cancer was detected in North/South America (SRRE = 1.40 95% CI: 1.05-1.86) and, moreover, fried egg intake positively associated with bladder cancer as well (SRRE = 2.04, 95% CI: 1.41-2.95). In conclusion, our findings suggest no significant association between egg consumption and bladder cancer risk, except for a possible positive relationship with the intake of fried eggs based on the limited number of studies. Additional studies, especially large prospective cohort studies, are warranted to confirm these findings.

Interactions of Cigarette Smoking with NAT2 Polymorphisms Impact Rheumatoid Arthritis Risk in African Americans

PubMed Central

Mikuls, Ted R.; LeVan, Tricia; Gould, Karen A.; Yu, Fang; Thiele, Geoffrey M.; Bynote, Kimberly K.; Conn, Doyt; Jonas, Beth L.; Callahan, Leigh F.; Smith, Edwin; Brasington, Richard; Moreland, Larry W.; Reynolds, Richard; Gaffo, Angelo; Bridges, S. Louis

2011-01-01

Objective To examine whether polymorphisms in genes coding for drug metabolizing enzymes (DMEs) impact rheumatoid arthritis (RA) risk due to cigarette smoking in African Americans. Methods Smoking status was evaluated in African American RA cases and non-RA controls categorized as heavy (≥ 10 pack-years) vs. other. Individuals were genotyped for a homozygous deletion polymorphism in glutathione S-transferase Mu-1 (GSTM1-null) in addition to tagging single nucleotide polymorphisms (SNPs) in N-acetyltransferase (NAT)1, NAT2, and epoxide hydrolase (EPXH1). Associations of genotypes with RA were examined using logistic regression and gene-smoking interactions were assessed. Results There were no significant associations of any DME genotype with RA. After adjustment for multiple comparisons, there were significant additive interactions between heavy smoking and NAT2 SNPs rs9987109 (Padd = 0.000003) and rs1208 (Padd = 0.00001); attributable proportions (APs) due to interaction ranged from 0.61 to 0.67. None of the multiplicative gene-smoking interactions examined remained significant after adjustment for multiple testing in overall disease risk. There was no evidence of significant gene-smoking interactions in analyses of GSTM1-null, NAT1, or EPXH1. DME gene-smoking interactions were similar when cases were limited to anti-citrullinated protein antibody (ACPA) positive individuals. Conclusion Among African Americans, RA risk imposed by heavy smoking appears to be mediated in part by genetic variation in NAT2. While further studies are needed to elucidate mechanisms underpinning these interactions, these SNPs appear to identify African American smokers at a much higher risk for RA with relative risks that are at least two-fold higher compared to non-smokers lacking these risk alleles. PMID:21989592

Influence of race/ethnicity on cardiovascular risk factors in polycystic ovary syndrome, the Dallas Heart Study.

PubMed

Chang, Alice Y; Oshiro, June; Ayers, Colby; Auchus, Richard J

2016-07-01

Polycystic ovarian syndrome (PCOS) is estimated to affect up to 20% of women. PCOS is associated with insulin resistance and cardiovascular (CV) risk factors. We aimed to evaluate the impact of race/ethnicity on the prevalence of CV risk factors and subclinical predictors of CV events. Cross-sectional analysis of data collected by the Dallas Heart Study, an urban, population-based cohort oversampled for blacks. A previously described cohort of women with PCOS and control subjects of the same racial/ethnic group, matched for age and body mass index. Hormonal and clinical measures associated with PCOS and CV risk factors. The study included 117 women with PCOS and 204 controls. Women with PCOS had significant differences across racial/ethnic groups in the prevalence of hypertension, hypercholesterolaemia, hypertriglyceridaemia and impaired fasting glucose (P < 0·05). Controls showed significant racial/ethnic differences in the prevalence of hypertension and impaired fasting glucose (P < 0·05). The odds of hypertension were significantly greater among women with PCOS than controls after adjusting for race/ethnicity (odds ratio, 1·50 [95% CI, 1·03-2·30]; P = 0·04). However, we did not see an interaction of race/ethnicity that significantly changed CV risk factor prevalence between PCOS and controls. In addition, subclinical measures of CV disease were not different between women with PCOS vs controls, even among hypertensive women. Race/ethnicity affects the prevalence of CV risk factors for women with and without PCOS. However, race/ethnicity does not interact with PCOS to additionally increase CV risk factor prevalence or subclinical CV disease. © 2015 John Wiley & Sons Ltd.

The Intersection of Stalking and the Severity of Intimate Partner Abuse.

PubMed

Brady, Patrick Q; Hayes, Brittany E

2018-04-01

Using data from the Chicago Women's Health Risk Study (N = 464), this study examined the intersection of stalking and the severity of intimate partner abuse while controlling for previously identified risk factors of intimate partner homicide. Findings indicate that (a) victims of life-threatening abuse by an intimate partner were significantly more likely to experience stalking than victims of nonlethal abuse; (b) after controlling for key risk factors, stalking increased the risk of life-threatening abuse; and (c) threats to kill the victim if she left was the only significant stalking-related behavior that increased the risk for life-threatening abuse. In addition, an offender's prior record and a higher number of previous abusive incidents increased the risk of life-threatening abuse. Implications for prevention and future directions for research are discussed.

Medication use and associated risk of falling in a geriatric outpatient population.

PubMed

Freeland, Kathryn N; Thompson, Amy N; Zhao, Yumin; Leal, Julie E; Mauldin, Patrick D; Moran, William P

2012-09-01

Studies have shown that approximately one third of community-dwelling people aged 65 years and older will experience a fall each year. Many studies indicate that use of multiple medications may put patients at an increased risk of falling, but few studies have been conducted to correlate the number of medications with the risk of falls. To determine the medications most frequently used in patients aged 65 years or older who have experienced a fall within the past year, with particular attention to type or number of medications most commonly associated with multiple falls or a fall with injury. We conducted a chart review in an outpatient internal medicine clinic over a 13-month period. A total of 118 patients 65 years of age or older who were taking 4 or more medications and had experienced at least 1 fall in the previous 12 months were included. Data relating to sex, age, race, diagnoses, medications, and number and type of falls were obtained during the chart review. The primary end point of the study was number and type of medications most commonly used in patients experiencing a fall. A total of 116 patients were examined for trends in fall risk. A logistic regression model and receiver operating characteristic curve demonstrated significant fall risk with the addition of medications, with patients experiencing a 14% increase in fall risk with the addition of each medication beyond a 4-medication regimen (OR 1.14; 95% CI 1.02 to 1.27; p = 0.027). The addition of medications is associated with a significant increase in risk of falls in elderly patients, regardless of drug class. Further studies are needed to assess the possible increased risk of falls with increasing number of medications.

Emotion recognition ability in mothers at high and low risk for child physical abuse.

PubMed

Balge, K A; Milner, J S

2000-10-01

The study sought to determine if high-risk, compared to low-risk, mothers make more emotion recognition errors when they attempt to recognize emotions in children and adults. Thirty-two demographically matched high-risk (n = 16) and low-risk (n = 16) mothers were asked to identify different emotions expressed by children and adults. Sets of high- and low-intensity, visual and auditory emotions were presented. Mothers also completed measures of stress, depression, and ego-strength. High-risk, compared to low-risk, mothers showed a tendency to make more errors on the visual and auditory emotion recognition tasks, with a trend toward more errors on the low-intensity, visual stimuli. However, the observed trends were not significant. Only a post-hoc test of error rates across all stimuli indicated that high-risk, compared to low-risk, mothers made significantly more emotion recognition errors. Although situational stress differences were not found, high-risk mothers reported significantly higher levels of general parenting stress and depression and lower levels of ego-strength. Since only trends and a significant post hoc finding of more overall emotion recognition errors in high-risk mothers were observed, additional research is needed to determine if high-risk mothers have emotion recognition deficits that may impact parent-child interactions. As in prior research, the study found that high-risk mothers reported more parenting stress and depression and less ego-strength.

75 FR 76461 - Petition for a Ban on Triclosan; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-08

... widespread use'' of triclosan poses significant risks to human health and the environment. In addition, the... human health and the environment, failed to conduct separate assessments for triclosan residues in... comprehensive review of the potential risks to human health and the environment resulting from the registered...

Financial Well-Being of Young Children with Disabilities and Their Families

ERIC Educational Resources Information Center

Parish, Susan L.; Cloud, Jennifer M.

2006-01-01

Young children with disabilities are significantly more likely to live in poverty than their peers without disabilities. Exposure to poverty creates additional risk of adverse outcomes for these vulnerable children. In this article, the following key circumstances contributing to this increased risk of impoverishment are analyzed: elevated costs…

DEVELOPMENT OF QUANTITATIVE STRUCTURE ACTIVITY RELATIONSHIPS TO PREDICT TOXICITY FOR A VARIETY OF HUMAN AND ECOLOGICAL ENDPOINTS

EPA Science Inventory

The number of chemicals released into the environment has significantly increased over the past few years, leading to increased risk of human exposure through inhalation, ingestion, or dermal uptake. In addition, the risk also increases with increasing toxicity of the chemical. ...

SNCA polymorphisms, smoking, and sporadic Parkinson's disease in Japanese.

PubMed

Miyake, Yoshihiro; Tanaka, Keiko; Fukushima, Wakaba; Kiyohara, Chikako; Sasaki, Satoshi; Tsuboi, Yoshio; Yamada, Tatsuo; Oeda, Tomoko; Shimada, Hiroyuki; Kawamura, Nobutoshi; Sakae, Nobutaka; Fukuyama, Hidenao; Hirota, Yoshio; Nagai, Masaki

2012-06-01

Several case-control studies and genome-wide association studies have examined the relationships between single nucleotide polymorphisms (SNPs) in the SNCA gene and Parkinson's disease (PD), and have provided inconsistent results. We investigated the relationships between SNPs rs356229, rs356219, rs356220, rs7684318, and rs2736990 and the risk of sporadic PD in Japan using data from a multicenter hospital-based case-control study. Included were 229 cases within 6 years of onset of PD as defined according to the UK PD Society Brain Bank clinical diagnostic criteria. Controls were 357 inpatients and outpatients without neurodegenerative disease. Adjustment was made for sex, age, region of residence, and smoking. Based on the recessive model, compared with subjects with the CC or CT genotype of SNP rs356220, those with the TT genotype had a significantly increased risk of sporadic PD: the adjusted OR was 1.42 (95% CI: 1.002-2.02). In the additive model, SNP rs2736990 was significantly related to the risk of sporadic PD: the adjusted OR was 1.30 (95% CI: 1.002-1.68). There were no significant relationships between SNP rs356229, rs356219, or rs7684318 and the risk of sporadic PD in any genetic model. The additive interactions between SNPs rs356219 and rs356220 and smoking with respect to sporadic PD were significant although the multiplicative interactions were not significant. This study suggests that SNCA SNPs rs356220 and rs2736990 are significantly associated with the risk of sporadic PD in Japanese. We also present new evidence for biological interactions between SNPs rs356219 and rs356220 and smoking that affect sporadic PD. Copyright © 2012 Elsevier Ltd. All rights reserved.

Hearing loss among older construction workers: Updated analyses.

PubMed

Dement, John; Welch, Laura S; Ringen, Knut; Cranford, Kim; Quinn, Patricia

2018-04-01

A prior study of this construction worker population found significant noise-associated hearing loss. This follow-up study included a much larger study population and consideration of additional risk factors. Data included audiometry, clinical chemistry, personal history, and work history. Qualitative exposure metrics for noise and solvents were developed. Analyses compared construction workers to an internal reference group with lower exposures and an external worker population with low noise exposure. Among participants (n = 19 127) an overall prevalence of hearing loss of 58% was observed, with significantly increased prevalence across all construction trades. Construction workers had significantly increased risk of hearing loss compared to reference populations, with increasing risk by work duration. Noise exposure, solvent exposure, hypertension, and smoking were significant risk factors in multivariate models. Results support a causal relationship between construction trades work and hearing loss. Prevention should focus on reducing exposure to noise, solvents, and cigarette smoke. © 2018 Wiley Periodicals, Inc.

Association Between Four Polymorphisms in lncRNA and Risk of Lung Cancer in a Chinese Never-Smoking Female Population.

PubMed

Gao, Min; Li, Hang; Lv, Xiaoting; Zhou, Baosen; Yin, Zhihua

2018-06-07

Long noncoding RNAs (lncRNAs) play important roles in the development of human cancers. This is the first case-control study of the association between specific polymorphisms in lncRNA genes and the risk of lung cancer, as well as the gene-environment interaction between the polymorphisms and cooking oil fume exposure in Chinese never-smoking females. A hospital-based case-control study was carried out in Shenyang, Liaoning province. The study included 395 cases and 556 controls. The polymorphisms of rs4785367, rs3803662, rs10750417, and rs1814343 in lncRNA genes were analyzed. The gene-environment interactions were explored on both additive and multiplicative scale. In addition, the results were listed as follows: for rs3803662, compared with the individuals carrying homozygous TT genotype, those with homozygous CC genotype had the decreased risk of lung cancer (adjusted odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.40-0.92, p = 0.018). As for rs4785367, compared with homozygous TT, homozygous CC could lessen the risk of lung cancer (adjusted OR = 0.54, 95% CI = 0.33-0.89, p = 0.016). The recessive models of rs3803662 and rs4785367 showed significant association (adjusted OR = 0.65, 95% CIs = 0.44-0.97, p = 0.033; adjusted OR = 0.54, 95% CIs = 0.33-0.88, p = 0.014). The C allele of rs3803662 was suggested to be protective allele of lung cancer (adjusted OR = 0.80, 95% CI = 0.66-0.97, p = 0.023). However, rs10750417 and rs1814343 polymorphisms were not significantly associated with lung cancer risks. The measures of additive interaction and logistic models suggested that the gene-environment interactions were not statistically significant on both additive and multiplicative scales.

Acute myeloid leukaemia: expression of MYC protein and its association with cytogenetic risk profile and overall survival.

PubMed

Mughal, Muhammad Kashif; Akhter, Ariz; Street, Lesley; Pournazari, Payam; Shabani-Rad, Meer-Taher; Mansoor, Adnan

2017-09-01

Acute myeloid leukaemia (AML) is a clinically aggressive disease with marked genetic heterogeneity. Cytogenetic abnormalities provide the basis for risk stratification into clinically favourable, intermediate, and unfavourable groups. There are additional genetic mutations, which further influence the prognosis of patients with AML. Most of these result in molecular aberrations whose downstream target is MYC. It is therefore logical to study the relationship between MYC protein expression and cytogenetic risk groups. We studied MYC expression by immunohistochemistry in a large cohort (n = 199) of AML patients and correlated these results with cytogenetic risk profile and overall survival (OS). We illustrated differential expression of MYC protein across various cytogenetic risk groups (p = 0.03). Highest expression of MYC was noted in AML patients with favourable cytogenetic risk group. In univariate analysis, MYC expression showed significant negative influence of OS in favourable and intermediate cytogenetic risk group (p = 0.001). Interestingly, MYC expression had a protective effect in the unfavourable cytogenetic risk group. In multivariate analysis, while age and cytogenetic risk group were significant factors influencing survival, MYC expression by immunohistochemistry methods also showed some marginal impact (p = 0.069). In conclusion, we have identified differential expression of MYC protein in relation to cytogenetic risk groups in AML patients and documented its possible impact on OS in favourable and intermediate cytogenetic risk groups. These preliminary observations mandate additional studies to further investigate the routine clinical use of MYC protein expression in AML risk stratification. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Interaction Effects of Acute Kidney Injury, Acute Respiratory Failure, and Sepsis on 30-Day Postoperative Mortality in Patients Undergoing High-Risk Intraabdominal General Surgical Procedures.

PubMed

Kim, Minjae; Brady, Joanne E; Li, Guohua

2015-12-01

Acute kidney injury (AKI), acute respiratory failure, and sepsis are distinct but related pathophysiologic processes. We hypothesized that these 3 processes may interact to synergistically increase the risk of short-term perioperative mortality in patients undergoing high-risk intraabdominal general surgery procedures. We performed a retrospective, observational cohort study of data (2005-2011) from the American College of Surgeons-National Surgical Quality Improvement Program, a high-quality surgical outcomes data set. High-risk procedures were those with a risk of AKI, acute respiratory failure, or sepsis greater than the average risk in all intraabdominal general surgery procedures. The effects of AKI, acute respiratory failure, and sepsis on 30-day mortality were assessed using a Cox proportional hazards model. Additive interactions were assessed with the relative excess risk due to interaction. Of 217,994 patients, AKI, acute respiratory failure, and sepsis developed in 1.3%, 3.7%, and 6.8%, respectively. The 30-day mortality risk with sepsis, acute respiratory failure, and AKI were 11.4%, 24.1%, and 25.1%, respectively, compared with 0.85% without these complications. The adjusted hazard ratios and 95% confidence intervals for a single complication (versus no complication) on mortality were 7.24 (6.46-8.11), 10.8 (8.56-13.6), and 14.2 (12.8-15.7) for sepsis, AKI, and acute respiratory failure, respectively. For 2 complications, the adjusted hazard ratios were 30.8 (28.0-33.9), 42.6 (34.3-52.9), and 65.2 (53.9-78.8) for acute respiratory failure/sepsis, AKI/sepsis, and acute respiratory failure/AKI, respectively. Finally, the adjusted hazard ratio for all 3 complications was 105 (92.8-118). Positive additive interactions, indicating synergism, were found for each combination of 2 complications. The relative excess risk due to interaction for all 3 complications was not statistically significant. In high-risk general surgery patients, the development of AKI, acute respiratory failure, or sepsis is independently associated with an increase in 30-day mortality. In addition, the development of 2 complications shows significant positive additive interactions to further increase the risk of mortality. Our findings suggest that interactions between these 3 perioperative complications increase the risk of mortality more than would be expected by the independent effects of each complication alone.

Malnutrition, functional ability and mortality among older people aged ⩾ 60 years: a 7-year longitudinal study.

PubMed

Naseer, M; Forssell, H; Fagerström, C

2016-03-01

This study aimed to assess the association between risk of malnutrition and 7-year mortality, controlling for functional ability, socio-demographics, lifestyle behavior and diseases, and investigate the interaction between risk of malnutrition and functional ability on the risk of mortality. A longitudinal study on home-living and special-housing residents aged ⩾ 60 years was conducted. Of 2312 randomly invited participants, 1402 responded and 1203 provided information on both nutritional status and functional ability. The risk of malnutrition was estimated by the occurrence of at least one anthropometric measure (BMI, MAC and CC) below cut-off in addition to the presence of at least one subjective measure (decreased food intake, weight loss and eating difficulty). At baseline, 8.6% of subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. The risk of malnutrition was independently associated with 7-year mortality (hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.28-2.65). Additional independent predictors were dementia (HR 2.76, 95% CI 1.85-4.10), activity of daily living (ADL) dependence (HR 2.08, 95% CI 1.62-2.67), heart disease (HR 1.44, 95% CI 1.16-1.78), diabetes (HR 1.41, 95% CI 1.03-1.93) and older age (HR 1.09, 95% CI 1.07-1.10). Moreover, the risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, P<0.001). The risk of malnutrition significantly increases the risk of mortality in older people. Moreover, risk of malnutrition and ADL dependence together explain a significantly poorer survival rate; however, the importance of this interaction decreased in the multivariable model and risk of malnutrition and ADL dependence independently explained a significant risk of mortality.

Factors influencing wound dehiscence.

PubMed

Riou, J P; Cohen, J R; Johnson, H

1992-03-01

Thirty-one abdominal fascial wound dehiscences occurred in 2,761 patients undergoing major abdominal surgery during a 5-year period (1%). Twenty-two specific local and systemic risk factors were analyzed and compared with the risk factors of a control group of 38 patients undergoing similar procedures without dehiscence. Through multivariate analysis, each factor was assessed as an independent statistical variable. Significant factors (p less than 0.05) were found to include age over 65, wound infection, pulmonary disease, hemodynamic instability, and ostomies in the incision. Additional systemic risk factors that were found to be significant included hypoproteinemia, systemic infection, obesity, uremia, hyperalimentation, malignancy, ascites, steroid use, and hypertension. Risk factors not found to be important independent variables included sex, type of incision, type of closure, foreign body in the wound, anemia, jaundice, and diabetes. When dehiscence and control groups were combined, 30% of patients with at least five significant risk factors developed dehiscence, and all the patients with more than eight risk factors developed a wound dehiscence. There was an overall mortality of 29%, which was directly related to the number of significant risk factors. The co-existence of 9 risk factors portended death in one third of the patients, and all the patients with more than 10 risk factors died.

Predicting adolescent breakfast consumption in the UK and Australia using an extended theory of planned behaviour.

PubMed

Mullan, Barbara; Wong, Cara; Kothe, Emily

2013-03-01

The aim of this study was to investigate whether the theory of planned behaviour (TPB) with the addition of risk awareness could predict breakfast consumption in a sample of adolescents from the UK and Australia. It was hypothesised that the TPB variables of attitudes, subjective norm and perceived behavioural control (PBC) would significantly predict intentions, and that inclusion of risk perception would increase the proportion of variance explained. Secondly it was hypothesised that intention and PBC would predict behaviour. Participants were recruited from secondary schools in Australia and the UK. A total of 613 participants completed the study (448 females, 165 males; mean=14years ±1.1). The TPB predicted 42.2% of the variance in intentions to eat breakfast. All variables significantly predicted intention with PBC as the strongest component. The addition of risk made a small but significant contribution to the prediction of intention. Together intention and PBC predicted 57.8% of the variance in breakfast consumption. Copyright © 2012 Elsevier Ltd. All rights reserved.

Testing the Predictive Validity of the Hendrich II Fall Risk Model.

PubMed

Jung, Hyesil; Park, Hyeoun-Ae

2018-03-01

Cumulative data on patient fall risk have been compiled in electronic medical records systems, and it is possible to test the validity of fall-risk assessment tools using these data between the times of admission and occurrence of a fall. The Hendrich II Fall Risk Model scores assessed during three time points of hospital stays were extracted and used for testing the predictive validity: (a) upon admission, (b) when the maximum fall-risk score from admission to falling or discharge, and (c) immediately before falling or discharge. Predictive validity was examined using seven predictive indicators. In addition, logistic regression analysis was used to identify factors that significantly affect the occurrence of a fall. Among the different time points, the maximum fall-risk score assessed between admission and falling or discharge showed the best predictive performance. Confusion or disorientation and having a poor ability to rise from a sitting position were significant risk factors for a fall.

Managing mixed dyslipidemia in special populations.

PubMed

Miller, Michael

2010-01-01

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

Breast cancer prevention.

PubMed

Euhus, David M; Diaz, Jennifer

2015-01-01

Breast cancer is the most common cancer in women with 232,670 new cases estimated in the USA for 2014. Approaches for reducing breast cancer risk include lifestyle modification, chemoprevention, and prophylactic surgery. Lifestyle modification has a variety of health benefits with few associated risks and is appropriate for all women regardless of breast cancer risk. Chemoprevention options have expanded rapidly, but most are directed at estrogen receptor positive breast cancer and uptake is low. Prophylactic surgery introduces significant additional risks of its own and is generally reserved for the highest risk women. © 2014 Wiley Periodicals, Inc.

Early decision framework for integrating sustainable risk management for complex remediation sites: Drivers, barriers, and performance metrics.

PubMed

Harclerode, Melissa A; Macbeth, Tamzen W; Miller, Michael E; Gurr, Christopher J; Myers, Teri S

2016-12-15

As the environmental remediation industry matures, remaining sites often have significant underlying technical challenges and financial constraints. More often than not, significant remediation efforts at these "complex" sites have not achieved stringent, promulgated cleanup goals. Decisions then have to be made about whether and how to commit additional resources towards achieving those goals, which are often not achievable nor required to protect receptors. Guidance on cleanup approaches focused on evaluating and managing site-specific conditions and risks, rather than uniformly meeting contaminant cleanup criteria in all media, is available to aid in this decision. Although these risk-based cleanup approaches, such as alternative endpoints and adaptive management strategies, have been developed, they are under-utilized due to environmental, socio-economic, and risk perception barriers. Also, these approaches are usually implemented late in the project life cycle after unsuccessful remedial attempts to achieve stringent cleanup criteria. In this article, we address these barriers by developing an early decision framework to identify if site characteristics support sustainable risk management, and develop performance metrics and tools to evaluate and implement successful risk-based cleanup approaches. In addition, we address uncertainty and risk perception challenges by aligning risk-based cleanup approaches with the concepts of risk management and sustainable remediation. This approach was developed in the context of lessons learned from implementing remediation at complex sites, but as a framework can, and should, be applied to all sites undergoing remediation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Non-steroidal anti-inflammatory drug use and ovarian cancer risk: findings from the NIH-AARP Diet and Health Study and systematic review.

PubMed

Murphy, Megan A; Trabert, Britton; Yang, Hannah P; Park, Yikyung; Brinton, Louise A; Hartge, Patricia; Sherman, Mark E; Hollenbeck, Albert; Wentzensen, Nicolas

2012-11-01

Chronic inflammation has been proposed as a risk factor for ovarian cancer. Some data suggest that anti-inflammatory medications may be protective against ovarian cancer; however, results have been inconsistent. We evaluated the risk of epithelial ovarian cancer with regular use of NSAIDs prospectively in the NIH-AARP Diet and Health Study, using Cox proportional hazard models. We also examined the risk of common subtypes of epithelial ovarian cancer (serous, mucinous, endometrioid, clear cell, and other epithelial) with regular use of NSAIDs. In addition, we performed meta-analyses summarizing the risk of ovarian cancer with "regular use" of NSAIDs in previously published studies. We did not observe a significant association between regular use of NSAIDs with ovarian cancer risk in the AARP cohort (aspirin: RR 1.06, 95 % CI 0.87-1.29; non-aspirin NSAIDs: RR 0.93, 95 % CI 0.74-1.15); however, summary estimates from prospective cohort studies demonstrated that use of non-aspirin NSAIDs may reduce the risk of ovarian cancer (RR 0.88, 95 % CI 0.77-1.01). Although not significant, we found that mucinous tumors were inversely associated with non-aspirin NSAID use (RR 0.69, 95 % CI 0.23-2.10) in the AARP cohort, which was supported by the meta-analysis (RR 0.69, CI 0.50-0.94.) Although results from the NIH-AARP cohort study were not statistically significant, our meta-analysis suggests that non-aspirin NSAIDs may be protective against ovarian cancer. Additional analyses, focusing on dose, duration, and frequency of NSAID use and accounting for ovarian cancer heterogeneity are necessary to further elucidate the association between NSAID use and ovarian cancer risk.

Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study.

PubMed

Hatta, Waku; Gotoda, Takuji; Oyama, Tsuneo; Kawata, Noboru; Takahashi, Akiko; Yoshifuku, Yoshikazu; Hoteya, Shu; Nakagawa, Masahiro; Hirano, Masaaki; Esaki, Mitsuru; Matsuda, Mitsuru; Ohnita, Ken; Yamanouchi, Kohei; Yoshida, Motoyuki; Dohi, Osamu; Takada, Jun; Tanaka, Keiko; Yamada, Shinya; Tsuji, Tsuyotoshi; Ito, Hirotaka; Hayashi, Yoshiaki; Nakamura, Tomohiro; Nakaya, Naoki; Shimosegawa, Tooru

2018-05-01

We have established a risk-scoring system, termed the "eCura system," for the risk stratification of lymph node metastasis in patients who have received noncurative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to clarify whether this system contributes to the selection of patients requiring radical surgery after ESD. Between 2000 and 2011, 1,969 patients with noncurative ESD for EGC were included in this multicenter study. Depending on the treatment strategy after ESD, we had patients with no additional treatment (n = 905) and those with radical surgery after ESD (n = 1,064). After the application of the eCura system to these patients, cancer recurrence and cancer-specific mortality in each risk category of the system were compared between the two patient groups. Multivariate Cox analysis revealed that in the high-risk category, cancer recurrence was significantly higher (hazard ratio = 3.13, p = 0.024) and cancer-specific mortality tended to be higher (hazard ratio = 2.66, p = 0.063) in patients with no additional treatment than in those with radical surgery after ESD, whereas no significant differences were observed in the intermediate-risk and low-risk categories. In addition, cancer-specific survival in the low-risk category was high in both patient groups (99.6 and 99.7%). A limitation of this study is that it included a small number of cases with undifferentiated-type EGC (292 cases). The eCura system is a useful aid for selecting the appropriate treatment strategy after noncurative ESD for EGC. However, caution is needed when applying this system to patients with undifferentiated-type EGC.

Managing the residual cardiovascular disease risk associated with HDL-cholesterol and triglycerides in statin-treated patients: a clinical update.

PubMed

Reiner, Z

2013-09-01

Cardiovascular disease (CVD) is a significant cause of death in Europe. In addition to patients with proven CVD, those with type 2 diabetes (T2D) are at a particularly high-risk of CVD and associated mortality. Treatment for dyslipidaemia, a principal risk factor for CVD, remains a healthcare priority; evidence supports the reduction of low-density lipoprotein cholesterol (LDL-C) as the primary objective of dyslipidaemia management. While statins are the treatment of choice for lowering LDL-C in the majority of patients, including those with T2D, many patients retain a high CVD risk despite achieving the recommended LDL-C targets with statins. This 'residual risk' is mainly due to elevated triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) levels. Following statin therapy optimisation additional pharmacotherapy should be considered as part of a multifaceted approach to risk reduction. Fibrates (especially fenofibrate) are the principal agents recommended for add-on therapy to treat elevated TG or low HDL-C levels. Currently, the strongest evidence of benefit is for the addition of fenofibrate to statin treatment in high-risk patients with T2D and dyslipidaemia. An alternative approach is the addition of agents to reduce LDL-C beyond the levels attainable with statin monotherapy. Here, addition of fibrates and niacin to statin therapy is discussed, and novel approaches being developed for HDL-C and TG management, including cholesteryl ester transfer protein inhibitors, Apo A-1 analogues, mipomersen, lomitapide and monoclonal antibodies against PCSK9, are reviewed. Copyright © 2013 Elsevier B.V. All rights reserved.

Substance Use Prevention among At-Risk Rural Youth: Piloting the Social Ecological "One Life" Program

ERIC Educational Resources Information Center

Williams, Ronald D., Jr.; Barnes, Jeremy T.; Holman, Thomas; Hunt, Barry P.

2014-01-01

Substance use among youth is a significant health concern in the rural United States, particularly among at-risk students. While evidence-based programs are available, literature suggests that an underdeveloped rural health prevention workforce often limits the adoption of such programs. Additionally, population-size restrictions of national…

Number of Psychosocial Strengths Predicts Reduced HIV Sexual Risk Behaviors Above and Beyond Syndemic Problems Among Gay and Bisexual Men.

PubMed

Hart, Trevor A; Noor, Syed W; Adam, Barry D; Vernon, Julia R G; Brennan, David J; Gardner, Sandra; Husbands, Winston; Myers, Ted

2017-10-01

Syndemics research shows the additive effect of psychosocial problems on high-risk sexual behavior among gay and bisexual men (GBM). Psychosocial strengths may predict less engagement in high-risk sexual behavior. In a study of 470 ethnically diverse HIV-negative GBM, regression models were computed using number of syndemic psychosocial problems, number of psychosocial strengths, and serodiscordant condomless anal sex (CAS). The number of syndemic psychosocial problems correlated with serodiscordant CAS (RR = 1.51, 95% CI 1.18-1.92; p = 0.001). When adding the number of psychosocial strengths to the model, the effect of syndemic psychosocial problems became non-significant, but the number of strengths-based factors remained significant (RR = 0.67, 95% CI 0.53-0.86; p = 0.002). Psychosocial strengths may operate additively in the same way as syndemic psychosocial problems, but in the opposite direction. Consistent with theories of resilience, psychosocial strengths may be an important set of variables predicting sexual risk behavior that is largely missing from the current HIV behavioral literature.

Additive Genetic Risk from Five Serotonin System Polymorphisms Interacts with Interpersonal Stress to Predict Depression

PubMed Central

Vrshek-Schallhorn, Suzanne; Stroud, Catherine B.; Mineka, Susan; Zinbarg, Richard E.; Adam, Emma K.; Redei, Eva E.; Hammen, Constance; Craske, Michelle G.

2016-01-01

Behavioral genetic research supports polygenic models of depression in which many genetic variations each contribute a small amount of risk, and prevailing diathesis-stress models suggest gene-environment interactions (GxE). Multilocus profile scores of additive risk offer an approach that is consistent with polygenic models of depression risk. In a first demonstration of this approach in a GxE predicting depression, we created an additive multilocus profile score from five serotonin system polymorphisms (one each in the genes HTR1A, HTR2A, HTR2C, and two in TPH2). Analyses focused on two forms of interpersonal stress as environmental risk factors. Using five years of longitudinal diagnostic and life stress interviews from 387 emerging young adults in the Youth Emotion Project, survival analyses show that this multilocus profile score interacts with major interpersonal stressful life events to predict major depressive episode onsets (HR = 1.815, p = .007). Simultaneously, there was a significant protective effect of the profile score without a recent event (HR = 0.83, p = .030). The GxE effect with interpersonal chronic stress was not significant (HR = 1.15, p = .165). Finally, effect sizes for genetic factors examined ignoring stress suggested such an approach could lead to overlooking or misinterpreting genetic effects. Both the GxE effect and the protective simple main effect were replicated in a sample of early adolescent girls (N = 105). We discuss potential benefits of the multilocus genetic profile score approach and caveats for future research. PMID:26595467

Consumption of salted fish and other risk factors for nasopharyngeal carcinoma (NPC) in Tianjin, a low-risk region for NPC in the People's Republic of China.

PubMed

Ning, J P; Yu, M C; Wang, Q S; Henderson, B E

1990-02-21

The dietary habits, occupational exposures, use of tobacco and alcohol, and medical history were compared among 100 patients with histologically confirmed nasopharyngeal carcinoma (NPC) in Tianjin City, People's Republic of China, and 300 neighborhood controls who were individually matched to the patients with regard to age (within 5 yr), sex, and race (Han). Exposure to salted fish was significantly associated with an increased risk of NPC. Four characteristics of exposure to salted fish independently contributed to the increased risk: (a) earlier age at first exposure, (b) increasing duration of consumption, (c) increasing frequency of consumption, and (d) cooking the fish by steaming it rather than frying, grilling, or boiling it. In addition, significant associations were observed for consumption in childhood of salted shrimp paste (increased risk) and carrots (reduced risk), and the three dietary effects (i.e., those from consumption of salted fish, salted shrimp paste, and carrots) were independent of each other. None of the non-dietary factors studied were significantly associated with NPC risk.

The clinical relevance of the Waterlow pressure sore risk scale in the ICU.

PubMed

Weststrate, J T; Hop, W C; Aalbers, A G; Vreeling, A W; Bruining, H A

1998-08-01

To evaluate whether the Waterlow pressure sore risk (PSR) scale has prognostic significance for intensive care patients. A prospective study. The surgical intensive care unit (ICU) of the University Hospital Rotterdam. Data were evaluated from 594 patients who had been admitted to the ICU during the year 1994. Each patient was assessed daily with respect to their Waterlow PSR score and the development of pressure sores in the sacral region. Actuarial statistical methods were used to analyse the predictive value of the risk score. When a patient had a Waterlow PSR score > 25 on admission, the risk of developing a pressure sore was significantly increased compared to patients with a PSR score < 25. After admission, the daily Waterlow PSR scores obtained were significantly associated with the risk of developing a pressure sore. For each additional point this risk increased by 23% (95% confidence interval 17 to 28%). The Waterlow PSR scale provides the medical and nursing staff at an early stage with reliable information about the risk patients have in developing a pressure sore.

Resisting rape: the effects of victim self-protection on rape completion and injury.

PubMed

Tark, Jongyeon; Kleck, Gary

2014-03-01

The impact of victim resistance on rape completion and injury was examined utilizing a large probability sample of sexual assault incidents, derived from the National Crime Victimization Survey (1992-2002), and taking into account whether harm to the victim followed or preceded self-protection (SP) actions. Additional injuries besides rape, particularly serious injuries, following victim resistance are rare. Results indicate that most SP actions, both forceful and nonforceful, reduce the risk of rape completion, and do not significantly affect the risk of additional injury.

Adiponectin Provides Additional Information to Conventional Cardiovascular Risk Factors for Assessing the Risk of Atherosclerosis in Both Genders

PubMed Central

Yoon, Jin-Ha; Kim, Sung-Kyung; Choi, Ho-June; Choi, Soo-In; Cha, So-Youn; Koh, Sang-Baek

2013-01-01

Background This study evaluated the relation between adiponectin and atherosclerosis in both genders, and investigated whether adiponectin provides useful additional information for assessing the risk of atherosclerosis. Methods We measured serum adiponectin levels and other cardiovascular risk factors in 1033 subjects (454 men, 579 women) from the Korean Genomic Rural Cohort study. Carotid intima–media-thickness (CIMT) was used as measure of atherosclerosis. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated using multiple logistic regression, and receiver operating characteristic curves (ROC), the category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. Results After adjustment for conventional cardiovascular risk factors, such as age, waist circumference, smoking history, low-density and high-density lipoprotein cholesterol, triglycerides, systolic blood pressure and insulin resistance, the ORs (95%CI) of the third tertile adiponectin group were 0.42 (0.25–0.72) in men and 0.47 (0.29–0.75) in women. The area under the curve (AUC) on the ROC analysis increased significantly by 0.025 in men and 0.022 in women when adiponectin was added to the logistic model of conventional cardiovascular risk factors (AUC in men: 0.655 to 0.680, p = 0.038; AUC in women: 0.654 to 0.676, p = 0.041). The NRI was 0.32 (95%CI: 0.13–0.50, p<0.001), and the IDI was 0.03 (95%CI: 0.01–0.04, p<0.001) for men. For women, the category-free NRI was 0.18 (95%CI: 0.02–0.34, p = 0.031) and the IDI was 0.003 (95%CI: −0.002–0.008, p = 0.189). Conclusion Adiponectin and atherosclerosis were significantly related in both genders, and these relationships were independent of conventional cardiovascular risk factors. Furthermore, adiponectin provided additional information to conventional cardiovascular risk factors regarding the risk of atherosclerosis. PMID:24116054

Adiponectin provides additional information to conventional cardiovascular risk factors for assessing the risk of atherosclerosis in both genders.

PubMed

Yoon, Jin-Ha; Kim, Sung-Kyung; Choi, Ho-June; Choi, Soo-In; Cha, So-Youn; Koh, Sang-Baek; Kang, Hee-Taik; Ahn, Song Vogue

2013-01-01

This study evaluated the relation between adiponectin and atherosclerosis in both genders, and investigated whether adiponectin provides useful additional information for assessing the risk of atherosclerosis. We measured serum adiponectin levels and other cardiovascular risk factors in 1033 subjects (454 men, 579 women) from the Korean Genomic Rural Cohort study. Carotid intima-media-thickness (CIMT) was used as measure of atherosclerosis. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated using multiple logistic regression, and receiver operating characteristic curves (ROC), the category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. After adjustment for conventional cardiovascular risk factors, such as age, waist circumference, smoking history, low-density and high-density lipoprotein cholesterol, triglycerides, systolic blood pressure and insulin resistance, the ORs (95%CI) of the third tertile adiponectin group were 0.42 (0.25-0.72) in men and 0.47 (0.29-0.75) in women. The area under the curve (AUC) on the ROC analysis increased significantly by 0.025 in men and 0.022 in women when adiponectin was added to the logistic model of conventional cardiovascular risk factors (AUC in men: 0.655 to 0.680, p = 0.038; AUC in women: 0.654 to 0.676, p = 0.041). The NRI was 0.32 (95%CI: 0.13-0.50, p<0.001), and the IDI was 0.03 (95%CI: 0.01-0.04, p<0.001) for men. For women, the category-free NRI was 0.18 (95%CI: 0.02-0.34, p = 0.031) and the IDI was 0.003 (95%CI: -0.002-0.008, p = 0.189). Adiponectin and atherosclerosis were significantly related in both genders, and these relationships were independent of conventional cardiovascular risk factors. Furthermore, adiponectin provided additional information to conventional cardiovascular risk factors regarding the risk of atherosclerosis.

Pavlovian conditioning to food reward as a function of eating disorder risk.

PubMed

Astur, Robert S; Palmisano, Alexandra N; Hudd, Ellie C; Carew, Andrew W; Deaton, Bonnie E; Kuhney, Franchesca S; Niezrecki, Rachel N; Santos, Melissa

2015-09-15

The aim of this experiment was to examine the extent to which eating disorder risk affects the strength of food-reward conditioning. Eighty food-restricted undergraduates were placed into a VR environment consisting of two visually distinct rooms. Participants underwent multiple pairing sessions in which they were confined into one of the two rooms and explored a VR environment. Room A was paired with real-life M&Ms for three sessions, and Room B was paired with no food for three sessions. After a short delay, a test session was administered, and participants were given free access to the entire VR environment for 5 min. Participants also completed the Eating Attitudes Test (EAT-26; [11]), which is a standard screening tool of eating disorder risk. Participants displayed a significant conditioned place preference for the VR room previously paired with food, and they displayed a significant explicit preference for the M&M-paired room in a forced-choice test. There was a significant positive correlation between place preference strength and scores on the dieting subscale of the EAT-26. Additionally, ratings of the no-food room were significantly lower as dieting scores increased. This suggests that components of eating disorder risk can influence basic conditioning strength to places associated with food reward. For both males and females, additional correlations between eating disorder risk subscales and conditioning variables are discussed, and implications for future research are proposed in hopes of understanding how conditioning paradigms can provide insight into treating and preventing eating disorders. Copyright © 2015 Elsevier B.V. All rights reserved.

Cardiorespiratory fitness and classification of risk of cardiovascular disease mortality.

PubMed

Gupta, Sachin; Rohatgi, Anand; Ayers, Colby R; Willis, Benjamin L; Haskell, William L; Khera, Amit; Drazner, Mark H; de Lemos, James A; Berry, Jarett D

2011-04-05

Cardiorespiratory fitness (fitness) is associated with cardiovascular disease (CVD) mortality. However, the extent to which fitness improves risk classification when added to traditional risk factors is unclear. Fitness was measured by the Balke protocol in 66 371 subjects without prior CVD enrolled in the Cooper Center Longitudinal Study between 1970 and 2006; follow-up was extended through 2006. Cox proportional hazards models were used to estimate the risk of CVD mortality with a traditional risk factor model (age, sex, systolic blood pressure, diabetes mellitus, total cholesterol, and smoking) with and without the addition of fitness. The net reclassification improvement and integrated discrimination improvement were calculated at 10 and 25 years. Ten-year risk estimates for CVD mortality were categorized as <1%, 1% to <5%, and ≥5%, and 25-year risk estimates were categorized as <8%, 8% to 30%, and ≥30%. During a median follow-up period of 16 years, there were 1621 CVD deaths. The addition of fitness to the traditional risk factor model resulted in reclassification of 10.7% of the men, with significant net reclassification improvement at both 10 years (net reclassification improvement=0.121) and 25 years (net reclassification improvement=0.041) (P<0.001 for both). The integrated discrimination improvement was 0.010 at 10 years (P<0.001), and the relative integrated discrimination improvement was 29%. Similar findings were observed for women at 25 years. A single measurement of fitness significantly improves classification of both short-term (10-year) and long-term (25-year) risk for CVD mortality when added to traditional risk factors.

A Study of the Factors Associated with Risk for Development of Pressure Ulcers: A Longitudinal Analysis

PubMed Central

Thomas, Elizebeth; Vinodkumar, Sudhaya; Mathew, Silvia; Setia, Maninder Singh

2015-01-01

Background: Pressure ulcers (PUs) are prevalent in hospitalized patients; they may cause clinical, psychological, and economic problems in these patients. Previous studies are cross-sectional, have used pooled data, or cox-regression models to assess the risk for developing PU. However, PU risk scores change over time and models that account for time varying variables are useful for cohort analysis of data. Aims and Objectives: The present longitudinal study was conducted to compare the risk of PU between surgical and nonsurgical patients, and to evaluate the factors associated with the development of these ulcers over a period of time. Materials and Methods: We evaluated 290 hospitalized patients over a 4 months period. The main outcomes for our analysis were: (1) Score on the pressure risk assessment scale; and (2) the proportion of individuals who were at severe risk for developing PUs. We used random effects models for longitudinal analysis of the data. Results: The mean PU score was significantly higher in the nonsurgical patients compared with surgical patients at baseline (15.23 [3.86] vs. 9.33 [4.57]; P < 0.01). About 7% of the total patients had a score of >20 at baseline and were considered as being at high-risk for PU; the proportion was significantly higher among the nonsurgical patients compared with the surgical patients (14% vs. 4%, P = 0.003). In the adjusted models, there was no difference for severe risk for PU between surgical and nonsurgical patients (odds ratios [ORs]: 0.37, 95% confidence interval [CI]: 0.01–12.80). An additional day in the ward was associated with a significantly higher likelihood of being at high-risk for PU (OR: 1.47, 95% CI: 1.16–1.86). Conclusion: There were no significant differences between patients who were admitted for surgery compared with those who were not. An additional day in the ward, however, is important for developing a high-risk score for PU on the monitoring scale, and these patients require active interventions. PMID:26677269

Association of Genetic Variants with Isolated Fasting Hyperglycaemia and Isolated Postprandial Hyperglycaemia in a Han Chinese Population

PubMed Central

Chen, Ying; Chen, Li; Zhao, Zhigang; Li, Qiang; Ge, Jiapu; Chen, Gang; Guo, Xiaohui; Lu, Juming; Weng, Jianping; Jia, Weiping; Ji, Linong; Xiao, Jianzhong; Shan, Zhongyan; Liu, Jie; Tian, Haoming; Ji, Qiuhe; Zhu, Dalong; Zhou, Zhiguang; Shan, Guangliang; Yang, Wenying

2013-01-01

Background Though multiple single nucleotide polymorphisms (SNPs) associated with type 2 diabetes have been identified, the genetic bases of isolated fasting hyperglycaemia (IFH) and isolated postprandial hyperglycaemia (IPH) were still unclear. In present study, we aimed to investigate the association of genome-wide association study-validated genetic variants and IFH or IPH in Han Chinese. Methods/Principal Findings We genotyped 27 validated SNPs in 6,663 unrelated individuals comprising 341 IFH, 865 IPH, 1,203 combined fasting hyperglycaemia and postprandial hyperglycaemia, and 4,254 normal glycaemic subjects of Han ancestry. The distributions of genotype frequencies of FTO, CDKAL1 and GCKR were significant different between individuals with IFH and those with IPH (SNP(ptrend): rs8050136(0.0024), rs9939609(0.0049), rs7756992(0.0122), rs780094(0.0037)). Risk allele of FTO specifically increased the risk of IFH (rs8050136: OR 1.403 [95% CI 1.125–1.750], p = 0.0027; rs9939609: 1.398 [1.120–1.744], p = 0.0030). G allele of CDKAL1 specifically increased the risk of IPH (1.217 [1.092–1.355], p = 0.0004). G allele of GCKR increased the risk of IFH (1.167 [0.999–1.362], p = 0.0513), but decreased the risk of IPH (0.891 [0.801–0.991], p = 0.0331). In addition, TCF7L2 and KCNQ1 increased the risk of both IFH and IPH. When combined, each additional risk allele associated with IFH increased the risk for IFH by 1.246-fold (p<0.0001), while each additional risk allele associated with IPH increased the risk for IPH by 1.190-fold (p<0.0001). Conclusion/Significance Our results indicate that genotype distributions of variants from FTO, GCKR, CDKAL1 were different between IPH and IFH in Han Chinese. Variants of genes modulating insulin sensitivity (FTO, GCKR) contributed to the risk of IFH, while variants of genes related to beta cell function (CDKAL1) increase the risk of IPH. PMID:23990951

[Risk hidden in the small print? : Some food additives may trigger pseudoallergic reactions].

PubMed

Zuberbier, Torsten; Hengstenberg, Claudine

2016-06-01

Some food additives may trigger pseudoallergenic reactions. However, the prevalence of such an overreaction is - despite the increasing number of food additives - rather low in the general population. The most common triggers of pseudoallergic reactions to food are naturally occurring ingredients. However, symptoms in patients with chronic urticaria should improve significantly on a pseudoallergen-free diet. In addition, some studies indicate that certain food additives may also have an impact on the symptoms of patients with neurodermatitis and asthma.

75 FR 60485 - NRC Enforcement Policy Revision

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... centrifuge or laser enrichment facilities. The NRC has issued licenses for two gas centrifuge uranium... significance)). In addition, the radiological and chemical risks of gas centrifuge uranium enrichment...

Trait Anxiety and Economic Risk Avoidance Are Not Necessarily Associated: Evidence from the Framing Effect.

PubMed

Gu, Ruolei; Wu, Runguo; Broster, Lucas S; Jiang, Yang; Xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-Jia

2017-01-01

According to previous literature, trait anxiety is related to the tendency to choose safety options during risk decision-making, that is, risk avoidance. In our opinion, anxious people's risk preference might actually reflect their hypersensitivity to emotional information. To examine this hypothesis, a decision-making task that could elicit the framing effect was employed. The framing effect indicates that risk preference could be modulated by emotional messages contained in the description (i.e., frame) of options. The behavioral results have showed the classic framing effect. In addition, individual level of trait anxiety was positively correlated with the framing effect size. However, trait anxiety was not correlated with risk-avoidance ratio in any condition. Finally, the relationship between anxiety and the framing effect remained significant after the level of depression was also taken into account. The theoretical significance and the major limitations of this study are discussed.

Health risk behavior of rural secondary school students in Zimbabwe.

PubMed

Gwede, C K; McDermott, R J; Westhoff, W W; Mushore, M; Mushore, T; Chitsika, E; Majange, C S; Chauke, P

2001-10-01

A socioculturally appropriate health risk behavior instrument, modeled after the U.S. Centers for Disease Control and Prevention's Youth Risk Behavior Survey (YRBS), was administered to 717 secondary school students in a rural area of Zimbabwe. Comparisons of risk behaviors by gender and school grade were made using univariate procedures and multiple logistic regression. Males were significantly more likely than females to have had sexual intercourse (odds ratio = 5.02, p < .0001) and to report drug use behaviors. Males also were significantly more likely to report early initiation (by age 13 years) of alcohol use, cigarette smoking, and marijuana use. School site violence and drug use behaviors also were prevalent in this sample. An interaction between gender and grade was evident for some behaviors. Additional research may further the understanding of these risk behaviors and facilitate development of effective, culturally relevant risk reduction programs.

Trait Anxiety and Economic Risk Avoidance Are Not Necessarily Associated: Evidence from the Framing Effect

PubMed Central

Gu, Ruolei; Wu, Runguo; Broster, Lucas S.; Jiang, Yang; Xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-Jia

2017-01-01

According to previous literature, trait anxiety is related to the tendency to choose safety options during risk decision-making, that is, risk avoidance. In our opinion, anxious people’s risk preference might actually reflect their hypersensitivity to emotional information. To examine this hypothesis, a decision-making task that could elicit the framing effect was employed. The framing effect indicates that risk preference could be modulated by emotional messages contained in the description (i.e., frame) of options. The behavioral results have showed the classic framing effect. In addition, individual level of trait anxiety was positively correlated with the framing effect size. However, trait anxiety was not correlated with risk-avoidance ratio in any condition. Finally, the relationship between anxiety and the framing effect remained significant after the level of depression was also taken into account. The theoretical significance and the major limitations of this study are discussed. PMID:28197116

OPPT workplan risk assessment for antimony trioxide (CASRN ...

EPA Pesticide Factsheets

This assessment will focus on the ecological hazards that may be associated with ATO use in flame retardants. Because ATO’s use in PET plastics was previously evaluated and determined to present minimal concerns for human health and the environment (EU, 2008), this use scenario will not be evaluated here. Human health risks have been evaluated previously and will be summarized in this assessment. EPA anticipates issuing draft risk assessments for public review and comment as they are completed. At the conclusion of the review process, if an assessment of specific uses indicates significant risk, EPA will evaluate and pursue appropriate risk reduction actions, as warranted. If an assessment indicates no significant risk, EPA will conclude its current work on assessment of those specified targeted uses of that chemical. Over time, additional chemicals will be added to the work plan as more data are developed and more chemicals screened.

Chromosomal microarray findings in pregnancies with an isolated pelvic kidney.

PubMed

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

2018-05-29

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

Cardiovascular disease in women.

PubMed

Lee, L Veronica; Foody, Joanne Micale

2008-08-01

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

Climate Change Education in Formal Settings, K-14: A Workshop Summary

ERIC Educational Resources Information Center

Beatty, Alexandra

2012-01-01

Climate change is occurring, is very likely caused by human activities, and poses significant risks for a broad range of human and natural systems. Each additional ton of greenhouse gases emitted commits us to further change and greater risks. In the judgment of the Committee on America's Climate Choices, the environmental, economic, and…

How Well Do We Understand the Long-Term Health Implications of Childhood Bullying?

PubMed

Zarate-Garza, Pablo Patricio; Biggs, Bridget K; Croarkin, Paul; Morath, Brooke; Leffler, Jarrod; Cuellar-Barboza, Alfredo; Tye, Susannah J

Once dismissed as an innocuous experience of childhood, bullying is now recognized as having significant psychological effects, particularly with chronic exposure. Victims of bullying are at risk for a number of psychiatric disturbances, and growing evidence suggests that the pathophysiological effects of bullying, as with other forms of trauma and chronic stress, create additional health risks. We review the literature on the known sequelae of bullying, including psychiatric and physiological health effects, with a focus on implications for the victim. In addition, since it is now well established that early and chronic exposure to stress has a significant negative impact on health outcomes, we explore the implications of this research in relation to bullying and victimization in childhood. In particular, we examine how aspects of the stress response, via epigenetic, inflammatory, and metabolic mediators, have the capacity to compromise mental and physical health, and to increase the risk of disease. Research on the relevant mechanisms associated with bullying and on potential interventions to decrease morbidity is urgently needed.

Contour plot assessment of existing meta-analyses confirms robust association of statin use and acute kidney injury risk.

PubMed

Chevance, Aurélie; Schuster, Tibor; Steele, Russell; Ternès, Nils; Platt, Robert W

2015-10-01

Robustness of an existing meta-analysis can justify decisions on whether to conduct an additional study addressing the same research question. We illustrate the graphical assessment of the potential impact of an additional study on an existing meta-analysis using published data on statin use and the risk of acute kidney injury. A previously proposed graphical augmentation approach is used to assess the sensitivity of the current test and heterogeneity statistics extracted from existing meta-analysis data. In addition, we extended the graphical augmentation approach to assess potential changes in the pooled effect estimate after updating a current meta-analysis and applied the three graphical contour definitions to data from meta-analyses on statin use and acute kidney injury risk. In the considered example data, the pooled effect estimates and heterogeneity indices demonstrated to be considerably robust to the addition of a future study. Supportingly, for some previously inconclusive meta-analyses, a study update might yield statistically significant kidney injury risk increase associated with higher statin exposure. The illustrated contour approach should become a standard tool for the assessment of the robustness of meta-analyses. It can guide decisions on whether to conduct additional studies addressing a relevant research question. Copyright © 2015 Elsevier Inc. All rights reserved.

Perinatal outcome and later implications of intrauterine growth restriction.

PubMed

Pallotto, Eugenia K; Kilbride, Howard W

2006-06-01

This chapter reviews outcomes for children who have intrauterine growth retardation (IUGR) or small-for-gestation-age (SGA) status at birth. Such infants are at risk for increased perinatal mortality, birth adaptation complications, including perinatal acidosis, hypoglycemia, hypothermia, coagulation abnormalities, and selected immunologic deficiencies. IUGR infants also appear to be at great risk for complications of prematurity, including chronic lung disease and necrotizing enterocolitis. Childhood implications for IUGR include an increased risk for short stature, cognitive delays with decreased academic achievement, and a small but significant increased risk of neurologic disorders, including cerebral palsy. Low socioeconomic status is correlated with the occurrence of IUGR and is significantly related to long-term disabilities. Morbidities associated with preterm delivery appear to be additive to those associated with fetal growth restriction so IUGR, preterm infants may be at great risk for poor neurodevelopmental outcome.

HIV Risk, Substance Use, and Personality Characteristics among Adults with History of Serious Mental Illness.

PubMed

Mainville, Cathryn H; Richardson, Mark A; Brady, Stephen M; Berger-Greenstein, Jori; Bacic, Janine

2017-01-01

The present study examined the relationship between characteristics associated with personality disorders, substance use, and HIV risk among adults with a history of serious mental illness. Participants included 103 adults with antisocial or borderline personality disorder, serious mental illness, and recent HIV risk behavior. The sample was predominately male (64%), diverse (42% African American and 13% Hispanic), and homeless/marginally housed (76%). In order to examine the relationship between personality characteristics and risk we constructed a risk index comprising key symptoms of antisocial and borderline personality disorders, namely; impulsivity, affective instability, and disregard for safety of self/others. Contrary to our primary hypotheses, risk index scores did not predict HIV risk behavior and substance abuse did not mediate this risk. Exploratory analyses did reveal that women engaged in significantly more risk behaviors than their male counterparts and that risk scores were a significant predictor of total sex acts for women but not men. In addition, increased emotional dysregulation was a significant predictor of condomless sex acts for women but not men. Finally, recent alcohol use and increased impulsivity was associated with more condomless oral sex for men and women. These results suggest the relationship among serious mental illness, personality disorder, substance abuse, and gender is complex and merits further study.

A risk assessment approach for fresh fruits.

PubMed

Bassett, J; McClure, P

2008-04-01

To describe the approach used in conducting a fit-for-purpose risk assessment of microbiological human pathogens associated with fresh fruit and the risk management recommendations made. A qualitative risk assessment for microbiological hazards in fresh fruit was carried out based on the Codex Alimentarius (Codex) framework, modified to consider multiple hazards and all fresh (whole) fruits. The assessment determines 14 significant bacterial, viral, protozoal and nematodal hazards associated with fresh produce, assesses the probable level of exposure from fresh fruit, concludes on the risk from each hazard, and considers and recommends risk management actions. A review of potential risk management options allowed the comparison of effectiveness with the potential exposure to each hazard. Washing to a recommended protocol is an appropriate risk management action for the vast majority of consumption events, particularly when good agricultural and hygienic practices are followed and with the addition of refrigerated storage for low acid fruit. Additional safeguards are recommended for aggregate fruits with respect to the risk from protozoa. The potentially complex process of assessing the risks of multiple hazards in multiple but similar commodities can be simplified in a qualitative assessment approach that employs the Codex methodology.

Late-onset Alzheimer disease genetic variants in posterior cortical atrophy and posterior AD.

PubMed

Carrasquillo, Minerva M; Khan, Qurat ul Ain; Murray, Melissa E; Krishnan, Siddharth; Aakre, Jeremiah; Pankratz, V Shane; Nguyen, Thuy; Ma, Li; Bisceglio, Gina; Petersen, Ronald C; Younkin, Steven G; Dickson, Dennis W; Boeve, Bradley F; Graff-Radford, Neill R; Ertekin-Taner, Nilüfer

2014-04-22

To investigate association of genetic risk factors for late-onset Alzheimer disease (LOAD) with risk of posterior cortical atrophy (PCA), a syndrome of visual impairment with predominant Alzheimer disease (AD) pathology in posterior cortical regions, and with risk of "posterior AD" neuropathology. We assessed 81 participants with PCA diagnosed clinically and 54 with neuropathologic diagnosis of posterior AD vs 2,523 controls for association with 11 significant single nucleotide polymorphisms (SNPs) from published LOAD risk genome-wide association studies. There was highly significant association with APOE ε4 and increased risk of PCA (p = 0.0003, odds ratio [OR] = 3.17) and posterior AD (p = 1.11 × 10(-17), OR = 6.43). No other locus was significant after corrections for multiple testing, although rs11136000 near CLU (p = 0.019, OR = 0.60) and rs744373 near BIN1 (p = 0.025, OR = 1. 63) associated nominally significantly with posterior AD, and rs3851179 at the PICALM locus had significant association with PCA (p = 0.0003, OR = 2.84). ABCA7 locus SNP rs3764650, which was also tested under the recessive model because of Hardy-Weinberg disequilibrium, also had nominally significant association with PCA risk. The direction of association at APOE, CLU, and BIN1 loci was the same for participants with PCA and posterior AD. The effects for all SNPs, except rs3851179, were consistent with those for LOAD risk. We identified a significant effect for APOE and nominate CLU, BIN1, and ABCA7 as additional risk loci for PCA and posterior AD. Our findings suggest that at least some of the genetic risk factors for LOAD are shared with these atypical conditions and provide effect-size estimates for their future genetic studies.

Value of Nonrigid Registration of Pre-Procedure MR with Post-Procedure CT After Radiofrequency Ablation for Hepatocellular Carcinoma

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

Park, Juil; Lee, Jeong Min, E-mail: jmlshy2000@gmail.com, E-mail: jmsh@snu.ac.kr; Lee, Dong Ho

PurposeTo evaluate the value of pre-radiofrequency ablation (RFA) MR and post-RFA CT registration for the assessment of the therapeutic response of hepatocellular carcinoma (HCC).Materials and MethodsA total of 178 patients with single HCC who received RFA as an initial treatment and had available pre-RFA MR and post-RFA CT images were included in this retrospective study. Two independent readers (one experienced radiologist, one inexperienced radiologist) scored the ablative margin (AM) of treated tumors on a four-point scale (1, residual tumor; 2, incomplete AM; 3, borderline AM; 4, sufficient AM), in two separate sessions: (1) visual comparison between pre-and post-RFA images; (2)more » with addition of nonrigid registration for pre- and post-RFA images. Local tumor progression (LTP) rates between low-risk (response score, 3–4) and high-risk groups (1–2) were analyzed using the Kaplan–Meier method at each interpretation session.ResultsThe patients’ reassignments after using the registered images were statistically significant for inexperienced reader (p < 0.001). In the inexperienced reader, LTP rates of low- and high-risk groups were significantly different with addition of registered images (session 2) (p < 0.001), but not significantly different in session 1 (p = 0.101). However, in the experienced reader, LTP rates of low- and high-risk groups were significantly different in both interpretation sessions (p < 0.001). Using the registered images, the cumulative incidence of LTP at 2 years was 3.0–6.6%, for the low-risk group, and 18.6–27.8% for the high-risk group.ConclusionRegistration between pre-RFA MR and post-RFA CT images may allow better assessment of the therapeutic response of HCC after RFA, especially for inexperienced radiologists, helping in the risk stratification for LTP.« less

Low dose radiation risks for women surviving the a-bombs in Japan: generalized additive model.

PubMed

Dropkin, Greg

2016-11-24

Analyses of cancer mortality and incidence in Japanese A-bomb survivors have been used to estimate radiation risks, which are generally higher for women. Relative Risk (RR) is usually modelled as a linear function of dose. Extrapolation from data including high doses predicts small risks at low doses. Generalized Additive Models (GAMs) are flexible methods for modelling non-linear behaviour. GAMs are applied to cancer incidence in female low dose subcohorts, using anonymous public data for the 1958 - 1998 Life Span Study, to test for linearity, explore interactions, adjust for the skewed dose distribution, examine significance below 100 mGy, and estimate risks at 10 mGy. For all solid cancer incidence, RR estimated from 0 - 100 mGy and 0 - 20 mGy subcohorts is significantly raised. The response tapers above 150 mGy. At low doses, RR increases with age-at-exposure and decreases with time-since-exposure, the preferred covariate. Using the empirical cumulative distribution of dose improves model fit, and capacity to detect non-linear responses. RR is elevated over wide ranges of covariate values. Results are stable under simulation, or when removing exceptional data cells, or adjusting neutron RBE. Estimates of Excess RR at 10 mGy using the cumulative dose distribution are 10 - 45 times higher than extrapolations from a linear model fitted to the full cohort. Below 100 mGy, quasipoisson models find significant effects for all solid, squamous, uterus, corpus, and thyroid cancers, and for respiratory cancers when age-at-exposure > 35 yrs. Results for the thyroid are compatible with studies of children treated for tinea capitis, and Chernobyl survivors. Results for the uterus are compatible with studies of UK nuclear workers and the Techa River cohort. Non-linear models find large, significant cancer risks for Japanese women exposed to low dose radiation from the atomic bombings. The risks should be reflected in protection standards.

Priorities and prospect theory.

PubMed

Happich, M; Mazurek, B

2002-01-01

Whose preferences are to be used for cost-effectiveness analysis? It has been recommended that community preferences for health states are the most appropriate ones for use in a reference case analysis. However, critics maintain that persons are not able properly to judge a health state if they have not experienced the condition themselves. This problem is analyzed here in the framework of Prospect Theory. It can be argued that the differing reference points of patients and the general public are responsible for deviating results. In addition, we argue that risk attitudes with respect to health-related quality of life are an indicator of reference points. If patients and the general public refer to the same reference point, i.e., they have the same risk attitude, the hypothesis is that deviations no longer significantly differ. Evaluations of the health condition of tinnitus by 210 patients and 210 unaffected persons were compared. The Time Tradeoff and Standard Gamble methods were applied to elicit preferences. Risk attitude was measured with the question of whether participants would undergo a treatment that could either improve or worsen their health condition, both with an equal chance (five possible answers between "in no case" and "in any case"). Affected persons indicated significantly higher values for tinnitus-related quality of life according to the Standard Gamble method. The difference between Time Tradeoff values was less dramatic but still significant. In addition, nonaffected persons are more risk-averse than affected persons. However, differences in evaluations are not significant considering single risk groups (e.g., those who answered "in no case"). Prospect Theory is a reasonable framework for considering the question of whose preferences count. If this result can be generalized for other diseases as well, it allows the mathematical combination of "objective" evaluations by the general public with the illness experience of patients. These evaluations should be weighted with patients' risk attitudes, i.e., community preferences can be used if they are corrected for risk attitudes.

The joint impact of smoking and exercise capacity on clinical outcomes among women with suspected myocardial ischemia: the WISE study.

PubMed

Linke, Sarah E; Rutledge, Thomas; Johnson, B Delia; Olson, Marian B; Bittner, Vera; Cornell, Carol E; Shaw, Leslee J; Eteiba, Wafia; Parashar, Susmita; Sheps, David S; Vido, Diane A; Mulukutla, Suresh; Bairey Merz, C Noel

2009-04-01

Although extensive research has been conducted on both smoking and low exercise capacity alone, few studies have examined the joint impact or interaction of these two risk factors. We examined the joint and interactive effects of smoking and self-reported exercise capacity on subsequent clinical events (heart failure, myocardial infarction [MI], stroke, and cardiovascular-related mortality) among women with suspected myocardial ischemia. At baseline (1996-1999), 789 women completed angiographic testing of coronary artery disease (CAD) severity and provided self-report information about their smoking history and exercise capacity as well as demographic and other risk factor data. Incidence of clinical events among the women was tracked for a median of 5.9 years; this analysis was conducted in 2008. In an adjusted survival analysis, women with a positive smoking history and self-reported low exercise capacity had the greatest risk of experiencing a clinical event (HR = 7.7, 95% CI 2.3, 25.5), followed by women with a positive smoking history and self-reported high exercise capacity (HR = 6.9, 95% CI 2.0, 24.6) and those with a negative smoking history and self-reported low exercise capacity (HR = 4.9, 95% CI 1.5, 15.8), relative to women with a negative smoking history and self-reported high exercise capacity. Additional analyses revealed a significant interaction between smoking history and exercise capacity, such that (1) women with a positive smoking history did not experience an additional significantly greater risk due to low exercise capacity, unlike those with a negative smoking history, and (2) all women experienced a significantly greater risk due to a positive smoking history regardless of their exercise capacity. Among women with suspected myocardial ischemia, the combined protective health effects of self-reported high exercise capacity and a negative smoking history remained significant after controlling for preexisting CAD severity and other established risk factors. These findings highlight the importance of studying behavioral risk factors in combination.

Association between high risk for preterm birth and changes in gingiva parameters during pregnancy-a prospective cohort study.

PubMed

Kruse, Anne Brigitte; Kuerschner, Anja C; Kunze, Mirjam; Woelber, Johan P; Al-Ahmad, Ali; Wittmer, Annette; Vach, Kirstin; Ratka-Krueger, Petra

2018-04-01

The objective of this study was to investigate clinical and microbiological gingival changes during pregnancy in women without periodontal disease. Additionally, these parameters were to be compared in women with high risk for preterm birth and women with a normal course of pregnancy. Group I consisted of 40 subjects at high risk for preterm birth, while group II involved 49 subjects with a normal course of pregnancy. The control group (III) was made up of 50 non-pregnant women. Clinical parameters (plaque index, gingival index, probing pocket depths, gingival swelling, bleeding on probing) and microbiological changes were monitored during pregnancy and 2-4 weeks after parturition. In the high-risk preterm group (I), 19 women could be included in data analysis. This group was compared to 41 women in the normal pregnancy group (II) and 50 non-pregnant women (III). Gingival inflammation was significantly higher in women with high risk for preterm birth (I) compared to non-risk pregnant women (II, p < 0.05). In addition, in this group (I), the subgingival amounts of Fusobacterium nucleatum (> 10 5 ) were found to be significantly higher after childbirth compared to non-pregnant women (p < 0.05). Even without having periodontal disease, women with high risk for preterm birth showed worse clinical values compared to non-risk pregnant and non-pregnant women and an increased detection of Fusobacterium nucleatum after delivery. High risk for preterm birth might be associated with the occurrence of increased gingival inflammation.

Infective Endocarditis and Cancer Risk

PubMed Central

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

2016-01-01

Abstract This study investigated the possible relationship between endocarditis and overall and individual cancer risk among study participants in Taiwan. We used data from the National Health Insurance program of Taiwan to conduct a population-based, observational, and retrospective cohort study. The case group consisted of 14,534 patients who were diagnosed with endocarditis between January 1, 2000 and December 31, 2010. For the control group, 4 patients without endocarditis were frequency matched to each endocarditis patient according to age, sex, and index year. Competing risks regression analysis was conducted to determine the effect of endocarditis on cancer risk. A large difference was noted in Charlson comorbidity index between endocarditis and nonendocarditis patients. In patients with endocarditis, the risk for developing overall cancer was significant and 119% higher than in patients without endocarditis (adjusted subhazard ratio = 2.19, 95% confidence interval = 1.98–2.42). Regarding individual cancers, in addition to head and neck, uterus, female breast and hematological malignancies, the risks of developing colorectal cancer, and some digestive tract cancers were significantly higher. Additional analyses determined that the association of cancer with endocarditis is stronger within the 1st 5 years after endocarditis diagnosis. This population-based cohort study found that patients with endocarditis are at a higher risk for colorectal cancer and other cancers in Taiwan. The risk was even higher within the 1st 5 years after endocarditis diagnosis. It suggested that endocarditis is an early marker of colorectal cancer and other cancers. The underlying mechanisms must still be explored and may account for a shared risk factor of infection in both endocarditis and malignancy. PMID:27015220

Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism.

PubMed

Solomon, David; Åsberg, Kia; Peer, Samuel; Prince, Gwendolyn

2016-08-01

Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2016-03-01

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

Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity.

PubMed

Udo, Tomoko; Purcell, Katherine; Grilo, Carlos M

2016-12-01

This study investigated whether perceived weight discrimination is associated with increased risk for major chronic medical conditions and whether the associations persist after adjusting for other stressful life events in addition to BMI, physical activity and sociodemographic variables. The study included 21 357 overweight/obese adults (52.9% women) from the 2001 to 2002 and 2004 to 2005 National Survey of Alcohol and Related Conditions. Perceived weight discrimination was significantly associated with risk for arteriosclerosis, diabetes, high cholesterol, myocardial infarction, minor heart conditions and stomach ulcers. Perceived weight discrimination was associated with reporting more stressful life events. After adjusting additionally for stressful life events in the final multiple logistic regression, associations with arteriosclerosis, diabetes and minor cardiac conditions remained significant. Gender-stratified analyses revealed that perceived weight discrimination was associated with different medical conditions in women than men, and many associations became non-significant when adjusting for stressful life events, particularly for women. Among overweight/obese adults, perceived weight discrimination is associated with significantly increased risk for obesity-related chronic medical conditions even after adjusting for BMI, physical activity and sociodemographic variables. Accounting for other acute stressful life events may also be important in understanding the health effects of perceived weight discrimination. Such added health risk of overweight/obesity posed by perceived weight discrimination warrants public health and policy interventions against weight discrimination to reduce the socioeconomic burden of obesity. © 2016 John Wiley & Sons Ltd.

When does speech sound disorder matter for literacy? The role of disordered speech errors, co-occurring language impairment and family risk of dyslexia.

PubMed

Hayiou-Thomas, Marianna E; Carroll, Julia M; Leavett, Ruth; Hulme, Charles; Snowling, Margaret J

2017-02-01

This study considers the role of early speech difficulties in literacy development, in the context of additional risk factors. Children were identified with speech sound disorder (SSD) at the age of 3½ years, on the basis of performance on the Diagnostic Evaluation of Articulation and Phonology. Their literacy skills were assessed at the start of formal reading instruction (age 5½), using measures of phoneme awareness, word-level reading and spelling; and 3 years later (age 8), using measures of word-level reading, spelling and reading comprehension. The presence of early SSD conferred a small but significant risk of poor phonemic skills and spelling at the age of 5½ and of poor word reading at the age of 8. Furthermore, within the group with SSD, the persistence of speech difficulties to the point of school entry was associated with poorer emergent literacy skills, and children with 'disordered' speech errors had poorer word reading skills than children whose speech errors indicated 'delay'. In contrast, the initial severity of SSD was not a significant predictor of reading development. Beyond the domain of speech, the presence of a co-occurring language impairment was strongly predictive of literacy skills and having a family risk of dyslexia predicted additional variance in literacy at both time-points. Early SSD alone has only modest effects on literacy development but when additional risk factors are present, these can have serious negative consequences, consistent with the view that multiple risks accumulate to predict reading disorders. © 2016 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

Passive smoking increased risk of gestational diabetes mellitus independently and synergistically with prepregnancy obesity in Tianjin, China.

PubMed

Leng, Junhong; Wang, Peng; Shao, Ping; Zhang, Cuiping; Li, Weiqin; Li, Nan; Wang, Leishen; Nan, Hairong; Yu, Zhijie; Hu, Gang; Chan, Juliana C N; Yang, Xilin

2017-03-01

Passive smoking increased type 2 diabetes mellitus risk, but it is uncertain whether it also increased gestational diabetes mellitus (GDM) risk. We aimed to examine the association of passive smoking during pregnancy and its interaction with maternal obesity for GDM. From 2010 to 2012, 12 786 Chinese women underwent a 50-g 1-hour glucose challenge test at 24 to 28 weeks of gestation and further underwent a 75-g 2-hour oral glucose tolerance test if the glucose challenge test result was ≥7.8 mmol/L. GDM was defined by the International Association of Diabetes and Pregnancy Study Group's cut points. Self-reported passive smoking during pregnancy was collected by a questionnaire. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between maternal obesity and passive smoking was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). Significant RERI > 0, AP > 0, or S > 1 indicated additive interaction. A total of 8331 women (65.2%) were exposed to passive smoking during pregnancy. More women exposed to passive smoking developed GDM than nonexposed women (7.8% versus 6.3%, P = 0.002) with an adjusted OR of 1.29 (95%CI, 1.11 to 1.50). Compared with nonobesity and nonpassive smoking, prepregnancy obesity and passive smoking was associated with GDM risk with an adjusted OR of 3.09 (95%CI, 2.38-4.02) with significant additive interaction (P < .05 for RERI and AP). Passive smoking during pregnancy increased GDM risk in Chinese women independently and synergistically with prepregnancy obesity. Copyright © 2016 John Wiley & Sons, Ltd.

Outcome after discontinuing anticoagulant therapy in women with venous thromboembolism during hormonal use.

PubMed

Blanco-Molina, Ángeles; Trujillo-Santos, Javier; Pesavento, Raffaele; Rosa, Vladimir; Falgá, Conxita; Tolosa, Carles; Mazzolai, Lucia; Sampériz, Ángel; Duce, Rita; Monreal, Manuel

2017-03-01

Whether women developing venous thromboembolism (VTE) while using hormonal therapy should be classified as having "unprovoked" or "provoked" VTE is controversial. We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic VTE recurrences after discontinuing anticoagulation in 3 subgroups of women aged ≤50years without cancer, pregnancy or puerperium: (1) those with hormonal therapy and no additional risk factors (hormonal users only); (2) those with unprovoked VTE; and (3) those with additional risk factors, with or without hormonal therapy. As of March 2016, 1513 women had been followed-up for at least one month after discontinuing anticoagulation. Of these, 654 (43%) were hormonal users only, 390 (26%) had unprovoked VTE and 469 (31%) had transient risk factors with or without hormonal therapy. After discontinuing anticoagulation, the rate of VTE recurrences in women with hormonal use only (2.44 per 100 patient-years; 95% CI: 1.53-3.69) was significantly lower than in those with unprovoked VTE (6.03; 95% CI: 3.97-8.77) and similar to those with transient risk factors (2.58; 95% CI: 1.50-4.13). Interestingly, the rate of VTE recurrences presenting as pulmonary embolism in women with hormonal use only (0.55 per 100 patient-years; 95% CI: 0.18-1.29) was similar to those with transient risk factors (0.46; 95% CI: 0.09-1.33) and 4-fold lower than in women with unprovoked VTE (2.23; 95% CI: 1.07-4.10). After discontinuing anticoagulation, the rate of VTE recurrences in hormonal users only was significantly lower than in women with unprovoked VTE and similar to the rate in women with additional risk factors. © 2017 Elsevier Ltd. All rights reserved.

Using the USGS Seismic Risk Web Application to estimate aftershock damage

USGS Publications Warehouse

McGowan, Sean M.; Luco, Nicolas

2014-01-01

The U.S. Geological Survey (USGS) Engineering Risk Assessment Project has developed the Seismic Risk Web Application to combine earthquake hazard and structural fragility information in order to calculate the risk of earthquake damage to structures. Enabling users to incorporate their own hazard and fragility information into the calculations will make it possible to quantify (in near real-time) the risk of additional damage to structures caused by aftershocks following significant earthquakes. Results can quickly be shared with stakeholders to illustrate the impact of elevated ground motion hazard and earthquake-compromised structural integrity on the risk of damage during a short-term, post-earthquake time horizon.

Influences on loneliness, depression, sexual-risk behaviour and suicidal ideation among Thai transgender youth.

PubMed

Yadegarfard, Mohammadrasool; Ho, Robert; Bahramabadian, Fatemeh

2013-01-01

This study examined the influence of age, education level and number of sex partners on levels of loneliness, depression, suicidal ideation and sexual-risk behaviour in Thai male-to-female transgender youth. A total of 190 participants filled in the study's questionnaire, designed to tap the primary variables of age, level of education, number of sex partners, loneliness, depression, suicidal ideation and sexual-risk behaviour. Results reveal that level of education has a significant influence on depression and loneliness, the number of sex partners has a significant influence on sexual-risk behaviour and suicidal ideation and age has a significant influence on sexual-risk behaviour and suicidal ideation. Participants with higher levels of education reported more loneliness than participants who did not graduate from high school. In addition, participants who did not graduate from high school reported more depression than participants with some university credit. Furthermore, participants aged 15 to 19 years, compared with those of 20 to 25 years, reported higher level of sexual-risk behaviour and higher levels of suicidal ideation.

Analysis of Oxygen Saturations Recorded During Dental Intravenous Sedations: A Retrospective Quality Assurance of 3500 Cases

PubMed Central

Viljoen, Andre; Byth, Karen; Coombs, Malcolm; Mahoney, Greg; Stewart, Douglas

2011-01-01

The death of a patient under sedation in New South Wales, Australia, in 2002 has again raised the question of the safety of dental sedation. This study sought answers to 2 questions: Can safe oxygen saturation levels (≥94%) be consistently maintained by a single operator/sedationist? Does the additional use of propofol, in subanesthetic doses, increase the risk of exposure to hypoxemia? Three thousand five hundred cases generated between 1996 and 2006 were randomly examined and divided into 2 subcohorts: 1750 patients were sedated with midazolam and fentanyl, and 1750 patients received propofol, in subanesthetic increments, in addition to midazolam and fentanyl. Initial sedation was established using midazolam and fentanyl in both subcohorts. The second subcohort received propofol during times of noxious stimulation. Patient exposure to 2 or more oxygen desaturations below 94% was uncommon. The variables that were significantly associated with low saturations were age, gender, and weight. Neither the dose of midazolam nor the additional use of propofol was a significant risk factor. ASA classification (I or II) was not a determinant of risk. The data, within the limitations of the study, showed that a single operator/sedationist, supported by a well-trained team of nurses, can consistently maintain safe oxygen saturation levels. The additional use of propofol did not increase exposure to hypoxemia. PMID:21882986

Risk Factors for Failure of Male Slings and Artificial Urinary Sphincters: Results from a Large Middle European Cohort Study.

PubMed

Hüsch, Tanja; Kretschmer, Alexander; Thomsen, Frauke; Kronlachner, Dominik; Kurosch, Martin; Obaje, Alice; Anding, Ralf; Pottek, Tobias; Rose, Achim; Olianas, Roberto; Friedl, Alexander; Hübner, Wilhelm; Homberg, Roland; Pfitzenmaier, Jesco; Grein, Ulrich; Queissert, Fabian; Naumann, Carsten Maik; Schweiger, Josef; Wotzka, Carola; Nyarangi-Dix, Joanne; Hofmann, Torben; Ulm, Kurt; Bauer, Ricarda M; Haferkamp, Axel

2017-01-01

We analysed the impact of predefined risk factors: age, diabetes, history of pelvic irradiation, prior surgery for stress urinary incontinence (SUI), prior urethral stricture, additional procedure during SUI surgery, duration of incontinence, ASA-classification and cause for incontinence on failure and complications in male SUI surgery. We retrospectively identified 506 patients with an artificial urinary sphincter (AUS) and 513 patients with a male sling (MS) in a multicenter cohort study. Complication rates were correlated to the risk factors in univariate analysis. Subsequently, a multivariate logistic regression adjusted to the risk factors was performed. A p value <0.05 was considered statistically significant. A history of pelvic irradiation was an independent risk factor for explantation in AUS (p < 0.001) and MS (p = 0.018). Moreover, prior urethral stricture (p = 0.036) and higher ASA-classification (p = 0.039) were positively correlated with explantation in univariate analysis for AUS. Urethral erosion was correlated with prior urethral stricture (p < 0.001) and a history of pelvic irradiation (p < 0.001) in AUS. Furthermore, infection was correlated with additional procedures during SUI surgery in univariate analysis (p = 0.037) in MS. We first identified the correlation of higher ASA-classification and explantation in AUS. Nevertheless, only a few novel risk factors had a significant influence on the failure of MS or AUS. © 2016 S. Karger AG, Basel.

The association of phosphatase and tensin homolog deleted on chromosome 10 polymorphisms and lifestyle habits with colorectal cancer risk in a Chinese population.

PubMed

Jing, Fangyuan; Mao, Yingying; Zhang, Zhenyu; Li, Yingjun; Cai, Shaofang; Li, Qilong; Ma, Xinyuan; Jin, Mingjuan; Chen, Kun

2014-09-01

The PI3K signaling pathway plays an important role in the development of colorectal cancer (CRC) and other neoplasm. Somatic phosphatase and tensin homolog deleted on chromosome 10 (PTEN) mutations and deletions or epigenetic silencing have been observed in multiple tumor types including CRC. To assess the association of PTEN polymorphisms and lifestyle habits with CRC risk in Chinese population, we carried out a case-control study which included 545 cases and 522 controls. In the present study, we genotyped eight single-nucleotide polymorphisms (SNPs) in PTEN and found that rs11202607 was associated with increased CRC risk (odds ratio (OR) = 1.40, 95 % confidence interval (CI) = 1.04-1.90). Stratification analysis by lifestyle habits showed a stronger association between rs11202607 and CRC risk among never tea drinkers than that among tea-drinkers (OR = 2.04, 95 % CI 1.29-3.22), and significant additive interaction between rs10490920 and tea drinking status was observed. Our study provided the evidence of an association between PTEN polymorphisms and the risk of CRC and significant additive interaction between PTEN polymorphism and tea drinking. Studies with larger sample size and further investigations into the mechanism are warranted to clarify the role of PTEN in colorectal carcinogenesis and the association between PTEN genetic variations, environment exposure, and CRC risk.

Predictive Factor Analysis of Response-Adapted Radiation Therapy for Chemotherapy-Sensitive Pediatric Hodgkin Lymphoma: Analysis of the Children's Oncology Group AHOD 0031 Trial

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

Charpentier, Anne-Marie; Friedman, Debra L.; Wolden, Suzanne

Purpose: To evaluate whether clinical risk factors could further distinguish children with intermediate-risk Hodgkin lymphoma (HL) with rapid early and complete anatomic response (RER/CR) who benefit significantly from involved-field RT (IFRT) from those who do not, and thereby aid refinement of treatment selection. Methods and Materials: Children with intermediate-risk HL treated on the Children's Oncology Group AHOD 0031 trial who achieved RER/CR with 4 cycles of chemotherapy, and who were randomized to 21-Gy IFRT or no additional therapy (n=716) were the subject of this study. Recursive partitioning analysis was used to identify factors associated with clinically and statistically significant improvement inmore » event-free survival (EFS) after randomization to IFRT. Bootstrap sampling was used to evaluate the robustness of the findings. Result: Although most RER/CR patients did not benefit significantly from IFRT, those with a combination of anemia and bulky limited-stage disease (n=190) had significantly better 4-year EFS with the addition of IFRT (89.3% vs 77.9% without IFRT; P=.019); this benefit was consistently reproduced in bootstrap analyses and after adjusting for other prognostic factors. Conclusion: Although most patients achieving RER/CR had favorable outcomes with 4 cycles of chemotherapy alone, those children with initial bulky stage I/II disease and anemia had significantly better EFS with the addition of IFRT as part of combined-modality therapy. Further work evaluating the interaction of clinical and biologic factors and imaging response is needed to further optimize and refine treatment selection.« less

Heterogeneous Risk Perceptions: The Case of Poultry Meat Purchase Intentions in Finland

PubMed Central

Heikkilä, Jaakko; Pouta, Eija; Forsman-Hugg, Sari; Mäkelä, Johanna

2013-01-01

This study focused on the heterogeneity of consumer reactions, measured through poultry meat purchase intentions, when facing three cases of risk. The heterogeneity was analysed by latent class logistic regression that included all three risk cases. Approximately 60% of the respondents belonged to the group of production risk avoiders, in which the intention to purchase risk food was significantly lower than in the second group of risk neutrals. In addition to socio-demographic variables, the purchase intentions were statistically associated with several attitude-based variables. We highlighted some policy implications of the heterogeneity. Overall, the study demonstrated that risk matters to consumers, not all risk is equal, and consumer types react somewhat differently to different types of risk. PMID:24157513

Additive genetic risk from five serotonin system polymorphisms interacts with interpersonal stress to predict depression.

PubMed

Vrshek-Schallhorn, Suzanne; Stroud, Catherine B; Mineka, Susan; Zinbarg, Richard E; Adam, Emma K; Redei, Eva E; Hammen, Constance; Craske, Michelle G

2015-11-01

Behavioral genetic research supports polygenic models of depression in which many genetic variations each contribute a small amount of risk, and prevailing diathesis-stress models suggest gene-environment interactions (G×E). Multilocus profile scores of additive risk offer an approach that is consistent with polygenic models of depression risk. In a first demonstration of this approach in a G×E predicting depression, we created an additive multilocus profile score from 5 serotonin system polymorphisms (1 each in the genes HTR1A, HTR2A, HTR2C, and 2 in TPH2). Analyses focused on 2 forms of interpersonal stress as environmental risk factors. Using 5 years of longitudinal diagnostic and life stress interviews from 387 emerging young adults in the Youth Emotion Project, survival analyses show that this multilocus profile score interacts with major interpersonal stressful life events to predict major depressive episode onsets (hazard ratio [HR] = 1.815, p = .007). Simultaneously, there was a significant protective effect of the profile score without a recent event (HR = 0.83, p = .030). The G×E effect with interpersonal chronic stress was not significant (HR = 1.15, p = .165). Finally, effect sizes for genetic factors examined ignoring stress suggested such an approach could lead to overlooking or misinterpreting genetic effects. Both the G×E effect and the protective simple main effect were replicated in a sample of early adolescent girls (N = 105). We discuss potential benefits of the multilocus genetic profile score approach and caveats for future research. (c) 2015 APA, all rights reserved).

Additive Interaction of MTHFR C677T and MTRR A66G Polymorphisms with Being Overweight/Obesity on the Risk of Type 2 Diabetes.

PubMed

Zhi, Xueyuan; Yang, Boyi; Fan, Shujun; Li, Yongfang; He, Miao; Wang, Da; Wang, Yanxun; Wei, Jian; Zheng, Quanmei; Sun, Guifan

2016-12-15

Although both methylenetetrahydrofolate reductase ( MTHFR ) C677T and methionine synthase reductase ( MTRR ) A66G polymorphisms have been associated with type 2 diabetes (T2D), their interactions with being overweight/obesity on T2D risk remain unclear. To evaluate the associations of the two polymorphisms with T2D and their interactions with being overweight/obesity on T2D risk, a case-control study of 180 T2D patients and 350 healthy controls was conducted in northern China. Additive interaction was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). After adjustments for age and gender, borderline significant associations of the MTHFR C677T and MTRR A66G polymorphisms with T2D were observed under recessive (OR = 1.43, 95% CI: 0.98-2.10) and dominant (OR = 1.43, 95% CI: 1.00-2.06) models, respectively. There was a significant interaction between the MTHFR 677TT genotype and being overweight/obesity on T2D risk (AP = 0.404, 95% CI: 0.047-0.761), in addition to the MTRR 66AG/GG genotypes (RERI = 1.703, 95% CI: 0.401-3.004; AP = 0.528, 95% CI: 0.223-0.834). Our findings suggest that individuals with the MTHFR 677TT or MTRR 66AG/GG genotypes are more susceptible to the detrimental effect of being overweight/obesity on T2D. Further large-scale studies are still needed to confirm our findings.

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

PubMed Central

German, Danielle; Latkin, Carl A.

2011-01-01

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

The association of health risks with on-the-job productivity.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Conti, Daniel J; Schultz, Alyssa B; Pransky, Glenn; Edington, Dee W

2005-08-01

Decreased on-the-job productivity represents a large yet poorly characterized indirect cost to employers. We studied the impact of employee health risk factors on self-reported worker productivity (presenteeism). Using a brief version of the Work Limitation Questionnaire incorporated into a Health Risk Appraisal, 28,375 employees of a national company responded to the survey. The association between health risks and work limitation and each of the four domains was examined. Percentage of lost productivity also was estimated. Ten of 12 health risk factors studied were significantly associated with self-reported work limitations. The strength of the associations varied between risks and the four domains of work limitation. Perception-related risk factors such as life dissatisfaction, job dissatisfaction, poor health, and stress showed the greatest association with presenteeism. As the number of self-reported health risk factors increased, so did the percentage of employees reporting work limitations. Each additional risk factor was associated with 2.4% excess productivity reduction. Medium and high-risk individuals were 6.2% and 12.2% less productive than low-risk individuals, respectively. The annual cost of lost productivity in this corporation was estimated at between 99Mdollars and 185Mdollars or between 1392dollars and 2592dollars per employee. Health risk factors represent additional causes of lost productivity.

Tea consumption and the risk of biliary tract cancer: a systematic review and dose-response meta-analysis of observational studies.

PubMed

Xiong, Jianping; Lin, Jianzhen; Wang, Anqiang; Wang, Yaqin; Zheng, Ying; Sang, Xinting; Xu, Yiyao; Lu, Xin; Zhao, Haitao

2017-06-13

Recent studies have shown that tea consumption is associated with the reduced incidence of some types of cancer, possibly including biliary tract cancer. However, the epidemiological evidences for the association with risk of biliary tract cancer are contradictory. Thus, we performed meta-analysis of published observational studies to assess the association between tea consumption and risk of biliary tract cancer. Relevant studies were identified by searching PubMed, EMBASE, and ISI Web of Science published before October 2016. The Newcastle-Ottawa Scale was used to evaluate the quality of included studies, and publication bias was evaluated using funnel plots, and Begg's and Egger's tests. This meta-analysis includes eight studies comprising 18 independent reports. The incidence of biliary tract cancer reduced about 34% (significantly) for tea intake group in comparison with never intake group (summary odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.48-0.85). Additionally, an inverse relationship between tea intake and risk of biliary tract cancer was statistically significant in women (OR = 0.65; 95 % CI = 0.47-0.83), but not in men (OR = 0.86; 95% CI = 0.58-1.13). Dose- response analysis indicated that the risk of biliary tract cancer decreased by 4% with each additional cup of tea one day (relative risk [RR] = 0.96, 95% CI = 0.93-0.98, p = 0.001). In summary, tea intake is associated with decreased risk of biliary tract cancer, especially for women.

Sensitivity to Uncertainty in Asteroid Impact Risk Assessment

NASA Astrophysics Data System (ADS)

Mathias, D.; Wheeler, L.; Prabhu, D. K.; Aftosmis, M.; Dotson, J.; Robertson, D. K.

2015-12-01

The Engineering Risk Assessment (ERA) team at NASA Ames Research Center is developing a physics-based impact risk model for probabilistically assessing threats from potential asteroid impacts on Earth. The model integrates probabilistic sampling of asteroid parameter ranges with physics-based analyses of entry, breakup, and impact to estimate damage areas and casualties from various impact scenarios. Assessing these threats is a highly coupled, dynamic problem involving significant uncertainties in the range of expected asteroid characteristics, how those characteristics may affect the level of damage, and the fidelity of various modeling approaches and assumptions. The presented model is used to explore the sensitivity of impact risk estimates to these uncertainties in order to gain insight into what additional data or modeling refinements are most important for producing effective, meaningful risk assessments. In the extreme cases of very small or very large impacts, the results are generally insensitive to many of the characterization and modeling assumptions. However, the nature of the sensitivity can change across moderate-sized impacts. Results will focus on the value of additional information in this critical, mid-size range, and how this additional data can support more robust mitigation decisions.

Risk factors for an additional port in single-incision laparoscopic cholecystectomy in patients with cholecystitis.

PubMed

Araki, Kenichiro; Shirabe, Ken; Watanabe, Akira; Kubo, Norio; Sasaki, Shigeru; Suzuki, Hideki; Asao, Takayuki; Kuwano, Hiroyuki

2017-01-01

Although single-incision laparoscopic cholecystectomy is now widely performed in patients with cholecystitis, some cases require an additional port to complete the procedure. In this study, we focused on risk factor of additional port in this surgery. We performed single-incision cholecystectomy in 75 patients with acute cholecystitis or after cholecystitis between 2010 and 2014 at Gunma University Hospital. Surgical indications followed the TG13 guidelines. Our standard procedure for single-incision cholecystectomy routinely uses two needlescopic devices. We used logistic regression analysis to identify the risk factors associated with use of an additional full-size port (5 or 10 mm). Surgical outcome was acceptable without biliary injury. Nine patients (12.0%) required an additional port, and one patient (1.3%) required conversion to open cholecystectomy because of severe adhesions around the cystic duct and common bile duct. In multivariate analysis, high C-reactive protein (CRP) values (>7.0 mg/dl) during cholecystitis attacks were significantly correlated with the need for an additional port (P = 0.009), with a sensitivity of 55.6%, specificity of 98.5%, and accuracy of 93.3%. This study indicated that the severe inflammation indicated by high CRP values during cholecystitis attacks predicts the need for an additional port. J. Med. Invest. 64: 245-249, August, 2017.

Diabetes mellitus, other medical conditions and familial history of cancer as risk factors for pancreatic cancer

PubMed Central

Silverman, D T; Schiffman, M; Everhart, J; Goldstein, A; Lillemoe, K D; Swanson, G M; Schwartz, A G; Brown, L M; Greenberg, R S; Schoenberg, J B; Pottern, L M; Hoover, R N; Fraumeni, J F

1999-01-01

In a population-based case-control study of pancreatic cancer conducted in three areas of the USA, 484 cases and 2099 controls were interviewed to evaluate the aetiologic role of several medical conditions/interventions, including diabetes mellitus, cholecystectomy, ulcer/gastrectomy and allergic states. We also evaluated risk associated with family history of cancer. Our findings support previous studies indicating that diabetes is a risk factor for pancreatic cancer, as well as a possible complication of the tumour. A significant positive trend in risk with increasing years prior to diagnosis of pancreatic cancer was apparent (P-value for test of trend = 0.016), with diabetics diagnosed at least 10 years prior to diagnosis having a significant 50% increased risk. Those treated with insulin had risks similar to those not treated with insulin (odds ratio (OR) = 1.6 and 1.5 respectively), and no trend in risk was associated with increasing duration of insulin treatment. Cholecystectomy also appeared to be a risk factor, as well as a consequence of the malignancy. Subjects with a cholecystectomy at least 20 years prior to the diagnosis of pancreatic cancer experienced a 70% increased risk, which was marginally significant. In contrast, subjects with a history of duodenal or gastric ulcer had little or no elevated risk (OR = 1.2; confidence interval = 0.9–1.6). Those treated by gastrectomy had the same risk as those not receiving surgery, providing little support for the hypothesis that gastrectomy is a risk factor for pancreatic cancer. A significant 40% reduced risk was associated with hay fever, a non-significant 50% decreased risk with allergies to animals, and a non-significant 40% reduced risk with allergies to dust/moulds. These associations, however, may be due to chance since no risk reductions were apparent for asthma or several other types of allergies. In addition, we observed significantly increased risks for subjects reporting a first-degree relative with cancers of the pancreas (OR = 3.2), colon (OR = 1.7) or ovary (OR = 5.3) and non-significantly increased risks for cancers of the endometrium (OR = 1.5) or breast (OR = 1.3). The pattern is consistent with the familial predisposition reported for pancreatic cancer and with the array of tumours associated with hereditary non-polyposis colon cancer. © 1999 Cancer Research Campaign PMID:10468306

Associations of TF Gene Polymorphisms with the Risk of Ischemic Stroke.

PubMed

Cai, Yi; Wu, Shaofang; Zeng, Chaosheng; Su, Qingjie; Zhou, Jingxia; Li, Pengxiang; Dai, Mingming; Wang, Desheng; Long, Faqing

2018-06-23

Ischemic stroke (IS) is the main cause of mortality and disability in China; thus, this study aimed to examine the association between six variants and their haplotypes within the transferrin (TF) gene and the risk of IS in the Southern Chinese Han population. Genotyping was performed using the Sequenom MassARRAY platform for 249 IS patients and 249 age- and sex-matched controls. The association between polymorphisms and IS risk was tested by Chi squared test and haplotype and stratification analysis. Odds ratios (ORs) and confidence intervals (CIs) were estimated by unconditional logistic regression analysis. The results of genetic model analyses indicated that the two SNPs (rs1880669 and rs2692695) were associated with decreased IS risk under the co-dominant, dominant, and additive models. Additionally, rs4525863 was also associated with decreased IS risk both under the dominant and additive models in males. Moreover, the CG haplotype of TF (rs1880669 and rs2692695) was significantly associated with a decreased risk of IS in the total population and males. Our findings suggested that polymorphisms (rs4525863, rs1880669, and rs2692695) of the TF gene might be a protective factor for IS in Southern Chinese Han population. Further large prospective studies are required to confirm these findings.

Lung cancer risk among construction workers in California, 1988-2007.

PubMed

Calvert, Geoffrey M; Luckhaupt, Sara; Lee, Soo-Jeong; Cress, Rosemary; Schumacher, Pam; Shen, Rui; Tak, SangWoo; Deapen, Dennis

2012-05-01

Although lung cancer risks can vary by race/ethnicity and by construction occupation, these risks have not been examined extensively. This study analyzed 110,937 lung cancer cases identified from the California Cancer Registry between 1988 and 2007. Mean age at diagnosis, proportion diagnosed at an advanced stage, and proportion with 3-year survival were calculated for lung cancer cases employed in the construction industry. Case-control methodology was also used to assess the risk of lung cancer. Morbidity odds ratios (MORs) were estimated by conditional logistic regression. Construction workers were found to have a significantly elevated risk for all lung cancer combined (MOR = 1.57) and for each lung cancer histologic subtype examined. All construction occupations, except managers/engineers and supervisors, had a significantly elevated risk for all lung cancer combined. Roofers and welders had the highest risks for total lung cancer and for each of the histologic subtypes. Construction workers in each of the four race/ethnicity groups also had significantly increased lung cancer risks. Compared to non-construction workers, construction workers were diagnosed at an earlier age, at a more advanced stage, and had significantly lower 3-year survival, though differences were modest. These findings justify additional reductions in carcinogenic exposures in construction, and increased support for smoking cessation programs at construction sites. Copyright © 2012 Wiley Periodicals, Inc.

Abuse, Nocturnal Stress Hormones, and Coronary Heart Disease Risk Among Women with HIV

PubMed Central

Dale, Sannisha K.; Weber, Kathleen M.; Cohen, Mardge H.; Brody, Leslie R.

2017-01-01

This study investigated the relationships among abuse, nocturnal levels of cortisol and norepinephrine (NE), and coronary heart disease (CHD) risk as measured by the Framingham Risk Score (FRS) among women with HIV. Participants (n=53) from the Chicago Women's Interagency HIV Study, a longitudinal prospective cohort study initiated in 1994, were enrolled in this study during 2012. At WIHS baseline and annual follow-up visits women were asked about recent experiences of abuse. Summary variables captured the proportion of visits for which women reported recent (past 12 months) physical, sexual, and domestic abuse. Cortisol and NE were assayed in overnight urine samples and adjusted for creatinine levels. Recent abuse was not significantly associated with levels of cortisol, NE, or NE/cortisol ratio. However, higher NE/cortisol ratio was significantly related to higher CHD risk score, higher cortisol was significantly related to lower CHD risk score, and NE was not associated with CHD risk score. In addition, higher proportions of visits with recent sexual abuse, physical abuse, and domestic abuse were significantly related to higher CHD risk score. The association between abuse exposure and CHD risk in the context of HIV infection is likely complex and may involve dysregulation of multiple neurobiological systems. Future research is needed to better understand these relationships and prevention and intervention efforts are needed to address abuse among women with HIV. PMID:27733045

The Impact of School Connectedness on Violent Behavior, Transport Risk-Taking Behavior, and Associated Injuries in Adolescence

ERIC Educational Resources Information Center

Chapman, Rebekah L.; Buckley, Lisa; Sheehan, Mary C.; Shochet, Ian M.; Romaniuk, Madeline

2011-01-01

Adolescents engage in many risk-taking behaviors that have the potential to lead to injury. The school environment has a significant role in shaping adolescent behavior, and this study aimed to provide additional information about the benefits associated with connectedness to school. Early adolescents aged 13 to 15 years (N=509, 49% boys) were…

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

ERIC Educational Resources Information Center

Werner, Mark J.

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

Personalizing lung cancer risk prediction and imaging follow-up recommendations using the National Lung Screening Trial dataset.

PubMed

Hostetter, Jason M; Morrison, James J; Morris, Michael; Jeudy, Jean; Wang, Kenneth C; Siegel, Eliot

2017-11-01

To demonstrate a data-driven method for personalizing lung cancer risk prediction using a large clinical dataset. An algorithm was used to categorize nodules found in the first screening year of the National Lung Screening Trial as malignant or nonmalignant. Risk of malignancy for nodules was calculated based on size criteria according to the Fleischner Society recommendations from 2005, along with the additional discriminators of pack-years smoking history, sex, and nodule location. Imaging follow-up recommendations were assigned according to Fleischner size category malignancy risk. Nodule size correlated with malignancy risk as predicted by the Fleischner Society recommendations. With the additional discriminators of smoking history, sex, and nodule location, significant risk stratification was observed. For example, men with ≥60 pack-years smoking history and upper lobe nodules measuring >4 and ≤6 mm demonstrated significantly increased risk of malignancy at 12.4% compared to the mean of 3.81% for similarly sized nodules (P < .0001). Based on personalized malignancy risk, 54% of nodules >4 and ≤6 mm were reclassified to longer-term follow-up than recommended by Fleischner. Twenty-seven percent of nodules ≤4 mm were reclassified to shorter-term follow-up. Using available clinical datasets such as the National Lung Screening Trial in conjunction with locally collected datasets can help clinicians provide more personalized malignancy risk predictions and follow-up recommendations. By incorporating 3 demographic data points, the risk of lung nodule malignancy within the Fleischner categories can be considerably stratified and more personalized follow-up recommendations can be made. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Risk-adjusted outcome measurement in pediatric allogeneic stem cell transplantation.

PubMed

Matthes-Martin, Susanne; Pötschger, Ulrike; Bergmann, Kirsten; Frommlet, Florian; Brannath, Werner; Bauer, Peter; Klingebiel, Thomas

2008-03-01

The purpose of the study was to define a risk score for 1-year treatment-related mortality (TRM) in children undergoing allogeneic stem cell transplantation as a basis for risk-adjusted outcome assessment. We analyzed 1364 consecutive stem cell transplants performed in 24 German and Austrian centers between 1998 and 2003. Five well-established risk factors were tested by multivariate logistic regression for predictive power: patient age, disease status, donor other than matched sibling donor, T cell depletion (TCD), and preceding stem cell transplantation. The risk score was defined by rounding the parameter estimates of the significant risk factors to the nearest integer. Crossvalidation was performed on the basis of 5 randomly extracted equal-sized parts from the database. Additionally, the score was validated for different disease entities and for single centers. Multivariate analysis revealed a significant correlation of TRM with 3 risk factors: age >10 years, advanced disease, and alternative donor. The parameter estimates were 0.76 for age, 0.73 for disease status, and 0.97 for donor type. Rounding the estimates resulted in a score with 1 point for each risk factor. One-year TRM (overall survival [OS]) were 5% (89%) with a score of 0, 18% (74%) with 1, 28% (54%) with 2, and 53% (27%) with 3 points. Crossvalidation showed stable results with a good correlation between predicted and observed mortality but moderate discrimination. The score seems to be a simple instrument to estimate the expected mortality for each risk group and for each center. Measuring TRM risk-adjusted and the comparison between expected and observed mortality may be an additional tool for outcome assessment in pediatric stem cell transplantation.

Is dietary nitrate/nitrite exposure a risk factor for development of thyroid abnormality? A systematic review and meta-analysis.

PubMed

Bahadoran, Zahra; Mirmiran, Parvin; Ghasemi, Asghar; Kabir, Ali; Azizi, Fereidoun; Hadaegh, Farzad

2015-05-01

The potential effects of inorganic nitrate/nitrite on global health are a much debated issue. In addition to possible methemoglobinemia and carcinogenic properties, anti-thyroid effects of nitrate/nitrite have been suggested. Considering the growing significance of nitrate/nitrite and since there is no comprehensive review in data available, clarifying the effect of nitrate/nitrite on thyroid disorder outcomes is essential. Therefore, we conducted this systematic review of experimental and clinical studies, and a meta-analysis of relevant cohort and cross-sectional studies investigating the association of nitrate/nitrite exposure and thyroid function. Most animal studies show that high exposure (~10-600 times of acceptable daily intake) to nitrate/nitrite induces anti-thyroid effects, including decreased serum level of thyroid hormones and histomorphological changes in thyroid gland; however no similar observations have been documented in humans. Based on our meta-analysis, no significant association was observed between nitrate exposure and the risk of thyroid cancer, hyper- and hypothyroidism; findings from three cohort studies however showed a significant association between higher exposure to nitrite and the risk of thyroid cancer (risk = 1.48, 95% confidence interval = 1.09-2.02, P = 0.012). Additional research is needed to clarify the association between nitrate/nitrite exposures and both thyroid function and cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

Risk and safety perception on urban and rural roads: Effects of environmental features, driver age and risk sensitivity.

PubMed

Cox, Jolene A; Beanland, Vanessa; Filtness, Ashleigh J

2017-10-03

The ability to detect changing visual information is a vital component of safe driving. In addition to detecting changing visual information, drivers must also interpret its relevance to safety. Environmental changes considered to have high safety relevance will likely demand greater attention and more timely responses than those considered to have lower safety relevance. The aim of this study was to explore factors that are likely to influence perceptions of risk and safety regarding changing visual information in the driving environment. Factors explored were the environment in which the change occurs (i.e., urban vs. rural), the type of object that changes, and the driver's age, experience, and risk sensitivity. Sixty-three licensed drivers aged 18-70 years completed a hazard rating task, which required them to rate the perceived hazardousness of changing specific elements within urban and rural driving environments. Three attributes of potential hazards were systematically manipulated: the environment (urban, rural); the type of object changed (road sign, car, motorcycle, pedestrian, traffic light, animal, tree); and its inherent safety risk (low risk, high risk). Inherent safety risk was manipulated by either varying the object's placement, on/near or away from the road, or altering an infrastructure element that would require a change to driver behavior. Participants also completed two driving-related risk perception tasks, rating their relative crash risk and perceived risk of aberrant driving behaviors. Driver age was not significantly associated with hazard ratings, but individual differences in perceived risk of aberrant driving behaviors predicted hazard ratings, suggesting that general driving-related risk sensitivity plays a strong role in safety perception. In both urban and rural scenes, there were significant associations between hazard ratings and inherent safety risk, with low-risk changes perceived as consistently less hazardous than high-risk impact changes; however, the effect was larger for urban environments. There were also effects of object type, with certain objects rated as consistently more safety relevant. In urban scenes, changes involving pedestrians were rated significantly more hazardous than all other objects, and in rural scenes, changes involving animals were rated as significantly more hazardous. Notably, hazard ratings were found to be higher in urban compared with rural driving environments, even when changes were matched between environments. This study demonstrates that drivers perceive rural roads as less risky than urban roads, even when similar scenarios occur in both environments. Age did not affect hazard ratings. Instead, the findings suggest that the assessment of risk posed by hazards is influenced more by individual differences in risk sensitivity. This highlights the need for driver education to account for appraisal of hazards' risk and relevance, in addition to hazard detection, when considering factors that promote road safety.

Epilepsy, seizures, physical exercise, and sports: A report from the ILAE Task Force on Sports and Epilepsy.

PubMed

Capovilla, Giuseppe; Kaufman, Kenneth R; Perucca, Emilio; Moshé, Solomon L; Arida, Ricardo M

2016-01-01

People with epilepsy (PWEs) are often advised against participating in sports and exercise, mostly because of fear, overprotection, and ignorance about the specific benefits and risks associated with such activities. Available evidence suggests that physical exercise and active participation in sports may favorably affect seizure control, in addition to producing broader health and psychosocial benefits. This consensus paper prepared by the International League Against Epilepsy (ILAE) Task Force on Sports and Epilepsy offers general guidance concerning participation of PWEs in sport activities, and provides suggestions on the issuance of medical fitness certificates related to involvement in different sports. Sports are divided into three categories based on potential risk of injury or death should a seizure occur: group 1, sports with no significant additional risk; group 2, sports with moderate risk to PWEs, but no risk to bystanders; and group 3, sports with major risk. Factors to be considered when advising whether a PWE can participate in specific activities include the type of sport, the probability of a seizure occurring, the type and severity of the seizures, seizure precipitating factors, the usual timing of seizure occurrence, and the person's attitude in accepting some level of risk. The Task Force on Sports and Epilepsy considers this document as a work in progress to be updated as additional data become available. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults.

PubMed

Hoffman, Geoffrey J; Hays, Ron D; Wallace, Steven P; Shapiro, Martin F; Yakusheva, Olga; Ettner, Susan L

2017-04-01

Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk. Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship. Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired. Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.

Travel risk assessment, advice and vaccinations in immunocompromised travellers (HIV, solid organ transplant and haematopoeitic stem cell transplant recipients): A review.

PubMed

Aung, A K; Trubiano, J A; Spelman, D W

2015-01-01

International travellers with immunocompromising conditions such as human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT) and haematopoietic stem cell transplantation (HSCT) are at a significant risk of travel-related illnesses from both communicable and non-communicable diseases, depending on the intensity of underlying immune dysfunction, travel destinations and activities. In addition, the choice of travel vaccinations, timing and protective antibody responses are also highly dependent on the underlying conditions and thus pose significant challenges to the health-care providers who are involved in pre-travel risk assessment. This review article provides a framework of understanding and approach to aforementioned groups of immunocompromised travellers regarding pre-travel risk assessment and management; in particular travel vaccinations, infectious and non-infectious disease risks and provision of condition-specific advice; to reduce travel-related mortality and morbidity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Water- and wastewater-related disease and infection risks: what is an appropriate value for the maximum tolerable additional burden of disease?

PubMed

Mara, Duncan

2011-06-01

The maximum additional burden of water- and wastewater-related disease of 10-6 disability-adjusted life year (DALY) loss per person per year (pppy), used in the WHO Drinking-water Quality Guidelines and the WHO Guidelines for Wastewater Use in Agriculture, is based on US EPA'S acceptance of a 70-year lifetime waterborne cancer risk of 10(-5) per person, equivalent to an annual risk of 1.4x10(-7) per person which is four orders of magnitude lower than the actual all-cancer incidence in the USA in 2009 of 1.8x10(-3) pppy. A maximum additional burden of 10(-4) DALY loss pppy would reduce this risk to a more cost-effective, but still low, risk of 1.4x10(-5) pppy. It would increase the DALY loss pppy in low- and middle-income countries due to diarrhoeal diseases from the current level of 0.0119 pppy to 0.0120 pppy, and that due to ascariasis from 0.0026 pppy to 0.0027 pppy, but neither increase is of public-health significance. It is therefore recommended that the maximum additional burden of disease from these activities be increased to a DALY loss of 10(-4) pppy as this provides an adequate margin of public-health safety in relation to waterborne-cancer deaths, diarrhoeal disease and ascariasis in all countries.

Cardiovascular risk assessment: addition of CKD and race to the Framingham equation

PubMed Central

Drawz, Paul E.; Baraniuk, Sarah; Davis, Barry R.; Brown, Clinton D.; Colon, Pedro J.; Cujyet, Aloysius B.; Dart, Richard A.; Graumlich, James F.; Henriquez, Mario A.; Moloo, Jamaluddin; Sakalayen, Mohammed G.; Simmons, Debra L.; Stanford, Carol; Sweeney, Mary Ellen; Wong, Nathan D.; Rahman, Mahboob

2012-01-01

Background/Aims The value of the Framingham equation in predicting cardiovascular risk in African Americans and patients with chronic kidney disease (CKD) is unclear. The purpose of the study was to evaluate whether the addition of CKD and race to the Framingham equation improves risk stratification in hypertensive patients. Methods Participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) were studied. Those randomized to doxazosin, age greater than 74 years, and those with a history of coronary heart disease (CHD) were excluded. Two risk stratification models were developed using Cox proportional hazards models in a two-thirds developmental sample. The first model included the traditional Framingham risk factors. The second model included the traditional risk factors plus CKD, defined by eGFR categories, and stratification by race (Black vs. Non-Black). The primary outcome was a composite of fatal CHD, nonfatal MI, coronary revascularization, and hospitalized angina. Results There were a total of 19,811 eligible subjects. In the validation cohort, there was no difference in C-statistics between the Framingham equation and the ALLHAT model including CKD and race. This was consistent across subgroups by race and gender and among those with CKD. One exception was among Non-Black women where the C-statistic was higher for the Framingham equation (0.68 vs 0.65, P=0.02). Additionally, net reclassification improvement was not significant for any subgroup based on race and gender, ranging from −5.5% to 4.4%. Conclusion The addition of CKD status and stratification by race does not improve risk prediction in high-risk hypertensive patients. PMID:23194494

Fate and risk assessment of heavy metals in residue from co-liquefaction of Camellia oleifera cake and sewage sludge in supercritical ethanol.

PubMed

Chen, Hongmei; Zhai, Yunbo; Xu, Bibo; Xiang, Bobin; Zhu, Lu; Qiu, Lei; Liu, Xiaoting; Li, Caiting; Zeng, Guangming

2014-09-01

The fate and risk assessment of heavy metals (HMs) in solid residue from co-liquefaction of sewage sludge (SS) and Camellia oleifera cake (COC) in supercritical ethanol (SCE) were investigated. SCE effectively stabilized HMs in solid residues and a better stabilization was presented on Zn than Cd. Moreover, SCE significantly transformed Cd, Cu and Zn into F4, which reduced the risk to the environment. Furthermore, risk assessments of Igeo, Er(i), RI and RAC demonstrated that the addition of COC was beneficial to the contamination decrement of HMs since pollution levels of HMs all decreased after treatment, and the lowest pollution level was obtained with SC-350. Therefore, SS treated by SCE with the addition of COC could be a promising technology for disposal of SS, especially considering the safety of COC as regards HMs problem. Copyright © 2014 Elsevier Ltd. All rights reserved.

Post-wildfire logging hinders regeneration and increases fire risk.

PubMed

Donato, D C; Fontaine, J B; Campbell, J L; Robinson, W D; Kauffman, J B; Law, B E

2006-01-20

We present data from a study of early conifer regeneration and fuel loads after the 2002 Biscuit Fire, Oregon, USA, with and without postfire logging. Natural conifer regeneration was abundant after the high-severity fire. Postfire logging reduced median regeneration density by 71%, significantly increased downed woody fuels, and thus increased short-term fire risk. Additional reduction of fuels is necessary for effective mitigation of fire risk. Postfire logging can be counterproductive to the goals of forest regeneration and fuel reduction.

Adjuvant radiotherapy for stage I endometrial cancer

PubMed Central

Kong, Anthony; Johnson, Nick; Kitchener, Henry C; Lawrie, Theresa A

2014-01-01

Background This is an updated version of the original Cochrane review published in Issue 2, 2007. The role of radiotherapy (both pelvic external beam radiotherapy (EBRT) and vaginal intracavity brachytherapy (VBT)) in stage I endometrial cancer following hysterectomy remains controversial. Objectives To assess the efficacy of adjuvant radiotherapy following surgery for stage I endometrial cancer. Search methods We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Specialised Register to end-2005 for the original review, and extended the search to January 2012 for the update. Selection criteria We included randomised controlled trials (RCTs) that compared post-operative adjuvant radiotherapy (either EBRTor VBT, or both) versus no radiotherapy or VBT in women with stage I endometrial cancer. Data collection and analysis Two review authors independently assessed trials and extracted data to a specifically designed data collection form. The primary outcome was overall survival. Secondary outcomes were endometrial cancer-related deaths, locoregional recurrence and distant recurrence. Meta-analyses were performed using Cochrane Review Manager Software 5.1. Main results We included eight trials. Seven trials (3628 women) compared EBRT with no EBRT (or VBT), and one trial (645 women) compared VBTwith no additional treatment. We considered six of the eight trials to be of a high quality. Time-to-event data were not available for all trials and all outcomes. EBRT (with or without VBT) compared with no EBRT (or VBT alone) for stage I endometrial carcinoma significantly reduced locoregional recurrence (time-to-event data: five trials, 2965 women; Hazard Ratio (HR) 0.36, 95% Confidence Interval (CI) 0.25 to 0.52; and dichotomous data: seven trials, 3628 women; Risk Ratio (RR) 0.33, 95% CI 0.23 to 0.47). This reduced risk of locoregional recurrence did not translate into improved overall survival (time-to-event data: five trials, 2,965 women; HR 0.99, 95% CI 0.82 to 1.20; and dichotomous data: seven trials, 3628 women; RR 0.98, 95% CI 0.83 to 1.15) or improved endometrial cancer-related survival (time-to-event data: five trials, 2965 women; HR 0.96, 95% CI 0.72 to 1.28; and dichotomous data: seven trials, 3628 women; RR 1.02, 95% CI 0.81 to 1.29) or improved distant recurrence rates (dichotomous data: seven trials, 3628 women; RR 1.04, 95% CI 0.80 to 1.35). EBRT did not improve survival outcomes in either the intermediate-risk or high-risk subgroups, although high-risk data were limited, and a benefit of EBRT for high-risk women could not be excluded. One trial (PORTEC-2) compared EBRT with VBT in the high-intermediate risk group and reported that VBT was effective in ensuring vaginal control with a non-significant difference in loco-regional relapse rate compared to EBRT (5.1% versus 2.1%; HR 2.08, 95% CI 0.71 to 6.09; P = 0·17). In the subgroup of low-risk patients (IA/B and grade 1/2), EBRT increased the risk of endometrial carcinoma-related deaths (including treatment-related deaths) (two trials, 517 women; RR 2.64, 95% CI 1.05 to 6.66) but there was a lack of data on overall survival. We considered the evidence for the low-risk subgroup to be of a low quality. EBRT was associated with significantly increased severe acute toxicity (two trials, 1328 patients, RR 4.68, 95% CI 1.35 to 16.16), increased severe late toxicity (six trials, 3501 women; RR 2.58, 95% CI 1.61 to 4.11) and significant reductions in quality of life scores and rectal and bladder function more than 10 years after randomisation (one trial, 351 women) compared with no EBRT. One trial of VBT versus no additional treatment in women with low-risk lesions reported a non-significant reduction in locoregional recurrence in the VBT group compared with the no additional treatment group (RR 0.39, (95% CI 0.14 to 1.09). There were no significant differences in survival outcomes in this trial. Authors’ conclusions EBRT reduces the risk of locoregional recurrence but has no significant impact on cancer-related deaths or overall survival. It is associated with significant morbidity and a reduction in quality of life. There is no demonstrable survival advantage from adjuvant EBRT for high-risk stage I endometrial cancer, however, the meta-analyses of this subgroup were underpowered and also included high-intermediate risk women, therefore we cannot exclude a small benefit in the high-risk subgroup. EBRT may have an adverse effect on endometrial cancer survival when used to treat uncomplicated low-risk (IA/B grade 1/2) endometrial cancer. For the intermediate to high-intermediate risk group, VBT alone appears to be adequate in ensuring vaginal control compared to EBRT. Further research is needed to guide practice for lesions that are truly high risk. In addition, the definitions of risk should be standardised. PMID:22513918

High-risk sexual activity in the House and Ball community: influence of social networks.

PubMed

Schrager, Sheree M; Latkin, Carl A; Weiss, George; Kubicek, Katrina; Kipke, Michele D

2014-02-01

We investigated the roles of House membership and the influence of social and sexual network members on the sexual risk behavior of men in the Los Angeles House and Ball community. From February 2009 to January 2010, male participants (n = 233) completed interviewer-assisted surveys during a House meeting or Ball event. We used logistic regression to model the effects of sexual network size, influence of sexual network members, House membership status, and their interactions on high-risk sex. Significant predictors of high-risk sex included number of sexual partners in the nominated social network, multiethnicity, and previous diagnosis of sexually transmitted infection. House membership was protective against high-risk sex. Additionally, a 3-way interaction emerged between number of sexual partners in the network, influence, and network members' House membership. Future research should assess network members' attitudes and behavior in detail to provide a greater understanding of the dynamics of social influence and to identify additional avenues for intervention.

Susceptibility loci of CNOT6 in the general mRNA degradation pathway and lung cancer risk - a re-analysis of eight GWASs

PubMed Central

Zhou, Fei; Wang, Yanru; Liu, Hongliang; Ready, Neal; Han, Younghun; Hung, Rayjean J.; Brhane, Yonathan; McLaughlin, John; Brennan, Paul; Bickeböller, Heike; Rosenberger, Albert; Houlston, Richard S.; Caporaso, Neil; Landi, Maria Teresa; Brüske, Irene; Risch, Angela; Ye, Yuanqing; Wu, Xifeng; Christiani, David C.; Goodman, Gary; Chen, Chu; Amos, Christopher I.; Qingyi, Wei

2017-01-01

Purpose mRNA degradation is an important regulatory step for controlling gene expression and cell functions. Genetic abnormalities of the genes involved in mRNA degradation were found to be associated with cancer risks. Therefore, we systematically investigated the roles of genetic variants of genes in the general mRNA degradation pathway in lung cancer risk. Experimental design Meta-analyses were conducted in six lung cancer genome-wide association studies (GWASs) from the Transdisciplinary Research in Cancer of the Lung and additional two GWASs from Harvard University and deCODE in the International Lung Cancer Consortium. Expression quantitative trait loci analysis (eQTL) was used for in silico functional validation of the identified significant susceptibility loci. Results This pathway-based analysis included 4,603 single nucleotide polymorphisms (SNP) in 68 genes in 14,463 lung cancer cases and 44,188 controls, of which 20 SNPs were found to be associated with lung cancer risk with a false discovery rate threshold of <0.05. Among the 11 newly identified SNPs in CNOT6, which were in high linkage disequilibrium, the rs2453176 with a RegulomDB score “1f” was chosen as the tag SNP for further analysis. We found that the rs2453176 T allele was significantly associated with lung cancer risk (odds ratio=1.11, 95% confidence interval=1.04–1.18, P=0.001) in the eight GWASs. In the eQTL analysis, we found that levels of CNOT6 mRNA expression were significantly correlated with the rs2453176 T allele, which provided additional biological basis for the observed positive association. Conclusion The CNOT6 rs2453176 SNP may be a new functional susceptible locus for lung cancer risk. PMID:27805284

Susceptibility loci of CNOT6 in the general mRNA degradation pathway and lung cancer risk-A re-analysis of eight GWASs.

PubMed

Zhou, Fei; Wang, Yanru; Liu, Hongliang; Ready, Neal; Han, Younghun; Hung, Rayjean J; Brhane, Yonathan; McLaughlin, John; Brennan, Paul; Bickeböller, Heike; Rosenberger, Albert; Houlston, Richard S; Caporaso, Neil; Landi, Maria Teresa; Brüske, Irene; Risch, Angela; Ye, Yuanqing; Wu, Xifeng; Christiani, David C; Goodman, Gary; Chen, Chu; Amos, Christopher I; Wei, Qingyi

2017-04-01

mRNA degradation is an important regulatory step for controlling gene expression and cell functions. Genetic abnormalities involved in mRNA degradation genes were found to be associated with cancer risks. Therefore, we systematically investigated the roles of genetic variants in the general mRNA degradation pathway in lung cancer risk. Meta-analyses were conducted using summary data from six lung cancer genome-wide association studies (GWASs) from the Transdisciplinary Research in Cancer of the Lung and additional two GWASs from Harvard University and deCODE in the International Lung Cancer Consortium. Expression quantitative trait loci analysis (eQTL) was used for in silico functional validation of the identified significant susceptibility loci. This pathway-based analysis included 6816 single nucleotide polymorphisms (SNP) in 68 genes in 14 463 lung cancer cases and 44 188 controls. In the single-locus analysis, we found that 20 SNPs were associated with lung cancer risk with a false discovery rate threshold of <0.05. Among the 11 newly identified SNPs in CNOT6, which were in high linkage disequilibrium, the rs2453176 with a RegulomDB score "1f" was chosen as the tagSNP for further analysis. We found that the rs2453176 T allele was significantly associated with lung cancer risk (odds ratio = 1.11, 95% confidence interval = 1.04-1.18) in the eight GWASs. In the eQTL analysis, we found that levels of CNOT6 mRNA expression were significantly correlated with the rs2453176 T allele, which provided additional biological basis for the observed positive association. The CNOT6 rs2453176 SNP may be a new functional susceptible locus for lung cancer risk. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Cyclin D1 G870A polymorphism and breast cancer risk: a meta-analysis comprising 9,911 cases and 11,171 controls.

PubMed

Sergentanis, Theodoros N; Economopoulos, Konstantinos P

2011-11-01

Cyclin D1 represents a key molecule in the regulation of cell cycle. CCND1 G870A (rs603965) polymorphism has drawn considerable attention as the A allele may generate a variant splice product with possible oncogenic actions. A meta-analysis examining the association between CCND1 G870A polymorphism and breast cancer risk was performed. Separate analyses on Caucasian and Chinese populations were also implemented. Eligible articles were identified for the period up to July 2010. Pooled odds ratios (OR) were appropriately derived from fixed-effects or random-effects models. Sensitivity analysis excluding studies whose genotype frequencies in controls significantly deviated from Hardy-Weinberg Equilibrium (HWE) was performed. Nine case-control studies on Caucasians (7,304 cases and 8,149 controls) and four case-control studies on Chinese (2,607 cases and 3,022 controls) were eligible. At the overall analysis the A allele seemed to be associated with elevated breast cancer risk; the effect seemed to be confined to homozygous carriers (pooled OR = 1.091, 95% CI: 1.008-1.179, P = 0.030, fixed effects) as heterozygous carriers did not exhibit significantly elevated breast cancer risk. No statistically significant associations were demonstrated in Caucasians. On the other hand, Chinese AA carriers exhibited marginally elevated breast cancer risk (pooled OR = 1.144, 95% CI: 0.984-1.329, P = 0.080, fixed effects). Nevertheless, the controls in two out of the four Chinese studies deviated from HWE. In conclusion, this meta-analysis suggests that the A allele of the CCND1 G870A polymorphism may confer additional breast cancer risk when it comes to homozygosity and Chinese populations. The need for additional, methodologically sound studies on Chinese populations seems warranted.

Additive influence of genetic predisposition and conventional risk factors in the incidence of coronary heart disease: a population-based study in Greece

PubMed Central

Yiannakouris, Nikos; Katsoulis, Michail; Trichopoulou, Antonia; Ordovas, Jose M; Trichopoulos, Dimitrios

2014-01-01

Objectives An additive genetic risk score (GRS) for coronary heart disease (CHD) has previously been associated with incident CHD in the population-based Greek European Prospective Investigation into Cancer and nutrition (EPIC) cohort. In this study, we explore GRS-‘environment’ joint actions on CHD for several conventional cardiovascular risk factors (ConvRFs), including smoking, hypertension, type-2 diabetes mellitus (T2DM), body mass index (BMI), physical activity and adherence to the Mediterranean diet. Design A case–control study. Setting The general Greek population of the EPIC study. Participants and outcome measures 477 patients with medically confirmed incident CHD and 1271 controls participated in this study. We estimated the ORs for CHD by dividing participants at higher or lower GRS and, alternatively, at higher or lower ConvRF, and calculated the relative excess risk due to interaction (RERI) as a measure of deviation from additivity. Results The joint presence of higher GRS and higher risk ConvRF was in all instances associated with an increased risk of CHD, compared with the joint presence of lower GRS and lower risk ConvRF. The OR (95% CI) was 1.7 (1.2 to 2.4) for smoking, 2.7 (1.9 to 3.8) for hypertension, 4.1 (2.8 to 6.1) for T2DM, 1.9 (1.4 to 2.5) for lower physical activity, 2.0 (1.3 to 3.2) for high BMI and 1.5 (1.1 to 2.1) for poor adherence to the Mediterranean diet. In all instances, RERI values were fairly small and not statistically significant, suggesting that the GRS and the ConvRFs do not have effects beyond additivity. Conclusions Genetic predisposition to CHD, operationalised through a multilocus GRS, and ConvRFs have essentially additive effects on CHD risk. PMID:24500614

Evidence Report: Risk of Cardiovascular Disease and Other Degenerative Tissue Effects from Radiation Exposure

NASA Technical Reports Server (NTRS)

Patel, Zarana; Huff, Janice; Saha, Janapriya; Wang, Minli; Blattnig, Steve; Wu, Honglu; Cucinotta, Francis

2015-01-01

Occupational radiation exposure from the space environment may result in non-cancer or non-CNS degenerative tissue diseases, such as cardiovascular disease, cataracts, and respiratory or digestive diseases. However, the magnitude of influence and mechanisms of action of radiation leading to these diseases are not well characterized. Radiation and synergistic effects of radiation cause DNA damage, persistent oxidative stress, chronic inflammation, and accelerated tissue aging and degeneration, which may lead to acute or chronic disease of susceptible organ tissues. In particular, cardiovascular pathologies such as atherosclerosis are of major concern following gamma-ray exposure. This provides evidence for possible degenerative tissue effects following exposures to ionizing radiation in the form of the GCR or SPEs expected during long-duration spaceflight. However, the existence of low dose thresholds and dose-rate and radiation quality effects, as well as mechanisms and major risk pathways, are not well-characterized. Degenerative disease risks are difficult to assess because multiple factors, including radiation, are believed to play a role in the etiology of the diseases. As additional evidence is pointing to lower, space-relevant thresholds for these degenerative effects, particularly for cardiovascular disease, additional research with cell and animal studies is required to quantify the magnitude of this risk, understand mechanisms, and determine if additional protection strategies are required.The NASA PEL (Permissive Exposure Limit)s for cataract and cardiovascular risks are based on existing human epidemiology data. Although animal and clinical astronaut data show a significant increase in cataracts following exposure and a reassessment of atomic bomb (A-bomb) data suggests an increase in cardiovascular disease from radiation exposure, additional research is required to fully understand and quantify these adverse outcomes at lower doses (less than 0.5 gray (SI unit for ionizing radiation dosage, i.e. one joule of radiation energy per one kilogram of matter)) to facilitate risk prediction. This risk has considerable uncertainty associated with it, and no acceptable model for projecting degenerative tissue risk is currently available. In particular, risk factors such as obesity, alcohol, and tobacco use can act as confounding factors that contribute to the large uncertainties. The PELs could be violated under certain scenarios, including following a large SPE (solar proton event) or long-term GCR (galactic cosmic ray) exposure. Specifically, for a Mars mission, the accumulated dose is sufficiently high that epidemiology data and preliminary risk estimates suggest a significant risk for cardiovascular disease. Ongoing research in this area is intended to provide the evidence base for accurate risk quantification to determine criticality for extended duration missions. Data specific to the space radiation environment must be compiled to quantify the magnitude of this risk to decrease the uncertainty in current PELs and to determine if additional protection strategies are required. New research results could lead to estimates of cumulative radiation risk from CNS and degenerative tissue diseases that, when combined with the cancer risk, may have major negative impacts on mission design, costs, schedule, and crew selection. The current report amends an earlier report (Human Research Program Requirements Document, HRP-47052, Rev. C, dated Jan 2009) in order to provide an update of evidence since 2009.

The impact of using visual images of the body within a personalized health risk assessment: an experimental study.

PubMed

Hollands, Gareth J; Marteau, Theresa M

2013-05-01

To examine the motivational impact of the addition of a visual image to a personalized health risk assessment and the underlying cognitive and emotional mechanisms. An online experimental study in which participants (n = 901; mean age = 27.2 years; 61.5% female) received an assessment and information focusing on the health implications of internal body fat and highlighting the protective benefits of physical activity. Participants were randomized to receive this in either (a) solely text form (control arm) or (b) text plus a visual image of predicted internal body fat (image arm). Participants received information representing one of three levels of health threat, determined by how physically active they were: high, moderate or benign. Main outcome measures were physical activity intentions (assessed pre- and post-intervention), worry, coherence and believability of the information. Intentions to undertake recommended levels of physical activity were significantly higher in the image arm, but only amongst those participants who received a high-threat communication. Believability of the results received was greater in the image arm and mediated the intervention effect on intentions. The addition of a visual image to a risk assessment led to small but significant increases in intentions to undertake recommended levels of physical activity in those at increased health risk. Limitations of the study and implications for future research are discussed. What is already known on this subject? Health risk information that is personalized to the individual may more strongly motivate risk-reducing behaviour change. Little prior research attention has been paid specifically to the motivational impact of personalized visual images and underlying mechanisms. What does this study add? In an experimental design, it is shown that receipt of visual images increases intentions to engage in risk-reducing behaviour, although only when a significant level of threat is presented. The study suggests that images increase the believability of health risk information and this may underlie motivational impact. © 2012 The British Psychological Society.

Risk of bladder cancer by disease severity in relation to metabolic factors and smoking; a prospective pooled cohort study of 800,000 men and women.

PubMed

Teleka, Stanley; Häggström, Christel; Nagel, Gabriele; Bjørge, Tone; Manjer, Jonas; Ulmer, Hanno; Liedberg, Fredrik; Ghaderi, Sara; Lang, Alois; Jonsson, Håkan; Jahnson, Staffan; Orho-Melander, Marju; Tretli, Steinar; Stattin, Pär; Stocks, Tanja

2018-05-14

Previous studies on metabolic factors and bladder cancer (BC) risk have shown inconsistent results and have commonly not investigated associations separately by sex, smoking, and tumor invasiveness. Among 811 633 participants in six European cohorts, we investigated sex-specific associations between body mass index (BMI), mid-blood pressure (BP, [systolic+diastolic]/2), plasma glucose, triglycerides, total cholesterol and risk of BC overall, non-muscle invasive BC (NMIBC) and muscle invasive BC (MIBC). Among men, we additionally assessed additive interactions between metabolic factors and smoking on BC risk. During follow-up, 2 983 men and 754 women were diagnosed with BC. Among men, triglycerides and BP were positively associated with BC risk overall (hazard ratio [HR] per standard deviation [SD]: 1.17 [95% CI 1.06-1.27] and 1.09 [1.02-1.17], respectively), and among women, BMI was inversely associated with risk (HR: 0.90 [0.82-0.99]). The associations for BMI and BP differed between men and women (P interaction ≤0.005). Among men, BMI, cholesterol and triglycerides were positively associated with risk for NMIBC (HRs: 1.09 [95% CI 1.01-1.18], 1.14 [1.02-1.25], and 1.30 [1.12-1.48] respectively), and BP was positively associated with MIBC (HR: 1.23 [1.02-1.49]). Among women, glucose was positively associated with MIBC (HR: 1.99 [1.04-3.81]). Apart from cholesterol, HRs for metabolic factors did not significantly differ between MIBC and NMIBC, and there were no interactions between smoking and metabolic factors on BC. This study supports an involvement of metabolic aberrations in BC risk. Whilst some associations were significant only in certain sub-groups, there were generally no significant differences in associations by smoking or tumor invasiveness. This article is protected by copyright. All rights reserved. © 2018 UICC.

Risk factors associated with Cryptosporidium parvum infection in dairy cattle in southeastern New York State.

PubMed

Mohammed, H O; Wade, S E; Schaaf, S

1999-06-01

An observational analytical epidemiologic study was carried out to identify factors associated with the risk of infection with Cryptosporidium parvum in dairy herds in southeastern New York state. A random sample of 2943 cattle on 109 farms was selected from the target population. Fecal samples were collected from animals in three different age groups and examined for the presence of C. parvum using a quantitative centrifugation concentration flotation method. Data on intrinsic, preweaning, postweaning, maternity, and general management factors were collected and evaluated for their association with the risk of infection with C. parvum. Indices for each of these categories of management were developed from factors significantly associated with the risk of infection with C. parvum. Significant factors were identified using the logistic regression statistical technique. A final analysis, including the indices, age, and season, was performed to identify factors significantly associated with the risk of infection with C. parvum while simultaneously controlling for the effect of other factors. The farm effect was evaluated using a mixed effect model. Preweaning factors found to be significantly associated with a decreased risk of infection were: use of ventilation in calf rearing areas, daily addition of bedding, feeding of milk replacer, daily disposal and cleaning of bedding, and use of antibiotics. Postweaning factors such as moving of the animals after weaning, cleaning of soiled bedding, and use of antibiotics and ionophores as preventive measures were significantly associated with the decreased risk of an infection with C. parvum. Consideration of maternity management factors showed that winter housing of cows individually within 2 months of calving, use of fresh colostrum to feed calves, and having a concrete floor in the calving area were significantly associated with decreased risk of C. parvum infection. The total number of dairy cattle, total number of other species of agricultural animals on the farm, and the distance of the barn water source from the septic system were found to be significantly associated with increased risk of C. parvum infection. In the final analysis, the risk of infection with C. parvum was significantly decreased with an increased value of the maternity management index score. The general management significantly affected the risk of infection with C. parvum where the risk increased with the increase of the value of the index. The risk of infection significantly decreased with increase in the age of the animal.

An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources.

PubMed

Harvey, Susan C; Di Carlo, Phillip A; Lee, Bonmyong; Obadina, Eniola; Sippo, Dorothy; Mullen, Lisa

2016-04-01

To review the ability of an abbreviated, high-risk, screening, breast MRI protocol to detect cancer and save resources. High-risk screening breast MR images were reviewed, from both an abbreviated protocol and a full diagnostic protocol. Differences in cancer detection, scanner utilization, interpretation times, and need for additional imaging were recorded in an integrated data form, and reviewed and compared. A total of 568 MRI cases were reviewed, with the abbreviated and full protocols. No difference was found in the number of cancers detected. Scan times were decreased by 18.8 minutes per case, for a total of 10,678 minutes (178 hours). Interpretation time, on average, was 1.55 minutes for the abbreviated protocol, compared with 6.43 minutes for the full protocol. Review of the full protocol led to a significant change in the final BI-RADS(®) assessment in 12 of 568 (2.1%) cases. Abbreviated MRI is as effective as full-protocol MRI for demonstration of cancers in the high-risk screening setting, with only 12 (2.1%) cases recommended for additional MRI evaluation. The efficiency and resource savings of an abbreviated protocol would be significant, and would allow for opportunities to provide MRI for additional patients, as well as improved radiologist time management and workflow, with the potential to add real-time MRI interpretation or double reading. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources.

PubMed

Harvey, Susan C; Di Carlo, Phillip A; Lee, Bonmyong; Obadina, Eniola; Sippo, Dorothy; Mullen, Lisa

2016-11-01

To review the ability of an abbreviated, high-risk, screening, breast MRI protocol to detect cancer and save resources. High-risk screening breast MR images were reviewed, from both an abbreviated protocol and a full diagnostic protocol. Differences in cancer detection, scanner utilization, interpretation times, and need for additional imaging were recorded in an integrated data form, and reviewed and compared. A total of 568 MRI cases were reviewed, with the abbreviated and full protocols. No difference was found in the number of cancers detected. Scan times were decreased by 18.8 minutes per case, for a total of 10,678 minutes (178 hours). Interpretation time, on average, was 1.55 minutes for the abbreviated protocol, compared with 6.43 minutes for the full protocol. Review of the full protocol led to a significant change in the final BI-RADS ® assessment in 12 of 568 (2.1%) cases. Abbreviated MRI is as effective as full-protocol MRI for demonstration of cancers in the high-risk screening setting, with only 12 (2.1 %) cases recommended for additional MRI evaluation. The efficiency and resource savings of an abbreviated protocol would be significant, and would allow for opportunities to provide MRI for additional patients, as well as improved radiologist time management and workflow, with the potential to add real-time MRI interpretation or double reading. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The TERT gene harbors multiple variants associated with pancreatic cancer susceptibility

PubMed Central

Campa, Daniele; Rizzato, Cosmeri; Stolzenberg-Solomon, Rachael; Pacetti, Paola; Vodicka, Pavel; Cleary, Sean P.; Capurso, Gabriele; Bueno-de-Mesquita, H. Bas; Werner, Jens; Gazouli, Maria; Butterbach, Katja; Ivanauskas, Audrius; Giese, Nathalia; Petersen, Gloria M.; Fogar, Paola; Wang, Zhaoming; Bassi, Claudio; Ryska, Miroslav; Theodoropoulos, George E.; Kooperberg, Charles; Li, Donghui; Greenhalf, William; Pasquali, Claudio; Hackert, Thilo; Fuchs, Charles S.; Mohelnikova-Duchonova, Beatrice; Sperti, Cosimo; Funel, Niccola; Dieffenbach, Aida Karina; Wareham, Nicholas J.; Buring, Julie; Holcátová, Ivana; Costello, Eithne; Zambon, Carlo-Federico; Kupcinskas, Juozas; Risch, Harvey A.; Kraft, Peter; Bracci, Paige M.; Pezzilli, Raffaele; Olson, Sara H.; Sesso, Howard D.; Hartge, Patricia; Strobel, Oliver; Małecka-Panas, Ewa; Visvanathan, Kala; Arslan, Alan A.; Pedrazzoli, Sergio; Souček, Pavel; Gioffreda, Domenica; Key, Timothy J.; Talar-Wojnarowska, Renata; Scarpa, Aldo; Mambrini, Andrea; Jacobs, Eric J.; Jamroziak, Krzysztof; Klein, Alison; Tavano, Francesca; Bambi, Franco; Landi, Stefano; Austin, Melissa A.; Vodickova, Ludmila; Brenner, Hermann; Chanock, Stephen J.; Fave, Gianfranco Delle; Piepoli, Ada; Cantore, Maurizio; Zheng, Wei; Wolpin, Brian M.; Amundadottir, Laufey T.; Canzian, Federico

2015-01-01

A small number of common susceptibility loci have been identified for pancreatic cancer, one of which is marked by rs401681 in the TERT – CLPTM1L gene region on chr5p15.33. Since this region is characterized by low linkage disequilibrium (LD), we sought to identify additional SNPs could be related to pancreatic cancer risk, independently of rs401681. We performed an in-depth analysis of genetic variability of the telomerase reverse transcriptase (TERT) and the telomerase RNA component (TERC) genes, in 5,550 subjects with pancreatic cancer and 7,585 controls from the PANcreatic Disease ReseArch (PANDoRA) and the PanScan consortia. We identified a significant association between a variant in TERT and pancreatic cancer risk (rs2853677, OR=0.85; 95% CI=0.80–0.90, P=8.3×10−8). Additional analysis adjusting rs2853677 for rs401681 indicated that the two SNPs are independently associated with pancreatic cancer risk, as suggested by the low LD between them (r2=0.07, D´=0.28). Three additional SNPs in TERT reached statistical significance after correction for multiple testing: rs2736100 (P=3.0×10−5), rs4583925 (P=4.0×10−5) and rs2735948 (P=5.0×10−5). In conclusion, we confirmed that the TERT locus is associated with pancreatic cancer risk, possibly through several independent variants. PMID:25940397

Risk factors and clinical indicators for the development of biliary strictures post liver transplant: Significance of bilirubin

PubMed Central

Forrest, Elizabeth Ann; Reiling, Janske; Lipka, Geraldine; Fawcett, Jonathan

2017-01-01

AIM To identify risk factors associated with the formation of biliary strictures post liver transplantation over a period of 10-year in Queensland. METHODS Data on liver donors and recipients in Queensland between 2005 and 2014 was obtained from an electronic patient data system. In addition, intra-operative and post-operative characteristics were collected and a logistical regression analysis was performed to evaluate their association with the development of biliary strictures. RESULTS Of 296 liver transplants performed, 285 (96.3%) were from brain dead donors. Biliary strictures developed in 45 (15.2%) recipients. Anastomotic stricture formation (n = 25, 48.1%) was the commonest complication, with 14 (58.3%) of these occurred within 6-mo of transplant. A percutaneous approach or endoscopic retrograde cholangiography was used to treat 17 (37.8%) patients with biliary strictures. Biliary reconstruction was initially or ultimately required in 22 (48.9%) patients. In recipients developing biliary strictures, bilirubin was significantly increased within the first post-operative week (Day 7 total bilirubin 74 μmol/L vs 49 μmol/L, P = 0.012). In both univariate and multivariate regression analysis, Day 7 total bilirubin > 55 μmol/L was associated with the development of biliary stricture formation. In addition, hepatic artery thrombosis and primary sclerosing cholangitis were identified as independent risk factors. CONCLUSION In addition to known risk factors, bilirubin levels in the early post-operative period could be used as a clinical indicator for biliary stricture formation. PMID:29312864

Characterizing the low wage immigrant workforce: a comparative analysis of the health disparities among selected occupations in Somerville, Massachusetts.

PubMed

Panikkar, Bindu; Woodin, Mark A; Brugge, Doug; Hyatt, Raymond; Gute, David M

2014-05-01

This study estimates job-related risks among common low wage occupations (cleaning, construction, food service, cashier/baggers, and factory workers) held by predominantly Haitian, El Salvadorian, and Brazilian immigrants living or working in Somerville, Massachusetts. A community-based cross-sectional survey on immigrant occupational health was conducted between 2006 and 2009 and logistic regression was used to assess the job-related risks among the most common low wage occupations. Construction workers reported significantly higher health risks, and lower access to occupational health services than the other occupations. Compared to cashier/baggers, the reference population in this study, cleaners reported significantly lower access to health and safety and work training and no knowledge of workers' compensation. Factory workers reported significantly lower work training compared to cashier/baggers. Food service workers reported the least access to doctors compared to the other occupations. We found significant variability in risks among different low wage immigrant occupations. The type of occupation independently contributed to varying levels of risks among these jobs. We believe our findings to be conservative and recommend additional inquiry aimed at assuring the representativeness of our findings. © 2013 Wiley Periodicals, Inc.

Attitudes toward risk and ambiguity in patients with autism spectrum disorder.

PubMed

Fujino, Junya; Tei, Shisei; Hashimoto, Ryu-Ichiro; Itahashi, Takashi; Ohta, Haruhisa; Kanai, Chieko; Okada, Rieko; Kubota, Manabu; Nakamura, Motoaki; Kato, Nobumasa; Takahashi, Hidehiko

2017-01-01

Although the ability to make optimal decisions under uncertainty is an integral part of everyday life, individuals with autism spectrum disorder (ASD) frequently report that they experience difficulties with this skill. In behavioral economics, researchers distinguish two types of uncertainty to understand decision-making in this setting: risk (known probabilities) and ambiguity (unknown probabilities). However, it remains unclear how individuals with ASD behave under risk and ambiguity, despite growing evidence of their altered decision-making under uncertainty. We therefore extended previous research by studying the attitudes of those with ASD toward risk and ambiguity in both positive and negative contexts (i.e., gain and loss). In gain contexts, no significant difference was observed between the groups in risk attitudes, but ambiguity aversion was attenuated in ASD. In loss contexts, ambiguity attitudes did not significantly differ between the groups, but the ASD participants were less risk-seeking compared with the controls. In addition, insensitivity to the context change under risk and ambiguity in ASD was both significantly associated with poor social skills. These results improve our understanding of altered decision-making under uncertainty by disentangling the attitudes toward risk and ambiguity in ASD individuals. Applying behavioral economic tools may provide insights into the mechanisms underlying behavioral disturbances in ASD.

Differences in suicide and death ideation among veterans and nonveterans with serious mental illness.

PubMed

Jahn, Danielle R; Muralidharan, Anjana; Drapalski, Amy L; Brown, Clayton H; Fang, Li Juan; Lucksted, Alicia

2018-02-01

Individuals with serious mental illness and veterans are two populations at elevated risk for suicide; however, research has not examined whether veterans with serious mental illness may be at higher suicide risk than nonveterans with serious mental illness. Additionally, overlapping risk factors for suicide in these populations may account for differences in suicide-related outcomes between these groups. Therefore, the aim of this study was to identify differences in death ideation and suicide ideation among veterans and nonveterans with serious mental illness. We also aimed to explore these effects after adjusting for potentially shared risk factors. We found that veterans with serious mental illness reported death ideation and suicide ideation more than twice as often as nonveterans with serious mental illness. After adjusting for demographic, psychiatric, and theory-driven risk factors, the effect of veteran status on death ideation remained significant, though the effect on suicide ideation was no longer significant. Depressive and psychotic symptoms were significant predictors of death ideation; depressive symptoms and hostility were significant predictors of suicide ideation. Clinicians should particularly monitor death ideation and suicide ideation in veterans with serious mental illness, as well as associated clinical risk factors such as depression, psychotic symptoms, and hostility. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Salivary cortisol and alpha-amylase levels during an assessment procedure correlate differently with risk-taking measures in male and female police recruits

PubMed Central

van den Bos, Ruud; Taris, Ruben; Scheppink, Bianca; de Haan, Lydia; Verster, Joris C.

2013-01-01

Recent laboratory studies have shown that men display more risk-taking behavior in decision-making tasks following stress, whilst women are more risk-aversive or become more task-focused. In addition, these studies have shown that sex differences are related to levels of the stress hormone cortisol (indicative of activation of the hypothalamus-pituitary-adrenocortical-axis): the higher the levels of cortisol the more risk-taking behavior is shown by men, whereas women generally display more risk-aversive or task-focused behavior following higher levels of cortisol. Here, we assessed whether such relationships hold outside the laboratory, correlating levels of cortisol obtained during a job-related assessment procedure with decision-making parameters in the Cambridge Gambling Task (CGT) in male and female police recruits. The CGT allows for discriminating different aspects of reward-based decision-making. In addition, we correlated levels of alpha-amylase [indicative of activation of the sympatho-adrenomedullary-axis (SAM)] and decision-making parameters. In line with earlier studies men and women only differed in risk-adjustment in the CGT. Salivary cortisol levels correlated positively and strongly with risk-taking measures in men, which was significantly different from the weak negative correlation in women. In contrast, and less strongly so, salivary alpha-amylase levels correlated positively with risk-taking in women, which was significantly different from the weak negative correlation with risk-taking in men. Collectively, these data support and extend data of earlier studies indicating that risky decision-making in men and women is differently affected by stress hormones. The data are briefly discussed in relation to the effects of stress on gambling. PMID:24474909

Comparison of direct measures of adiposity with indirect measures for assessing cardiometabolic risk factors in preadolescent girls.

PubMed

Hetherington-Rauth, Megan; Bea, Jennifer W; Lee, Vinson R; Blew, Robert M; Funk, Janet; Lohman, Timothy G; Going, Scott B

2017-02-23

Childhood overweight and obesity remains high, contributing to cardiometabolic risk factors at younger ages. It is unclear which measures of adiposity serve as the best proxies for identifying children at metabolic risk. This study assessed whether DXA-derived direct measures of adiposity are more strongly related to cardiometabolic risk factors in children than indirect measures. Anthropometric and DXA measures of adiposity and a comprehensive assessment of cardiometabolic risk factors were obtained in 288, 9-12 year old girls, most being of Hispanic ethnicity. Multiple regression models for each metabolic parameter were run against each adiposity measure while controlling for maturation and ethnicity. In addition, regression models including both indirect and direct measures were developed to assess whether using direct measures of adiposity could provide a better prediction of the cardiometabolic risk factors beyond that of using indirect measures alone. Measures of adiposity were significantly correlated with cardiometabolic risk factors (p < 0.05) except fasting glucose. After adjusting for maturation and ethnicity, indirect measures of adiposity accounted for 29-34% in HOMA-IR, 10-13% in TG, 14-17% in HDL-C, and 5-8% in LDL-C while direct measures accounted for 29-34% in HOMA-IR, 10-12% in TG, 13-16% in HDL-C, and 5-6% in LDL-C. The addition of direct measures of adiposity to indirect measures added significantly to the variance explained for HOMA-IR (p = 0.04). Anthropometric measures may perform as well as the more precise direct DXA-derived measures of adiposity for assessing most CVD risk factors in preadolescent girls. The use of DXA-derived adiposity measures together with indirect measures may be advantageous for predicting insulin resistance risk. NCT02654262 . Retrospectively registered 11 January 2016.

Clinical Predictive Models for Chemotherapy-Induced Febrile Neutropenia in Breast Cancer Patients: A Validation Study

PubMed Central

Zhu, Liling; Su, Fengxi; Jia, Weijuan; Deng, Xiaogeng

2014-01-01

Background Predictive models for febrile neutropenia (FN) would be informative for physicians in clinical decision making. This study aims to validate a predictive model (Jenkin’s model) that comprises pretreatment hematological parameters in early-stage breast cancer patients. Patients and Methods A total of 428 breast cancer patients who received neoadjuvant/adjuvant chemotherapy without any prophylactic use of colony-stimulating factor were included. Pretreatment absolute neutrophil counts (ANC) and absolute lymphocyte counts (ALC) were used by the Jenkin’s model to assess the risk of FN. In addition, we modified the threshold of Jenkin’s model and generated Model-A and B. We also developed Model-C by incorporating the absolute monocyte count (AMC) as a predictor into Model-A. The rates of FN in the 1st chemotherapy cycle were calculated. A valid model should be able to significantly identify high-risk subgroup of patients with FN rate >20%. Results Jenkin’s model (Predicted as high-risk when ANC≦3.1*10∧9/L;ALC≦1.5*10∧9/L) did not identify any subgroups with significantly high risk (>20%) of FN in our population, even if we used different thresholds in Model-A(ANC≦4.4*10∧9/L;ALC≦2.1*10∧9/L) or B(ANC≦3.8*10∧9/L;ALC≦1.8*10∧9/L). However, with AMC added as an additional predictor, Model-C(ANC≦4.4*10∧9/L;ALC≦2.1*10∧9/L; AMC≦0.28*10∧9/L) identified a subgroup of patients with a significantly high risk of FN (23.1%). Conclusions In our population, Jenkin’s model, cannot accurately identify patients with a significant risk of FN. The threshold should be changed and the AMC should be incorporated as a predictor, to have excellent predictive ability. PMID:24945817

Personality and diabetes mellitus incidence in a national sample.

PubMed

Cukić, Iva; Weiss, Alexander

2014-09-01

To test whether personality traits were prospectively associated with type 2 diabetes incidence. The sample (n=6798) was derived from the National Health and Nutrition Examination Survey Epidemiological Follow-up Study cohort. We fit four logistic regression models to test whether neuroticism, extraversion, openness to experience, or the Type A behavior pattern predicted type 2 diabetes incidence. Model 1 included sex, age, and race/ethnicity. Model 2 added personality traits, Model 3 added depressive symptoms, and Model 4 added body mass index (BMI), hypertension, and cigarette smoking status as predictors. In Model 1 age was associated with increased risk of diabetes (2% per year); being black as opposed to white was associated with a three-fold increase in risk. In Model 2 age and being black were still significant and extraversion was associated with decreased risk (17% per standard deviation [SD]). In Model 3 age, being black, and extraversion were still significant. In addition, neuroticism was associated with decreased risk (26% per SD) and depressive symptoms were associated with increased risk (28% per SD). In Model 4 age, being black, neuroticism, and depressive symptoms were still significant. BMI was associated with increased risk (14% per SD) and extraversion was no longer significant. Higher neuroticism was associated with reduced type 2 diabetes risk even after controlling for race/ethnicity, age, depressive symptoms, and BMI. Extraversion and Type A behavior were not significant after including covariates. Copyright © 2014 Elsevier Inc. All rights reserved.

Risk Preferences and the Timing of Marriage and Childbearing

PubMed Central

SCHMIDT, LUCIE

2008-01-01

The existing literature on marriage and fertility decisions pays little attention to the roles played by risk preferences and uncertainty. However, given uncertainty regarding the availability of suitable marriage partners, the ability to contracept, and the ability to conceive, women’s risk preferences might be expected to play an important role in marriage and fertility timing decisions. By using data from the Panel Study of Income Dynamics (PSID), I find that measured risk preferences have a significant effect on the timing of both marriage and fertility. Highly risk-tolerant women are more likely to delay marriage, consistent with either a search model of marriage or a risk-pooling explanation. In addition, risk preferences affect fertility timing in a way that differs by marital status and education, and that varies over the life cycle. Greater tolerance for risk leads to earlier births at young ages, consistent with these women being less likely to contracept effectively. In addition, as the subgroup of college-educated, unmarried women nears the end of their fertile periods, highly risk-tolerant women are likely to delay childbearing relative to their more risk-averse counterparts and are therefore less likely to become mothers. These findings may have broader implications for both individual and societal well-being. PMID:18613489

Associations between expression levels of nucleotide excision repair proteins in lymphoblastoid cells and risk of squamous cell carcinoma of the head and neck.

PubMed

Han, Peng; Liu, Hongliang; Shi, Qiong; Liu, Zhensheng; Troy, Jesse D; Lee, Walter T; Zevallos, Jose P; Li, Guojun; Sturgis, Erich M; Wei, Qingyi

2018-06-01

Squamous cell carcinoma of head and neck (SCCHN) is one of the most common malignancies worldwide, and nucleotide excision repair (NER) is involved in SCCHN susceptibility. In this analysis of 349 newly diagnosed SCCHN patients and 295 cancer-free controls, we investigated whether expression levels of eight core NER proteins were associated with risk of SCCHN. We quantified NER protein expression levels in cultured peripheral lymphocytes using a reverse-phase protein microarray. Compared with the controls, SCCHN patients had statistically significantly lower expression levels of ERCC3 and XPA (P = 0.001 and 0.001, respectively). After dividing the subjects by controls' median values of expression levels, we found a dose-dependent association between an increased risk of SCCHN and low expression levels of ERCC3 (adjusted OR, 1.75, and 95% CI: 1.26-2.42; P trend  = 0.008) and XPA (adjusted OR, 1.88; 95% CI, 1.35-2.60; P trend  = 0.001). We also identified a significant multiplicative interaction between smoking status and ERCC3 expression levels (P = 0.014). Finally, after integrating demographic and clinical variables, we found that the addition of ERCC3 and XPA expression levels to the model significantly improved the sensitivity of the expanded model on SCCHN risk. In conclusion, reduced protein expression levels of ERCC3 and XPA were associated with an increased risk of SCCHN. However, these results need to be confirmed in additional large studies. © 2018 Wiley Periodicals, Inc.

Preventive oral health intervention for pediatricians.

PubMed

2008-12-01

This policy is a compilation of current concepts and scientific evidence required to understand and implement practice-based preventive oral health programs designed to improve oral health outcomes for all children and especially children at significant risk of dental decay. In addition, it reviews cariology and caries risk assessment and defines, through available evidence, appropriate recommendations for preventive oral health intervention by primary care pediatric practitioners.

2009 Space Shuttle Probabilistic Risk Assessment Overview

NASA Technical Reports Server (NTRS)

Hamlin, Teri L.; Canga, Michael A.; Boyer, Roger L.; Thigpen, Eric B.

2010-01-01

Loss of a Space Shuttle during flight has severe consequences, including loss of a significant national asset; loss of national confidence and pride; and, most importantly, loss of human life. The Shuttle Probabilistic Risk Assessment (SPRA) is used to identify risk contributors and their significance; thus, assisting management in determining how to reduce risk. In 2006, an overview of the SPRA Iteration 2.1 was presented at PSAM 8 [1]. Like all successful PRAs, the SPRA is a living PRA and has undergone revisions since PSAM 8. The latest revision to the SPRA is Iteration 3. 1, and it will not be the last as the Shuttle program progresses and more is learned. This paper discusses the SPRA scope, overall methodology, and results, as well as provides risk insights. The scope, assumptions, uncertainties, and limitations of this assessment provide risk-informed perspective to aid management s decision-making process. In addition, this paper compares the Iteration 3.1 analysis and results to the Iteration 2.1 analysis and results presented at PSAM 8.

Risk for Low Pathogenicity Avian Influenza Virus on Poultry Farms, the Netherlands, 2007-2013.

PubMed

Bouwstra, Ruth; Gonzales, Jose L; de Wit, Sjaak; Stahl, Julia; Fouchier, Ron A M; Elbers, Armin R W

2017-09-01

Using annual serologic surveillance data from all poultry farms in the Netherlands during 2007-2013, we quantified the risk for the introduction of low pathogenicity avian influenza virus (LPAIV) in different types of poultry production farms and putative spatial-environmental risk factors: distance from poultry farms to clay soil, waterways, and wild waterfowl areas. Outdoor-layer, turkey (meat and breeder), and duck (meat and breeder) farms had a significantly higher risk for LPAIV introduction than did indoor-layer farms. Except for outdoor-layer, all poultry types (i.e., broilers, chicken breeders, ducks, and turkeys) are kept indoors. For all production types, LPAIV risk decreased significantly with increasing distance to medium-sized waterways and with increasing distance to areas with defined wild waterfowl, but only for outdoor-layer and turkey farms. Future research should focus not only on production types but also on distance to waterways and wild bird areas. In addition, settlement of new poultry farms in high-risk areas should be discouraged.

Who comes to a workplace health risk assessment?

PubMed

Dobbins, T A; Simpson, J M; Oldenburg, B; Owen, N; Harris, D

1998-01-01

Workplace health promotion initiatives have proliferated, but there are difficulties in recruiting employees of lower socioeconomic status and at higher risk of disease. A survey of health behaviors and attitudes was administered in 20 worksites and the opportunity to attend a health risk assessment promoted. Those more likely to attend were women, those of higher occupational prestige, and those from a non-English-speaking background. After adjustment for these variables, the only health behavior associated with attendance was smoking status. Perceived risk of lung cancer was significant, even after adjustment for smoking status. Stage of readiness to change health behaviors was associated with attendance, with those in the preparation stage being more likely to attend than those in the precontemplation stage. However, this association was statistically significant only for fruit and vegetable consumption. There was no relation between attendance and support for health promotion, perceived general health, or other perceived risk of disease. These findings suggest that additional risk communication strategies and environmental support are required to involve those with less prestigious occupations.

Risk for Low Pathogenicity Avian Influenza Virus on Poultry Farms, the Netherlands, 2007–2013

PubMed Central

Bouwstra, Ruth; Gonzales, Jose L.; de Wit, Sjaak; Stahl, Julia; Fouchier, Ron A.M.

2017-01-01

Using annual serologic surveillance data from all poultry farms in the Netherlands during 2007–2013, we quantified the risk for the introduction of low pathogenicity avian influenza virus (LPAIV) in different types of poultry production farms and putative spatial-environmental risk factors: distance from poultry farms to clay soil, waterways, and wild waterfowl areas. Outdoor-layer, turkey (meat and breeder), and duck (meat and breeder) farms had a significantly higher risk for LPAIV introduction than did indoor-layer farms. Except for outdoor-layer, all poultry types (i.e., broilers, chicken breeders, ducks, and turkeys) are kept indoors. For all production types, LPAIV risk decreased significantly with increasing distance to medium-sized waterways and with increasing distance to areas with defined wild waterfowl, but only for outdoor-layer and turkey farms. Future research should focus not only on production types but also on distance to waterways and wild bird areas. In addition, settlement of new poultry farms in high-risk areas should be discouraged. PMID:28820139

Association of methylenetetrahydrofolate reductase gene-gene interaction and haplotype with susceptibility to acute lymphoblastic leukemia in Chinese children.

PubMed

Xia, Xiaojun; Duan, Yun; Cui, Jie; Jiang, Junfeng; Lin, Li; Peng, Xiaojuan; Wang, YuHong; Guo, Bingtao; Liu, Shouhai; Lei, Xudong

2017-08-01

The aim of this study was to investigate the association of methylenetetrahydrofolate reductase (MTHFR) gene polymorphism and additional gene-gene interaction with acute lymphoblastic leukemia (ALL) risk. Logistic regression was performed to investigate the association between two single nucleotide polymorphisms (SNPs) within MTHFR gene and ALL risk and additional gene-gene interaction between rs1801133 and rs1801131. The minor allele of rs1801133 and rs1801131 is associated with decreased ALL risk, OR (95% CI) were 0.61 (0.38-0.89), and 0.68 (0.50-0.96), respectively. We also found a significantly interaction between the two SNPs, participants with rs1801133 - CT or TT and rs1801131 - AC or CC genotype have the lowest ALL risk, compared with participants with rs1801133 - CC and rs1801131 - AA genotype, OR (95% CI) was 0.32 (0.12-0.63). We did not find any haplotype between the rs1801133 and rs1801131 associated with ALL risk. rs1801133 and rs1801131 within MTHFR gene and their interaction were both associated with ALL risk in Chinese children.

Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants.

PubMed

Bell, Edward F; Acarregui, Michael J

2014-01-01

Most premature infants are physiologically not sufficiently mature to orally ingest all of their required water and nutrients. Therefore, premature infants rely on their caregivers to regulate their volume of water intake. Thus, the caregiver must determine the amount of water to be given each day to such infants. To determine the effect of water intake on postnatal weight loss and the risks of dehydration, patent ductus arteriosus, necrotizing enterocolitis, bronchopulmonary dysplasia, intracranial hemorrhage, and death in premature infants. Randomized clinical trials (RCTs) identified in previous versions of this review were re-examined and, in each case, retained. Additional trials were sought that compared the outcomes of interest in groups of premature infants who were given different levels of water intake according to an experimental protocol. Such trials were sought in a list of trials provided by the Cochrane Neonatal Review Group, with a PubMed search and in the authors' personal files.This search was updated in 2014. Only RCTs of varying water intake in premature infants were included. The review was limited to trials that included infants whose water intake was provided mainly or entirely by intravascular infusion. The standard methods of The Cochrane Collaboration were used. Study selection and data abstraction were performed independently by each review author. The adverse event rates were calculated for the restricted and liberal water intake groups for each dichotomous outcome, and the relative risk and risk difference were computed. In addition, the maximal weight loss results were recorded and the weighted mean difference was computed. The analysis of the five studies taken together indicated that restricted water intake significantly increased postnatal weight loss and significantly reduced the risks of patent ductus arteriosus and necrotizing enterocolitis. With restricted water intake, there were trends toward increased risk of dehydration and reduced risks of bronchopulmonary dysplasia, intracranial hemorrhage, and death but these trends were not statistically significant. Based on this analysis, the most prudent prescription for water intake to premature infants would seem to be careful restriction of water intake so that physiological needs are met without allowing significant dehydration. This practice could be expected to decrease the risks of patent ductus arteriosus and necrotizing enterocolitis without significantly increasing the risk of adverse consequences.

In vitro bioassays reveal that additives are significant contributors to the toxicity of commercial household pesticides.

PubMed

van de Merwe, Jason P; Neale, Peta A; Melvin, Steven D; Leusch, Frederic D L

2018-06-01

Pesticides commonly used around households can contain additives of unknown concentrations and toxicity. Given the likelihood of these chemicals washing into urban waterways, it is important to understand the effects that these additives may have on aquatic organisms. The aim of this study was to compare the toxicity of commercially available household pesticides to that of the active ingredient(s) alone. The toxicity of five household pesticides (three herbicides and two insecticides) was investigated using a bacterial cytotoxicity bioassay and an algal photosynthesis bioassay. The commercial products were up to an order of magnitude more toxic than the active ingredient(s) alone. In addition, two commercial products with the same listed active ingredients in the same ratio had a 600× difference in potency. These results clearly demonstrate that additives in commercial formulations are significant contributors to the toxicity of household pesticides. The toxicity of pesticides in aquatic systems is therefore likely underestimated by conventional chemical monitoring and risk assessment when only the active ingredients are considered. Regulators and customers should require more clarity from pesticide manufacturers about the nature and concentrations of not only the active ingredients, but also additives used in commercial formulations. In addition, monitoring programmes and chemical risk assessments schemes should develop a structured approach to assessing the toxic effects of commercial formulations, including additives, rather than simply those of the listed active ingredients. Copyright © 2018. Published by Elsevier B.V.

Development of standardized inspections in restaurants using visual assessments and microbiological sampling to quantify the risks.

PubMed Central

Tebbutt, G. M.

1991-01-01

The relationship between visual inspections carried out by environmental health officers and microbiological examination was studied in 89 restaurants. Using 30 variables a standardized inspection procedure was developed and each of the premises was assessed in six main areas-structure and design, cleaning and cleanliness, personal hygiene, risk of contamination, temperature control, and training and knowledge about food hygiene. Selected foods and specimens from hands, surfaces, and wiping cloths were examined. There were significant associations between all six areas of the inspections. The structure and design were significantly related to the combined score from all the other areas (P less than 0.001). There were no highly significant associations between microbiological examination and visual assessments. The microbial contamination of wiping cloths, however, was related to the cleaning and cleanliness (P = 0.005). Microbial sampling provided additional information to inspections and was a valuable aid. Further development of this risk-assessment approach could provide an effective system for monitoring potential health risks in high-risk food premises. PMID:1936161

Multiple risk factors during pregnancy in South Africa: the need for a horizontal approach to perinatal care.

PubMed

Tomlinson, Mark; O'Connor, Mary J; le Roux, Ingrid M; Stewart, Jacqueline; Mbewu, Nokwanele; Harwood, Jessica; Rotheram-Borus, Mary Jane

2014-06-01

South African children's long-term health and well-being is jeopardized during their mothers' pregnancies by the intersecting epidemics of HIV, alcohol use, low birth weight (LBW; <2,500 g) related to poor nutrition, and depressed mood. This research examines these overlapping risk factors among 1,145 pregnant Xhosa women living in 24 township neighborhoods in Cape Town, South Africa. Results revealed that 66 % of pregnant women experienced at least one risk factor. In descending order of prevalence, 37 % reported depressed mood, 29 % were HIV+, 25 % used alcohol prior to knowing that they were pregnant, and 15 % had a previous childbirth with a LBW infant. Approximately 27 % of women had more than one risk factor: depressed mood was significantly associated with alcohol use and LBW, with a trend to significance with HIV+. In addition, alcohol use was significantly related to HIV+. These results suggest the importance of intervening across multiple risks to maternal and child health, and particularly with depression and alcohol use, to positively impact multiple maternal and infant outcomes.

Esomeprazole and aspirin fixed combination for the prevention of cardiovascular events.

PubMed

Sylvester, Katelyn W; Cheng, Judy Wm; Mehra, Mandeep R

2013-01-01

Low dose aspirin therapy plays a fundamental role in both the primary and secondary prevention of cardiovascular events. Although the evidence using low dose aspirin for secondary prevention is well-established, the decision to use aspirin for primary prevention is based on an evaluation of the patient's risk of cardiovascular events compared to their risk of adverse events, such as bleeding. In addition to the risk of bleeding associated with long term aspirin administration, upper gastrointestinal side effects, such as dyspepsia often lead to discontinuation of therapy, which places patients at an increased risk for cardiovascular events. One option to mitigate adverse events and increase adherence is the addition of esomeprazole to the medication regimen. This review article provides an evaluation of the literature on the concomitant use of aspirin and esomeprazole available through February 2013. The efficacy, safety, tolerability, cost effectiveness, and patient quality of life of this regimen is discussed. A summary of the pharmacokinetic and pharmacodynamic interactions between aspirin and esomeprazole, as well as other commonly used cardiovascular medications are also reviewed. The addition of esomeprazole to low dose aspirin therapy in patients at high risk of developing gastric ulcers for the prevention of cardiovascular disease, significantly reduced their risk of ulcer development. Pharmacokinetic and pharmacodynamic studies suggested that esomeprazole did not affect the pharmacokinetic parameters or the antiplatelet effects of aspirin. Therefore, for those patients who are at a high risk of developing a gastrointestinal ulcer, the benefit of adding esomeprazole likely outweighs the risks of longer term proton pump inhibitor use, and the combination can be recommended. Administering the two agents separately may also be more economical. On the other hand, for those patients at lower risk of developing a gastrointestinal ulcer, both the additional risk and cost make the inclusion of a proton pump inhibitor unwarranted.

Disordered Gambling Prevalence: Methodological Innovations in a General Danish Population Survey.

PubMed

Harrison, Glenn W; Jessen, Lasse J; Lau, Morten I; Ross, Don

2018-03-01

We study Danish adult gambling behavior with an emphasis on discovering patterns relevant to public health forecasting and economic welfare assessment of policy. Methodological innovations include measurement of formative in addition to reflective constructs, estimation of prospective risk for developing gambling disorder rather than risk of being falsely negatively diagnosed, analysis with attention to sample weights and correction for sample selection bias, estimation of the impact of trigger questions on prevalence estimates and sample characteristics, and distinguishing between total and marginal effects of risk-indicating factors. The most significant novelty in our design is that nobody was excluded on the basis of their response to a 'trigger' or 'gateway' question about previous gambling history. Our sample consists of 8405 adult Danes. We administered the Focal Adult Gambling Screen to all subjects and estimate prospective risk for disordered gambling. We find that 87.6% of the population is indicated for no detectable risk, 5.4% is indicated for early risk, 1.7% is indicated for intermediate risk, 2.6% is indicated for advanced risk, and 2.6% is indicated for disordered gambling. Correcting for sample weights and controlling for sample selection has a significant effect on prevalence rates. Although these estimates of the 'at risk' fraction of the population are significantly higher than conventionally reported, we infer a significant decrease in overall prevalence rates of detectable risk with these corrections, since gambling behavior is positively correlated with the decision to participate in gambling surveys. We also find that imposing a threshold gambling history leads to underestimation of the prevalence of gambling problems.

Diplomatic Solutions to Additive Challenges

DTIC Science & Technology

Additive manufacturing (AM) technology, colloquially known as 3D printing , will bring significant benefits to society, but also poses great risks...regimes, are not sufficient to address the challenges presented by 3D printing technology. The DOS should evaluate and promote unconventional strategies...from printed weapons proliferation. Working with other nations to resolve the appropriate balance between development and security, and to promote norms

Genetic Investigation into the Paradoxical Differential Risk of Atrial Fibrillation Among Blacks and Whites

PubMed Central

Roberts, Jason D.; Hu, Donglei; Heckbert, Susan R.; Alonso, Alvaro; Dewland, Thomas A.; Vittinghoff, Eric; Liu, Yongmei; Psaty, Bruce M.; Olgin, Jeffrey E.; Magnani, Jared W.; Huntsman, Scott; Burchard, Esteban G.; Arking, Dan E.; Bibbins-Domingo, Kirsten; Harris, Tamara B.; Perez, Marco V.; Ziv, Elad; Marcus, Gregory M.

2017-01-01

Importance Whites have a higher risk of atrial fibrillation (AF) relative to Blacks, despite a lower prevalence of risk factors. This difference may be due, at least in part, to genetic factors. Objective To determine whether 9 single nucleotide polymorphisms (SNPs) associated with AF account for this paradoxical differential racial risk. We also used admixture mapping to search genome wide for loci that may account for this phenomenon. Design, Setting, and Participants Genome wide admixture analysis and candidate SNP study involving 3 population-based cohort studies initiated between 1987 and 1997, including the Cardiovascular Health Study (CHS; n=3,969), the Atherosclerosis Risk in Communities Study (ARIC; n=12,341), and the Health, Aging, and Body Composition Study (Health ABC; n=1,015). Main Outcomes and Measures Incident AF systematically ascertained using clinic visit ECGs, hospital discharge diagnosis codes, death certificates and Medicare claims data. Results Cox proportional hazards models and the proportion of treatment effect method were utilized to determine the impact of 9 AF-risk SNPs among participants from CHS and ARIC. A single SNP, rs10824026 (chromosome 10: position 73661450), was found to significantly mediate 11.4% (95% CI 2.9–29.9%) and 31.7% (95% CI 16.0–53.0%) of the higher risk in Whites compared to Blacks in CHS and ARIC, respectively. Admixture mapping was performed in a meta-analysis of Black participants within CHS (n=811), ARIC (n=3,112), and Health ABC (n=1,015). No loci that reached the pre-specified statistical threshold for genome-wide significance were identified. Conclusions and Relevance The rs10824026 SNP on chromosome 10q22 mediates a modest proportion of the increased risk of AF among Whites relative to Blacks, potentially through an impact on gene expression levels of MYOZ1. No additional genetic variants accounting for a significant portion of the differential racial risk of AF were identified with genome wide admixture mapping, suggesting that additional genetic or environmental influences beyond single SNPs in isolation may account for the paradoxical racial risk of AF among Whites and Blacks. PMID:27438321

Common variant at 16p11.2 conferring risk of psychosis.

PubMed

Steinberg, S; de Jong, S; Mattheisen, M; Costas, J; Demontis, D; Jamain, S; Pietiläinen, O P H; Lin, K; Papiol, S; Huttenlocher, J; Sigurdsson, E; Vassos, E; Giegling, I; Breuer, R; Fraser, G; Walker, N; Melle, I; Djurovic, S; Agartz, I; Tuulio-Henriksson, A; Suvisaari, J; Lönnqvist, J; Paunio, T; Olsen, L; Hansen, T; Ingason, A; Pirinen, M; Strengman, E; Hougaard, D M; Orntoft, T; Didriksen, M; Hollegaard, M V; Nordentoft, M; Abramova, L; Kaleda, V; Arrojo, M; Sanjuán, J; Arango, C; Etain, B; Bellivier, F; Méary, A; Schürhoff, F; Szoke, A; Ribolsi, M; Magni, V; Siracusano, A; Sperling, S; Rossner, M; Christiansen, C; Kiemeney, L A; Franke, B; van den Berg, L H; Veldink, J; Curran, S; Bolton, P; Poot, M; Staal, W; Rehnstrom, K; Kilpinen, H; Freitag, C M; Meyer, J; Magnusson, P; Saemundsen, E; Martsenkovsky, I; Bikshaieva, I; Martsenkovska, I; Vashchenko, O; Raleva, M; Paketchieva, K; Stefanovski, B; Durmishi, N; Pejovic Milovancevic, M; Lecic Tosevski, D; Silagadze, T; Naneishvili, N; Mikeladze, N; Surguladze, S; Vincent, J B; Farmer, A; Mitchell, P B; Wright, A; Schofield, P R; Fullerton, J M; Montgomery, G W; Martin, N G; Rubino, I A; van Winkel, R; Kenis, G; De Hert, M; Réthelyi, J M; Bitter, I; Terenius, L; Jönsson, E G; Bakker, S; van Os, J; Jablensky, A; Leboyer, M; Bramon, E; Powell, J; Murray, R; Corvin, A; Gill, M; Morris, D; O'Neill, F A; Kendler, K; Riley, B; Craddock, N; Owen, M J; O'Donovan, M C; Thorsteinsdottir, U; Kong, A; Ehrenreich, H; Carracedo, A; Golimbet, V; Andreassen, O A; Børglum, A D; Mors, O; Mortensen, P B; Werge, T; Ophoff, R A; Nöthen, M M; Rietschel, M; Cichon, S; Ruggeri, M; Tosato, S; Palotie, A; St Clair, D; Rujescu, D; Collier, D A; Stefansson, H; Stefansson, K

2014-01-01

Epidemiological and genetic data support the notion that schizophrenia and bipolar disorder share genetic risk factors. In our previous genome-wide association study, meta-analysis and follow-up (totaling as many as 18 206 cases and 42 536 controls), we identified four loci showing genome-wide significant association with schizophrenia. Here we consider a mixed schizophrenia and bipolar disorder (psychosis) phenotype (addition of 7469 bipolar disorder cases, 1535 schizophrenia cases, 333 other psychosis cases, 808 unaffected family members and 46 160 controls). Combined analysis reveals a novel variant at 16p11.2 showing genome-wide significant association (rs4583255[T]; odds ratio=1.08; P=6.6 × 10(-11)). The new variant is located within a 593-kb region that substantially increases risk of psychosis when duplicated. In line with the association of the duplication with reduced body mass index (BMI), rs4583255[T] is also associated with lower BMI (P=0.0039 in the public GIANT consortium data set; P=0.00047 in 22 651 additional Icelanders).

Risk Distribution of Human Infections with Avian Influenza H7N9 and H5N1 virus in China

PubMed Central

Li, Xin-Lou; Yang, Yang; Sun, Ye; Chen, Wan-Jun; Sun, Ruo-Xi; Liu, Kun; Ma, Mai-Juan; Liang, Song; Yao, Hong-Wu; Gray, Gregory C.; Fang, Li-Qun; Cao, Wu-Chun

2015-01-01

It has been documented that the epidemiological characteristics of human infections with H7N9 differ significantly between H5N1. However, potential factors that may explain the different spatial distributions remain unexplored. We use boosted regression tree (BRT) models to explore the association of agro-ecological, environmental and meteorological variables with the occurrence of human cases of H7N9 and H5N1, and map the probabilities of occurrence of human cases. Live poultry markets, density of human, coverage of built-up land, relative humidity and precipitation were significant predictors for both. In addition, density of poultry, coverage of shrub and temperature played important roles for human H7N9 infection, whereas human H5N1 infection was associated with coverage of forest and water body. Based on the risks and distribution of ecological characteristics which may facilitate the circulation of the two viruses, we found Yangtze River Delta and Pearl River Delta, along with a few spots on the southeast coastline, to be the high risk areas for H7N9 and H5N1. Additional, H5N1 risk spots were identified in eastern Sichuan and southern Yunnan Provinces. Surveillance of the two viruses needs to be enhanced in these high risk areas to reduce the risk of future epidemics of avian influenza in China. PMID:26691585

Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization.

PubMed

Brennan, Julia; Kuhns, Lisa M; Johnson, Amy K; Belzer, Marvin; Wilson, Erin C; Garofalo, Robert

2012-09-01

We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors. Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey. Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration. These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization.

Addition of rituximab to chop does not increase the risk of cardiotoxicity in patients with non-Hodgkin's lymphoma.

PubMed

Kilickap, Saadettin; Yavuz, Bunyamin; Aksoy, Sercan; Sahiner, Levent; Dincer, Murat; Harputluoglu, Hakan; Erman, Mustafa; Aytemir, Kudret; Tokgozoglu, Lale; Barista, Ibrahim

2008-01-01

The addition of rituximab to doxorubicin-containing standard chemotherapy significantly improves response to therapy and reduces the risk of death in B-cell non-Hodgkin's lymphoma (NHL) patients. However, the impact of this approach on doxorubicin-induced cardiotoxicity has not been elucidated. Patients who had been planned to receive CHOP or rituximab plus CHOP (R-CHOP) combination chemotherapy with a diagnosis of NHL were included in the study. In all patients, systolic and diastolic parameters were measured by using conventional and pulsed-wave tissue Doppler echocardiography, which is more sensitive than conventional lead-dependent techniques, both before and in the sixth month of therapy. There were 28 (M/F; 14/14) patients on CHOP and 33 (M/F; 16/17) patients on R-CHOP. Median age in CHOP and R-CHOP was 49 and 50 years (P = 0.44), respectively. Cumulative doxorubicin doses were 280 and 286 mg/m(2) on CHOP and R-CHOP (P = 0.65), respectively. None of the patients developed clinically evident congestive heart failure. Parameters of systolic function such as LVEF and FS did not significantly change in any patients. In both arms, tissue Doppler parameters of diastolic function such as lateral E and septal E velocity of mitral annulus decreased significantly after therapy (P < 0.001). However, the decrease in diastolic function was similar in both arms (P > 0.05). Conventional Doppler echocardiography yielded consistent findings. Both CHOP and R-CHOP cause diastolic dysfunction in the early period following their administration. The addition of rituximab to CHOP chemotherapy does not significantly increase the risk of doxorubicin-induced cardiotoxicity during this period.

An enzyme-mediated assay to quantify inoculation volume delivered by suture needlestick injury: two gloves are better than one.

PubMed

Lefebvre, Daniel R; Strande, Louise F; Hewitt, Charles W

2008-01-01

Acquiring a blood-borne disease is a risk of performing operations. Most data about seroconversion are based on hollow-bore needlesticks. Some studies have examined the inoculation volumes of pure blood delivered by suture needles. There is a lack of data about the effect of double-gloving on contaminant transmission in less viscous fluids that are not prone to coagulation. We used enzymatic colorimetry to quantify the volume of inoculation delivered by a suture needle that was coated with an aqueous contaminant. Substrate color change was measured using a microplate reader. Both cutting and tapered suture needles were tested against five different glove types and differing numbers of glove layers (from zero to three). One glove layer removed 97% of contaminant from tapered needles and 65% from cutting needles, compared with the no-glove control data. Additional glove layers did not significantly improve contaminant removal from tapered needles (p > 0.05). For the cutting needle, 2 glove layers removed 91% of contaminant, which was significantly better than a single glove (p = 0.002). Three glove layers did not afford statistically significant additional protection (p = 0.122). There were no statistically significant differences between glove types (p = 0.41). With an aqueous needle contaminant, a single glove layer removes contaminant from tapered needles as effectively as multiple glove layers. For cutting needles, double-glove layering offers superior protection. There is no advantage to triple-glove layering. A surgeon should double-glove for maximum safety. Additionally, a surgeon should take advantage of other risk-reduction strategies, such as sharps safety, risk management, and use of sharpless instrumentation when possible.

Lifestyle Factors and Metabolic Syndrome among Workers: The Role of Interactions between Smoking and Alcohol to Nutrition and Exercise

PubMed Central

Huang, Jui-Hua; Li, Ren-Hau; Huang, Shu-Ling; Sia, Hon-Ke; Chen, Yu-Ling; Tang, Feng-Cheng

2015-01-01

This study aimed to investigate (1) relations of smoking and alcohol to metabolic syndrome (MetS) and its components, with nutrition and exercise controlled; and (2) interactions between smoking/alcohol and nutrition/exercise on MetS. This cross-sectional study enrolled 4025 workers. Self-reported lifestyles, anthropometric values, blood pressure (BP), and biochemical determinations were obtained. Among males, smoking significantly increased the risk of low high-density lipoprotein cholesterol (HDL-C), high triglyceride, abdominal obesity (AO), and MetS. Additionally, smoking showed significant interaction effects with nutrition on high BP, AO, and MetS; after further analysis, nutrition did not decrease above-mentioned risks for smokers. However, there was no significant interaction of smoking with exercise on any metabolic parameter. Alcohol increased the risk of AO, but decreased low HDL-C. It also showed an interaction effect with exercise on AO; after further analysis, exercise decreased AO risk for drinkers. Among females, alcohol significantly decreased the risk of high fasting blood glucose, but did not show significant interaction with nutrition/exercise on any metabolic parameter. In conclusion, in males, smoking retained significant associations with MetS and its components, even considering benefits of nutrition; exercise kept predominance on lipid parameters regardless of smoking status. Alcohol showed inconsistencies on metabolic parameters for both genders. PMID:26694434

Lifestyle Factors and Metabolic Syndrome among Workers: The Role of Interactions between Smoking and Alcohol to Nutrition and Exercise.

PubMed

Huang, Jui-Hua; Li, Ren-Hau; Huang, Shu-Ling; Sia, Hon-Ke; Chen, Yu-Ling; Tang, Feng-Cheng

2015-12-16

This study aimed to investigate (1) relations of smoking and alcohol to metabolic syndrome (MetS) and its components, with nutrition and exercise controlled; and (2) interactions between smoking/alcohol and nutrition/exercise on MetS. This cross-sectional study enrolled 4025 workers. Self-reported lifestyles, anthropometric values, blood pressure (BP), and biochemical determinations were obtained. Among males, smoking significantly increased the risk of low high-density lipoprotein cholesterol (HDL-C), high triglyceride, abdominal obesity (AO), and MetS. Additionally, smoking showed significant interaction effects with nutrition on high BP, AO, and MetS; after further analysis, nutrition did not decrease above-mentioned risks for smokers. However, there was no significant interaction of smoking with exercise on any metabolic parameter. Alcohol increased the risk of AO, but decreased low HDL-C. It also showed an interaction effect with exercise on AO; after further analysis, exercise decreased AO risk for drinkers. Among females, alcohol significantly decreased the risk of high fasting blood glucose, but did not show significant interaction with nutrition/exercise on any metabolic parameter. In conclusion, in males, smoking retained significant associations with MetS and its components, even considering benefits of nutrition; exercise kept predominance on lipid parameters regardless of smoking status. Alcohol showed inconsistencies on metabolic parameters for both genders.

Genetic and Psychosocial Predictors of Alcohol Use Trajectories Among Disaster-Exposed Adolescents

PubMed Central

Bountress, Kaitlin; Danielson, Carla Kmett; Williamson, Vernell; Vladmirov, Vladimir; Gelernter, Joel; Ruggiero, Kenneth; Amstadter, Ananda

2017-01-01

Background and Objectives Adolescent alcohol misuse is associated with numerous long-term adverse outcomes, so we examined predictors of alcohol use among disaster-exposed adolescents, a group at-risk for alcohol misuse. Methods The current study (n =332) examined severity of tornado-related exposure, posttraumatic stress disorder (PTSD) symptoms, emotional support, and a genetic risk sum score (GRSS) as predictors of alcohol use trajectories. Results Severity of exposure interacted with the GRSS to predict both intercept (12-month follow up quantity of alcohol use) and growth rate. Emotional support also interacted with adolescent PTSD symptoms to predict intercept and growth rate. Discussion and Conclusions Adolescents with greater severity of disaster exposure and high genetic risk comprise a high risk group, on which efforts to prevent alcohol use should be focused. Additionally, emotional support is essential in buffering the effects of PTSD symptoms on alcohol use outcomes among adolescents. Scientific Significance Toward the aim of reducing adolescent alcohol misuse following disaster exposure, there is utility in inserting immediate supports (e.g., basic resources) into communities/families that have experienced significant disaster-related severity, particularly among adolescents at high levels of genetic risk for alcohol use/misuse. Additionally, prevention efforts aimed at improving emotional supports for adolescents with more PTSD symptoms may reduce propensity for alcohol misuse following disaster. This information can be easily incorporated into existing web-based interventions. PMID:28594439

The internal suicide debate hypothesis: exploring the life versus death struggle.

PubMed

Harris, Keith M; McLean, John P; Sheffield, Jeanie; Jobes, David

2010-04-01

Researchers and theorists (e.g., Shneidman, Stengel, Kovacs, and Beck) hyothesized that suicidal people engage in an internal debate, or struggle, over whether to live or die, but few studies have tested its tenability. This study introduces direct assessment of a suicidal debate, revealing new aspects of suicidal ideation. Results, from an online survey (N = 1,016), showed nearly all suicide-risk respondents engaged in the debate. In addition, debate frequency accounted for 54% of the variance in suicidality scores, and showed significant associations with other indicators of suicide risk. Likely factors of the debate, reasons for living and dying, showed significant differences by suicidality, and most suicide-risk participants reported going online for such purposes, demonstrating a behavioral component of the debate.

Genetic variations in CYP17A1, CACNB2 and PLEKHA7 are associated with blood pressure and/or hypertension in She ethnic minority of China.

PubMed

Lin, Yinghua; Lai, Xiaolan; Chen, Bin; Xu, Yuan; Huang, Baoying; Chen, Zichun; Zhu, Shaoheng; Yao, Jin; Jiang, Qiqin; Huang, Huibin; Wen, Junping; Chen, Gang

2011-12-01

Two large-scale genome-wide association studies (GWAs) have identified multiple variants associated with blood pressure (BP) or hypertension. The present study was to investigate whether some variations were associated with BP traits and hypertension or even prehypertension in adult She ethnic minority of China. The population of the present study comprised 4460 (1979 males and 2481 females, respectively) unrelated she ethnic minority based on a cross-sectional study from Ningde City in Fujian province of China. There were 1692 hypertensives, 1600 prehypertensives and 1168 normotensive controls, respectively. We genotyped 7 variants in CYP17A1, PLEKHA7, CACNB2, ATP2B1, TBX3-TBX5, CSK-ULK3 and SH2B3 reported by the previous GWAs on Europeans. All analyses were performed in an additive genetic model. As the minor allele of rs653178 in/near SH2B3 was very rare with the frequency of 0.018, we excluded this single nucleotide polymorphism (SNP) in the further analyses. Of the other 6 loci, linear regression analyses revealed that rs11191548 in CYP17A1 and rs11014166 in CACNB2 were significantly associated with systolic BP (β = -1.17, P = 0.002 and β = -0.50, P = 0.006, respectively), while only SNP rs11191548 was significantly associated with diastolic BP (β = -0.56, P=0.002) after adjusted by age, sex and BMI. Two variants in CACNB2 and PLEKHA7 were found to be significantly related to hypertension (odds ratios [OR] and (95% confidence interval [CI]): 0.79 (0.65-0.97) and 1.19 (1.01-1.41), respectively) in logistic regression analyses after adjusted by age, sex and BMI. In addition, we found that combined risk alleles of the 6 SNPs increased risk of hypertension in a stepwise fashion (P for trend < 0.001). However, none of the 6 SNPs was significantly associated with BMI or prehypertension status. While logistic analysis showed that subjects with cumulative risk alleles more than 9 had significantly higher risk for prehypertension (adjusted OR: 3.10, P < 0.001) compared with those with risk alleles less than 4. We replicated that variations in CYP17A1, CACNB2 and PLEKHA7 were related to BP traits and/or hypertension in She population. In addition, although we failed to observe single gene associated with prehypertension, we first found that conjoint effect of multiple risk alleles on BP might increase the risk of progressing to prehypertension. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Case-control study of IL13 polymorphisms, smoking, and rhinoconjunctivitis in Japanese women: the Kyushu Okinawa Maternal and Child Health Study

PubMed Central

2011-01-01

Background Six previous studies have examined the relationships between single nucleotide polymorphisms (SNPs) in the IL13 gene and allergic rhinitis, but the results have been inconsistent. However, a recent meta-analysis using data from these 6 studies has shown that the A allele of IL13 SNP rs20541 was associated with an increased risk of allergic rhinitis, whereas no such relationship existed between IL13 SNP rs1800925 and allergic rhinitis. We investigated the associations between IL13 SNPs rs1800925 and rs20541 and the risk of rhinoconjunctivitis in Japanese women. Methods Included were 393 cases who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for rhinoconjunctivitis. Control subjects were 767 women without rhinoconjunctivitis according to the ISAAC criteria, who had also not been diagnosed with allergic rhinitis by a doctor. Adjustment was made for age, region of residence, presence of older siblings, smoking, family history of allergic rhinitis, and education. Results Compared with the GG genotype of IL13 SNP rs20541, the AA genotype, occurring in 7.1% of control subjects, was significantly positively related to the risk of rhinoconjunctivitis: the adjusted odds ratio was 1.65 (95% confidence interval: 1.05 - 2.60). SNP rs1800925 was not associated with rhinoconjunctivitis. The haplotype comprising the rs1800925 C allele and the rs20541 A allele was significantly positively related to rhinoconjunctivitis. The multiplicative interactions between the two SNPs under study and smoking on the risk of rhinoconjunctivitis were not statistically significant. Based on the recessive model, however, the additive interaction between SNP rs1800925, but not rs20541, and smoking was significant. Conclusions This study suggests that the minor genotype of IL13 SNP rs20541 and the CA haplotype are significantly positively associated with the risk of rhinoconjunctivitis. In addition, a new pattern of biological interaction that affects the risk of rhinoconjunctivitis is described between SNP rs1800925 and smoking. PMID:22023794

Synergy and other ineffective mixture risk definitions.

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

Hertzberg, R.; MacDonell, M.; Environmental Assessment

2002-04-08

A substantial effort has been spent over the past few decades to label toxicologic interaction outcomes as synergistic, antagonistic, or additive. Although useful in influencing the emotions of the public and the press, these labels have contributed fairly little to our understanding of joint toxic action. Part of the difficulty is that their underlying toxicological concepts are only defined for two chemical mixtures, while most environmental and occupational exposures are to mixtures of many more chemicals. Furthermore, the mathematical characterizations of synergism and antagonism are inextricably linked to the prevailing definition of 'no interaction,' instead of some intrinsic toxicological property.more » For example, the US EPA has selected dose addition as the no-interaction definition for mixture risk assessment, so that synergism would represent toxic effects that exceed those predicted from dose addition. For now, labels such as synergism are useful to regulatory agencies, both for qualitative indications of public health risk as well as numerical decision tools for mixture risk characterization. Efforts to quantify interaction designations for use in risk assessment formulas, however, are highly simplified and carry large uncertainties. Several research directions, such as pharmacokinetic measurements and models, and toxicogenomics, should promote significant improvements by providing multi-component data that will allow biologically based mathematical models of joint toxicity to replace these pairwise interaction labels in mixture risk assessment procedures.« less

Aeroallergens, allergic rhinitis, and sedating antihistamines: risk factors for traumatic occupational injury and economic impact.

PubMed

Hanrahan, L P; Paramore, L C

2003-10-01

The U.S. workplace injury burden is significant. Our objective was to assess the particular impact of aeroallergen, allergic rhinitis, and antihistamine exposures and side effects on the risk of traumatic work-related injuries, and the associated economic impact. This is an observational case-control study with 1,223 acute traumatic injury cases that are compared to 1,202 chronic back injury controls. Structured telephone interviews were conducted in 1998 and 1999 on Workers' Compensation applicants injured in 1997. Antihistamine use and pollen levels were measured 2 weeks prior to the injury date. Sedating antihistamine exposures elevated acute injury risk (main effect OR: 2.93). A significant increase in traumatic injury risk was observed for combined sedating antihistamine and high pollen exposures among subjects with physician and self-diagnosed allergic rhinitis (OR: 2.41). Direct medical costs associated with this increased risk were estimated at $143 million in 2001. Workers with physician-diagnosed allergic rhinitis have as high a reliance on sedating antihistamines as do self-diagnosed and self-medicating nasal allergy sufferers. High pollen exposures along with sedating antihistamine use may confer significant additional injury risks among allergic rhinitis sufferers. Medical management "best practices" of diagnosed allergic rhinitis should include avoidance of sedating antihistamines to minimize acute, traumatic injury risks. Copyright 2003 Wiley-Liss, Inc.

Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco.

PubMed

Shields, John P; Whitaker, Kelly; Glassman, Jill; Franks, Heather M; Howard, Kelli

2012-04-01

This study investigated the association between sexual orientation, victimization, and suicide risk-related outcomes among youth attending public high schools in San Francisco. Data from the 2009 Youth Risk Behavior Survey were analyzed using bivariate and logistic regression methods for complex samples to examine the relationship between sexual orientation, victimization, and three suicide risk-related outcomes (sadness/depression, suicide planning, and attempting suicide) while controlling for demographics and substance use. Lesbian, gay, or bisexual (LGB) youth reported significantly higher rates of substance use, victimization, and suicide risk-related outcomes than heterosexual youth. However, in the controlled regression models, victimization was a significant predictor of sadness/depression and suicide attempts, regardless of sexual orientation. There was a significant interaction effect between sexual orientation and victimization on suicide planning, with heterosexual youth more affected than LGB youth. Results underscore the deleterious effect of victimization on suicide risk-related outcomes, regardless of sexual orientation. As LGB youth continue to report higher rates of victimization, effective violence prevention approaches must focus on reducing violence among youth, specifically LGB youth. Additional research should focus on identification of other factors that may help further explain elevated suicide risk among LGB youth. Copyright © 2012 Society for Adolescent Health and Medicine. All rights reserved.

Burn-center quality improvement: are burn outcomes dependent on admitting facilities and is there a volume-outcome "sweet-spot"?

PubMed

Hranjec, Tjasa; Turrentine, Florence E; Stukenborg, George; Young, Jeffrey S; Sawyer, Robert G; Calland, James F

2012-05-01

Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.

Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa.

PubMed

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

2009-10-06

The lifestyle risk factors for nasopharyngeal carcinoma (NPC) in North Africa are not known. 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. 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. Tobacco, cannabis and domestic cooking fumes intake are risk factors for NPC in western North Africa.

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

Evaluating genetic risk for prostate cancer among Japanese and Latinos

PubMed Central

Cheng, Iona; Chen, Gary K.; Nakagawa, Hidewaki; He, Jing; Wan, Peggy; Laurie, Cathy; Shen, Jess; Sheng, Xin; Pooler, Loreall C.; Crenshaw, Andrew T.; Mirel, Daniel B.; Takahashi, Atsushi; Kubo, Michiaki; Nakamura, Yusuke; Al Olama, Ali Amin; Benlloch, Sara; Donovan, Jenny L.; Guy, Michelle; Hamdy, Freddie C.; Kote-Jarai, Zsofia; Neal, David E.; Wilkens, Lynne R.; Monroe, Kristine R.; Stram, Daniel O.; Muir, Kenneth; Eeles, Rosalind A.; Easton, Douglas F.; Kolonel, Laurence N.; Henderson, Brian E.; Le Marchand, Loïc; Haiman, Christopher A.

2012-01-01

Background There have been few genome-wide association studies (GWAS) of prostate cancer among diverse populations. To search for novel prostate cancer risk variants, we conducted GWAS of prostate cancer in Japanese and Latinos. In addition, we tested prostate cancer risk variants and developed genetic risk models of prostate cancer for Japanese and Latinos. Methods Our first stage GWAS of prostate cancer included Japanese (cases/controls=1,033/1,042) and Latino (cases/controls=1,043/1,057) from the Multiethnic Cohort. Significant associations from stage 1 (P < 1.0×10−4) were examined in silico in GWAS of prostate cancer (stage 2) in Japanese (cases/controls=1,583/3,386) and Europeans (cases/controls=1,854/1,894). Results No novel stage 1 SNPs outside of known risk regions reached genome-wide significance. For Japanese, in stage 1, the most notable putative novel association was seen with 10 SNPs (P<8.0. x10−6) at chromosome 2q33; however, this was not replicated in stage 2. For Latinos, the most significant association was observed with rs17023900 at the known 3p12 risk locus (stage 1: OR=1.45; P=7.01×10−5 and stage 2: OR=1.58; P =3.05×10−7). The majority of the established risk variants for prostate cancer, 79% and 88%, were positively associated with prostate cancer in Japanese and Latinos (stage I), respectively. The cumulative effects of these variants significantly influence prostate cancer risk (OR per allele=1.10; P = 2.71×10−25 and OR=1.07; P = 1.02×10−16 for Japanese and Latinos, respectively). Conclusion and Impact Our GWAS of prostate cancer did not identify novel genome-wide significant variants. However, our findings demonstrate that established risk variants for prostate cancer significantly contribute to risk among Japanese and Latinos. PMID:22923026

Evaluating genetic risk for prostate cancer among Japanese and Latinos.

PubMed

Cheng, Iona; Chen, Gary K; Nakagawa, Hidewaki; He, Jing; Wan, Peggy; Laurie, Cathy C; Shen, Jess; Sheng, Xin; Pooler, Loreall C; Crenshaw, Andrew T; Mirel, Daniel B; Takahashi, Atsushi; Kubo, Michiaki; Nakamura, Yusuke; Al Olama, Ali Amin; Benlloch, Sara; Donovan, Jenny L; Guy, Michelle; Hamdy, Freddie C; Kote-Jarai, Zsofia; Neal, David E; Wilkens, Lynne R; Monroe, Kristine R; Stram, Daniel O; Muir, Kenneth; Eeles, Rosalind A; Easton, Douglas F; Kolonel, Laurence N; Henderson, Brian E; Le Marchand, Loïc; Haiman, Christopher A

2012-11-01

There have been few genome-wide association studies (GWAS) of prostate cancer among diverse populations. To search for novel prostate cancer risk variants, we conducted GWAS of prostate cancer in Japanese and Latinos. In addition, we tested prostate cancer risk variants and developed genetic risk models of prostate cancer for Japanese and Latinos. Our first-stage GWAS of prostate cancer included Japanese (cases/controls = 1,033/1,042) and Latino (cases/controls = 1,043/1,057) from the Multiethnic Cohort (MEC). Significant associations from stage I (P < 1.0 × 10(-4)) were examined in silico in GWAS of prostate cancer (stage II) in Japanese (cases/controls = 1,583/3,386) and Europeans (cases/controls = 1,854/1,894). No novel stage I single-nucleotide polymorphism (SNP) outside of known risk regions reached genome-wide significance. For Japanese, in stage I, the most notable putative novel association was seen with 10 SNPs (P ≤ 8.0 × 10(-6)) at chromosome 2q33; however, this was not replicated in stage II. For Latinos, the most significant association was observed with rs17023900 at the known 3p12 risk locus (stage I: OR = 1.45; P = 7.01 × 10(-5) and stage II: OR = 1.58; P = 3.05 × 10(-7)). The majority of the established risk variants for prostate cancer, 79% and 88%, were positively associated with prostate cancer in Japanese and Latinos (stage I), respectively. The cumulative effects of these variants significantly influence prostate cancer risk (OR per allele = 1.10; P = 2.71 × 10(-25) and OR = 1.07; P = 1.02 × 10(-16) for Japanese and Latinos, respectively). Our GWAS of prostate cancer did not identify novel genome-wide significant variants. However, our findings show that established risk variants for prostate cancer significantly contribute to risk among Japanese and Latinos. ©2012 AACR.

Prevalence of Giardia infection in households of Giardia cases and risk factors for household transmission.

PubMed

Waldram, Alison; Vivancos, Roberto; Hartley, Catherine; Lamden, Kenneth

2017-07-11

Giardia is a leading but neglected cause of infectious gastroenteritis worldwide and is treatable. There is a substantial burden of undetected Giardia in the UK and for every one case of Giardia reported to national surveillance there are 14 cases in the community. We aimed to ascertain the prevalence of, and risk factors associated with secondary household Giardia infections to assess the burden of infection and inform control measures. We identified all giardiasis cases notified in nine local authorities in Lancashire between June 2014 and June 2015, and invited their household contacts to submit faecal specimens for Giardia testing and complete a risk factor questionnaire. We estimated the proportion of households with additional Giardia infection. We compared household risk factors between households with and without additional Giardia using Fisher's exact test. We used multivariable logistic regression to identify independent risk factors for additional Giardia infections. We identified additional Giardia infections in 30% (27/91) of included households. A total of 41 infections were found from 212 household members, of which 37 were asymptomatic. The majority of infections were assemblage B (57%) but there were also a high number of mixed infections (20%). Risk factors significantly associated with additional household infections were; having children under 5 years in the household (odds ratio 42; 95% confidence intervals 10-178) and the presence of gastrointestinal illness in the household before the onset of the index case (odds ratio 9; 95% confidence intervals 1.5-48). Our finding of a high household prevalence of asymptomatic infection has raised the public health question of whether treatment of asymptomatic household contacts may be justified in preventing Giardia re-infection of the index case or in preventing secondary cases and household clusters. We recommend the communication of this risk in household contacts of Giardia and reinforcement of standard hygiene controls.

Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta-Analysis.

PubMed

Kojima, Gotaro; Avgerinou, Christina; Iliffe, Steve; Walters, Kate

2018-04-01

To conduct a systematic review of the literature on prospective cohort studies examining associations between adherence to a Mediterranean diet and incident frailty and to perform a meta-analysis to synthesize the pooled risk estimates. Systematic review and meta-analysis. Embase, MEDLINE, CINAHL, PsycINFO, and Cochrane Library were systematically searched on September 14, 2017. We reviewed references of included studies and relevant review papers and performed forward citation tracking for additional studies. Corresponding authors were contacted for additional data necessary for a meta-analysis. Community-dwelling older adults (mean age ≥60). Incident frailty risk according to adherence to a Mediterranean diet. Two reviewers independently screened the title, abstract, and full text to ascertain the eligibility of 125 studies that the systematic search of the literature identified, and four studies were included (5,789 older people with mean follow-up of 3.9 years). Two reviewers extracted data from the studies independently. All four studies provided adjusted odds ratios (ORs) of incident frailty risk according to three Mediterranean diet score (MDS) groups (0-3, 4-5, and 6-9). Greater adherence to a Mediterranean diet was associated with significantly lower incident frailty risk (pooled OR = 0.62, 95% CI = 0.47-0.82, P = .001 for MDS 4-5; pooled OR = 0.44, 95% CI = 0.31-0.64, P < .001 for MDS 6-9) than poorer adherence (MDS 0-3). Neither significant heterogeneity (I 2  = 0-16%, P = .30) nor evidence of publication bias was observed. Greater adherence to a Mediterranean diet is associated with significantly lower risk of incident frailty in community-dwelling older people. Future studies should confirm these findings and evaluate whether adherence to a Mediterranean diet can reduce the risk of frailty, including in non-Mediterranean populations. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Risk Factors for Infection After Rotator Cuff Repair.

PubMed

Vopat, Bryan G; Lee, Bea J; DeStefano, Sherilyn; Waryasz, Gregory R; Kane, Patrick M; Gallacher, Stacey E; Fava, Joseph; Green, Andrew G

2016-03-01

To identify risk factors for infection after rotator cuff repair. We hypothesized that patient characteristics and surgical technique would affect the rate of infection. The records of 1,824 rotator cuff repairs performed by a single surgeon from 1995 to 2010 were reviewed retrospectively. Fourteen patients had an early deep postoperative wound infection that was treated with surgical irrigation and debridement. One hundred eighty-five control patients who were treated with rotator cuff repair and did not develop an infection were selected randomly for comparison and statistical analysis. Data regarding preoperative and intraoperative risk factors for infection were recorded, and a multiple logistic regression was conducted to investigate predictors of infection. The infection rate was 0.77% (14/1,822). On average 2.1 (range 1 to 4) surgical debridements were performed in addition to treatment with intravenous antibiotics. Patients who had open or miniopen rotator cuff repair had a significantly greater risk of acute postoperative infection (odds ratio [OR] = 8.63, P = .002). Seventy-nine percent of the patients in the infection group had an open or miniopen repair, whereas only 28% of the control group had an open or miniopen repair. Male patients also had a significantly greater risk of acute postoperative infection (OR = 9.52, P = .042). A total of 92% of the infection patients were male compared with 58% of the control group. In addition, as body mass index increased there was a reduction in the odds of infection (OR = 0.81, P = .023). The results of this case control study demonstrate that open or miniopen surgical technique and male sex are significant risk factors for infection after rotator cuff repair. In our study, arthroscopic rotator cuff repair reduced the risk of infection compared with open techniques. Level IV. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Pharmaceutical supply chain risk assessment in Iran using analytic hierarchy process (AHP) and simple additive weighting (SAW) methods.

PubMed

Jaberidoost, Mona; Olfat, Laya; Hosseini, Alireza; Kebriaeezadeh, Abbas; Abdollahi, Mohammad; Alaeddini, Mahdi; Dinarvand, Rassoul

2015-01-01

Pharmaceutical supply chain is a significant component of the health system in supplying medicines, particularly in countries where main drugs are provided by local pharmaceutical companies. No previous studies exist assessing risks and disruptions in pharmaceutical companies while assessing the pharmaceutical supply chain. Any risks affecting the pharmaceutical companies could disrupt supply medicines and health system efficiency. The goal of this study was the risk assessment in pharmaceutical industry in Iran considering process's priority, hazard and probability of risks. The study was carried out in 4 phases; risk identification through literature review, risk identification in Iranian pharmaceutical companies through interview with experts, risk analysis through a questionnaire and consultation with experts using group analytic hierarchy process (AHP) method and rating scale (RS) and risk evaluation of simple additive weighting (SAW) method. In total, 86 main risks were identified in the pharmaceutical supply chain with perspective of pharmaceutical companies classified in 11 classes. The majority of risks described in this study were related to the financial and economic category. Also financial management was found to be the most important factor for consideration. Although pharmaceutical industry and supply chain were affected by current political conditions in Iran during the study time, but half of total risks in the pharmaceutical supply chain were found to be internal risks which could be fixed by companies, internally. Likewise, political status and related risks forced companies to focus more on financial and supply management resulting in less attention to quality management.

The novel EuroSCORE II algorithm predicts the hospital mortality of thoracic aortic surgery in 461 consecutive Japanese patients better than both the original additive and logistic EuroSCORE algorithms.

PubMed

Nishida, Takahiro; Sonoda, Hiromichi; Oishi, Yasuhisa; Tanoue, Yoshihisa; Nakashima, Atsuhiro; Shiokawa, Yuichi; Tominaga, Ryuji

2014-04-01

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was developed to improve the overestimation of surgical risk associated with the original (additive and logistic) EuroSCOREs. The purpose of this study was to evaluate the significance of the EuroSCORE II by comparing its performance with that of the original EuroSCOREs in Japanese patients undergoing surgery on the thoracic aorta. We have calculated the predicted mortalities according to the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II algorithms in 461 patients who underwent surgery on the thoracic aorta during a period of 20 years (1993-2013). The actual in-hospital mortality rates in the low- (additive EuroSCORE of 3-6), moderate- (7-11) and high-risk (≥11) groups (followed by overall mortality) were 1.3, 6.2 and 14.4% (7.2% overall), respectively. Among the three different risk groups, the expected mortality rates were 5.5 ± 0.6, 9.1 ± 0.7 and 13.5 ± 0.2% (9.5 ± 0.1% overall) by the additive EuroSCORE algorithm, 5.3 ± 0.1, 16 ± 0.4 and 42.4 ± 1.3% (19.9 ± 0.7% overall) by the logistic EuroSCORE algorithm and 1.6 ± 0.1, 5.2 ± 0.2 and 18.5 ± 1.3% (7.4 ± 0.4% overall) by the EuroSCORE II algorithm, indicating poor prediction (P < 0.0001) of the mortality in the high-risk group, especially by the logistic EuroSCORE. The areas under the receiver operating characteristic curves of the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II algorithms were 0.6937, 0.7169 and 0.7697, respectively. Thus, the mortality expected by the EuroSCORE II more closely matched the actual mortality in all three risk groups. In contrast, the mortality expected by the logistic EuroSCORE overestimated the risks in the moderate- (P = 0.0002) and high-risk (P < 0.0001) patient groups. Although all of the original EuroSCOREs and EuroSCORE II appreciably predicted the surgical mortality for thoracic aortic surgery in Japanese patients, the EuroSCORE II best predicted the mortalities in all risk groups.

Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery.

PubMed

Sujata, Nambiath; Tobin, Raj; Kaur, Ranjeet; Aneja, Anjila; Khanna, Mona; Hanjoora, Vijay M

2016-06-01

To assess the effects of tranexamic acid among patients undergoing cesarean delivery who were at high risk of postpartum hemorrhage. Between August 1, 2012, and April 30, 2013, a randomized controlled trial was performed at a tertiary care center in India. Women undergoing an elective or emergency cesarean delivery who were at high risk for postpartum hemorrhage were enrolled. They were randomly assigned using sealed, opaque envelopes to receive 10mg/kg tranexamic acid or normal saline 10min before skin incision. Anesthesiologists were not masked to group assignment, but patients and obstetricians were. The primary outcome was need for additional uterotonic drugs within 24h after delivery. Analyses were by intention to treat. Thirty patients were assigned to each group. Additional uterotonic drugs were required in 7 (23%) patients assigned to tranexamic acid and 25 (83%) patients in the control group (P<0.001). Intravenous tranexamic acid, administered before skin incision, significantly reduced the requirement for additional uterotonics among women at increased risk for postpartum hemorrhage. Clinical Trials Registry India: CTRI/2015/05/005752. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

General Practice Clinical Data Help Identify Dementia Hotspots: A Novel Geospatial Analysis Approach.

PubMed

Bagheri, Nasser; Wangdi, Kinley; Cherbuin, Nicolas; Anstey, Kaarin J

2018-01-01

We have a poor understanding of whether dementia clusters geographically, how this occurs, and how dementia may relate to socio-demographic factors. To shed light on these important questions, this study aimed to compute a dementia risk score for individuals to assess spatial variation of dementia risk, identify significant clusters (hotspots), and explore their association with socioeconomic status. We used clinical records from 16 general practices (468 Statistical Area level 1 s, N = 14,746) from the city of west Adelaide, Australia for the duration of 1 January 2012 to 31 December 2014. Dementia risk was estimated using The Australian National University-Alzheimer's Disease Risk Index. Hotspot analyses were applied to examine potential clusters in dementia risk at small area level. Significant hotspots were observed in eastern and southern areas while coldspots were observed in the western area within the study perimeter. Additionally, significant hotspots were observed in low socio-economic communities. We found dementia risk scores increased with age, sex (female), high cholesterol, no physical activity, living alone (widow, divorced, separated, or never married), and co-morbidities such as diabetes and depression. Similarly, smoking was associated with a lower dementia risk score. The identification of dementia risk clusters may provide insight into possible geographical variations in risk factors for dementia and quantify these risks at the community level. As such, this research may enable policy makers to tailor early prevention strategies to the correct individuals within their precise locations.

Anxiety and Shame as Risk Factors for Depression, Suicidality, and Functional Impairment in Body Dysmorphic Disorder and Obsessive Compulsive Disorder.

PubMed

Weingarden, Hilary; Renshaw, Keith D; Wilhelm, Sabine; Tangney, June P; DiMauro, Jennifer

2016-11-01

Body dysmorphic disorder (BDD) and obsessive compulsive disorder (OCD) are associated with elevated depression, suicidality, functional impairment, and days housebound, yet little research has identified risk factors for these outcomes. Using path analysis, the present study examined anxiety and shame as risk factors for these outcomes across Internet-recruited self-report groups (BDD [n = 114], OCD [n = 114], and healthy control [HC; n = 133]). Paths from anxiety and shame to outcomes were similar and mostly significant across BDD and OCD, compared to non-significant paths for HCs, with one exception: the path from shame to depression was significant in the BDD group (b = 0.32) but non-significant in the OCD group (b = 0.07). Findings underscore similarities in BDD and OCD, supporting their reclassification into the same Obsessive Compulsive Related Disorders category. Results emphasize the importance of targeting shame, in addition to anxiety, in treatments for BDD and OCD.

Anxiety and Shame as Risk Factors for Depression, Suicidality, and Functional Impairment in Body Dysmorphic Disorder and Obsessive Compulsive Disorder

PubMed Central

Weingarden, Hilary; Renshaw, Keith D.; Wilhelm, Sabine; Tangney, June P.; DiMauro, Jennifer

2016-01-01

Body dysmorphic disorder (BDD) and obsessive compulsive disorder (OCD) are associated with elevated depression, suicidality, functional impairment, and days housebound, yet little research has identified risk factors for these outcomes. Using path analysis, the present study examined anxiety and shame as risk factors for these outcomes across Internet-recruited self-report groups (BDD [n = 114], OCD [n = 114], and healthy control [HC; n = 133]. Paths from anxiety and shame to outcomes were similar and mostly significant across BDD and OCD, compared to non-significant paths for HCs, with one exception: the path from shame to depression was significant in the BDD group (b = .32) but non-significant in the OCD group (b = .07). Findings underscore similarities in BDD and OCD, supporting their reclassification into the same Obsessive Compulsive Related Disorders category. Results emphasize the importance of targeting shame, in addition to anxiety, in treatments for BDD and OCD. PMID:26998694

Stroke risk perception among participants of a stroke awareness campaign

PubMed Central

Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus

2007-01-01

Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. Stroke risk factor knowledge, perception of lifetime stroke risk and risk factor status were included in the questionnaire, and the determinants of good risk factor knowledge and high stroke risk perception were identified using logistic regression models. Results Overall stroke risk factor knowledge was good with 67–96% of the participants recognizing established risk factors. The two exceptions were diabetes (recognized by 49%) and myocardial infarction (57%). Knowledge of a specific factor was superior among those affected by it. 13% of all participants considered themselves of having a high stroke risk, 55% indicated a moderate risk. All major risk factors contributed significantly to the perception of being at high stroke risk, but the effects of age, sex and education were non-significant. Poor self-rated health was additionally associated with high individual stroke risk perception. Conclusion Stroke risk factor knowledge was high in this study. The self perception of an increased stroke risk was associated with established risk factors as well as low perception of general health. PMID:17371603

Failure of ganciclovir prophylaxis to completely eradicate CMV disease in renal transplant recipients treated with intense anti-rejection immunotherapy.

PubMed

Isenberg, A L; Shen, G K; Singh, T P; Hahn, A; Conti, D J

2000-06-01

Ganciclovir prophylactic regimens have been shown to be effective in renal transplant recipients at risk for primary (donor seropositive/recipient seronegative) and secondary (recipient seropositive) cytomegalovirus (CMV) disease. However, in addition to serologic factors, the type and intensity of the administered immunosuppression is a strong risk factor for CMV disease. Since January 1995, we have utilized a potent immunosuppressive protocol selectively in recipients at high risk for immunologic graft loss, defined as retransplant recipients, recipients with delayed graft function, non-Caucasian recipients, and recipients suffering from acute rejection. Between January 1995 and December 1996, 110 consecutive renal transplants were performed in recipients who were either CMV seropositive or received an allograft from a CMV-seropositive donor. All recipients received ganciclovir prophylactic therapy for 3 months post-transplant. Group I (N = 43) consisted of recipients at high-immunologic risk for graft loss as defined above. These recipients were treated with an intense anti-rejection immunotherapeutic regimen consisting of Cellcept, Neoral, and prednisone, with the frequent addition of antilymphocyte antibody therapies and intravenous methylprednisolone. The remaining 67 recipients (group II) were treated with a less intense immunotherapeutic regimen consisting of azathioprine, Neoral, and prednisone. The incidence and severity of CMV disease and the patient and allograft survival were compared. The incidence of CMV syndrome was greater in group I (28%) compared with group II (7%), and was statistically significant (p < 0.05). The 1-yr patient and graft survival were similar, 95 and 91%, respectively, for group I compared with 97 and 97%, respectively, for group II. These data suggest that 3 months of ganciclovir prophylactic therapy is significantly less effective for the prevention of CMV disease in renal transplant recipients at high risk for acute rejection treated with an intense immunotherapeutic regimen. These data suggest that more effective prevention of CMV disease in these high-risk recipients will require the addition of other anti-viral agents, such as immunoglobulin preparation to the prophylactic regimen.

Public health risk of trace metals in fresh chicken meat products on the food markets of a major production region in southern China.

PubMed

Hu, Yuanan; Zhang, Wenfeng; Chen, Gang; Cheng, Hefa; Tao, Shu

2018-03-01

Because most chickens are reared in intensive farms, where a range of feed additives are used routinely, concerns have been raised on the potential public health risk of chicken product consumption. This study was conducted to characterize the contents of trace metals in fresh chicken tissues (354 samples) on the food markets in Guangdong province of southern China, a major region of chicken production with heavy per capita chicken consumption, and to assess the public health risk from chronic dietary exposure to the trace metals through chicken consumption. With the exception of Cr, Ni, and Pb, the contents of trace metals were generally higher in the chicken giblets (livers, gizzards, hearts, and kidneys) compared to muscles (breasts and drumsticks). Chicken tissues from the urban markets generally contained higher levels of As, Cu, Mn, and Zn than those from the rural markets, while the contents of Pb were typically higher in the chicken muscles from the rural markets. Results of statistical analyses indicate that Cu, Zn, and As in the chicken tissues derived mainly from the feeds, which is consistent with the widespread use of Cu, Zn, and phenylarsenic compounds as feed supplements/additives in intensive poultry farming. No non-carcinogenic risk is found with the consumption of fresh chicken meat products on the food markets, while approximately 70% of the adult population in Guangzhou and 30% of those in Lianzhou have bladder and lung cancer risk above the serious or priority level (10 -4 ), which arises from the inorganic arsenic contained in the chicken tissues. These findings indicate that the occurrence of inorganic arsenic at elevated levels in chicken tissues on the food markets in Guangdong province poses a significant public health risk, thus the use of phenylarsenic feed additives in China's poultry farming should be significantly reduced and eventually phased out. Copyright © 2017 Elsevier Ltd. All rights reserved.

Case-control study of paternal occupation and childhood leukaemia in Great Britain, 1962-2006.

PubMed

Keegan, T J; Bunch, K J; Vincent, T J; King, J C; O'Neill, K A; Kendall, G M; MacCarthy, A; Fear, N T; Murphy, M F G

2012-10-23

Paternal occupational exposures have been proposed as a risk factor for childhood leukaemia. This study investigates possible associations between paternal occupational exposure and childhood leukaemia in Great Britain. The National Registry of Childhood Tumours provided all cases of childhood leukaemia born and diagnosed in Great Britain between 1962 and 2006. Controls were matched on sex, period of birth and birth registration subdistrict. Fathers' occupations were assigned to 1 or more of 33 exposure groups. Social class was derived from father's occupation at the time of the child's birth. A total of 16 764 cases of childhood leukaemia were ascertained. One exposure group, paternal social contact, was associated with total childhood leukaemia (odds ratio 1.14, 1.05-1.23); this association remained significant when adjusted for social class. The subtypes lymphoid leukaemia (LL) and acute myeloid leukaemia showed increased risk with paternal exposure to social contact before adjustment for social class. Risk of other leukaemias was significantly increased by exposure to electromagnetic fields, persisting after adjustment for social class. For total leukaemia, the risks for exposure to lead and exhaust fumes were significantly <1. Occupationally derived social class was associated with risk of LL, with the risk being increased in the higher social classes. Our results showed some support for a positive association between childhood leukaemia risk and paternal occupation involving social contact. Additionally, LL risk increased with higher paternal occupational social class.

Application of Probabilistic Modeling to Quantify the Reduction Levels of Hepatocellular Carcinoma Risk Attributable to Chronic Aflatoxins Exposure.

PubMed

Wambui, Joseph M; Karuri, Edward G; Ojiambo, Julia A; Njage, Patrick M K

2017-01-01

Epidemiological studies show a definite connection between areas of high aflatoxin content and a high occurrence of human hepatocellular carcinoma (HCC). Hepatitis B virus in individuals further increases the risk of HCC. The two risk factors are prevalent in rural Kenya and continuously predispose the rural populations to HCC. A quantitative cancer risk assessment therefore quantified the levels at which potential pre- and postharvest interventions reduce the HCC risk attributable to consumption of contaminated maize and groundnuts. The assessment applied a probabilistic model to derive probability distributions of HCC cases and percentage reductions levels of the risk from secondary data. Contaminated maize and groundnuts contributed to 1,847 ± 514 and 158 ± 52 HCC cases per annum, respectively. The total contribution of both foods to the risk was additive as it resulted in 2,000 ± 518 cases per annum. Consumption and contamination levels contributed significantly to the risk whereby lower age groups were most affected. Nonetheless, pre- and postharvest interventions might reduce the risk by 23.0-83.4% and 4.8-95.1%, respectively. Therefore, chronic exposure to aflatoxins increases the HCC risk in rural Kenya, but a significant reduction of the risk can be achieved by applying specific pre- and postharvest interventions.

Socioeconomic status and risk factors for cardiovascular disease: Impact of dietary mediators.

PubMed

Psaltopoulou, Theodora; Hatzis, George; Papageorgiou, Nikolaos; Androulakis, Emmanuel; Briasoulis, Alexandros; Tousoulis, Dimitris

It is well known that cardiovascular disease is the leading cause of mortality in the western societies. A number of risk factors such as family history, diabetes, hypertension, obesity, diabetes, smoking and physical inactivity are responsible for a significant proportion of the overall cardiovascular risk. Interestingly, recent data suggest there is a gradient in the incidence, morbidity and mortality of cardiovascular disease across the spectrum of socioeconomic status, as this is defined by educational level, occupation or income. Additionally, dietary mediators seem to play significant role in the pathogenesis of cardiovascular disease, mediating some of the discrepancies in atherosclerosis among different socioeconomic layers. Therefore, in the present article, we aim to review the association between socioeconomic status and cardiovascular disease risk factors and the role of different dietary mediators. Copyright © 2017 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.

B-type Natriuretic Peptide and RISK-PCI Score in the Risk Assessment in Patients with STEMI Treated by Primary Percutaneous Coronary Intervention.

PubMed

Asanin, Milika; Mrdovic, Igor; Savic, Lidija; Matic, Dragan; Krljanac, Gordana; Vukcevic, Vladan; Orlic, Dejan; Stankovic, Goran; Marinkovic, Jelena; Stankovic, Sanja

2016-01-01

RISK-PCI score is a novel score for risk stratification of patients with ST elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). The aim of this study was to evaluate the role of B-type natriuretic peptide (BNP) and the RISK-PCI score for early risk assessment in patients with STEMI treated by pPCI. In 120 patients with STEMI treated by pPCI, BNP was measured on admission before pPCI. The primary end point was 30-day mortality. The ROC curve analysis revealed that the most powerful predictive factors of 30-day mortality were the plasma level of BNP ≥ 206.6 pg/mL with the sensitivity of 75% and specificity of 87.5% and the RISK-PCI score ≥ 5.25 with the sensitivity of 75% and specificity of 85.7%. Thirty-day mortality was 6.7%. After multivariate adjustment, admission BNP (≥ 206.6 pg/mL) (OR 2.952, 95% CI 1.072 - 8.133, p = 0.036) and the RISK-PCI score (≥ 5.25) (OR 2.284, 95% CI 1.140-4.578, p = 0.020) were independent predictors of 30-day mortality. The area under the ROC curve using the RISK-PCI score and BNP to detect mortality was 0.828 (p = 0.002) and 0.903 (p < 0.001), respectively. Addition of BNP to RISK-PCI score increased the area under the ROC to 0.949 (p < 0.001), but this increase measured by the c-statistic was not significant (p = 0.107). Furthermore, the significant improvement in risk reclassification (p < 0.001) and the integrated discrimination index (p = 0.042) were observed with the addition of BNP to RISK-PCI score for 30-day mortality. BNP on admission and the RISK-PCI score were the independent predictors of 30-day mortality in patients with the STEMI treated by pPCI. BNP in combination with the RISK-PCI score showed the way to more accurate risk assessment in patients with STEMI treated by pPCI.

Efficacy of Implementation of a Chest Pain Center at a Community Hospital.

PubMed

Davis, Alexandra; Chiu, Jason; Lau, Stanley K; Kok, Yih Jen; Wu, Jonathan Y H

2017-12-01

Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention. This retrospective review and assessment sought to evaluate the efficacy of implementation of a Chest Pain Center (CPC) at a predominantly Asian-based community hospital in the United States. Additionally, this assessment sought to evaluate the effectiveness and safety of a HEART protocol in the first 4 months after its adoption. The facility implemented the CPC, an observation unit, in October 2016. ED physicians risk stratified patients using the HEART score. The guidelines allow ED physicians to stratify patients into 3 categories: to discharge low-risk patients, observe moderate-risk patients in the CPC, and admit high-risk patients. Patients in the CPC received additional diagnostic work-up under the care of ED physicians and cardiologists for less than 24 hours. In addition, CPC patients were followed-up 2 and 30 days after discharge. A total of 172 patients presented at the ED with a chief complaint of chest pain. The majority of the patients were classified into the moderate-risk group (n = 101). Low-risk patients spent significantly less hours in the hospital than the moderate- and high-risk groups, and the high-risk group spent more time in the hospital than the moderate-risk group. The staff followed-up with 74 CPC patients through telephone calls to assess if patients were still experiencing chest pain and if they had followed-up with a cardiologist or primary care physician. The 2- and 30-day survival rates were 100% and 97%, respectively. The data showed a significant reduction in total length of stay for all chest pain patients. This retrospective program evaluation demonstrated some evidence in using HEART score to safely risk stratify chest pain patients to the appropriate level of care. As healthcare moves from a fee-for-service environment to value-based purchasing, hospitals need to devise and implement innovative strategies to provide efficient, beneficial, and safe care for the patients.

Association Among Television and Computer/Video Game Use, Victimization, and Suicide Risk Among U.S. High School Students.

PubMed

Rostad, Whitney L; Basile, Kathleen C; Clayton, Heather B

2018-03-01

With the increasing popularity of mobile Internet devices, the exposure of adolescents to media has significantly increased. There is limited information about associations between the types and frequency of media use and experiences of violence victimization and suicide risk. The current study sought to examine the association of bullying and teen dating violence (TDV) victimization, suicide risk with different types of media use (i.e., television and computer/video game use), and number of total media use hours per school day. Data from the nationally representative 2015 Youth Risk Behavior Survey ( n = 15,624) were used to examine the association between media use and violence victimization and suicide risk. Logistic regression models generated prevalence ratios adjusted for demographic characteristics and substance use behaviors to identify significant associations between media use and victimization and suicide risk, stratified by gender. Media use was associated with TDV victimization for male students only, while media use was related to experiences of bullying and suicide risk for both male and female students. In addition, limited (2 or fewer hours) and excessive (5 or more hours) media use emerged as significant correlates of suicide risk and bullying victimization, with limited media use associated with decreased risk and excessive media use with increased risk. Comprehensive, cross-cutting efforts to prevent different forms of victimization should take into account media use and its potential association with adolescent victimization and suicide risk. The current study results suggest limiting adolescent media use, as part of comprehensive prevention programming, might relate to reductions in risk for victimization and suicide.

Refusal of Recommended Chemotherapy for Ovarian Cancer: Risk Factors and Outcomes; a National Cancer Data Base Study.

PubMed

Wallace, Sumer K; Lin, Jeff F; Cliby, William A; Leiserowitz, Gary S; Tergas, Ana I; Bristow, Robert E

2016-05-01

To identify risk factors associated with refusal of recommended chemotherapy and its impact on patients with epithelial ovarian cancer (EOC). We identified patients in the National Cancer Data Base diagnosed with EOC from January 1998 to December 2011. Patients who refused chemotherapy were identified and compared with those who received recommended, multiagent chemotherapy. Univariate and multivariable analyses were performed using chi-square test with Bonferroni correction, binary logistic regression, log-rank test, and Cox proportional hazards modeling. The threshold for statistical significance was set at a P value of less than 0.05. From a cohort of 147,713 eligible patients, 2,707 refused chemotherapy. These patients were compared with 92,212 patients who received recommended multiagent chemotherapy. Older age, more medical comorbidities, not having insurance, and later year of diagnosis were directly and significantly associated with chemotherapy refusal when analyzed using multivariable logistic regression. In addition, lower-than-expected facility adherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer, treatment at low-volume center, lower grade, and higher stage were all significantly and independently associated with chemotherapy refusal. Median overall survival of patients who received multiagent chemotherapy was significantly longer than that of those who refused chemotherapy (43 vs 4.8 months; P<.0005). After controlling for known patient, facility, and disease prognostic factors, chemotherapy refusal is significantly associated with increased risk of death. Refusal of recommended chemotherapy carries significant risk of early death from ovarian cancer. Our data demonstrate that the decision to refuse chemotherapy is multifactorial and, in addition to unalterable factors (eg, stage/grade, age), involves factors that can be changed, including facility type and payor. Efforts at addressing these discrepancies in care can improve compliance with chemotherapy recommendations in the NCCN Guidelines for Ovarian Cancer and outcomes. Copyright © 2016 by the National Comprehensive Cancer Network.

Germline genetic variants in somatically significantly mutated genes in tumors are associated with renal cell carcinoma risk and outcome.

PubMed

Shu, Xiang; Gu, Jianchun; Huang, Maosheng; Tannir, Nizar M; Matin, Surena F; Karam, Jose A; Wood, Christopher G; Wu, Xifeng; Ye, Yuanqing

2018-05-28

Genome-wide association studies (GWAS) have identified 13 susceptibility loci for renal cell carcinoma (RCC). Additional genetic loci of risk remain to be explored. Moreover, the role of germline genetic variants in predicting RCC recurrence and overall survival (OS) is less understood. In this study, we focused on 127 significantly mutated genes from The Cancer Genome Atlas (TCGA) Pan-Cancer Analysis across 12 major cancer sites to identify potential genetic variants predictive of RCC risk and clinical outcomes. In a three-phase design with a total of 2657 RCC cases and 5315 healthy controls, two single nucleotide polymorphisms (SNPs) that map to PIK3CG (rs6466135:A, ORmeta = 0.85, 95% CI = 0.77-0.94, Pmeta = 1.4 × 10-3) and ATM (rs611646:T, ORmeta = 1.17, 95% CI = 1.05-1.31, Pmeta = 3.5 × 10-3) were significantly associated with RCC risk. With respect to RCC recurrence and OS, two separate datasets with a total of 661 stages I-III RCC patients (discovery: 367; validation: 294) were analyzed. The most significant association was observed for rs10932384:C (ERBB4) with both outcomes (recurrence: HRmeta = 0.52, 95% CI = 0.39-0.68, Pmeta = 3.81 × 10-6; OS: HRmeta = 0.50, 95% CI = 0.37-0.67, Pmeta = 6.00 × 10-6). In addition, six SNPs were significantly associated with either RCC recurrence or OS but not both (Pmeta < 0.01). Rs10932384:C was significantly correlated with mutation frequency of ERBB4 in clear cell RCC (ccRCC) patients (P = 0.003, Fisher's exact test). Cis-eQTL was observed for several SNPs in blood/transformed fibroblasts but not in RCC tumor tissues. In summary, we identified promising genetic predictors of recurrence and OS among RCC patients with localized disease.

Perioperative Opioid Analgesics and Hip Arthroscopy: Trends, Risk Factors for Prolonged Use, and Complications.

PubMed

Anciano Granadillo, Victor; Cancienne, Jourdan M; Gwathmey, F Winston; Werner, Brian C

2018-05-02

The purpose of this article is to (1) examine trends in preoperative and prolonged postoperative opioid analgesic use in patient undergoing hip arthroscopy, (2) characterize risk factors for prolonged opioid analgesic use following hip arthroscopy, and (3) explore preoperative and prolonged postoperative opioid analgesic use as independent risk factors for complications following hip arthroscopy. A private insurance database was queried for patients undergoing hip arthroscopy from 2007 to 2015 with a minimum of 6 months of follow-up. Independent risk factors for prolonged opioid analgesic use were determined. Preoperative and prolonged opioid analgesic use as risk factors for complications were examined. There was a significantly decreasing trend in preoperative (P = .002) and prolonged postoperative (P = .009) opioid analgesic use. The most significant risk factor for prolonged postoperative opioid analgesic use was preoperative use (odds ratio [OR], 3.61; P < .0001). Other preoperative prescriptions, including muscle relaxants (OR, 1.5; P < .0001) and anxiolytics (OR, 2.0; P < .0001), were also significant risk factors. Preoperative opioid analgesic use was a significant risk factor for postoperative complications, including emergency room visits (OR, 2.1; P < .0001) and conversion to total hip arthroplasty (THA) (OR, 1.6; P < .0001). Prolonged postoperative opioid analgesic use was associated with a higher risk of revision hip arthroscopy (OR, 1.4; P = .0004) and conversion to THA (OR, 1.8; P < .0001). More than a quarter of patients undergoing hip arthroscopy continue to receive opioid analgesic prescriptions more than 3 months postoperatively. The most significant risk factor for prolonged opioid analgesic use is preoperative opioid analgesic use. Additionally, anxiolytics, substance use or abuse, morbid obesity, and back pain were among the more notable risk factors for prolonged postoperative opioid analgesic use. Preoperative and prolonged postoperative opioid analgesic use was associated with a higher likelihood of several adverse effects/complications. Level III, retrospective comparative study. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Coffee consumption and risk of colorectal cancer in a population-based prospective cohort of Japanese men and women.

PubMed

Lee, Kyung-Jae; Inoue, Manami; Otani, Tetsuya; Iwasaki, Motoki; Sasazuki, Shizuka; Tsugane, Shoichiro

2007-09-15

We prospectively examined the association between coffee consumption and the risk of developing colorectal cancer in a large population-based cohort study (the JPHC Study) of Japanese men and women. Data were analyzed from a population-based cohort of 96,162 subjects (46,023 men and 50,139 women). A total of 1,163 incident colorectal cancers were identified during the follow-up period, including 763 cases of colon cancer and 400 of rectal cancer. We observed a significant inverse association between coffee consumption and the risk of developing invasive colon cancer among women. Compared with those who almost never consumed coffee, women who regularly consumed 3 or more cups of coffee per day had a RR of 0.44 (95% CI = 0.19-1.04; p for trend = 0.04) after adjustment for potential confounding factors. However, no significant association was found for rectal cancer in women. In men, no significant decrease was observed in any colorectal cancer site. Further, additional analyses on the association of green tea consumption with colorectal cancer risk found no significant association in men or women. These findings suggest that coffee consumption may lower the risk of colon cancer among Japanese women. (c) 2007 Wiley-Liss, Inc.

Remission is the goal for cardiovascular risk management in patients with rheumatoid arthritis: a cross-sectional comparative study.

PubMed

Provan, Sella A; Semb, Anne Grete; Hisdal, Jonny; Stranden, Einar; Agewall, Stefan; Dagfinrud, Hanne; Angel, Kristin; Atar, Dan; Kvien, Tore K

2011-05-01

To compare markers of cardiovascular disease (CVD) risk between patients with rheumatoid arthritis (RA) in an active disease state and those with RA in remission, and to compare both groups with community controls. 113 patients with RA and 86 community controls were assessed across a panel of biomarkers for CVD. RA in remission was defined as Clinical Disease Activity Index ≤2.8. Community controls were selected at random by Statistics Norway, and controls were matched with patients in the cohorts in strata using details of age, sex and residential area. A panel of biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), total cholesterol, reactive hyperaemia index (RHI), pressure measurements, measures of arterial stiffness and intima-media thickness) were compared between patients with active RA and those with RA in remission. Both groups were compared with controls. In addition, biomarker levels were compared across subgroups based on anticyclic citrullinated peptide status, level of joint destruction and presence of extra-articular manifestations. Patients with active RA had significantly higher levels of NT-proBNP, brachial systolic pressure, augmentation index and central systolic pressure but lower cholesterol than patients in remission and controls. In addition, patients with active RA had significantly higher levels of pulse wave velocity and worse RHI than patients in remission. Comparison across other subgroups gave less consistent differentiations in levels of CVD risk markers. Patients with active RA, but not those in remission, had significantly increased levels of CVD risk markers. These results link inflammatory activity to markers of CVD risk in patients with RA and may indirectly support the notion that remission in RA confers diminished cardiovascular morbidity.

Validation of the IHC4 Breast Cancer Prognostic Algorithm Using Multiple Approaches on the Multinational TEAM Clinical Trial.

PubMed

Bartlett, John M S; Christiansen, Jason; Gustavson, Mark; Rimm, David L; Piper, Tammy; van de Velde, Cornelis J H; Hasenburg, Annette; Kieback, Dirk G; Putter, Hein; Markopoulos, Christos J; Dirix, Luc Y; Seynaeve, Caroline; Rea, Daniel W

2016-01-01

Hormone receptors HER2/neu and Ki-67 are markers of residual risk in early breast cancer. An algorithm (IHC4) combining these markers may provide additional information on residual risk of recurrence in patients treated with hormone therapy. To independently validate the IHC4 algorithm in the multinational Tamoxifen Versus Exemestane Adjuvant Multicenter Trial (TEAM) cohort, originally developed on the trans-ATAC (Arimidex, Tamoxifen, Alone or in Combination Trial) cohort, by comparing 2 methodologies. The IHC4 biomarker expression was quantified on TEAM cohort samples (n = 2919) by using 2 independent methodologies (conventional 3,3'-diaminobezidine [DAB] immunohistochemistry with image analysis and standardized quantitative immunofluorescence [QIF] by AQUA technology). The IHC4 scores were calculated by using the same previously established coefficients and then compared with recurrence-free and distant recurrence-free survival, using multivariate Cox proportional hazards modeling. The QIF model was highly significant for prediction of residual risk (P < .001), with continuous model scores showing a hazard ratio (HR) of 1.012 (95% confidence interval [95% CI]: 1.010-1.014), which was significantly higher than that for the DAB model (HR: 1.008, 95% CI: 1.006-1.009); P < .001). Each model added significant prognostic value in addition to recognized clinical prognostic factors, including nodal status, in multivariate analyses. Quantitative immunofluorescence, however, showed more accuracy with respect to overall residual risk assessment than the DAB model. The use of the IHC4 algorithm was validated on the TEAM trial for predicting residual risk in patients with breast cancer. These data support the use of the IHC4 algorithm clinically, but quantitative and standardized approaches need to be used.

Cardiovascular disease risk factors in relation to smoking behaviour and history: a population-based cohort study

PubMed Central

Keto, Jaana; Ventola, Hanna; Jokelainen, Jari; Linden, Kari; Keinänen-Kiukaanniemi, Sirkka; Timonen, Markku; Ylisaukko-oja, Tero; Auvinen, Juha

2016-01-01

Objective To investigate how individual risk factors for cardiovascular disease (CVD) (blood pressure, lipid levels, body mass index, waist and hip circumference, use of antihypertensive or hypolipidemic medication, and diagnosed diabetes) differ in people aged 46 years with different smoking behaviour and history. Methods This population-based cohort study is based on longitudinal data from the Northern Finland Birth Cohort 1966 project. Data were collected at the 31-year and 46-year follow-ups, when a total of 5038 and 5974 individuals participated in clinical examinations and questionnaires. Data from both follow-ups were available for 3548 participants. In addition to individual CVD risk factors, Framingham and Systematic Coronary Risk Evaluation (SCORE) algorithms were used to assess the absolute risk of a CVD event within the next decade. Results The differences in individual risk factors for CVD reached statistical significance for some groups, but the differences were not consistent or clinically significant. There were no clinically significant differences in CVD risk as measured by Framingham or SCORE algorithms between never smokers, recent quitters and former smokers (7.5%, 7.4%, 8.1% for men; 3.3%, 3.0%, 3.2% for women; p<0.001). Conclusions The effect of past or present smoking on individual CVD risk parameters such as blood pressure and cholesterol seems to be of clinically minor significance in people aged 46 years. In other words, smoking seems to be above all an independent risk factor for CVD in the working-age population. Quitting smoking in working age may thus reduce calculated CVD risk nearly to the same level with people who have never smoked. PMID:27493759

Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria.

PubMed

Methven, S; Traynor, J P; Hair, M D; St J O'Reilly, D; Deighan, C J; MacGregor, M S

2011-08-01

Proteinuria predicts poor renal and cardiovascular outcomes. Some guidelines recommend measuring proteinuria using albumin:creatinine ratio (ACR), while others recommend total protein:creatinine ratio (TPCR). To compare renal outcomes and mortality in the populations identified by these different recommendations. Retrospective longitudinal cohort study. Baseline ACR and TPCR measurements were obtained from 5586 patients with chronic kidney disease (CKD) attending a Scottish hospital nephrology clinic. The cohort was divided into three groups with concordant results by ACR and TPCR (no proteinuria; low proteinuria; significant proteinuria) and one group with discordant results (significant proteinuria with TPCR, but not ACR). Outcomes were assessed using Kaplan-Meier plots and Cox proportional hazards models. Median follow-up was 3.5 years [interquartile range (IQR) 2.1-6.0]; 844 (15%) died at 3.0 years (IQR 1.8-4.7) and 468 (8%) started renal replacement therapy (RRT) at 1.7 years (IQR 0.6-3.4). Proteinuria was associated with a substantially increased risk of RRT and death. Patients with significant proteinuria by TPCR, but not ACR (n = 231) had high renal risk, and the highest all-cause mortality (log-rank P < 0.001). With multivariate analysis the risk fell below those with significant proteinuria with concordant results by ACR and TPCR but remained considerably higher than those without significant proteinuria. Proteinuria screening with TPCR identifies an additional 16% of patients with significant proteinuria, not identified using ACR. This subgroup has high renal risk, and high risk of all-cause mortality and therefore warrant identification. Guideline recommendations on proteinuria screening in CKD should be reconsidered.

Estimating the risks of acquiring a kidney abroad: a meta-analysis of complications following participation in transplant tourism.

PubMed

Anker, Ashley E; Feeley, Thomas H

2012-01-01

A meta-analysis of odds ratios comparing the risks of participating in transplant tourism by acquiring a kidney abroad to the risks associated with domestic kidney transplant was undertaken. Comparison across 12 medical outcomes indicates transplant tourists are significantly more likely to contract cytomegalovirus, hepatitis B, HIV, post-transplantation diabetes mellitus, and wound infection than those receiving domestic kidney transplant. Results also indicate that domestic kidney transplant recipients experience significantly higher one-yr patient- and graft-survival rates. Analyses are supplemented by independent comparisons of outcomes and provide practitioners with weighted estimates of the proportion of transplant recipients experiencing 15 medical outcomes. Practitioners are encouraged to caution patients of the medical risks associated with transplant tourism. Despite the illegal and unethical nature of transplant tourism, additional efforts are indicated to eliminate the organ trade and to educate wait-listed patients about the risks of transplant tourism. © 2012 John Wiley & Sons A/S.

OPPT workplan risk assessment Methylene Chloride ...

EPA Pesticide Factsheets

These assessments will focus on the use of DCM and NMP in paint stripping. NMP exposures scenarios for this use result in inhalation and dermal exposure to consumers and workers. The low concern for environmental effects of NMP will be discussed in the assessment. In the case of DCM, there are human health concerns for both cancer and non-cancer effects. This DCM assessment of paint stripping uses will focus only on inhalation exposure to consumers and workers. The low concern for environmental effects of DCM will be discussed in the assessment. EPA anticipates issuing draft risk assessments for public review and comment as they are completed. At the conclusion of the review process, if an assessment of specific uses indicates significant risk, EPA will evaluate and pursue appropriate risk reduction actions, as warranted. If an assessment indicates no significant risk, EPA will conclude its current work on assessment of those specified targeted uses of that chemical. Over time, additional chemicals will be added to the work plan as more data are developed and more chemicals screened.

Understanding the link between childhood maltreatment and violent delinquency: what do schools have to add?

PubMed

Crooks, Claire V; Scott, Katreena L; Wolfe, David A; Chiodo, Debbie; Killip, Steve

2007-08-01

Child maltreatment constitutes significant risk for adolescent delinquency. Although an ecological model has been proposed to explain this relationship, most studies focus on individual risk factors. Prospective data from 1,788 students attending 23 schools were used to examine the additive influence of childhood maltreatment, individual-level risk factors, and school-level variables assessed at the beginning of Grade 9 on delinquency 4 to 6 months later. Individual-level results indicated that being male, experiencing childhood maltreatment, and poor parental nurturing were predictors of violent delinquency. School climate also played a significant role: Given the same individual risk profile, a student attending a school that was perceived by students as safe was less likely to engage in violent delinquency than was a student attending a school perceived to be unsafe. Moreover, the impact of childhood maltreatment on risk for engaging in violent delinquency was somewhat mitigated by schools' participation in a comprehensive violence prevention program.

OPPT workplan risk assessment for Trichloroethylene ...

EPA Pesticide Factsheets

The assessment will focus on uses of TCE as a degreaser and in consumer products used by individuals in the arts/crafts field. Given the range of endpoints (cancer, non-cancer; the latter includes potential effects on the developing fetus), it is expected that susceptible populations would be children (as bystanders physically near the actual consumer use of the products) and adults of all ages (including pregnant women). Thus, the assessment will focus on all human/lifestages. EPA anticipates issuing draft risk assessments for public review and comment as they are completed. At the conclusion of the review process, if an assessment of specific uses indicates significant risk, EPA will evaluate and pursue appropriate risk reduction actions, as warranted. If an assessment indicates no significant risk, EPA will conclude its current work on assessment of those specified targeted uses of that chemical. Over time, additional chemicals will be added to the work plan as more data are developed and more chemicals screened.

Fat mass and obesity-associated gene rs11642015 polymorphism is significantly associated with prediabetes and type 2 diabetes subsequent to adjustment for body mass index.

PubMed

Han, Liyuan; Tang, Linlin; Wang, Changyi; Chen, Zhongwei; Zhang, Tao; Chen, Sihan; Liu, Shengyuan; Peng, Xiaolin; Mai, Yifeng; Duan, Shiwei

2014-09-01

The association of the fat mass and obesity-associated gene ( FTO ) rs11642015 polymorphism with prediabetes, type 2 diabetes and obesity in certain populations has not been previously reported. A population-based study was conducted that included 490 type 2 diabetic, 471 prediabetic and 575 normal subjects. The main outcomes of the study were prediabetes, type 2 diabetes and obesity. Binary logistic regression was performed to estimate the association of FTO rs11642015 with the risk of prediabetes, type 2 diabetes and obesity following adjustment for the corresponding confounders. A meta-analysis was also conducted to evaluate the association between FTO rs11642015 and obesity. FTO rs11642015 was significantly associated with prediabetes in the whole sample under the additive model [odds ratio (OR), 1.50; 95% confidence interval (CI), 1.17-1.93; P=0.002], particularly in females. The polymorphism remained consistently significant following adjustment for age and body mass index (BMI), showing an increased prediabetes risk with an additive effect (OR, 1.55; 95% CI, 1.19-2.01; P=0.001). In addition, a significant association was found for rs11642015 with prediabetes and type 2 diabetes under the dominant model. However, under the stringent Bonferroni's correction there was no evidence of positive associations for FTO rs11642015 with obesity in the whole sample, females or males. Findings of the meta-analysis showed that FTO rs11642015 was not predisposed to obesity. In conclusion, the T allele of FTO rs11642015 is positively associated with an increased risk of prediabetes, even after adjustment for age and BMI, particularly in females. Subjects carrying the CT + TT genotype are predisposed to prediabetes and type 2 diabetes. Therefore, results of the population-based study and follow-up meta-analysis suggested that FTO rs11642015 is not significantly associated with susceptibility to obesity.

Vocal cord paralysis after aortic surgery.

PubMed

DiLisio, Ralph P; Mazzeffi, Michael A; Bodian, Carol A; Fischer, Gregory W

2013-06-01

The purpose of this study was to investigate variables associated with vocal cord paralysis during complex aortic procedures. A retrospective review. A tertiary care center. Four hundred ninety-eight patients who underwent aortic surgery between 2002 and 2007. Two groups were studied. Group A patients had procedures only involving their aortic root and/or ascending aorta. Group B patients had procedures only involving their aortic arch and/or descending aorta. The incidence of vocal cord paralysis was higher (7.26% v 0.8%) in group B patients (p < 0.0001). Increasing the duration of cardiopulmonary bypass time was associated with an increased risk of vocal cord paralysis and death in both groups A and B (p = 0.0002 and 0.002, respectively). Additionally, within group B, descending aneurysms emerged as an independent risk factor associated with vocal cord paralysis (p = 0.03). Length of stay was statistically significantly longer among group A patients who suffered vocal cord paralysis (p = 0.017) and trended toward significance in group B patients who suffered vocal cord paralysis (p = 0.059). The association between tracheostomy and vocal cord paralysis among group A patients reached statistical significance (p = 0.007) and trended toward significance in group B patients (p = 0.057). Increasing duration of cardiopulmonary bypass time was associated with a higher risk of vocal cord paralysis in patients undergoing aortic surgery. Additionally, within group B patients, descending aortic aneurysm was an independent risk factor associated with vocal cord paralysis. Most importantly, vocal cord paralysis appeared to have an association between an increased length of stay and tracheostomy among a select group of patients undergoing aortic surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

In search for genetic determinants of clinically meaningful differential cardiovascular event reduction by pravastatin in the PHArmacogenetic study of Statins in the Elderly at risk (PHASE)/PROSPER study.

PubMed

Postmus, Iris; Johnson, Paul C D; Trompet, Stella; de Craen, Anton J M; Slagboom, P Eline; Devlin, James J; Shiffman, Dov; Sacks, Frank M; Kearney, Patricia M; Stott, David J; Buckley, Brendan M; Sattar, Naveed; Ford, Ian; Westendorp, Rudi G J; Jukema, J Wouter

2014-07-01

Statin therapy is widely used in the prevention and treatment of cardiovascular events and is associated with significant risk reductions. However, there is considerable variation in response to statin therapy both in terms of LDL cholesterol reduction and clinical outcomes. It has been hypothesized that genetic variation contributes importantly to this individual drug response. We investigated the interaction between genetic variants and pravastatin or placebo therapy on the incidence of cardiovascular events by performing a genome-wide association study in the participants of the PROspective Study of Pravastatin in the Elderly at Risk for vascular disease--PHArmacogenetic study of Statins in the Elderly at risk (PROSPER/PHASE) study (n = 5244). We did not observe genome-wide significant associations with a clinically meaningful differential cardiovascular event reduction by pravastatin therapy. In addition, SNPs with p-values lower than 1 × 10(-4) were assessed for replication in a case-only analysis within two randomized placebo controlled pravastatin trials, CARE (n = 711) and WOSCOPS (n = 522). rs7102569, on chromosome 11 near the ODZ4 gene, was replicated in the CARE study (p = 0.008), however the direction of effect was opposite. This SNP was not associated in WOSCOPS. In addition, none of the SNPs replicated significantly after correcting for multiple testing. We could not identify genetic variation that was significantly associated at genome-wide level with a clinically meaningful differential event reduction by pravastatin treatment in a large prospective study. We therefore assume that in daily practice the use of genetic characteristics to personalize pravastatin treatment to improve prevention of cardiovascular disease will be limited. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Predation Risk within Fishing Gear and Implications for South Australian Rock Lobster Fisheries.

PubMed

Briceño, Felipe; Linnane, Adrian Joseph; Quiroz, Juan Carlos; Gardner, Caleb; Pecl, Gretta Tatyana

2015-01-01

Depredation of southern rock lobster (Jasus edwardsii) within fishing gear by the Maori octopus (Pinnoctopus cordiformis) has economic and ecological impacts on valuable fisheries in South Australia. In addition, depredation rates can be highly variable resulting in uncertainties for the fishery. We examined how in-pot lobster predation was influenced by factors such as lobster size and sex, season, fishing zone, and catch rate. Using mixed modelling techniques, we found that in-pot predation risk increased with lobster size and was higher for male lobsters. In addition, the effect of catch rate of lobsters on predation risk by octopus differed among fishing zones. There was both a seasonal and a spatial component to octopus predation, with an increased risk within discrete fishing grounds in South Australia at certain times of the year. Information about predation within lobster gear can assist fishery management decision-making, potentially leading to significant reduction in economic losses to the fishery.

Predation Risk within Fishing Gear and Implications for South Australian Rock Lobster Fisheries

PubMed Central

Briceño, Felipe; Linnane, Adrian Joseph; Quiroz, Juan Carlos; Gardner, Caleb; Pecl, Gretta Tatyana

2015-01-01

Depredation of southern rock lobster (Jasus edwardsii) within fishing gear by the Maori octopus (Pinnoctopus cordiformis) has economic and ecological impacts on valuable fisheries in South Australia. In addition, depredation rates can be highly variable resulting in uncertainties for the fishery. We examined how in-pot lobster predation was influenced by factors such as lobster size and sex, season, fishing zone, and catch rate. Using mixed modelling techniques, we found that in-pot predation risk increased with lobster size and was higher for male lobsters. In addition, the effect of catch rate of lobsters on predation risk by octopus differed among fishing zones. There was both a seasonal and a spatial component to octopus predation, with an increased risk within discrete fishing grounds in South Australia at certain times of the year. Information about predation within lobster gear can assist fishery management decision-making, potentially leading to significant reduction in economic losses to the fishery. PMID:26489035

Coffee and tea: perks for health and longevity?

PubMed

Bhatti, Salman K; O'Keefe, James H; Lavie, Carl J

2013-11-01

Tea and coffee, after water, are the most commonly consumed beverages in the world and are the top sources of caffeine and antioxidant polyphenols in the American diet. The purpose of this review is to assess the health effects of chronic tea and/or coffee consumption. Tea consumption, especially green tea, is associated with significantly reduced risks for stroke, diabetes and depression, and improved levels of glucose, cholesterol, abdominal obesity and blood pressure. Habitual coffee consumption in large epidemiological studies is associated with reduced mortality, both for all-cause and cardiovascular deaths. In addition, coffee intake is associated with risks of heart failure, stroke, diabetes mellitus and some cancers in an inverse dose-dependent fashion. Surprisingly, coffee is associated with neutral to reduced risks for both atrial and ventricular arrhythmias. However, caffeine at high doses can increase anxiety, insomnia, calcium loss and possibly the risk of fractures. Coffee and tea can generally be recommended as health-promoting additions to an adult diet. Adequate dietary calcium intake may be particularly important for tea and coffee drinkers.

Sexual risk behaviors by relationship type and trauma history among HIV-positive men who have sex with men.

PubMed

Kamen, Charles; Etter, Darryl; Flores, Sergio; Sharp, Susan; Lee, Susanne; Gore-Felton, Cheryl

2013-02-01

The association of trauma exposure and coping style to sexual risk behavior has yet to be fully examined in the context of primary and casual sexual partnerships. The current study assessed a high risk sexual behavior-unprotected anal intercourse (UAI)-in a high risk population of HIV-positive men who have sex with men (MSM) with a history of trauma. Using audio computer-assisted self-interview technology, 132 HIV-positive MSM completed measures of trauma exposure, trauma symptoms, coping strategies, and sexual risk behavior. Hierarchical logistic regression analyses indicated that completing more years of education and having experienced sexual abuse were positively associated with UAI with casual partners. Additionally, use of active coping was negatively associated with UAI with casual partners and the final model significantly predicted variance in UAI with casual partners. However, no variables were significantly associated with UAI with primary partners, suggesting that sexual risk behavior with primary partners may be associated with factors not commonly assessed in risk prediction or prevention research. We discuss the results in the context of developing new or modifying existing interventions to address rates of sexual risk in the relationships of HIV-positive MSM.

Microvascular function predicts cardiovascular events in primary prevention: long-term results from the Firefighters and Their Endothelium (FATE) study.

PubMed

Anderson, Todd J; Charbonneau, Francois; Title, Lawrence M; Buithieu, Jean; Rose, M Sarah; Conradson, Heather; Hildebrand, Kathy; Fung, Marinda; Verma, Subodh; Lonn, Eva M

2011-01-18

Biomarkers of atherosclerosis may refine clinical decision making in individuals at risk of cardiovascular disease. The purpose of the study was to determine the prognostic significance of endothelial function and other vascular markers in apparently healthy men. The cohort consisted of 1574 men (age, 49.4 years) free of vascular disease. Measurements included flow-mediated dilation and its microvascular stimulus, hyperemic velocity, carotid intima-media thickness, and C-reactive protein. Cox proportional hazard models evaluated the relationship between vascular markers, Framingham risk score, and time to a first composite cardiovascular end point of vascular death, revascularization, myocardial infarction, angina, and stroke. Subjects had low median Framingham risk score (7.9%). Cardiovascular events occurred in 71 subjects (111 events) over a mean follow-up of 7.2±1.7 years. Flow-mediated dilation was not associated with subsequent cardiovascular events (hazard ratio, 0.92; P=0.54). Both hyperemic velocity (hazard ratio, 0.70; 95% confidence interval, 0.54 to 0.90; P=0.006) and carotid intima-media thickness (hazard ratio, 1.45; confidence interval, 1.15 to 1.83; P=0.002) but not C-reactive protein (P=0.35) were related to events in a multivariable analysis that included Framingham risk score (per unit SD). Furthermore, the addition of hyperemic velocity to Framingham risk score resulted in a net clinical reclassification improvement of 28.7% (P<0.001) after 5 years of follow-up in the intermediate-risk group. Overall net reclassification improvement for hyperemic velocity was 6.9% (P=0.24). In men, hyperemic velocity, the stimulus for flow-mediated dilation, but not flow-mediated dilation itself was a significant risk marker for adverse cardiovascular outcomes. The prognostic value was additive to traditional risk factors and carotid intima-media thickness. Hyperemic velocity, a newly described marker of microvascular function, is a novel tool that may improve risk stratification of lower-risk healthy men.

Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II).

PubMed

Kogevinas, Manolis; Zock, Jan-Paul; Jarvis, Debbie; Kromhout, Hans; Lillienberg, Linnéa; Plana, Estel; Radon, Katja; Torén, Kjell; Alliksoo, Ada; Benke, Geza; Blanc, Paul D; Dahlman-Hoglund, Anna; D'Errico, Angelo; Héry, Michel; Kennedy, Susan; Kunzli, Nino; Leynaert, Bénédicte; Mirabelli, Maria C; Muniozguren, Nerea; Norbäck, Dan; Olivieri, Mario; Payo, Félix; Villani, Simona; van Sprundel, Marc; Urrutia, Isabel; Wieslander, Gunilla; Sunyer, Jordi; Antó, Josep M

2007-07-28

The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

Gastrointestinal Injuries in Blunt Abdominal Traumas.

PubMed

Gönüllü, D; Ilgun, S; Gedik, M L; Demiray, O; Öner, Z; Er, M; Köksoy, F N

2015-01-01

To discuss the efficiency of RTS (Revised TraumaScore), ISS (Injury Severity Score), and factors that affect mortality and morbidity in gastrointestinal injuries due to blunt trauma.Method and methods: Patients with gastrointestinal injuries due to blunt trauma operated within the last six years have been studied retrospectively in terms of demographics,injury mechanism and localization, additional injuries, RTS and ISS, operative technique, morbidity, mortality and duration of hospitalization. Of the eighteen cases, cause of injury was a traffic accident for 11 (61.1%), fall from height for 5 (27%) and physical attack for 2 (11%). Among the eighteen patients,there were 21 gastrointestinal injuries (11 intestinal, 6 colon,3 duodenum, 1 stomach). 10 (55.6%) had additional intraabdominal injuries while the number for extra-abdominal injuries were 12 (66.7%). Primary suture (10), segmentary resection (9) and pyloric exclusion (2) were the operations performed for the twenty-one gastrointestinal injuries.Although statistically not significant, 13(72.2%) patients with additional injuries compared with 5 (27.8%) patients with isolated gastrointestinal injuries, were found to have lower RTS (7.087/7.841), higher ISS (19.4/12.2), longer duration of hospitalization (11.5/8.4 day) as well as higher morbidity (7/1) and mortality (2/0) rates. Comparing the RTS (7.059/7.490) of patients who have and have not developed morbidity revealed no significant difference.However, ISS (23.9/12.2) was significantly higher in patients who have developed morbidity (p=0.003). RTS (6.085 7.445) and ISS (39.5/14.6) of patients who have survived were significantly different than patients who have not(p=0.037 and p=0.023, respectively) Additional injuries in patients with gastrointestinal injury due blunt abdominal traumas increases, although not significantly, morbidity, mortality and duration of hospitalization even when operated early. High ISS is significantly related to the risk of both morbidity and mortality while low RTS is significantly related only to the mortality risk. Celsius.

Risks and Benefits of Salpingectomy at the Time of Sterilization.

PubMed

Castellano, Tara; Zerden, Matthew; Marsh, Laura; Boggess, Kim

2017-11-01

Bilateral salpingectomy reduces the risk ovarian cancer. The Society of Gynecologic Oncology has recommended surgeons discuss salpingectomy with patients desiring sterilization. This review summarizes current literature on the benefits and risks of bilateral salpingectomy to reduce ovarian cancer risk. Areas of insufficient evidence and directions for further research are discussed. We examined the benefits and risks of bilateral salpingectomy for female surgical sterilization, using a PubMed and EMBASE literature review. Search parameters included articles in English language and keywords "salpingectomy" or "ovarian cancer" combined with "contraception," "sterilization," or "tubal ligation." We reviewed 4 high-quality studies that investigated the increased risk reduction of bilateral salpingectomy compared with traditional sterilization. Overall, evidence shows that salpingectomy moderately decreases the risk of ovarian cancer compared with traditional sterilization. An additional 4 studies, including a meta-analysis, showed salpingectomy likely does not have significant long-term impact on ovarian reserve. Additional benefits include improved contraceptive efficacy and elimination of subsequent ectopic pregnancies. Risks include need for in vitro fertilization for patients experiencing sterilization regret, increases in operative time, and potential increases in surgical risks. Bilateral salpingectomy can reduce ovarian cancer risk compared with traditional sterilization; however, research regarding other outcomes is limited. Challenges to implementation include physician concern regarding surgical risks and patient education. Studies investigating patient-based outcomes are lacking. Bilateral salpingectomy for surgical sterilization is a reasonable option when patients are appropriately informed. Ovarian cancer risk reduction should be one of several factors considered when patients choose a surgical sterilization method.

Sleep disorders and the interpersonal-psychological theory of suicide: independent pathways to suicidality?

PubMed

Nadorff, Michael R; Anestis, Michael D; Nazem, Sarra; Claire Harris, H; Samuel Winer, E

2014-01-01

Although sleep disorders are a risk factor for suicidal behavior little research has examined why sleep disorders confer suicide risk. The present study examined the relation between two sleep disorders, insomnia symptoms and nightmares, and suicide risk in the context of Joiner's interpersonal-psychological theory of suicide (IPTS). The present study utilized two large samples (N=747 and 604) recruited from two large public universities in the Southeast. Both studies included measures of insomnia symptoms, nightmares, depressive symptoms, and prior suicide attempts. In addition, study one contained a measure of suicide risk. In study 1, the relations between insomnia symptoms and both suicide risk and prior attempts were not significant after controlling for the IPTS. However, nightmares were related to both suicide risk and suicide attempts independent of the IPTS. Furthermore, nightmares nearly missed significance in the prediction of suicide risk (p=0.054) and significantly predicted suicide attempts even after controlling for depressive symptoms. In study 2, both insomnia and nightmares were found to be significantly associated with prior suicide attempts after controlling for the IPTS and depressive symptoms. The study is limited by its use of a college sample and cross-sectional design. These studies suggest that the IPTS may not explain the relation between sleep problems and suicidality. More research is needed to understand the mechanism by which sleep disorders confer suicide risk, which is clinically relevant as it may inform specific interventions to reduce the adverse effects of sleep disorders. © 2013 Published by Elsevier B.V.

Association between regulator of telomere elongation helicase1 (RTEL1) gene and HAPE risk: A case-control study.

PubMed

Rong, Hao; He, Xue; Zhu, Linhao; Zhu, Xikai; Kang, Longli; Wang, Li; He, Yongjun; Yuan, Dongya; Jin, Tianbo

2017-09-01

High altitude pulmonary edema (HAPE) is a paradigm of pulmonary edema. Mutations in regulator of telomere elongation helicase1 (RTEL1) represent an important contributor to risk for pulmonary fibrosis. However, little information is found about the association between RTEL1 and HAPE risk. The present study was undertaken to tentatively explore the potential relation between single-nucleotide polymorphisms (SNPs) in RTEL1 and HAPE risk in Chinese Han population. A total of 265 HAPE patients and 303 healthy controls were included in our case-control study. Four SNPs in RTEL1 were selected and genotyped using the Sequenom MassARRAY method. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by unconditional logistic regression with adjustment for gender and age. All P values were Bonferroni corrected, and statistical significance was set at P < .0025 (.05/20). In allelic model analysis, we found that the allele "G" of rs6089953 and rs6010621 and the allele "A" of rs2297441 were associated with decreased risk of HAPE. In the genetic model analysis, we found that rs6010621, rs6089953, and rs2297441 were relevant to decreased HAPE risk under dominant model (rs6010621: OR = 0.55; 95% CI = 0.39-0.78; P = .001; rs6089953: OR = 0.68; 95% CI = 0.48-0.96; P = .027; rs2297441: OR = 0.63; 95% CI = 0.45-0.89; P = .008, respectively) and additive model (rs6010621: OR = 0.51; 95% CI = 0.46-0.81; P < .001; rs6089953: OR = 0.72; 95% CI = 0.55-0.95; P = .022; rs2297441: OR = 0.73; 95% CI = 0.57-0.95; P = .019, respectively). SNPs rs6010621 remained significant after Bonferroni correction (P < .0025). In addition, haplotype "GG, GT, AT" of rs6089953-rs6010621 were detected significantly associated with HAPE risk (P < .05), haplotype "GG" remained significant after Bonferroni correction (P < .0025). Our findings provide new evidence for the association between SNPs in RTEL1 and a decreased risk HAPE in the Chinese population. The results need further confirmation.

Association between regulator of telomere elongation helicase1 (RTEL1) gene and HAPE risk

PubMed Central

Rong, Hao; He, Xue; Zhu, Linhao; Zhu, Xikai; Kang, Longli; Wang, Li; He, Yongjun; Yuan, Dongya; Jin, Tianbo

2017-01-01

Abstract High altitude pulmonary edema (HAPE) is a paradigm of pulmonary edema. Mutations in regulator of telomere elongation helicase1 (RTEL1) represent an important contributor to risk for pulmonary fibrosis. However, little information is found about the association between RTEL1 and HAPE risk. The present study was undertaken to tentatively explore the potential relation between single-nucleotide polymorphisms (SNPs) in RTEL1 and HAPE risk in Chinese Han population. A total of 265 HAPE patients and 303 healthy controls were included in our case-control study. Four SNPs in RTEL1 were selected and genotyped using the Sequenom MassARRAY method. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by unconditional logistic regression with adjustment for gender and age. All P values were Bonferroni corrected, and statistical significance was set at P < .0025 (.05/20). In allelic model analysis, we found that the allele “G” of rs6089953 and rs6010621 and the allele “A” of rs2297441 were associated with decreased risk of HAPE. In the genetic model analysis, we found that rs6010621, rs6089953, and rs2297441 were relevant to decreased HAPE risk under dominant model (rs6010621: OR = 0.55; 95% CI = 0.39–0.78; P = .001; rs6089953: OR = 0.68; 95% CI = 0.48–0.96; P = .027; rs2297441: OR = 0.63; 95% CI = 0.45–0.89; P = .008, respectively) and additive model (rs6010621: OR = 0.51; 95% CI = 0.46–0.81; P < .001; rs6089953: OR = 0.72; 95% CI = 0.55–0.95; P = .022; rs2297441: OR = 0.73; 95% CI = 0.57–0.95; P = .019, respectively). SNPs rs6010621 remained significant after Bonferroni correction (P < .0025). In addition, haplotype “GG, GT, AT” of rs6089953-rs6010621 were detected significantly associated with HAPE risk (P < .05), haplotype “GG” remained significant after Bonferroni correction (P < .0025). Our findings provide new evidence for the association between SNPs in RTEL1 and a decreased risk HAPE in the Chinese population. The results need further confirmation. PMID:28953687

Clinically Relevant Cytotoxic Immune Cell Signatures and Clonal Expansion of T Cell Receptors in High-risk MYCN-not-amplified Human Neuroblastoma.

PubMed

Wei, Jun S; Kuznetsov, Igor B; Zhang, Shile; Song, Young K; Asgharzadeh, Shahab; Sindiri, Sivasish; Wen, Xinyu; Patidar, Rajesh; Nagaraj, Sushma; Walton, Ashley; Guidry Auvil, Jaime M; Gerhard, Daniela S; Yuksel, Aysen; Catchpoole, Daniel R; Hewitt, Stephen M; Sondel, Paul M; Seeger, Robert C; Maris, John M; Khan, Javed

2018-05-21

High-risk neuroblastoma is an aggressive disease. DNA sequencing studies have revealed a paucity of actionable genomic alterations and a low mutation burden, posing challenges to develop effective novel therapies. We used RNA sequencing (RNA-seq) to investigate the biology of this disease including a focus on tumor-infiltrating lymphocytes (TILs). We performed deep RNA-seq on pre-treatment diagnostic tumors from 129 high-risk and 21 low- or intermediate-risk patients with neuroblastomas. We used single-sample gene set enrichment analysis to detect gene expression signatures of TILs in tumors and examined their association with clinical and molecular parameters including patient outcome. The expression profiles of 190 additional pre-treatment diagnostic neuroblastomas, a neuroblastoma tissue microarray, and T-cell receptor (TCR) sequencing were used to validate our findings. We found that MYCN -not-amplified ( MYCN -NA) tumors had significant higher cytotoxic TIL signatures compared to MYCN -amplified ( MYCN -A) tumors. A reported MYCN-activation-signature was significantly associated with poor outcome for high-risk patients with MYCN -NA tumors; however, a subgroup of these patients who had elevated activated NK cells, CD8+ T-cells, and cytolytic signatures showed improved outcome and expansion of infiltrating T-cell receptor (TCR) clones. Furthermore, we observed up-regulation of immune exhaustion marker genes, indicating an immune suppressive microenvironment in these neuroblastomas. Conclusions: This study provides evidence that RNA signatures of cytotoxic TIL are associated with the presence of activated NK-/T-cells and improved outcomes in high-risk neuroblastoma patients harboring MYCN -NA tumors. Our findings suggest that these high-risk patients with MYCN -NA neuroblastoma may benefit from additional immunotherapies incorporated into the current therapeutic strategies. Copyright ©2018, American Association for Cancer Research.

Common variants at the CHEK2 gene locus and risk of epithelial ovarian cancer

PubMed Central

Lawrenson, Kate; Iversen, Edwin S.; Tyrer, Jonathan; Weber, Rachel Palmieri; Concannon, Patrick; Hazelett, Dennis J.; Li, Qiyuan; Marks, Jeffrey R.; Berchuck, Andrew; Lee, Janet M.; Aben, Katja K.H.; Anton-Culver, Hoda; Antonenkova, Natalia; Bandera, Elisa V.; Bean, Yukie; Beckmann, Matthias W.; Bisogna, Maria; Bjorge, Line; Bogdanova, Natalia; Brinton, Louise A.; Brooks-Wilson, Angela; Bruinsma, Fiona; Butzow, Ralf; Campbell, Ian G.; Carty, Karen; Chang-Claude, Jenny; Chenevix-Trench, Georgia; Chen, Ann; Chen, Zhihua; Cook, Linda S.; Cramer, Daniel W.; Cunningham, Julie M.; Cybulski, Cezary; Plisiecka-Halasa, Joanna; Dennis, Joe; Dicks, Ed; Doherty, Jennifer A.; Dörk, Thilo; du Bois, Andreas; Eccles, Diana; Easton, Douglas T.; Edwards, Robert P.; Eilber, Ursula; Ekici, Arif B.; Fasching, Peter A.; Fridley, Brooke L.; Gao, Yu-Tang; Gentry-Maharaj, Aleksandra; Giles, Graham G.; Glasspool, Rosalind; Goode, Ellen L.; Goodman, Marc T.; Gronwald, Jacek; Harter, Philipp; Hasmad, Hanis Nazihah; Hein, Alexander; Heitz, Florian; Hildebrandt, Michelle A.T.; Hillemanns, Peter; Hogdall, Estrid; Hogdall, Claus; Hosono, Satoyo; Jakubowska, Anna; Paul, James; Jensen, Allan; Karlan, Beth Y.; Kjaer, Susanne Kruger; Kelemen, Linda E.; Kellar, Melissa; Kelley, Joseph L.; Kiemeney, Lambertus A.; Krakstad, Camilla; Lambrechts, Diether; Lambrechts, Sandrina; Le, Nhu D.; Lee, Alice W.; Cannioto, Rikki; Leminen, Arto; Lester, Jenny; Levine, Douglas A.; Liang, Dong; Lissowska, Jolanta; Lu, Karen; Lubinski, Jan; Lundvall, Lene; Massuger, Leon F.A.G.; Matsuo, Keitaro; McGuire, Valerie; McLaughlin, John R.; Nevanlinna, Heli; McNeish, Iain; Menon, Usha; Modugno, Francesmary; Moysich, Kirsten B.; Narod, Steven A.; Nedergaard, Lotte; Ness, Roberta B.; Noor Azmi, Mat Adenan; Odunsi, Kunle; Olson, Sara H.; Orlow, Irene; Orsulic, Sandra; Pearce, Celeste L.; Pejovic, Tanja; Pelttari, Liisa M.; Permuth-Wey, Jennifer; Phelan, Catherine M.; Pike, Malcolm C.; Poole, Elizabeth M.; Ramus, Susan J.; Risch, Harvey A.; Rosen, Barry; Rossing, Mary Anne; Rothstein, Joseph H.; Rudolph, Anja; Runnebaum, Ingo B.; Rzepecka, Iwona K.; Salvesen, Helga B.; Budzilowska, Agnieszka; Sellers, Thomas A.; Shu, Xiao-Ou; Shvetsov, Yurii B.; Siddiqui, Nadeem; Sieh, Weiva; Song, Honglin; Southey, Melissa C.; Sucheston, Lara; Tangen, Ingvild L.; Teo, Soo-Hwang; Terry, Kathryn L.; Thompson, Pamela J.; Timorek, Agnieszka; Tworoger, Shelley S.; Nieuwenhuysen, Els Van; Vergote, Ignace; Vierkant, Robert A.; Wang-Gohrke, Shan; Walsh, Christine; Wentzensen, Nicolas; Whittemore, Alice S.; Wicklund, Kristine G.; Wilkens, Lynne R.; Woo, Yin-Ling; Wu, Xifeng; Wu, Anna H.; Yang, Hannah; Zheng, Wei; Ziogas, Argyrios; Coetzee, Gerhard A.; Freedman, Matthew L.; Monteiro, Alvaro N.A.; Moes-Sosnowska, Joanna; Kupryjanczyk, Jolanta; Pharoah, Paul D.; Gayther, Simon A.; Schildkraut, Joellen M.

2015-01-01

Genome-wide association studies have identified 20 genomic regions associated with risk of epithelial ovarian cancer (EOC), but many additional risk variants may exist. Here, we evaluated associations between common genetic variants [single nucleotide polymorphisms (SNPs) and indels] in DNA repair genes and EOC risk. We genotyped 2896 common variants at 143 gene loci in DNA samples from 15 397 patients with invasive EOC and controls. We found evidence of associations with EOC risk for variants at FANCA, EXO1, E2F4, E2F2, CREB5 and CHEK2 genes (P ≤ 0.001). The strongest risk association was for CHEK2 SNP rs17507066 with serous EOC (P = 4.74 x 10–7). Additional genotyping and imputation of genotypes from the 1000 genomes project identified a slightly more significant association for CHEK2 SNP rs6005807 (r 2 with rs17507066 = 0.84, odds ratio (OR) 1.17, 95% CI 1.11–1.24, P = 1.1×10−7). We identified 293 variants in the region with likelihood ratios of less than 1:100 for representing the causal variant. Functional annotation identified 25 candidate SNPs that alter transcription factor binding sites within regulatory elements active in EOC precursor tissues. In The Cancer Genome Atlas dataset, CHEK2 gene expression was significantly higher in primary EOCs compared to normal fallopian tube tissues (P = 3.72×10−8). We also identified an association between genotypes of the candidate causal SNP rs12166475 (r 2 = 0.99 with rs6005807) and CHEK2 expression (P = 2.70×10-8). These data suggest that common variants at 22q12.1 are associated with risk of serous EOC and CHEK2 as a plausible target susceptibility gene. PMID:26424751

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

PubMed

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

2016-07-01

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

Clinical evaluation incorporating a personal genome

PubMed Central

Ashley, Euan A.; Butte, Atul J.; Wheeler, Matthew T.; Chen, Rong; Klein, Teri E.; Dewey, Frederick E.; Dudley, Joel T.; Ormond, Kelly E.; Pavlovic, Aleksandra; Hudgins, Louanne; Gong, Li; Hodges, Laura M.; Berlin, Dorit S.; Thorn, Caroline F.; Sangkuhl, Katrin; Hebert, Joan M.; Woon, Mark; Sagreiya, Hersh; Whaley, Ryan; Morgan, Alexander A.; Pushkarev, Dmitry; Neff, Norma F; Knowles, Joshua W.; Chou, Mike; Thakuria, Joseph; Rosenbaum, Abraham; Zaranek, Alexander Wait; Church, George; Greely, Henry T.; Quake, Stephen R.; Altman, Russ B.

2010-01-01

Background The cost of genomic information has fallen steeply but the path to clinical translation of risk estimates for common variants found in genome wide association studies remains unclear. Since the speed and cost of sequencing complete genomes is rapidly declining, more comprehensive means of analyzing these data in concert with rare variants for genetic risk assessment and individualisation of therapy are required. Here, we present the first integrated analysis of a complete human genome in a clinical context. Methods An individual with a family history of vascular disease and early sudden death was evaluated. Clinical assessment included risk prediction for coronary artery disease, screening for causes of sudden cardiac death, and genetic counselling. Genetic analysis included the development of novel methods for the integration of whole genome sequence data including 2.6 million single nucleotide polymorphisms and 752 copy number variations. The algorithm focused on predicting genetic risk of genes associated with known Mendelian disease, recognised drug responses, and pathogenicity for novel variants. In addition, since integration of risk ratios derived from case control studies is challenging, we estimated posterior probabilities from age and sex appropriate prior probability and likelihood ratios derived for each genotype. In addition, we developed a visualisation approach to account for gene-environment interactions and conditionally dependent risks. Findings We found increased genetic risk for myocardial infarction, type II diabetes and certain cancers. Rare variants in LPA are consistent with the family history of coronary artery disease. Pharmacogenomic analysis suggested a positive response to lipid lowering therapy, likely clopidogrel resistance, and a low initial dosing requirement for warfarin. Many variants of uncertain significance were reported. Interpretation Although challenges remain, our results suggest that whole genome sequencing can yield useful and clinically relevant information for individual patients, especially for those with a strong family history of significant disease. PMID:20435227

Clinical dysphagia risk predictors after prolonged orotracheal intubation

PubMed Central

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

2014-01-01

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

Digital media and sexually transmitted infections.

PubMed

Gilliam, Melissa; Chor, Julie; Hill, Brandon

2014-10-01

Digital media, including the Internet, social networking sites, text messaging, and mobile applications, are ubiquitous among adolescents and young adults. These platforms enable users to obtain important information on a multitude of health topics, they may facilitate risk-taking behaviors, and they can be key components of health interventions. The purpose of this article is to review the recent literature on digital media and sexually transmitted infections, discussing their role in potentiating and reducing risk. This review demonstrates adolescents' use of digital media to gather information on health topics and discusses significant privacy concerns regarding using media to explore sexual health information. Although several studies demonstrate an association between social media and increased sexual risk-taking behaviors, this relationship is not fully understood. Digital media-based interventions are increasingly being developed to either reduce risk or improve management of sexually transmitted infections. As greater numbers of adolescents use digital media, the potential for these platforms to influence sexual risk-taking behaviors is significant. Additional research is needed to better understand the impact of digital media on sexually transmitted infection risk and to develop social media-based interventions to improve sexually transmitted infection outcomes.

Clinical dysphagia risk predictors after prolonged orotracheal intubation.

PubMed

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

2014-01-01

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

Sublingual misoprostol to decrease blood loss after caesarean delivery: a randomised controlled trial.

PubMed

Ugwu, I A; Enabor, O O; Adeyemi, A B; Lawal, O O; Oladokun, A; Olayemi, O

2014-07-01

The aim of the study was to compare the efficacy of sublingual misoprostol in addition to intravenous oxytocin, with oxytocin alone, in reducing blood loss during and following caesarean section. A total of 120 women undergoing caesarean delivery at the University College Hospital, Ibadan, were randomised into two equal groups. In Group A, 20 IU of intravenous oxytocin was given after umbilical cord clamping, while in Group B, the women received 400 μg misoprostol sublingually and 20 IU oxytocin intravenously. The outcome measures were blood loss, additional uterotonics, change in packed cell volume and side-effect profile. Associations between variables were determined by the χ(2) and Student's t-test. Relative risks were calculated for side-effects; the level of significance was p < 0.05. Intraoperative and postoperative blood loss were significantly lower in Group B (451.3 ml vs 551.2 ml, p = 0.007; 22.7 vs 42.2 ml, p < 0.001, respectively). In Group B, women were 7.4 (p < 0.001) and 9.0 (p = 0.008) times more likely to experience shivering and fever, respectively. The need for additional uterotonics was greater in the oxytocin group (66.7% vs 27.6%, p < 0.001). The addition of sublingual misoprostol to intravenous oxytocin reduces postpartum blood loss and the need for additional uterotonics. There is however, an increased risk of shivering and fever with this combination.

Violent Behaviors, Weapon Carrying, and Firearm Homicide Trends in African American Adolescents, 2001-2015.

PubMed

Khubchandani, Jagdish; Price, James H

2018-04-07

African American youths have the highest risk for firearm and other weapon related homicides. This study utilized the national Youth Risk Behavior Surveys from 2001 to 2015 to assess trends in violence related behaviors and weapon carrying of African American adolescents. Our analyses found statistically significant reductions in physical fighting and weapon carrying among African American male adolescents from 2007 to 2015. Planning suicide increased in both male and female African American adolescents since 2007. In addition, the number of firearm homicides increased in African American males. African American females and males had groups of items highly predictive of weapon carrying behaviors: alcohol, tobacco, and other drug use and violent risk behaviors. Both female and male students who made mostly A's or B's in school were significantly less likely to carry weapons in and out of school. Our findings indicate that firearm homicides have increased in African American adolescents, but weapon carrying in school going adolescents has significantly declined. School engagement and satisfactory school performance seems to have a significant protective effect on firearm homicides and violent behavior risks in African American adolescents.

Pregnancy outcomes among women with beta-thalassemia trait.

PubMed

Charoenboon, Chitrakan; Jatavan, Phudit; Traisrisilp, Kuntharee; Tongsong, Theera

2016-04-01

To compare the obstetric outcomes between pregnant women affected by beta-thalassemia trait and normal controls. A retrospective cohort study was conducted on singleton pregnant women complicated by beta-thalassemia trait and normal controls, randomly selected with the controls-to-case ratio of 2:1. All were low-risk pregnancies without underlying medical diseases and fetal anomalies. The pregnancies undergoing invasive prenatal diagnosis were excluded. A total of 597 pregnant women with beta-thalassemia trait and 1194 controls were recruited. Baseline characteristics and maternal outcomes in the two groups were similar, except that hemoglobin levels were slightly lower in the study group. The prevalence of small for gestational age and preterm birth tended to be higher in the study group but not reached the significant levels but the rate of low birth weight was significantly higher in the study group (relative risk 1.25; 95 % CI 1.00-1.57). Additionally, abortion rate was also significantly higher in the study group (relative risk 3.25; 95 % CI 1.35-7.80). Beta-thalassemia trait could minimally, but significantly, increase risk of low birth weight but did not increase rates of maternal adverse outcomes.

Distribution System Nitrification 101 - slides

EPA Science Inventory

As a result of the implementation of the Stage 1 and Stage 2 Disinfectants and Disinfection Byproduct Rules, chloramine use as a secondary disinfectant in the United States is predicted to increase significantly. Along with the addition of chloramine comes the risk of nitrificat...

Short sleep duration as a risk factor for hypercholesterolemia: analyses of the National Longitudinal Study of Adolescent Health.

PubMed

Gangwisch, James E; Malaspina, Dolores; Babiss, Lindsay A; Opler, Mark G; Posner, Kelly; Shen, Sa; Turner, J Blake; Zammit, Gary K; Ginsberg, Henry N

2010-07-01

To explore the relationship between sleep duration in adolescence and hypercholesterolemia in young adulthood. Experimental sleep restriction has been shown to significantly increase total cholesterol and LDL cholesterol levels in women. Short sleep duration has been found in cross sectional studies to be associated with higher total cholesterol and lower HDL cholesterol levels. Sleep deprivation could increase the risk for hypercholesterolemia by increasing appetite and dietary consumption of saturated fats, decreasing motivation to engage in regular physical activity, and increasing stress and resultant catecholamine induced lipolysis. No previous published population studies have examined the longitudinal relationship between sleep duration and high cholesterol. Multivariate longitudinal analyses stratified by sex of the ADD Health using logistic regression. United States nationally representative, school-based, probability-based sample. Adolescents (n = 14,257) in grades 7 to 12 at baseline (1994-95) and ages 18 to 26 at follow-up (2001-02). Among females, each additional hour of sleep was associated with a significantly decreased odds of being diagnosed with high cholesterol in young adulthood (OR = 0.85, 95% CI 0.75-0.96) after controlling for covariates. Additional sleep was associated with decreased, yet not statistically significant, odds ratios for hypercholesterolemia in males (OR = 0.91, 95% CI 0.79-1.05). Short sleep durations in adolescent women could be a significant risk factor for high cholesterol. Interventions that lengthen sleep could potentially serve as treatments and as primary preventative measures for hypercholesterolemia.

Impairment of innate immune responses in cirrhotic patients and treatment by branched-chain amino acids

PubMed Central

Nakamura, Ikuo

2014-01-01

It has been reported that host defense responses, such as phagocytic function of neutrophils and natural killer (NK) cell activity of lymphocytes, are impaired in cirrhotic patients. This review will concentrate on the impairment of innate immune responses in decompensated cirrhotic patients and the effect of the treatment by branched-chain amino acids (BCAA) on innate immune responses. We already reported that phagocytic function of neutrophils was significantly improved by 3-mo BCAA supplementation. In addition, the changes of NK activity were also significant at 3 mo of supplementation compared with before supplementation. Also, Fisher’s ratios were reported to be significantly increased at 3 mo of BCAA supplementation compared with those before oral supplementation. Therefore, administration of BCAA could reduce the risk of bacterial and viral infection in patients with decompensated cirrhosis by restoring impaired innate immune responses of the host. In addition, it was also revealed that BCAA oral supplementation could reduce the risk of development of hepatocellular carcinoma in cirrhotic patients. The mechanisms of the effects will also be discussed in this review article. PMID:24966600

[Helicobacter pylori gastritis: assessment of OLGA and OLGIM staging systems].

PubMed

Ben Slama, Sana; Ben Ghachem, Dorra; Dhaoui, Amen; Jomni, Mohamed Taieb; Dougui, Mohamed Hédi; Bellil, Khadija

2016-01-01

Helicobacter pylori (H pylori) gastritis presents a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to identify high-risk forms (stages III and IV). The aim of this study is to evaluate the OLGA and OLGIM staging systems in H pylori gastritis. A descriptive study of 100 cases of chronic H pylori gastritis was performed. The revaluation of Sydney System parameters of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed identifying respectively the stages of OLGA and OLGIM systems. The progressive risk of our H pylori gastritis was 6% according to OLGA staging and 7% according to OLGIM staging. Significant correlation was revealed between age and OLGA staging. High-risk gastritis according to OLGIM staging was significantly associated with moderate to severe atrophy. High-risk forms according to OLGA staging were associated in 80% of the cases to intestinal metaplasia. OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 5% for H pylori gastritis. The OLGA and OLGIM staging systems in addition to Sydney System, allow selection of high risk forms of chronic gastritis requiring accurate observation.

Increased Risk Taking in Relation to Chronic Stress in Adults

PubMed Central

Ceccato, Smarandita; Kudielka, Brigitte M.; Schwieren, Christiane

2016-01-01

Chronic stress is a public health problem that affects a significant part of the population. While the physiological damage it causes is under ongoing scrutiny, its behavioral effects have been overlooked. This is one of the first studies to examine the relation between chronic stress and decision-making, using a standard lottery paradigm. We measured risk taking in the gain domain through binary choices between financially incentivized lotteries. We then measured self-reported chronic stress with the Trier Inventory for the Assessment of Chronic Stress (TICS). We additionally collected hair samples in a subsample of volunteers, in order to quantify accumulation of the stress hormone cortisol. We discovered a significant positive, though modest, correlation between self-reported chronic stress and risk taking that is stronger for women than for men. This confirms part of the findings in acute stress research that show a connection between higher stress and increased risk taking. However, unlike the biologically-based results from acute stress research, we did not identify a significant relation between hair cortisol and behavior. In line with previous literature, we found a clear gender difference in risk taking and self-reports: women generally take less risk and report slightly higher stress levels than men. We conclude that perceived chronic stress can impact behavior in risky situations. PMID:26858663

Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants.

PubMed

Bell, E F; Acarregui, M J

2008-01-23

Most premature infants are not sufficiently mature physiologically to ingest all of their required water and nutrients orally. Therefore, premature infants rely on their caregivers to regulate their volume of water intake. Thus, the caregiver must determine the amount of water to be given each day to such infants. The objective of this review is to examine the effects of water intake on postnatal weight loss and on the risks of dehydration, patent ductus arteriosus, necrotizing enterocolitis, bronchopulmonary dysplasia, intracranial hemorrhage, and death in premature infants. Randomized clinical trials identified in previous versions of this review were re-examined and, in each case, retained. Additional trials were sought that compared the outcomes of interest in groups of premature infants who were given different levels of water intake according to experimental protocol. Such trials were sought in a list of trials provided by the Cochrane Neonatal Review Group, with a PubMed search, and in the authors' personal files. Only randomized clinical trials of varying water intake in premature infants are included. The review was limited to trials that included infants whose water intake was provided mainly or entirely by intravascular infusion. Included studies reported at least one of the following outcomes: postnatal weight loss, dehydration, patent ductus arteriosus, necrotizing enterocolitis, bronchopulmonary dysplasia, intracranial hemorrhage, and death. Standard methods of the Cochrane Collaboration were used. The studies to be included were selected by two reviewers, each of whom also assessed the methodological quality of each trial. Data were independently extracted by the reviewers, who agreed on the key details. The data were then entered into tables using RevMan 4.3.1. The adverse event rates were calculated for the restricted and liberal water intake groups for each dichotomous outcome, and the relative risk and risk difference were computed. In addition, the maximal weight loss results were recorded, and the weighted mean difference was computed. The analyses - including calculation of relative risk, risk difference, and weighted mean difference - and tests of heterogeneity were accomplished using RevMan 4.3.1 software. The analysis of the five studies taken together indicates that restricted water intake significantly increases postnatal weight loss and significantly reduces the risks of patent ductus arteriosus and necrotizing enterocolitis. With restricted water intake, there are trends toward increased risk of dehydration and reduced risks of bronchopulmonary dysplasia, intracranial hemorrhage, and death, but these trends are not statistically significant. Based on this analysis, the most prudent prescription for water intake to premature infants would seem to be careful restriction of water intake so that physiological needs are met without allowing significant dehydration. This practice could be expected to decrease the risks of patent ductus arteriosus and necrotizing enterocolitis without significantly increasing the risk of adverse consequences.

Effects of bioaerosol exposure on respiratory health in compost workers: a 13-year follow-up study.

PubMed

van Kampen, V; Hoffmeyer, F; Deckert, A; Kendzia, B; Casjens, S; Neumann, H D; Buxtrup, M; Willer, E; Felten, C; Schöneich, R; Brüning, T; Raulf, M; Bünger, J

2016-12-01

To determine the risk of German compost workers developing chronic respiratory effects from long-term exposure to bioaerosols. Respiratory health was determined in 74 currently exposed compost workers and 37 non-exposed controls after 13 years of follow-up. In addition, 42 former compost workers (drop-outs) who left their work during the follow-up period were also examined. Respiratory symptoms and working conditions were assessed using identical questionnaires as at baseline. In addition, lung function was measured using the same spirometer as in the initial study. Sera from both surveys were tested for specific IgE and IgG antibodies to moulds and the risk of work-related symptoms was evaluated using regression approaches for prospective studies with binary data. In the follow-up period, the number of participants reporting cough significantly increased in compost workers and drop-outs compared to the controls. Working as a compost worker for at least 5 years increased the relative risk for cough (RR 1.28; 95% CI 1.2 to 1.4) and for cough with phlegm (RR 1.32; 95% CI 1.2 to 1.5). Current and former compost workers had slightly lower predicted percentage of forced expiratory volume in 1 s and predicted percentage of forced vital capacity than controls, but decrease in lung function during follow-up was not different among the 3 groups. In addition, no significant changes could be detected in antibody concentrations. Our results suggest that chronic exposure to bioaerosols in composting plants is related to a significantly higher risk for cough with phlegm, indicating chronic bronchitis. However, compost workers showed no higher incidence of deterioration of pulmonary function over the study. 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/.

Perceived safety and controllability of events: Markers of risk for marijuana use in young adults?

PubMed

Sartor, Carolyn E; Ecker, Anthony H; Kraus, Shane W; Leeman, Robert F; Dukes, Kristin N; Foster, Dawn W

2017-03-01

Drawing on constructs from the trauma literature, the current study evaluated perceptions of safety and controllability of events as potential markers of risk for marijuana use. In addition, we characterized these perceptions in relation to individual level substance abuse risk factors (marijuana expectancies, impulsivity, depression, and anxiety), gender, and race. Data were collected via web survey from college students at two northeastern universities (n=228, 82.0% female). Controllability of events (CE) was rated significantly higher by Blacks than Whites. Safety/vulnerability (SV) and CE were associated with impulsivity, depression, and anxiety. CE was also associated with marijuana expectancies. Logistic regression analyses revealed a modest but significant association between SV and lifetime use even after adjusting for race, gender, age, and individual level substance abuse risk factors (odds ratio=1.10, 95% confidence intervals:1.02-1.18). No association between SV and past 3month frequency of use or between CE and either marijuana outcome was found. Findings support a link between perceptions of safety and ever using marijuana. They further demonstrate overlap of both perceived safety and controllability of events with substance use related risk factors, and suggest that they differ by race. Additional studies that assess substance use more broadly and query trauma history, using larger, more diverse samples, are needed to more fully grasp the relevance of these constructs to substance use, including their potential as targets for substance abuse prevention efforts. Copyright © 2016 Elsevier Ltd. All rights reserved.

Novel pedigree analysis implicates DNA repair and chromatin remodeling in multiple myeloma risk.

PubMed

Waller, Rosalie G; Darlington, Todd M; Wei, Xiaomu; Madsen, Michael J; Thomas, Alun; Curtin, Karen; Coon, Hilary; Rajamanickam, Venkatesh; Musinsky, Justin; Jayabalan, David; Atanackovic, Djordje; Rajkumar, S Vincent; Kumar, Shaji; Slager, Susan; Middha, Mridu; Galia, Perrine; Demangel, Delphine; Salama, Mohamed; Joseph, Vijai; McKay, James; Offit, Kenneth; Klein, Robert J; Lipkin, Steven M; Dumontet, Charles; Vachon, Celine M; Camp, Nicola J

2018-02-01

The high-risk pedigree (HRP) design is an established strategy to discover rare, highly-penetrant, Mendelian-like causal variants. Its success, however, in complex traits has been modest, largely due to challenges of genetic heterogeneity and complex inheritance models. We describe a HRP strategy that addresses intra-familial heterogeneity, and identifies inherited segments important for mapping regulatory risk. We apply this new Shared Genomic Segment (SGS) method in 11 extended, Utah, multiple myeloma (MM) HRPs, and subsequent exome sequencing in SGS regions of interest in 1063 MM / MGUS (monoclonal gammopathy of undetermined significance-a precursor to MM) cases and 964 controls from a jointly-called collaborative resource, including cases from the initial 11 HRPs. One genome-wide significant 1.8 Mb shared segment was found at 6q16. Exome sequencing in this region revealed predicted deleterious variants in USP45 (p.Gln691* and p.Gln621Glu), a gene known to influence DNA repair through endonuclease regulation. Additionally, a 1.2 Mb segment at 1p36.11 is inherited in two Utah HRPs, with coding variants identified in ARID1A (p.Ser90Gly and p.Met890Val), a key gene in the SWI/SNF chromatin remodeling complex. Our results provide compelling statistical and genetic evidence for segregating risk variants for MM. In addition, we demonstrate a novel strategy to use large HRPs for risk-variant discovery more generally in complex traits.

Contributors to suicidality in rural communities: beyond the effects of depression

PubMed Central

2012-01-01

Background Rural populations experience a higher suicide rate than urban areas despite their comparable prevalence of depression. This suggests the identification of additional contributors is necessary to improve our understanding of suicide risk in rural regions. Investigating the independent contribution of depression, and the impact of co-existing psychiatric disorders, to suicidal ideation and suicide attempts in a rural community sample may provide clarification of the role of depression in rural suicidality. Methods 618 participants in the Australian Rural Mental Health Study completed the Composite International Diagnostic Interview, providing assessment of lifetime suicidal ideation and attempts, affective disorders, anxiety disorders and substance-use disorders. Logistic regression analyses explored the independent contribution of depression and additional diagnoses to suicidality. A receiver operating characteristic (ROC) analysis was performed to illustrate the benefit of assessing secondary psychiatric diagnoses when determining suicide risk. Results Diagnostic criteria for lifetime depressive disorder were met by 28% (174) of the sample; 25% (154) had a history of suicidal ideation. Overall, 41% (63) of participants with lifetime suicidal ideation and 34% (16) of participants with a lifetime suicide attempt had no history of depression. When lifetime depression was controlled for, suicidal ideation was predicted by younger age, being currently unmarried, and lifetime anxiety or post-traumatic stress disorder. In addition to depression, suicide attempts were predicted by lifetime anxiety and drug use disorders, as well as younger age; being currently married and employed were significant protective factors. The presence of comorbid depression and PTSD significantly increased the odds of reporting a suicide attempt above either of these conditions independently. Conclusions While depression contributes significantly to suicidal ideation, and is a key risk factor for suicide attempts, other clinical and demographic factors played an important role in this rural sample. Consideration of the contribution of factors such as substance use and anxiety disorders to suicidal ideation and behaviours may improve our ability to identify individuals at risk of suicide. Acknowledging the contribution of these factors to rural suicide may also result in more effective approaches for the identification and treatment of at-risk individuals. PMID:22873772

Identifying patterns of immune-related disease: use in disease prevention and management.

PubMed

Dietert, Rodney R; Zelikoff, Judith T

2010-05-01

Childhood susceptibility to diseases linked with immune dysfunction affects over a quarter of the pediatric population in some countries. While this alone is a significant health issue, the actual impact of immune-related diseases extends over a lifetime and involves additional secondary conditions. Some comorbidities are well known (e.g., allergic rhinitis and asthma). However, no systematic approach has been used to identify life-long patterns of immune-based disease where the primary condition arises in childhood. Such information is useful for both disease prevention and treatment approaches. Recent primary research papers as well as review articles were obtained from PubMed, Chem Abstracts, Biosis and from the personal files of the authors. Search words used were: the diseases and conditions shown Figs. 1 and 2 in conjunction with comorbid, comorbidities, pediatric, childhood, adult, immune, immune dysfunction, allergy, autoimmune, inflammatory, infectious, health risks, environment, risk factors. Childhood diseases such as asthma, type-1 diabetes, inflammatory bowel disease, respiratory infections /rhinitis, recurrent otitis media, pediatric celiac, juvenile arthritis and Kawasaki disease are examples of significant childhood health problems where immune dysfunction plays a significant role. Each of these pediatric diseases is associated with increased risk of several secondary conditions, many of which appear only later in life. To illustrate, four prototypes of immune-related disease patterns (i.e., allergy, autoimmunity, inflammation and infectious disease) are shown as tools for: 1) enhanced disease prevention; 2) improved management of immune-based pediatric diseases; and 3) better recognition of underlying pediatric immune dysfunction. Identification of immune-related disease patterns beginning in childhood provides the framework for examining the underlying immune dysfunctions that can contribute to additional diseases in later life. Many pediatric diseases associated with dysfunctional immune responses have been linked with an elevated risk of other diseases or conditions as the child ages. Diseases within a pattern may be interlinked based on underlying immune dysfunctions and/or current therapeutic approaches for managing the entryway diseases. It may be beneficial to consider treatment options for the earliest presenting diseases that will concomitantly reduce the risk of immune-linked secondary conditions. Additionally, improved disease prevention is possible with more relevant and age-specific immune safety testing.

Spatial Variability of Geriatric Depression Risk in a High-Density City: A Data-Driven Socio-Environmental Vulnerability Mapping Approach.

PubMed

Ho, Hung Chak; Lau, Kevin Ka-Lun; Yu, Ruby; Wang, Dan; Woo, Jean; Kwok, Timothy Chi Yui; Ng, Edward

2017-08-31

Previous studies found a relationship between geriatric depression and social deprivation. However, most studies did not include environmental factors in the statistical models, introducing a bias to estimate geriatric depression risk because the urban environment was found to have significant associations with mental health. We developed a cross-sectional study with a binomial logistic regression to examine the geriatric depression risk of a high-density city based on five social vulnerability factors and four environmental measures. We constructed a socio-environmental vulnerability index by including the significant variables to map the geriatric depression risk in Hong Kong, a high-density city characterized by compact urban environment and high-rise buildings. Crude and adjusted odds ratios (ORs) of the variables were significantly different, indicating that both social and environmental variables should be included as confounding factors. For the comprehensive model controlled by all confounding factors, older adults who were of lower education had the highest geriatric depression risks (OR: 1.60 (1.21, 2.12)). Higher percentage of residential area and greater variation in building height within the neighborhood also contributed to geriatric depression risk in Hong Kong, while average building height had negative association with geriatric depression risk. In addition, the socio-environmental vulnerability index showed that higher scores were associated with higher geriatric depression risk at neighborhood scale. The results of mapping and cross-section model suggested that geriatric depression risk was associated with a compact living environment with low socio-economic conditions in historical urban areas in Hong Kong. In conclusion, our study found a significant difference in geriatric depression risk between unadjusted and adjusted models, suggesting the importance of including environmental factors in estimating geriatric depression risk. We also developed a framework to map geriatric depression risk across a city, which can be used for identifying neighborhoods with higher risk for public health surveillance and sustainable urban planning.

Spatial Variability of Geriatric Depression Risk in a High-Density City: A Data-Driven Socio-Environmental Vulnerability Mapping Approach

PubMed Central

Lau, Kevin Ka-Lun; Yu, Ruby; Wang, Dan; Kwok, Timothy Chi Yui; Ng, Edward

2017-01-01

Previous studies found a relationship between geriatric depression and social deprivation. However, most studies did not include environmental factors in the statistical models, introducing a bias to estimate geriatric depression risk because the urban environment was found to have significant associations with mental health. We developed a cross-sectional study with a binomial logistic regression to examine the geriatric depression risk of a high-density city based on five social vulnerability factors and four environmental measures. We constructed a socio-environmental vulnerability index by including the significant variables to map the geriatric depression risk in Hong Kong, a high-density city characterized by compact urban environment and high-rise buildings. Crude and adjusted odds ratios (ORs) of the variables were significantly different, indicating that both social and environmental variables should be included as confounding factors. For the comprehensive model controlled by all confounding factors, older adults who were of lower education had the highest geriatric depression risks (OR: 1.60 (1.21, 2.12)). Higher percentage of residential area and greater variation in building height within the neighborhood also contributed to geriatric depression risk in Hong Kong, while average building height had negative association with geriatric depression risk. In addition, the socio-environmental vulnerability index showed that higher scores were associated with higher geriatric depression risk at neighborhood scale. The results of mapping and cross-section model suggested that geriatric depression risk was associated with a compact living environment with low socio-economic conditions in historical urban areas in Hong Kong. In conclusion, our study found a significant difference in geriatric depression risk between unadjusted and adjusted models, suggesting the importance of including environmental factors in estimating geriatric depression risk. We also developed a framework to map geriatric depression risk across a city, which can be used for identifying neighborhoods with higher risk for public health surveillance and sustainable urban planning. PMID:28858265

Risk factors for antenatal depression, postnatal depression and parenting stress.

PubMed

Leigh, Bronwyn; Milgrom, Jeannette

2008-04-16

Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them. Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program 1. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26-32 weeks gestation. A subsample of these women (N = 161) also completed questionnaires at 10-12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI). Regression analyses identified significant risk factors for the three outcome measures. (1). Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2). Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3). Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator for other risk factors. Risk factor profiles for antenatal depression, postnatal depression and parenting stress differ but are interrelated. Antenatal depression was the strongest predictor of postnatal depression, and in turn postnatal depression was the strongest predictor for parenting stress. These results provide clinical direction suggesting that early identification and treatment of perinatal depression is important.

Studies of the mortality of atomic bomb survivors, Report 14, 1950-2003: an overview of cancer and noncancer diseases.

PubMed

Ozasa, Kotaro; Shimizu, Yukiko; Suyama, Akihiko; Kasagi, Fumiyoshi; Soda, Midori; Grant, Eric J; Sakata, Ritsu; Sugiyama, Hiromi; Kodama, Kazunori

2012-03-01

This is the 14th report in a series of periodic general reports on mortality in the Life Span Study (LSS) cohort of atomic bomb survivors followed by the Radiation Effects Research Foundation to investigate the late health effects of the radiation from the atomic bombs. During the period 1950-2003, 58% of the 86,611 LSS cohort members with DS02 dose estimates have died. The 6 years of additional follow-up since the previous report provide substantially more information at longer periods after radiation exposure (17% more cancer deaths), especially among those under age 10 at exposure (58% more deaths). Poisson regression methods were used to investigate the magnitude of the radiation-associated risks, the shape of the dose response, and effect modification by gender, age at exposure, and attained age. The risk of all causes of death was positively associated with radiation dose. Importantly, for solid cancers the additive radiation risk (i.e., excess cancer cases per 10(4) person-years per Gy) continues to increase throughout life with a linear dose-response relationship. The sex-averaged excess relative risk per Gy was 0.42 [95% confidence interval (CI): 0.32, 0.53] for all solid cancer at age 70 years after exposure at age 30 based on a linear model. The risk increased by about 29% per decade decrease in age at exposure (95% CI: 17%, 41%). The estimated lowest dose range with a significant ERR for all solid cancer was 0 to 0.20 Gy, and a formal dose-threshold analysis indicated no threshold; i.e., zero dose was the best estimate of the threshold. The risk of cancer mortality increased significantly for most major sites, including stomach, lung, liver, colon, breast, gallbladder, esophagus, bladder and ovary, whereas rectum, pancreas, uterus, prostate and kidney parenchyma did not have significantly increased risks. An increased risk of non-neoplastic diseases including the circulatory, respiratory and digestive systems was observed, but whether these are causal relationships requires further investigation. There was no evidence of a radiation effect for infectious or external causes of death.

Chronic ingestion of flavan-3-ols and isoflavones improves insulin sensitivity and lipoprotein status and attenuates estimated 10-year CVD risk in medicated postmenopausal women with type 2 diabetes: a 1-year, double-blind, randomized, controlled trial.

PubMed

Curtis, Peter J; Sampson, Mike; Potter, John; Dhatariya, Ketan; Kroon, Paul A; Cassidy, Aedín

2012-02-01

To assess the effect of dietary flavonoids on cardiovascular disease (CVD) risk in postmenopausal women with type 2 diabetes on established statin and hypoglycemic therapy. Despite being medicated, patients with type 2 diabetes have elevated CVD risk, particularly postmenopausal women. Although dietary flavonoids have been shown to reduce CVD risk factors in healthy participants, no long-term trials have examined the additional benefits of flavonoids to CVD risk in medicated postmenopausal women with type 2 diabetes. We conducted a parallel-design, placebo-controlled trial with type 2 diabetic patients randomized to consume 27 g/day (split dose) flavonoid-enriched chocolate (containing 850 mg flavan-3-ols [90 mg epicatechin] and 100 mg isoflavones [aglycone equivalents)]/day) or matched placebo for 1 year. Ninety-three patients completed the trial, and adherence was high (flavonoid 91.3%; placebo 91.6%). Compared with the placebo group, the combined flavonoid intervention resulted in a significant reduction in estimated peripheral insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] -0.3 ± 0.2; P = 0.004) and improvement in insulin sensitivity (quantitative insulin sensitivity index [QUICKI] 0.003 ± 0.00; P = 0.04) as a result of a significant decrease in insulin levels (-0.8 ± 0.5 mU/L; P = 0.02). Significant reductions in total cholesterol:HDL-cholesterol (HDL-C) ratio (-0.2 ± 0.1; P = 0.01) and LDL-cholesterol (LDL-C) (-0.1 ± 0.1 mmol/L; P = 0.04) were also observed. Estimated 10-year total coronary heart disease risk (derived from UK Prospective Diabetes Study algorithm) was attenuated after flavonoid intervention (flavonoid +0.1 ± 0.3 vs. placebo 1.1 ± 0.3; P = 0.02). No effect on blood pressure, HbA(1c), or glucose was observed. One-year intervention with flavan-3-ols and isoflavones improved biomarkers of CVD risk, highlighting the additional benefit of flavonoids to standard drug therapy in managing CVD risk in postmenopausal type 2 diabetic patients.

Chronic Ingestion of Flavan-3-ols and Isoflavones Improves Insulin Sensitivity and Lipoprotein Status and Attenuates Estimated 10-Year CVD Risk in Medicated Postmenopausal Women With Type 2 Diabetes

PubMed Central

Curtis, Peter J.; Sampson, Mike; Potter, John; Dhatariya, Ketan; Kroon, Paul A.; Cassidy, Aedín

2012-01-01

OBJECTIVE To assess the effect of dietary flavonoids on cardiovascular disease (CVD) risk in postmenopausal women with type 2 diabetes on established statin and hypoglycemic therapy. RESEARCH DESIGN AND METHODS Despite being medicated, patients with type 2 diabetes have elevated CVD risk, particularly postmenopausal women. Although dietary flavonoids have been shown to reduce CVD risk factors in healthy participants, no long-term trials have examined the additional benefits of flavonoids to CVD risk in medicated postmenopausal women with type 2 diabetes. We conducted a parallel-design, placebo-controlled trial with type 2 diabetic patients randomized to consume 27 g/day (split dose) flavonoid-enriched chocolate (containing 850 mg flavan-3-ols [90 mg epicatechin] and 100 mg isoflavones [aglycone equivalents)]/day) or matched placebo for 1 year. RESULTS Ninety-three patients completed the trial, and adherence was high (flavonoid 91.3%; placebo 91.6%). Compared with the placebo group, the combined flavonoid intervention resulted in a significant reduction in estimated peripheral insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] −0.3 ± 0.2; P = 0.004) and improvement in insulin sensitivity (quantitative insulin sensitivity index [QUICKI] 0.003 ± 0.00; P = 0.04) as a result of a significant decrease in insulin levels (−0.8 ± 0.5 mU/L; P = 0.02). Significant reductions in total cholesterol:HDL-cholesterol (HDL-C) ratio (−0.2 ± 0.1; P = 0.01) and LDL-cholesterol (LDL-C) (−0.1 ± 0.1 mmol/L; P = 0.04) were also observed. Estimated 10-year total coronary heart disease risk (derived from UK Prospective Diabetes Study algorithm) was attenuated after flavonoid intervention (flavonoid +0.1 ± 0.3 vs. placebo 1.1 ± 0.3; P = 0.02). No effect on blood pressure, HbA1c, or glucose was observed. CONCLUSIONS One-year intervention with flavan-3-ols and isoflavones improved biomarkers of CVD risk, highlighting the additional benefit of flavonoids to standard drug therapy in managing CVD risk in postmenopausal type 2 diabetic patients. PMID:22250063

Genome-wide significant association between a sequence variant at 15q15.2 and lung cancer risk

PubMed Central

Rafnar, Thorunn; Sulem, Patrick; Besenbacher, Soren; Gudbjartsson, Daniel F.; Zanon, Carlo; Gudmundsson, Julius; Stacey, Simon N.; Kostic, Jelena P.; Thorgeirsson, Thorgeir E.; Thorleifsson, Gudmar; Bjarnason, Hjordis; Skuladottir, Halla; Gudbjartsson, Tomas; Isaksson, Helgi J.; Isla, Dolores; Murillo, Laura; García-Prats, Maria D.; Panadero, Angeles; Aben, Katja K.H.; Vermeulen, Sita H.; van der Heijden, Henricus F.M.; Feser, William; Miller, York E.; Bunn, Paul A.; Kong, Augustine; Wolf, Holly J.; Franklin, Wilbur A.; Mayordomo, Jose I; Kiemeney, Lambertus A.; Jonsson, Steinn; Thorsteinsdottir, Unnur; Stefansson, Kari

2010-01-01

Genome-wide association studies (GWAS) have identified three genomic regions, at 15q24-25.1, 5p15.33 and 6p21.33, which associate with risk of lung cancer. Large meta-analyses of GWA data have failed to find additional associations of genome-wide significance. In this study, we sought to confirm 7 variants with suggestive association to lung cancer (P<10−5) in a recently published meta-analysis. In a GWA dataset of 1,447 lung cancer cases and 36,256 controls in Iceland, three correlated variants on 15q15.2 (rs504417, rs11853991 and rs748404) showed a significant association with lung cancer whereas rs4254535 on 2p14, rs1530057 on 3p24.1, rs6438347 on 3q13.31 and rs1926203 on 10q23.31 did not. The most significant variant, rs748404, was genotyped in additional 1,299 lung cancer cases and 4,102 controls from the Netherlands, Spain and the USA and the results combined with published GWAS data. In this analysis, the T allele of rs748404 reached genome-wide significance (OR=1.15, P=1.1×10−9). Another variant at the same locus, rs12050604, showed association with lung cancer (OR=1.09, 3.6×10−6) and remained significant after adjustment for rs748404 and vice versa. rs748404 is located 140 kb centromeric of the TP53BP1 gene that has been implicated in lung cancer risk. Two fully correlated, non-synonymous coding variants in TP53BP1, rs2602141 (Q1136K) and rs560191 (E353D), showed association with lung cancer in our sample set; however, this association did not remain significant after adjustment for rs748404. Our data show that one or more lung cancer risk variants of genome-wide significance and distinct from the coding variants in TP53BP1 are located at 15q15.2. PMID:21303977

Do not fear the Framingham: Practical application to properly evaluate and modify cardiovascular risk in commercial divers.

PubMed

Suresh, Rahul; Pavela, James; Kus, Marcus S; Alleman, Tony; Sanders, Robert

2018-01-01

In April 2016 the Association of Diving Contractors International (ADCI) consensus guidelines began recommending annual cardiovascular risk stratification of commercial divers using the Framingham Risk Score (FRS). For those at elevated risk, further testing is recommended. This approach has raised concerns about potential operational and financial impacts. However, the prevalence of elevated cardiovascular risk and need for additional testing among commercial divers is not known. Clinical data required to calculate the FRS was abstracted for 190 commercial divers in two cohorts. Population demographics, FRS distribution, contributions of risk factors and effect of interventions on reducing risk-factor burden were assessed. Mean FRS score was 1.68 ± 6.35 points, with 13 divers (6.8%) at intermediate risk and none at high 10-year risk. In these 13 divers, the mean contributions to the FRS were from age (6.5 points), cholesterol (3.1 pts.), smoking (1.3 pts.), highdensity lipoprotein (1 pt.), and systolic blood pressure (0.8 pts). The youngest age group had a significantly higher modifiable risk core than the oldest age group (5.87 vs. 1.2 points, P ⟨ 0.001). All 13 intermediate risk divers could have been reclassified as low-risk with successful treatment of modifiable risk factors. The prevalence of elevated cardiovascular risk among commercial divers is low, and treatment of modifiable risk factors could reclassify those at intermediate risk to low risk. Therefore, FRS implementation coupled with intensive risk-reduction strategies for at risk-divers may help improve diver health and prolong the careers of divers while limiting the need for additional testing and adverse operational impact. Copyright© Undersea and Hyperbaric Medical Society.

Divorce in Ethiopia: the impact of early marriage and childlessness.

PubMed

Tilson, D; Larsen, U

2000-07-01

Forty-five per cent of first marriages in Ethiopia end in divorce within 30 years, and two-thirds of women who divorce do so within the first 5 years of marriage. This paper looks at two factors that may have an impact on the risk of divorce in Ethiopia: early age of first marriage, and childlessness within the first marriage. Data used were from the 1990 National Family and Fertility Survey conducted by the Government of Ethiopia. A total of 8757 women of reproductive age (15-49) were analysed. Life table analysis was used to determine the median age at first marriage, first birth and the median duration of marriage. Cox models were analysed to determine the differentials of divorce. The results of this analysis showed that both early age at marriage and childlessness have a significant impact on the risk of divorce. An inverse relationship was found between age at marriage and risk of divorce. Having a child within the first marriage also significantly reduced the risk of divorce. In addition, several cultural and socioeconomic variables were significant predictors of divorce.

Breast and Ovarian Cancer Risk and Risk Reduction in Jewish BRCA1/2 Mutation Carriers

PubMed Central

Finkelman, Brian S.; Rubinstein, Wendy S.; Friedman, Sue; Friebel, Tara M.; Dubitsky, Shera; Schonberger, Niecee Singer; Shoretz, Rochelle; Singer, Christian F.; Blum, Joanne L.; Tung, Nadine; Olopade, Olufunmilayo I.; Weitzel, Jeffrey N.; Lynch, Henry T.; Snyder, Carrie; Garber, Judy E.; Schildkraut, Joellen; Daly, Mary B.; Isaacs, Claudine; Pichert, Gabrielle; Neuhausen, Susan L.; Couch, Fergus J.; van't Veer, Laura; Eeles, Rosalind; Bancroft, Elizabeth; Evans, D. Gareth; Ganz, Patricia A.; Tomlinson, Gail E.; Narod, Steven A.; Matloff, Ellen; Domchek, Susan; Rebbeck, Timothy R.

2012-01-01

Purpose Mutations in BRCA1/2 dramatically increase the risk of both breast and ovarian cancers. Three mutations in these genes (185delAG, 5382insC, and 6174delT) occur at high frequency in Ashkenazi Jews. We evaluated how these common Jewish mutations (CJMs) affect cancer risks and risk reduction. Methods Our cohort comprised 4,649 women with disease-associated BRCA1/2 mutations from 22 centers in the Prevention and Observation of Surgical End Points Consortium. Of these women, 969 were self-identified Jewish women. Cox proportional hazards models were used to estimate breast and ovarian cancer risks, as well as risk reduction from risk-reducing salpingo-oophorectomy (RRSO), by CJM and self-identified Jewish status. Results Ninety-one percent of Jewish BRCA1/2-positive women carried a CJM. Jewish women were significantly more likely to undergo RRSO than non-Jewish women (54% v 41%, respectively; odds ratio, 1.87; 95% CI, 1.44 to 2.42). Relative risks of cancer varied by CJM, with the relative risk of breast cancer being significantly lower in 6174delT mutation carriers than in non-CJM BRCA2 carriers (hazard ratio, 0.35; 95% CI, 0.18 to 0.69). No significant difference was seen in cancer risk reduction after RRSO among subgroups. Conclusion Consistent with previous results, risks for breast and ovarian cancer varied by CJM in BRCA1/2 carriers. In particular, 6174delT carriers had a lower risk of breast cancer. This finding requires additional confirmation in larger prospective and population-based cohort studies before being integrated into clinical care. PMID:22430266

Thinking beyond Opisthorchis viverrini for risk of cholangiocarcinoma in the lower Mekong region: a systematic review and meta-analysis.

PubMed

Steele, Jennifer A; Richter, Carsten H; Echaubard, Pierre; Saenna, Parichat; Stout, Virginia; Sithithaworn, Paiboon; Wilcox, Bruce A

2018-05-17

Cholangiocarcinoma (CCA) is a fatal bile duct cancer associated with infection by the liver fluke, Opisthorchis viverrini, in the lower Mekong region. Numerous public health interventions have focused on reducing exposure to O. viverrini, but incidence of CCA in the region remains high. While this may indicate the inefficacy of public health interventions due to complex social and cultural factors, it may further indicate other risk factors or interactions with the parasite are important in pathogenesis of CCA. This systematic review aims to provide a comprehensive analysis of described risk factors for CCA in addition to O. viverrini to guide future integrative interventions. We searched five international and seven Thai research databases to identify studies relevant to risk factors for CCA in the lower Mekong region. Selected studies were assessed for risk of bias and quality in terms of study design, population, CCA diagnostic methods, and statistical methods. The final 18 included studies reported numerous risk factors which were grouped into behaviors, socioeconomics, diet, genetics, gender, immune response, other infections, and treatment for O. viverrini. Seventeen risk factors were reported by two or more studies and were assessed with random effects models during meta-analysis. This meta-analysis indicates that the combination of alcohol and smoking (OR = 11.1, 95% CI: 5.63-21.92, P <  0.0001) is most significantly associated with increased risk for CCA and is an even greater risk factor than O. viverrini exposure. This analysis also suggests that family history of cancer, consumption of raw cyprinoid fish, consumption of high nitrate foods, and praziquantel treatment are associated with significantly increased risk. These risk factors may have complex relationships with the host, parasite, or pathogenesis of CCA, and many of these risk factors were found to interact with each other in one or more studies. Our findings suggest that a complex variety of risk factors in addition to O. viverrini infection should be addressed in future public health interventions to reduce CCA in affected regions. In particular, smoking and alcohol use, dietary patterns, and socioeconomic factors should be considered when developing intervention programs to reduce CCA.

Effect of APAP and heated humidification with a heated breathing tube on adherence, quality of life, and nasopharyngeal complaints.

PubMed

Nilius, Georg; Franke, Karl J; Domanski, Ulrike; Schroeder, Maik; Ruhle, Karl H

2016-03-01

Positive airway pressure (PAP) therapy adherence can be affected by rhinitis sicca and xerostomia complaints. Additional heated humidification (HH) is the appropriate method when such complaints arise. The aim of this study was to determine if HH with a supplementary heated breathing tube can increase adherence, reduce subjective nasopharyngeal complaints (NPC), and improve sleepiness (ESS: Epworth Sleepiness Scale) and quality of life (FOSQ: Functional Outcome of Sleep Questionnaire). We subdivided 72 obstructive sleep apnea (OSA) patients into two groups before therapy initiation. The NPC risk group consists of subjects with NPC and the low-risk group without. The risk group was identified by a score of >9 in a 5-item 25-point NPC questionnaire and pathological ESS. All patients were eligible for automatic CPAP devices (APAP), which were randomly configured with or without HH during 6 weeks. The adherence differences with and without HH were not significant in the NPC risk group (330 ± 103 vs. 281 ± 118 min/night) and in the low-risk group (330 ± 116 vs. 321 ± 89). NPC and ESS scores in the risk group were both significantly reduced with HH. Daily function (FOSQ) in the risk group was significantly improved with HH (90.0 ± 11.9 vs. 82.0 ± 12.0 (p < 0.05)). HH showed a tendency to improve APAP adherence. The adherence in both groups was quite high, and for that reason, it is difficult to show a statistically significant effect. A differentiation into NPC risk groups before starting PAP treatment is useful. HH reduces side effects and sleepiness and improves quality of life in an NPC risk group.

Placental Growth Factor Levels in Populations with High Versus Low Risk for Cardiovascular Disease and Stressful Physiological Environments such as Microgravity: A Pilot Study

NASA Astrophysics Data System (ADS)

Sundaresan, Alamelu; Mehta, Satish K.; Schlegel, Todd. T.; Russomano, Thais; Pierson, Duane L.; Mann, Vivek; Mansoor, Elvedina; Olamigoke, Loretta; Okoro, Elvis

2017-02-01

This pilot study compared placental growth factor (PIGF) levels in populations with high versus low risk for cardiovascular disease. Previous experiments from our laboratory (Sundaresan et al. 2005, 2009) revealed that the angiogenic factor PIGF was up regulated in modeled microgravity conditions in human lymphocytes leading to possible atherogenesis and pathogenesis in microgravity. Since the findings came from microgravity analog experiments, there is a strong link to its usefulness in the microgravity field as a biomarker. It is important to understand, that these findings came from both studies on expression levels of this cardiovascular marker in human lymphocytes in microgravity ( in vitro microgravity analog), and a follow up gene expression study in hind limb suspended mice ( in vivo microgravity analog). The relevance is enhanced because in life on earth, PIGF is an inflammatory biomarker for cardiovascular disease. Studies on the levels of PIGF would help to reduce the risk and prevention of heart failures in astronauts. If we can use this marker to predict and reduce the risk of cardiac events in astronauts and pilots, it would significantly help aerospace medicine operations. The investigations here confirmed that in a cardiovascular stressed population such as coronary artery disease (CAD) and acute coronary syndrome (ACS) patients, PIGF could be overexpressed. We desired to re-evaluate this marker in patients with cardiovascular disease in our own study. PIGF is a marker of inflammation and a predictor of short-term and long-term adverse outcome in ACS. In addition, elevated PIGF levels may be associated with increased risk for CAD.PIGF levels were determined in thirty-one patients undergoing cardiovascular catheterization for reasons other than ACS and in thirty-three low-risk asymptomatic subjects. Additional data on traditional cardiovascular risk factors for both populations were also compiled and compared. We found that PIGF levels were significantly higher in the high-risk population as compared to low-risk population. Also we were able to ascertain that PIGF levels were inversely correlated with HDL-cholesterol but directly correlated with the triglyceride levels. With further validation, PIGF may prove a useful addition to the armamentarium of noninvasive biomarkers for cardiovascular disease including a new area of stressful physiological conditions such as microgravity.

It's all about gains: Risk preferences in problem gambling.

PubMed

Ring, Patrick; Probst, Catharina C; Neyse, Levent; Wolff, Stephan; Kaernbach, Christian; van Eimeren, Thilo; Camerer, Colin F; Schmidt, Ulrich

2018-06-07

Problem gambling is a serious socioeconomic problem involving high individual and social costs. In this article, we study risk preferences of problem gamblers including their risk attitudes in the gain and loss domains, their weighting of probabilities, and their degree of loss aversion. Our findings indicate that problem gamblers are systematically more risk taking and less sensitive toward changes in probabilities in the gain domain only. Neither their risk attitudes in the loss domain nor their degree of loss aversion are significantly different from the controls. Additional evidence for a similar degree of sensitivity toward negative outcomes is gained from skin conductance data-a psychophysiological marker for emotional arousal-in a threat-of-shock task. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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

PubMed

Sun, Sam Z; Empie, Mark W

2007-08-01

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

Risk-sensitive reinforcement learning.

PubMed

Shen, Yun; Tobia, Michael J; Sommer, Tobias; Obermayer, Klaus

2014-07-01

We derive a family of risk-sensitive reinforcement learning methods for agents, who face sequential decision-making tasks in uncertain environments. By applying a utility function to the temporal difference (TD) error, nonlinear transformations are effectively applied not only to the received rewards but also to the true transition probabilities of the underlying Markov decision process. When appropriate utility functions are chosen, the agents' behaviors express key features of human behavior as predicted by prospect theory (Kahneman & Tversky, 1979 ), for example, different risk preferences for gains and losses, as well as the shape of subjective probability curves. We derive a risk-sensitive Q-learning algorithm, which is necessary for modeling human behavior when transition probabilities are unknown, and prove its convergence. As a proof of principle for the applicability of the new framework, we apply it to quantify human behavior in a sequential investment task. We find that the risk-sensitive variant provides a significantly better fit to the behavioral data and that it leads to an interpretation of the subject's responses that is indeed consistent with prospect theory. The analysis of simultaneously measured fMRI signals shows a significant correlation of the risk-sensitive TD error with BOLD signal change in the ventral striatum. In addition we find a significant correlation of the risk-sensitive Q-values with neural activity in the striatum, cingulate cortex, and insula that is not present if standard Q-values are used.

Risk evaluation mitigation strategies: the evolution of risk management policy.

PubMed

Hollingsworth, Kristen; Toscani, Michael

2013-04-01

The United States Food and Drug Administration (FDA) has the primary regulatory responsibility to ensure that medications are safe and effective both prior to drug approval and while the medication is being actively marketed by manufacturers. The responsibility for safe medications prior to marketing was signed into law in 1938 under the Federal Food, Drug, and Cosmetic Act; however, a significant risk management evolution has taken place since 1938. Additional federal rules, entitled the Food and Drug Administration Amendments Act, were established in 2007 and extended the government's oversight through the addition of a Risk Evaluation and Mitigation Strategy (REMS) for certain drugs. REMS is a mandated strategy to manage a known or potentially serious risk associated with a medication or biological product. Reasons for this extension of oversight were driven primarily by the FDA's movement to ensure that patients and providers are better informed of drug therapies and their specific benefits and risks prior to initiation. This article provides an historical perspective of the evolution of medication risk management policy and includes a review of REMS programs, an assessment of the positive and negative aspects of REMS, and provides suggestions for planning and measuring outcomes. In particular, this publication presents an overview of the evolution of the REMS program and its implications.

Disrupted latent inhibition in individuals at ultra high-risk for developing psychosis.

PubMed

Kraus, Michael; Rapisarda, Attilio; Lam, Max; Thong, Jamie Y J; Lee, Jimmy; Subramaniam, Mythily; Collinson, Simon L; Chong, Siow Ann; Keefe, Richard S E

2016-12-01

The addition of off-the-shelf cognitive measures to established prodromal criteria has resulted in limited improvement in the prediction of conversion to psychosis. Tests that assess cognitive processes central to schizophrenia might better identify those at highest risk. The latent inhibition paradigm assesses a subject's tendency to ignore irrelevant stimuli, a process integral to healthy perceptual and cognitive function that has been hypothesized to be a key deficit underlying the development of schizophrenia. In this study, 142 young people at ultra high-risk for developing psychosis and 105 controls were tested on a within-subject latent inhibition paradigm. Additionally, we later inquired about the strategy that each subject employed to complete the test, and further investigated the relationship between reported strategy and the extent of latent inhibition exhibited. Unlike controls, ultra high-risk subjects did not demonstrate a significant latent inhibition effect. This difference between groups became greater when controlling for strategy. The lack of latent inhibition effect in our ultra high-risk sample suggests that individuals at ultra high-risk for psychosis are impaired in their allocation of attentional resources based on past predictive value of repeated stimuli. This fundamental deficit in the allocation of attention may contribute to the broader array of cognitive impairments and clinical symptoms displayed by individuals at ultra high-risk for psychosis.

Default mode network connectivity as a function of familial and environmental risk for psychotic disorder.

PubMed

Peeters, Sanne C T; van de Ven, Vincent; Gronenschild, Ed H B M; Patel, Ameera X; Habets, Petra; Goebel, Rainer; van Os, Jim; Marcelis, Machteld

2015-01-01

Research suggests that altered interregional connectivity in specific networks, such as the default mode network (DMN), is associated with cognitive and psychotic symptoms in schizophrenia. In addition, frontal and limbic connectivity alterations have been associated with trauma, drug use and urban upbringing, though these environmental exposures have never been examined in relation to DMN functional connectivity in psychotic disorder. Resting-state functional MRI scans were obtained from 73 patients with psychotic disorder, 83 non-psychotic siblings of patients with psychotic disorder and 72 healthy controls. Posterior cingulate cortex (PCC) seed-based correlation analysis was used to estimate functional connectivity within the DMN. DMN functional connectivity was examined in relation to group (familial risk), group × environmental exposure (to cannabis, developmental trauma and urbanicity) and symptomatology. There was a significant association between group and PCC connectivity with the inferior parietal lobule (IPL), the precuneus (PCu) and the medial prefrontal cortex (MPFC). Compared to controls, patients and siblings had increased PCC connectivity with the IPL, PCu and MPFC. In the IPL and PCu, the functional connectivity of siblings was intermediate to that of controls and patients. No significant associations were found between DMN connectivity and (subclinical) psychotic/cognitive symptoms. In addition, there were no significant interactions between group and environmental exposures in the model of PCC functional connectivity. Increased functional connectivity in individuals with (increased risk for) psychotic disorder may reflect trait-related network alterations. The within-network "connectivity at rest" intermediate phenotype was not associated with (subclinical) psychotic or cognitive symptoms. The association between familial risk and DMN connectivity was not conditional on environmental exposure.

Epidural Abscess: A Propensity Analysis of Surgical Treatment Strategies.

PubMed

Chaker, Anisse N; Bhimani, Abhiraj D; Esfahani, Darian R; Rosinski, Clayton L; Geever, Brett W; Patel, Akash S; Hobbs, Jonathan G; Burch, Taylor G; Patel, Saavan; Mehta, Ankit I

2018-06-18

Observational analysis of retrospectively collected data. A retrospective study was performed in order to compare the surgical profile of risk factors and perioperative complications for laminectomy and laminectomy with fusion procedures in the treatment of SEA. Spinal epidural abscess (SEA) is a highly morbid condition typically presenting with back pain, fever, and neurologic deficits. Posterior fusion has been used to supplement traditional laminectomy of SEA to improve spinal stability. At present, the ideal surgical strategy - laminectomy with or without fusion - remains elusive. 30-day outcomes such as reoperation and readmission following laminectomy and laminectomy with fusion in patients with SEA were investigated utilizing the American College of Surgeons National Quality Improvement Program database. Demographics and clinical risk factors were collected, and propensity matching was performed to account for differences in risk profiles between the groups. 738 patients were studied (608 laminectomy alone, 130 fusion). The fusion population was in worse health. The fusion population experienced significantly greater rate of return to the operating room (odds ratio (OR) 1.892), with the difference primarily accounted for by cervical spine operations. Additionally, fusion patients had significantly greater rates of blood transfusion. Infection was the most common reason for reoperation in both populations. Both laminectomy and laminectomy with fusion effectively treat SEA, but addition of fusion is associated with significantly higher rates of transfusion and perioperative return to the operating room. In operative situations where either procedure is reasonable, surgeons should consider that fusion nearly doubles the odds of reoperation in the short-term, and weigh this risk against the benefit of added stability. 3.

Syndemic Theory and HIV-Related Risk Among Young Transgender Women: The Role of Multiple, Co-Occurring Health Problems and Social Marginalization

PubMed Central

Brennan, Julia; Kuhns, Lisa M.; Johnson, Amy K.; Belzer, Marvin; Wilson, Erin C.

2012-01-01

Objectives. We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors. Methods. Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey. Results. Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration. Conclusions. These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization. PMID:22873480

Genetic association of ubiquilin with Alzheimer's disease and related quantitative measures.

PubMed

Kamboh, M I; Minster, R L; Feingold, E; DeKosky, S T

2006-03-01

The gene coding for ubiquilin 1 (UBQLN1) is located near a linkage peak on chromosome 9q22.2 and it also impacts the function of presenilin proteins involved in early-onset Alzheimer's disease (AD). Recently, genetic variation in UBQLN1 has been shown to affect the risk of AD in two independent family-based samples. The purpose of this study was to confirm the reported association in a large case-control sample and to also examine the association of UBQLN1 SNPs with quantitative measures of AD progression, namely age-at-onset (AAO), disease duration and Mini-Mental State Examination (MMSE) score. We examined the associations of three SNPs in the UBQLN1 gene (intron 6/A>C, intron 8/T>C and intron 9/A>G) in up to 978 LOAD cases and 808 controls. All SNPs were in significant linkage disequilibrium (P<0.0001). While modest significant associations were observed in the single-site regression analysis, 3-site haplotype analysis revealed significant associations (P<0.0001 for overall haplotype analysis). One common haplotype (H4) defined by intron 6/A-intron 8/C-intron 9/G alleles was associated with AD risk and one less common haplotype (H5) defined by intron 6/C-intron 8/C-intron 9/A alleles was associated with protection. The adjusted odds ratios with potentially one and two copies of risk haplotype H4 were 1.5 (95% CI: 0.99-2.26; P=0.054) and 3.66 (95% CI: 1.43-9.39; P=0.007), respectively, and odds ratio for haplotype H5 carriers was 0.31 (95% CI: 0.10-0.95; P=0.0398). In addition to disease risk, the homozygosity of the risk haplotype was also associated with older AAO, longer disease duration and lower MMSE score. In summary, our data from a large case-control cohort indicate that genetic variation in the UBQLN1 gene has a modest effect on risk, AAO and disease duration of AD. Our haplotype data suggest the presence of additional putative functional variants either in the UBQLN1 gene or nearby genes and provide strong justification for additional work in this region on chromosome 9.

Polymorphisms in the TNFA and IL6 Genes Represent Risk Factors for Autoimmune Thyroid Disease

PubMed Central

Alvelos, Inês; Mendes, Adélia; Santos, Liliana R.; Machado, José Carlos; Melo, Miguel; Esteves, César; Neves, Celestino; Sobrinho-Simões, Manuel; Soares, Paula

2014-01-01

Background Autoimmune thyroid disease (AITD) comprises diseases including Hashimoto's thyroiditis and Graves' disease, both characterized by reactivity to autoantigens causing, respectively, inflammatory destruction and autoimmune stimulation of the thyroid-stimulating hormone receptor. AITD is the most common thyroid disease and the leading form of autoimmune disease in women. Cytokines are key regulators of the immune and inflammatory responses; therefore, genetic variants at cytokine-encoding genes are potential risk factors for AITD. Methods Polymorphisms in the IL6-174 G/C (rs1800795), TNFA-308 G/A (rs1800629), IL1B-511 C/T (rs16944), and IFNGR1-56 T/C (rs2234711) genes were assessed in a case-control study comprising 420 Hashimoto's thyroiditis patients, 111 Graves' disease patients and 735 unrelated controls from Portugal. Genetic variants were discriminated by real-time PCR using TaqMan SNP genotyping assays. Results A significant association was found between the allele A in TNFA-308 G/A and Hashimoto's thyroiditis, both in the dominant (OR = 1.82, CI = 1.37–2.43, p-value = 4.4×10−5) and log-additive (OR = 1.64, CI = 1.28–2.10, p-value = 8.2×10−5) models. The allele C in IL6-174 G/C is also associated with Hashimoto's thyroiditis, however, only retained significance after multiple testing correction in the log-additive model (OR = 1.28, CI = 1.06–1.54, p-value = 8.9×10−3). The group with Graves' disease also registered a higher frequency of the allele A in TNFA-308 G/A compared with controls both in the dominant (OR = 1.85, CI = 1.19–2.87, p-value = 7.0×10−3) and log-additive (OR = 1.69, CI = 1.17–2.44, p-value = 6.6×10−3) models. The risk for Hashimoto's thyroiditis and Graves' disease increases with the number of risk alleles (OR for two risk alleles is, respectively, 2.27 and 2.59). Conclusions This study reports significant associations of genetic variants in TNFA and IL6 with the risk for AITD, highlighting the relevance of polymorphisms in inflammation-related genes in the etiopathogenesis of AITD. PMID:25127106

HLA DPA1, DPB1 alleles and haplotypes contribute to the risk associated with type 1 diabetes: analysis of the type 1 diabetes genetics consortium families.

PubMed

Varney, Michael D; Valdes, Ana Maria; Carlson, Joyce A; Noble, Janelle A; Tait, Brian D; Bonella, Persia; Lavant, Eva; Fear, Anna Lisa; Louey, Anthony; Moonsamy, Priscilla; Mychaleckyj, Josyf C; Erlich, Henry

2010-08-01

To determine the relative risk associated with DPA1 and DPB1 alleles and haplotypes in type 1 diabetes. The frequency of DPA1 and DPB1 alleles and haplotypes in type 1 diabetic patients was compared to the family based control frequency in 1,771 families directly and conditional on HLA (B)-DRB1-DQA1-DQB1 linkage disequilibrium. A relative predispositional analysis (RPA) was performed in the presence or absence of the primary HLA DR-DQ associations and the contribution of DP haplotype to individual DR-DQ haplotype risks examined. Eight DPA1 and thirty-eight DPB1 alleles forming seventy-four DPA1-DPB1 haplotypes were observed; nineteen DPB1 alleles were associated with multiple DPA1 alleles. Following both analyses, type 1 diabetes susceptibility was significantly associated with DPB1*0301 (DPA1*0103-DPB1*0301) and protection with DPB1*0402 (DPA1*0103-DPB1*0402) and DPA1*0103-DPB1*0101 but not DPA1*0201-DPB1*0101. In addition, DPB1*0202 (DPA1*0103-DPB1*0202) and DPB1*0201 (DPA1*0103-DPB1*0201) were significantly associated with susceptibility in the presence of the high risk and protective DR-DQ haplotypes. Three associations (DPB1*0301, *0402, and *0202) remained statistically significant when only the extended HLA-A1-B8-DR3 haplotype was considered, suggesting that DPB1 alone may delineate the risk associated with this otherwise conserved haplotype. HLA DP allelic and haplotypic diversity contributes significantly to the risk for type 1 diabetes; DPB1*0301 (DPA1*0103-DPB1*0301) is associated with susceptibility and DPB1*0402 (DPA1*0103-DPB1*0402) and DPA1*0103-DPB1*0101 with protection. Additional evidence is presented for the susceptibility association of DPB1*0202 (DPA1*0103-DPB1*0202) and for a contributory role of individual amino acids and DPA1 or a gene in linkage disequilibrium in DR3-DPB1*0101 positive haplotypes.

Smoke, alcohol consumption and illicit drug use in an Italian population of pregnant women.

PubMed

De Santis, Marco; De Luca, Carmen; Mappa, Ilenia; Quattrocchi, Tomasella; Angelo, Licameli; Cesari, Elena

2011-11-01

High-risk behaviours are associated with an increased risk of adverse pregnancy outcomes. Exposure to drugs, infection or radiation is a cause of concern for pregnant women, who contact Teratology Information Services (TIS) to have a counseling but with an accurate medical history is possible to detect additional behavioural risk factors that can significantly interfere with pregnancy outcome. The aim of this study is to describe risk behaviours in a population of Italian women calling our TIS and to identify related maternal factors. Between December 2008 and January 2010 we collected data from 503 pregnant women calling our TIS (Telefono Rosso, Rome). We investigated about smoke, alcohol and abuse substances addiction and we also collected demographic data. Of the 503 women consenting to participate 34% were found to have an additional risk marker during the current pregnancy. Within this group were 22.7% (n=119) who reported smoking, the 17.7% (n=89) admitted to drink and 2 women (0.4%) used illicit drugs. In 13.7% of cases (n=69) reason for calling represented an exposure to teratogenic agents. Unmarried status and previous induced abortion represent a risk factor for all high-risk behaviours. Lower education (p<0.001) and use of neurological drugs (p<0.001) are related with cigarette consumption. A lower parity was a risk factor for alcohol assumption (p=0.04). Women with high-risk behaviours tend to be exposed to more than a risk factor. Teratogen Information Services are an important system to identify women with pregnancy risk markers. These services should have the ability to provide risk reduction information to women who smoke cigarettes or with alcohol or drug use. In addition to the phone based information these women may benefit from referral back to their physician for assessment and management of substance use/abuse during pregnancy. Substance abuse risks are often underestimated by pregnant women. Single mothers or women with an history of terminations of pregnancy represents an high-risk population. Physicians should inform their patients about possible risks related to high-risk behaviours during preconception counseling or during the first obstetric visit. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the Osteoporotic Fractures in Men (MrOs) Study.

PubMed

Yu, Ruby; Leung, Jason; Woo, Jean

2014-08-01

We examined whether sarcopenia is predictive of incident fractures among older men, whether the inclusion of sarcopenia in models adds any incremental value to bone mineral density (BMD), and whether sarcopenia is associated with a higher risk of fractures in elderly with osteoporosis. A cohort of 2000 community-dwelling men aged ≥65 years were examined for which detailed information regarding demographics, socioeconomic, medical history, clinical, and lifestyle factors were documented. Body composition and BMD were measured using dual energy X-ray absorptiometry. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013, and related to sarcopenia and its component measures using Cox proportional hazard regressions. The contribution of sarcopenia for predicting fracture risk was evaluated by receiver operating characteristic analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During an average of 11.3 years of follow-up, 226 (11.3%) men sustained at least 1 incident fracture, making the incidence of fractures 1200.6/100,000 person-years. After multivariate adjustments, sarcopenia was associated with increased fracture risk (hazard ratio [HR], 1.87, 95% confidence interval [CI], 1.26-2.79) independent of BMD and other clinical risk factors. The addition of sarcopenia did not significantly increase area under curve or IDI but significantly improved the predictive ability on fracture risk over BMD and other clinical risk factors by 5.12% (P < .05) using the NRI approach. In addition, the combination of osteoporosis and sarcopenia (sarco-osteoporosis) resulted in a significantly increased risk of fractures (HR, 3.49, 95% CI, 1.76-6.90) compared with those with normal BMD and without sarcopenia. This study confirms that sarcopenia is a predictor of fracture risk in this elderly men cohort, establishes that sarcopenia provides incremental predictive value for fractures over the integration of BMD and other clinical risk factors, and suggests that the combination of osteoporosis and sarcopenia could identify a subgroup with a particularly high fracture risk. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Current tobacco smoking, formal education, and the risk of rheumatoid arthritis.

PubMed

Uhlig, T; Hagen, K B; Kvien, T K

1999-01-01

To identify if tobacco smoking or sociodemographic characteristics are risk factors of rheumatoid arthritis (RA). From a county RA register 361 patients in the age range 20-79 years were recruited from incidence cohorts with recent disease onset (mean 3.4 years) and compared with 5851 randomly selected individuals from the same population area. Data on selected risk factors were collected by questionnaires (response rate 75 and 59%, respectively) and associations with smoking and risk factors were expressed as odds ratios (OR) with 95% confidence intervals (CI) in a multiple regression analysis. Age and female sex were, as expected, identified as risk factors of RA. In addition, current smoking was an overall risk factor (OR 1.46, 95% CI 1.10-1.94), in men (OR 2.38, 95% CI 1.45-3.92), especially in men with seropositive RA (OR 4.77, 95% CI 2.09-10.90). Separate analyses revealed no statistically significant risk in women (OR 1.14, 95% CI 0.80-1.62). Low level of formal education, body mass index, marital or employment status were not significantly associated with risk of RA. Current smoking in men was identified as an independent risk factor for RA, whereas surrogate markers of socioeconomic status were unrelated to the onset of RA.

Effects of vertical and side-alternating vibration training on fall risk factors and bone turnover in older people at risk of falls.

PubMed

Corrie, Heather; Brooke-Wavell, Katherine; Mansfield, Neil J; Cowley, Alison; Morris, Robert; Masud, Tahir

2015-01-01

whole-body vibration training may improve neuromuscular function, falls risk and bone density, but previous studies have had conflicting findings. this study aimed to evaluate the influence of vertical vibration (VV) and side-alternating vibration (SV) on musculoskeletal health in older people at risk of falls. single-blind, randomised, controlled trial comparing vibration training to sham vibration (Sham) in addition to usual care. participants were 61 older people (37 women and 24 men), aged 80.2 + 6.5 years, referred to an outpatient falls prevention service. participants were randomly assigned to VV, SV or Sham in addition to the usual falls prevention programme. Participants were requested to attend three vibration sessions per week for 12 weeks, with sessions increasing to six, 1 min bouts of vibration. Falls risk factors and neuromuscular tests were assessed, and blood samples collected for determination of bone turnover, at baseline and following the intervention. chair stand time, timed-up-and-go time, fear of falling, NEADL index and postural sway with eyes open improved in the Sham group. There were significantly greater gains in leg power in the VV than in the Sham group and in bone formation in SV and VV compared with the Sham group. Conversely, body sway improved less in the VV than in the Sham group. Changes in falls risk factors did not differ between the groups. whole-body vibration increased leg power and bone formation, but it did not provide any additional benefits to balance or fall risk factors beyond a falls prevention programme in older people at risk of falls. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Nitrification in the Drinking Water Distribution System

EPA Science Inventory

As a result of the implementation of the Stage 1 and Stage 2 Disinfectants and Disinfection Byproduct Rules, chloramine use as a secondary disinfectant in the United States is predicted to increase significantly. Along with the addition of chloramine comes the risk of nitrificat...

Perception of risks from electromagnetic fields: A psychometric evaluation of a risk-communication approach

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

MacGregor, D.G.; Slovic, P.; Morgan, M.G.

Potential health risks from exposure to power-frequency electromagnetic fields (EMF) have become an issue of significant public concern. This study evaluates a brochure designed to communicate EMF health risks from a scientific perspective. The study utilized a pretest-posttest design in which respondents judged various sources of EMF (and other) health and safety risks, both before reaching the brochure and after. Respondents assessed risks on dimensions similar to those utilized in previous studies of risk perception. In addition, detailed ratings were made that probed respondents' beliefs about the possible causal effects of EMF exposure. The findings suggest that naive beliefs aboutmore » the potential of EMF exposure to cause harm were highly influenced by specific content elements of the brochure. The implications for using risk-communication approaches based on communicating scientific uncertainty are discussed. 19 refs., 1 fig., 11 tabs.« less

Predictors of non-vertebral fracture in older Chinese males and females: Mr. OS and Ms. OS (Hong Kong).

PubMed

Kwok, Timothy Chi Yui; Su, Yi; Khoo, Chyi Chyi; Leung, Jason; Kwok, Anthony; Orwoll, Eric; Woo, Jean; Leung, Ping Chung

2017-05-01

Clinical risk factors to predict fracture are useful in guiding management of patients with osteoporosis or falls. Clinical predictors may however be population specific because of differences in lifestyle, environment and ethnicity. Four thousand community-dwelling Chinese males and females with average ages of 72.4 and 72.6 years were followed up for incident fractures, with an average of 6.5 and 8.8 years, respectively. Clinical information was collected, and bone mineral density (BMD) measurements were carried out at baseline. Stepwise Cox regression models were used to identify risk factors of nonvertebral fractures, with BMD as covariate. Areas under the receiver-operating characteristic (ROC) curve (AUC) were compared among different risk models. The incidence rates of nonvertebral fractures were 10.3 and 20.5 per 1000 person years in males and females, respectively. In males, age ≥80, history of a fall in the past year, fracture history, chronic obstructive pulmonary disease, impaired visual depth perception and low physical health-related quality of life were significant fracture risk factors, independent of BMD. In females, the significant factors were fracture history, low visual acuity and slow narrow walking speed. The clinical risk factors had a significant influence on fracture risk irrespective of osteoporosis status, even having a better risk discrimination than BMD alone, especially in males. The best risk prediction model consisted both BMD and clinical risk factors. Clinical risk factors have additive value to hip BMD in predicting nonvertebral fractures in older Chinese people and may predict them better than BMD alone in older Chinese males.

The Importance of High-Risk Human Papillomavirus Types Other Than 16 and 18 in Cervical Neoplasia.

PubMed

Robadi, Ibrahim A; Pharaon, Majed; Ducatman, Barbara S

2018-06-01

- Types 16 and 18 are the most widely studied high-risk types of human papillomavirus (HPV). However, other high-risk HPV types (HPV non-16/18) also play a significant role in cervical neoplasia. Currently, screening and management algorithms separate out HPV 16/18 from all other HPV non-16/18 types. In addition, most of the previously vaccinated population has only been vaccinated for these high-risk types, so many women are still vulnerable to HPV non-16/18 infections. - To review the prevalence and role of HPV non-16/18 neoplasia and to review current surveillance, management, and vaccination strategies in view of these findings. - The study comprised a review of the literature. - Although HPV non-16/18 types are less frequently associated with cervical intraepithelial neoplasia and cancer, they are nonetheless a significant cause of disease. Further stratification of higher-risk HPV non-16/18 may be necessary to improve prevention and management, however, regional prevalence differences may make a unified approach difficult. As HPV 16/18 infections decrease owing to vaccination of at-risk women, the relative frequency of HPV non-16/18 will increase, although the latest vaccine covers several more high-risk types.

Comparison of Accuracy of Diabetes Risk Score and Components of the Metabolic Syndrome in Assessing Risk of Incident Type 2 Diabetes in Inter99 Cohort

PubMed Central

Shafizadeh, Tracy B.; Moler, Edward J.; Kolberg, Janice A.; Nguyen, Uyen Thao; Hansen, Torben; Jorgensen, Torben; Pedersen, Oluf; Borch-Johnsen, Knut

2011-01-01

Background Given the increasing worldwide incidence of diabetes, methods to assess diabetes risk which would identify those at highest risk are needed. We compared two risk-stratification approaches for incident type 2 diabetes mellitus (T2DM); factors of metabolic syndrome (MetS) and a previously developed diabetes risk score, PreDx® Diabetes Risk Score (DRS). DRS assesses 5 yr risk of incident T2DM based on the measurement of 7 biomarkers in fasting blood. Methodology/Principal Findings DRS was evaluated in baseline serum samples from 4,128 non-diabetic subjects in the Inter99 cohort (Danes aged 30–60) for whom diabetes outcomes at 5 years were known. Subjects were classified as having MetS based on the presence of at least 3 MetS risk factors in baseline clinical data. The sensitivity and false positive rate for predicting diabetes using MetS was compared to DRS. When the sensitivity was fixed to match MetS, DRS had a significantly lower false positive rate. Similarly, when the false positive rate was fixed to match MetS, DRS had a significantly higher specificity. In further analyses, subjects were classified by presence of 0–2, 3 or 4–5 risk factors with matching proportions of subjects distributed among three DRS groups. Comparison between the two risk stratification schemes, MetS risk factors and DRS, were evaluated using Net Reclassification Improvement (NRI). Comparing risk stratification by DRS to MetS factors in the total population, the NRI was 0.146 (p = 0.008) demonstrating DRS provides significantly improved stratification. Additionally, the relative risk of T2DM differed by 15 fold between the low and high DRS risk groups, but only 8-fold between the low and high risk MetS groups. Conclusions/Significance DRS provides a more accurate assessment of risk for diabetes than MetS. This improved performance may allow clinicians to focus preventive strategies on those most in need of urgent intervention. PMID:21829540

Effects of interleukin 10 polymorphisms on the development of hepatitis B virus infection: a systemic review and meta-analysis

PubMed Central

Shu, Chi; Wang, Jiarong; He, Yazhou; Song, Tiange; Chen, Zhiyuan; Tang, Siqi; Tang, Xueyang

2015-01-01

Current opinion varies in the roles of the IL-10 polymorphisms in the process of hepatitis B virus (HBV) infection. We have performed a systemic review and up-dated meta-analysis including 37 eligible case-control studies to summarize all the available data on the association between IL-10 polymorphisms and development of HBV infection. In the present study, we found that the IL-10-1082 G/A, -592 C/A polymorphisms were associated with a significantly decreased risk of chronic HBV infection (AA + GA vs. GG: P = 0.003, OR = 0.55, 95% CI = 0.37-0.82; AA vs. CA + CC: P = 0.03, OR = 0.83, 95% CI = 0.71-0.98). While the -819 C/T TT carriers were associated with a borderline significantly decreased risk of chronic HBV infection (TT vs. CT + CC: P = 0.05, OR = 0.82, 95% CI = 0.68-1.00). Significant result was observed in the association between IL-10-1082 G/A polymorphism and HBV clearance (AA vs. GG: P = 0.04, OR = 1.33, 95% CI = 1.01-1.75). In addition, significant association was found between the -1082 G/A, -819 C/T polymorphisms and an increased risk of progression of HBV infection from asymptomatic carrier to chronic hepatitis B (AA + GA vs. GG: P = 0.0003, OR = 2.13, 95% CI = 1.41-3.22; TT + CT vs. CC: P = 0.005, OR = 1.53, 95% CI = 1.13-2.07), whereas the -592 C/A polymorphism was associated with a significantly decreased risk of progression from asymptomatic carrier to hepatocellular carcinoma (AA vs. CC: P = 0.02, OR = 0.63, 95% CI = 0.43-0.92). Our meta-analysis suggested that the IL-10 polymorphisms might be associated with a decreased risk of chronic HBV infection, while the -1082 AA carriers might be more likely to clear HBV following acute infection. In addition, these three polymorphisms might cast in roles of the progression of HBV infection. PMID:26550115

A Population-Based Study of Dietary Acrylamide and Prostate Cancer Risk

DTIC Science & Technology

2007-06-01

mcg/ kilogram body weight per day. The top food contributors to acrylamide intake were crispbread, coffee , other bread, fried potatoes, and buns...contributors to acrylamide intake were crispbread, coffee , other bread, fried potatoes, and buns and cakes (Figure 1). There was a significant (pɘ.0001...additional data on coffee [Letter]. Br. J. Cancer 89:775-776. Mucci, L.F. et al. (2004) Dietary acrylamide and risk of renal cell cancer. Int. J

Clopidogrel bisulfate (Plavix) does not increase bleeding complications in patients undergoing rubber band ligation for symptomatic hemorrhoids.

PubMed

Hite, Nathan; Klinger, Aaron L; Miller, Peter; Beck, David E; Whitlow, Charles B; Hicks, Terry C; Green, Heather M; Margolin, David A

2018-09-01

The incidence of postprocedural bleeding in patients undergoing rubber band ligation (RBL) for symptomatic internal hemorrhoids while taking clopidogrel bisulfate is unknown. To determine the postprocedural bleeding risk of RBL for patients taking clopidogrel compared with age- and sex-matched controls. This is a retrospective case-controlled cohort study analyzing data from 2005 to 2013 conducted at a single tertiary care academic center. The study included a total of 80 rubber bands placed on 41 patients taking clopidogrel bisulfate and 72 bands placed on 41 control patients not taking clopidogrel matched for age and sex. The 30-d rates of significant and insignificant bleeding events after RBL were recorded. A bleeding event was considered significant if the patient required admission to the hospital, transfusion of blood products, or additional procedures to stop the bleeding. Insignificant bleeding was defined as passage of blood or clots per rectum with spontaneous cessation and no need for additional intervention. There was no significant difference in the number of bleeding events per band placed in the clopidogrel group when compared with the control group (3.75% versus 2.78%, P = 0.7387). The rate of significant (2.5% versus 1.39%, P = 0.6244) and insignificant bleeding events (1.25% versus 1.39%, P = 0.9399) was also similar between the two groups. Two significant bleeding events occurred in the clopidogrel group requiring intervention: cauterization in one patient and colonoscopy and transfusion in the other. The risk of a bleeding complication after RBL for hemorrhoids does not appear to be increased in patients taking clopidogrel. Our results support the practice of continuing clopidogrel bisulfate in the periprocedural period as the associated risk of thrombosis is greater than the risk of bleeding. Copyright © 2018 Elsevier Inc. All rights reserved.

Effects of the floods on dysentery in north central region of Henan Province, China from 2004 to 2009.

PubMed

Ni, Wei; Ding, Guoyong; Li, Yifei; Li, Hongkai; Liu, Qiyong; Jiang, Baofa

2014-11-01

Zhengzhou, Kaifeng and Xinxiang, the cities in the north central region of Henan Province, suffered from many times floods from 2004 to 2009. We focused on dysentery disease consequences of floods and examined the association between floods and the morbidity of dysentery, based on a longitudinal data. A generalized additive mixed model was conducted to examine the relationship between the monthly morbidity of dysentery and floods from 2004 to 2009 in the study areas. The relative risks (RRs) of the floods risk on the morbidity of dysentery were estimated in each city and the whole region. The RRs on dysentery were 11.47 (95% CI: 8.67-15.33), 1.35 (95% CI: 1.23-3.90) and 2.75 (95% CI: 1.36-4.85) in Kaifeng, Xinxiang and Zhengzhou, respectively. The RR on dysentery in the whole region was 1.66 (95% CI: 1.52-1.82). Our study confirms that flooding has significantly increased the risk of dysentery in the study areas. Additionally, we observed that a sudden and severe flooding can contribute more risk to the morbidity of dysentery than a persistent and moderate flooding. Our findings have significant implications for developing strategies to prevent and reduce health impact of floods. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Gender-specific differences of interaction between cadmium exposure and obesity on prediabetes in the NHANES 2007-2012 population.

PubMed

Jiang, Fei; Zhi, Xueyuan; Xu, Miao; Li, Bingyan; Zhang, Zengli

2018-05-30

Data from National Health and Nutrition Examination Survey (NHANES) for the years 2007-2012 were used to evaluate the interactions of cadmium (Cd) exposure with being overweight/obesity on the risk of prediabetes among adults 20 years older. A total of 3552 subjects were included in the analysis. Urinary cadmium levels (UCd) was used as a biomarker for long-term exposure to Cd. Additive interaction was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). Following covariates adjustments, we found significant associations of UCd with higher prediabetes prevalence, and this association was more apparent in males (Q4 vs Q1: OR = 1.95, 95%CI: 1.34-2.84); while overweight/obesity was associated with prediabetes both in males and in females. Additionally, there was a significant interaction between Cd exposure and being overweight/obesity on prediabetes risk among males (RERI = 1.18, 95% CI: 0.42-1.93; AP = 0.35, 95% CI: 0.12-0.58; S = 2.00, 95% CI: 0.92-4.34). Our results suggest that being overweight/obesity may substantially amplify the adverse effects of long-term cadmium exposure on prediabetes risk, and this interaction is more severe in male adults. Further studies are needed to confirm these findings.

Rare Genome-Wide Copy Number Variation and Expression of Schizophrenia in 22q11.2 Deletion Syndrome.

PubMed

Bassett, Anne S; Lowther, Chelsea; Merico, Daniele; Costain, Gregory; Chow, Eva W C; van Amelsvoort, Therese; McDonald-McGinn, Donna; Gur, Raquel E; Swillen, Ann; Van den Bree, Marianne; Murphy, Kieran; Gothelf, Doron; Bearden, Carrie E; Eliez, Stephan; Kates, Wendy; Philip, Nicole; Sashi, Vandana; Campbell, Linda; Vorstman, Jacob; Cubells, Joseph; Repetto, Gabriela M; Simon, Tony; Boot, Erik; Heung, Tracy; Evers, Rens; Vingerhoets, Claudia; van Duin, Esther; Zackai, Elaine; Vergaelen, Elfi; Devriendt, Koen; Vermeesch, Joris R; Owen, Michael; Murphy, Clodagh; Michaelovosky, Elena; Kushan, Leila; Schneider, Maude; Fremont, Wanda; Busa, Tiffany; Hooper, Stephen; McCabe, Kathryn; Duijff, Sasja; Isaev, Karin; Pellecchia, Giovanna; Wei, John; Gazzellone, Matthew J; Scherer, Stephen W; Emanuel, Beverly S; Guo, Tingwei; Morrow, Bernice E; Marshall, Christian R

2017-11-01

Chromosome 22q11.2 deletion syndrome (22q11.2DS) is associated with a more than 20-fold increased risk for developing schizophrenia. The aim of this study was to identify additional genetic factors (i.e., "second hits") that may contribute to schizophrenia expression. Through an international consortium, the authors obtained DNA samples from 329 psychiatrically phenotyped subjects with 22q11.2DS. Using a high-resolution microarray platform and established methods to assess copy number variation (CNV), the authors compared the genome-wide burden of rare autosomal CNV, outside of the 22q11.2 deletion region, between two groups: a schizophrenia group and those with no psychotic disorder at age ≥25 years. The authors assessed whether genes overlapped by rare CNVs were overrepresented in functional pathways relevant to schizophrenia. Rare CNVs overlapping one or more protein-coding genes revealed significant between-group differences. For rare exonic duplications, six of 19 gene sets tested were enriched in the schizophrenia group; genes associated with abnormal nervous system phenotypes remained significant in a stepwise logistic regression model and showed significant interactions with 22q11.2 deletion region genes in a connectivity analysis. For rare exonic deletions, the schizophrenia group had, on average, more genes overlapped. The additional rare CNVs implicated known (e.g., GRM7, 15q13.3, 16p12.2) and novel schizophrenia risk genes and loci. The results suggest that additional rare CNVs overlapping genes outside of the 22q11.2 deletion region contribute to schizophrenia risk in 22q11.2DS, supporting a multigenic hypothesis for schizophrenia. The findings have implications for understanding expression of psychotic illness and herald the importance of whole-genome sequencing to appreciate the overall genomic architecture of schizophrenia.

Effect of Wave Reflection and Arterial Stiffness on the Risk of Development of Hypertension in Japanese Men.

PubMed

Tomiyama, Hirofumi; Komatsu, Shunsuke; Shiina, Kazuki; Matsumoto, Chisa; Kimura, Kazutaka; Fujii, Masatsune; Takahashi, Lisa; Chikamori, Taishiro; Yamashina, Akira

2018-05-08

We conducted analyses of repeated-measures data to examine whether pressure wave reflection acts additively or synergistically with arterial stiffness in the pathogenesis of hypertension. In 3172 middle-aged (42±9 years) healthy Japanese men without hypertension at the study baseline, systolic and diastolic blood pressures, brachial-ankle pulse wave velocity, and radial augmentation index were measured annually during a 9-year study period. Of these, 474 participants (15%) developed hypertension by the end of the study period. Binary logistic regression analysis demonstrated significant individual odds ratios for both baseline brachial-ankle pulse wave velocity and radial augmentation index for the development of hypertension. The rate of onset of hypertension during the study period was highest in the participant group with high values for both brachial-ankle pulse wave velocity and radial augmentation index at study baseline (262 of 965 participants: 27%). The generalized estimating equation analysis revealed that both radial augmentation index (estimate=0.06, SE=0.03, P =0.05) and brachial-ankle pulse wave velocity (estimate=0.07×10 -1 , SE=0.02×10 -1 , P <0.01) showed significant longitudinal association with new onset of hypertension, with no significant interaction. In Japanese men, abnormal wave reflection and increased arterial stiffness may be additively associated with the risk of new onset of hypertension. Abnormal wave reflection and elevated central blood pressure may be longitudinally associated with increase in arterial stiffness, and this longitudinal association may be a mechanism underlying the additive effect of these 2 variables on the risk of new onset of hypertension. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Association between TLR2 and TLR4 Gene Polymorphisms and the Susceptibility to Inflammatory Bowel Disease: A Meta-Analysis.

PubMed

Cheng, Yang; Zhu, Yun; Huang, Xiuping; Zhang, Wei; Han, Zelong; Liu, Side

2015-01-01

The associations between toll-like receptor 2 (TLR2) and toll-like receptor 4(TLR4) polymorphisms and inflammatory bowel disease (IBD) susceptibility remain controversial. A meta-analysis was performed to assess these associations. A systematic search was performed to identify all relevant studies relating TLR2 and TLR4 polymorphisms and IBD susceptibility. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed by ethnicity and publication quality. Thirty-eight eligible studies, assessing 10970 cases and 7061 controls were included. No TLR2 Arg677Trp polymorphism was found. No significant association was observed between TLR2 Arg753Gln polymorphism and Crohn's disease (CD) or ulcerative colitis (UC) in all genetic models. Interestingly, TLR4 Asp299Gly polymorphism was significantly associated with increased risk of CD and UC in all genetic models, except for the additive one in CD. In addition, a statistically significant association between TLR4 Asp299Gly polymorphism and IBD was observed among high quality studies evaluating Caucasians, but not Asians. Associations between TLR4 Thr399Ile polymorphisms and CD risk were found only in the allele and dominant models. The TLR4 Thr399Ile polymorphism was associated with UC risk in pooled results as well as subgroup analysis of high quality publications assessing Caucasians, in allele and dominant models. The meta-analysis provides evidence that TLR2 Arg753Gln is not associated with CD and UC susceptibility in Asians; TLR4 Asp299Gly is associated with CD and UC susceptibility in Caucasians, but not Asians. TLR4 Thr399Ile may be associated with IBD susceptibility in Caucasians only. Additional well-powered studies of Asp299Gly and other TLR4 variants are warranted.

Case–control study of paternal occupation and childhood leukaemia in Great Britain, 1962–2006

PubMed Central

Keegan, T J; Bunch, K J; Vincent, T J; King, J C; O'Neill, K A; Kendall, G M; MacCarthy, A; Fear, N T; MFG, Murphy

2012-01-01

Background: Paternal occupational exposures have been proposed as a risk factor for childhood leukaemia. This study investigates possible associations between paternal occupational exposure and childhood leukaemia in Great Britain. Methods: The National Registry of Childhood Tumours provided all cases of childhood leukaemia born and diagnosed in Great Britain between 1962 and 2006. Controls were matched on sex, period of birth and birth registration subdistrict. Fathers' occupations were assigned to 1 or more of 33 exposure groups. Social class was derived from father's occupation at the time of the child's birth. Results: A total of 16 764 cases of childhood leukaemia were ascertained. One exposure group, paternal social contact, was associated with total childhood leukaemia (odds ratio 1.14, 1.05–1.23); this association remained significant when adjusted for social class. The subtypes lymphoid leukaemia (LL) and acute myeloid leukaemia showed increased risk with paternal exposure to social contact before adjustment for social class. Risk of other leukaemias was significantly increased by exposure to electromagnetic fields, persisting after adjustment for social class. For total leukaemia, the risks for exposure to lead and exhaust fumes were significantly <1. Occupationally derived social class was associated with risk of LL, with the risk being increased in the higher social classes. Conclusion: Our results showed some support for a positive association between childhood leukaemia risk and paternal occupation involving social contact. Additionally, LL risk increased with higher paternal occupational social class. PMID:22968649

Prognostic discrimination in "good-risk" chronic granulocytic leukemia.

PubMed

Sokal, J E; Cox, E B; Baccarani, M; Tura, S; Gomez, G A; Robertson, J E; Tso, C Y; Braun, T J; Clarkson, B D; Cervantes, F

1984-04-01

The prognostic significance of disease features recorded at the time of diagnosis was examined among 813 patients with Philadelphia chromosome-positive, nonblastic chronic granulocytic leukemia (CGL) collected from six European and American series. The survival pattern for this population was typical of "good-risk" patients, and median survival was 47 mo. There were multiple interrelationships among different disease features, which led to highly significant correlations with survival for some that had no primary prognostic significance, such as hematocrit. Multivariable regression analysis indicated that spleen size and the percentage of circulating blasts were the most important prognostic indicators. These features, and age, behaved as continuous variables with progressively unfavorable import at higher values. The platelet count did not influence survival significantly at values below 700 X 10(9)/liter but was increasingly unfavorable above this level. Basophils plus eosinophils over 15%, more than 5% marrow blasts, and karyotypic abnormalities in addition to the Ph1 were also significant unfavorable signs. The Cox model, generated with four variables representing percent blasts, spleen size, platelet count, and age, provided a useful representation of risk status in this population, with good fit between predicted and observed survival over more than a twofold survival range. A hazard function derived from half of the patient population successfully segregated the remainder into three groups with significantly different survival patterns. We conclude that it should be possible to identify a lower risk group of patients with a 2-yr survival of 90%, subsequent risk averaging somewhat less than 20%/yr and median survival of 5 yr, an intermediate group, and a high-risk group with a 2-yr survival of 65%, followed by a death rate of about 35%/yr and median survival of 2.5 yr.

Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population.

PubMed

Jeemon, Panniyammakal; Prabhakaran, Dorairaj; Goenka, Shifalika; Ramakrishnan, Lakshmy; Padmanabhan, Sandosh; Huffman, Mark; Joshi, Prashant; Sivasankaran, Sivasubramonian; Mohan, B V M; Ahmed, F; Ramanathan, Meera; Ahuja, R; Sinha, Nakul; Thankappan, K R; Reddy, K S

2012-04-01

Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions. Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group. Mean age of participants was 40.9 ± 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and >3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while it continued to be high in the control arm without interventions (both within group and between group P<0.001). The proportion of 'low risk phenotype' increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P<0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 13.3 to 17.8 per cent in the control arm (P<0.001). Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden.

Effects of biochar addition on toxic element concentrations in plants: A meta-analysis.

PubMed

Peng, Xin; Deng, Yinger; Peng, Yan; Yue, Kai

2018-03-01

Consuming food contaminated by toxic elements (TEs) could pose a substantial risk to human health. Recently, biochar has been extensively studied as an effective soil ameliorant in situ because of its ability to suppress the phytoavailability of TEs. However, despite the research interest, the effects of biochar applications to soil on different TE concentrations in different plant parts remain unclear. Here, we synthesize 1813 individual observations data collected from 97 articles to evaluate the effects of biochar addition on TE concentrations in plant parts. We found that (1) the experiment type, biochar feedstock and pyrolysis temperature all significantly decreased the TE concentration in plant parts; (2) the responses of Cd and Pb concentrations in edible and indirectly edible plant parts were significantly more sensitive to the effect of biochar than the Zn, Ni, Mn, Cr, Co and Cu concentrations; and (3) the biochar dosage and surface area, significantly influenced certain TE concentrations in plant tissues as determined via correlation analysis. Moreover, the only exception in this study was found for metalloid element (i.e., As) concentrations in plants, which were not significantly influenced by biochar addition. Overall, the effects of biochar on TE concentrations in plant tissues were negative, at least on average, and the central trends suggest that biochar has a considerable ability to mitigate the transfer of TEs to food, thereby reducing the associated health risks. Our results provide an initial quantitative determination of the effects of biochar addition on multifarious TEs in different plant parts as well as an assessment of the ability of biochar to reduce TE concentrations in plants. Copyright © 2017 Elsevier B.V. All rights reserved.

The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing.

PubMed

Weindler, J; Kiefer, R T

2001-06-01

The study evaluated the impact of the additional imposed work of breathing (WBimp) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications (PPCs). Additionally, we investigated whether maximal inspiratory pressure (PImax) is an easy estimate of the WBimp imposed by incentive spirometers. Prospective, randomized, single-blind clinical trial. ICU of a university hospital. Thirty male patients were assigned to a group at high risk for PPCs (group A; inspiratory capacity [IC], < 1.6 L) or to a group at moderate risk for PPCs (group B; IC, 1.6 to 2.5 L) after upper-abdominal, thoracic, or two-cavity surgery. On the first or second postoperative day WBimp, IC, and PImax were recorded without spirometers (baseline) and during incentive spirometry with the Mediflo spirometer (Medimex; Hamburg, Germany) (high WBimp) and the Coach spirometer (Kendall; Neustadt, Germany) (low WBimp) using a pneumotachograph. In group A, the baseline and the ICs for both spirometers only differed slightly. In group B, the IC was significantly reduced for the Mediflo (p < 0.05), which imposed a WBimp twice as high as the Coach (p < 0.01). PImax was significantly increased for both the Mediflo and the Coach (p < 0.01). PImax was positively correlated with WBimp (r = 0.8). Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance. PImax might be an easy clinical estimate for the WBimp during incentive spirometry. Incentive spirometers with low WBimp permit increased maximal sustained inspiration and, thus, enhanced incentive spirometry performance, and, therefore, it might be more suitable for use in postoperative respiratory care.

Vaccinations in early life are not associated with development of islet autoimmunity in type 1 diabetes high-risk children: Results from prospective cohort data.

PubMed

Beyerlein, Andreas; Strobl, Andreas N; Winkler, Christiane; Carpus, Michaela; Knopff, Annette; Donnachie, Ewan; Ankerst, Donna P; Ziegler, Anette-G

2017-03-27

Vaccinations in early childhood potentially stimulate the immune system and may thus be relevant for the pathogenesis of autoimmune diseases such as type 1 diabetes (T1D). We determined the association of vaccination burden with T1D-associated islet autoimmunity in children with high familial risk followed prospectively from birth. A total of 20,570 certified vaccination records from 1918 children were correlated with time to onset of T1D-associated islet autoimmunity using Cox regression, considering multiple time periods up until age two years and vaccination types, and adjusting for HLA genotype, sex, delivery mode, season of birth, preterm delivery and maternal T1D status. Additionally, prospective claims data of 295,420 subjects were used to validate associations for the tick-borne encephalitis (TBE) vaccination. Most vaccinations were not associated with a significantly increased hazard ratio (HR) for islet autoimmunity (e.g. HR [95% confidence interval]: 1.08 [0.96-1.21] per additional vaccination against measles, mumps and rubella at age 0-24months). TBE vaccinations within the first two years of life were nominally associated with a significantly increased autoimmunity risk (HR: 1.44 [1.06-1.96] per additional vaccination at age 0-24months), but this could not be confirmed with respect to outcome T1D in the validation cohort (HR: 1.02 [0.90-1.16]). We found no evidence that early vaccinations increase the risk of T1D-associated islet autoimmunity development. The potential association with early TBE vaccinations could not be confirmed in an independent cohort and appears to be a false positive finding. Copyright © 2017 Elsevier Ltd. All rights reserved.

Black-white disparities in the association between posttraumatic stress disorder and chronic illness

PubMed Central

Nobles, Carrie J.; Valentine, Sarah E.; Borba, Christina P.C.; Gerber, Monica W.; Shtasel, Derri L.; Marques, Luana

2016-01-01

Objective Non-Latino blacks experience a higher proportion of chronic illness and associated disabilities than non-Latino whites. Posttraumatic stress disorder (PTSD) is associated with a greater risk of chronic illness, although few studies have investigated whether the interaction of PTSD with racial disparities may lead to a greater risk of chronic illness among blacks with PTSD than among whites with PTSD. Methods We evaluated data from the population-based National Survey of American Life and the National Comorbidity Survey Replication to investigate the association between race, lifetime PTSD and self-reported chronic illness. Weighted linear and Poisson regression models assessed differences in the magnitude of association between PTSD and chronic illness by race on both the additive and multiplicative scales. Results The magnitude of the association between lifetime PTSD and diabetes was greater among blacks (RD 0.07, 95% CI 0.02, 0.11; RR 1.9, 95% CI 1.4, 2.5) than whites (RD 0.004, 95% CI −0.02, 0.03; RR 1.2, 95% CI 0.7, 1.9) on the additive (p=0.017) scale. The magnitude of the association between lifetime PTSD and heart disease was greater among blacks (RD 0.09, 95% CI 0.05, 0.13) than whites (RD 0.04, 95% CI 0.01, 0.07) on the additive scale at a level approaching significance (p=0.051). Conclusion A lifetime history of PTSD was associated with a significantly greater risk of diabetes among blacks as compared to whites. These findings suggest that continuous exposure to racial inequalities may be associated with a greater risk of PTSD-related health sequela. PMID:27212665

Small Bowel Gastrointestinal Stromal Tumors: Multidetector Computed Tomography Enhancement Pattern and Risk of Progression.

PubMed

Verde, Franco; Hruban, Ralph H; Fishman, Elliot K

Small bowel gastrointestinal stromal tumors (SB-GISTs) are rare lesions with a variable appearance on computed tomography (CT). This case series analyzes the CT enhancement pattern with the histologic risk assessment of tumor progression. Local institutional pathology database was searched for SB-GISTs from 2000 to 2015. Pathology reports and clinical notes were reviewed. Imaging was qualitatively reviewed for pattern of enhancement categorized into homogeneous or heterogeneous groups. Nonparametric statistical analysis was performed comparing enhancement to segment of bowel involved, presence of necrosis, tumor size, histologic grade (ie, G1 or G2), and histologic risk of progression (ie low, moderate, high). For simplicity, risk of progression was binned into low-risk or non-low-risk groups. Twenty-six pathology-proven, first presentation, nonmetastatic SB-GISTs were included into study. Seventeen were located in duodenum, 7 in jejunum, and 2 within the ileum. Dual phase (arterial and venous) CT imaging was available for 22 cases. Four cases did not have dual phase (three venous phase and one arterial phase only). Seventeen cases demonstrated heterogeneous enhancement and 9 cases homogeneous enhancement. Statistically significant difference was found between size versus enhancement groups (3.1 cm for homogeneous versus 6.8 cm for heterogeneous) (Mann-Whitney U test, n = 26, P = 0.002). Presence of necrosis versus enhancement group was statistically significant (Pearson χ, P = 0.001). Low-risk and non-low-risk groups versus enhancement groups was very significant (P = 0.001). Bowel segment involvement and histologic grading versus enhancement group did not reach statistical significance (P = 0.174 and P = 0.07, respectively). This case series reveals an important significant association between heterogeneous enhancement and non-low risk (ie, moderate/high) SB-GISTs. Beyond just describing the tumor, using enhancing pattern, the interpreting radiologist can preoperatively suggest additional prognostic information, potentially helpful for surgical planning.

Impact of coronary calcium score on the prevalence of coronary artery stenosis on dual source CT coronary angiography in caucasian patients with an intermediate risk.

PubMed

Meyer, Mathias; Henzler, Thomas; Fink, Christian; Vliegenthart, Rozemarijn; Barraza, J Michael; Nance, John W; Apfaltrer, Paul; Schoenberg, Stefan O; Wasser, Klaus

2012-11-01

To investigate the prevalence of significant coronary artery stenosis on coronary computed tomography angiography (cCTA) in symptomatic Caucasian patients with an intermediate risk score at different levels of coronary artery calcification (CAC). In total, 383 consecutive symptomatic Caucasian patients (147 females, 60 ± 13 years) with an intermediate risk score underwent nonenhanced CT for CAC scoring immediately before contrast-enhanced cCTA on a dual-source CT scanner. Additionally clinically indicated invasive coronary angiography (ICA) was performed in 90 patients. The prevalence of significant coronary artery stenosis (>50%) on cCTA and ICA was correlated at different CAC score levels. Of 121 patients with a zero CAC score, none had significant coronary artery stenosis on cCTA or ICA. Coronary CTA diagnosed in 54 of 70 patients with high CAC score (>400), a significant stenosis. Subsequent ICA confirmed significant stenosis in 30 of 32 patients. Sensitivity and a negative predictive value of CAC score ruling out significant stenosis on cCTA were 100% and 100%, respectively, using cutoff value of zero and specificity and positive predictive value to predict significant stenosis on cCTA were 79% and 51%, respectively, using a cutoff value of >400. Significant coronary artery stenosis is extremely unlikely, with an estimated risk of 4 in 1000 patients in symptomatic Caucasian patients with an intermediate risk score and negative CAC score. To reduce radiation exposure, radiation-free tests should be considered for differential diagnosis of chest pain in these patients. Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.

Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers.

PubMed

Agha, Syed A; Kalogeropoulos, Andreas P; Shih, Jeffrey; Georgiopoulou, Vasiliki V; Giamouzis, Grigorios; Anarado, Perry; Mangalat, Deepa; Hussain, Imad; Book, Wendy; Laskar, Sonjoy; Smith, Andrew L; Martin, Randolph; Butler, Javed

2009-09-01

Incremental value of echocardiography over clinical parameters for outcome prediction in advanced heart failure (HF) is not well established. We evaluated 223 patients with advanced HF receiving optimal therapy (91.9% angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 92.8% beta-blockers, 71.8% biventricular pacemaker, and/or defibrillator use). The Seattle Heart Failure Model (SHFM) was used as the reference clinical risk prediction scheme. The incremental value of echocardiographic parameters for event prediction (death or urgent heart transplantation) was measured by the improvement in fit and discrimination achieved by addition of standard echocardiographic parameters to the SHFM. After a median follow-up of 2.4 years, there were 38 (17.0%) events (35 deaths; 3 urgent transplants). The SHFM had likelihood ratio (LR) chi(2) 32.0 and C statistic 0.756 for event prediction. Left ventricular end-systolic volume, stroke volume, and severe tricuspid regurgitation were independent echocardiographic predictors of events. The addition of these parameters to SHFM improved LR chi(2) to 72.0 and C statistic to 0.866 (P < .001 and P=.019, respectively). Reclassifying the SHFM-predicted risk with use of the echocardiography-added model resulted in improved prognostic separation. Addition of standard echocardiographic variables to the SHFM results in significant improvement in risk prediction for patients with advanced HF.

An Examination of the Efficacy of a Multitiered Intervention on Early Reading Outcomes for First Grade Students at Risk for Reading Difficulties.

PubMed

Fien, Hank; Smith, Jean Louise M; Smolkowski, Keith; Baker, Scott K; Nelson, Nancy J; Chaparro, Erin

2015-01-01

This article presents findings of an efficacy trial examining the effect of a multitiered instruction and intervention model on first grade at-risk students' reading outcomes. Schools (N = 16) were randomly assigned to the treatment or control condition. In the fall of Grade 1, students were assigned to an instructional tier on the basis of Stanford Achievement Test-10th Edition scores (31st percentile and above = Tier 1; from the 10th to the 30th percentile = Tier 2). In both conditions, students identified as at risk (i.e., Tier 2; n = 267) received 90 min of whole group instruction (Tier 1) and an additional 30 min of daily small group intervention (Tier 2). In the treatment condition, teachers were trained to enhance core reading instruction by making instruction more explicit and increasing practice opportunities for students in Tier 1. In addition, at-risk readers were provided an additional 30-min daily small group intervention with content that was highly aligned with the Tier 1 core reading program. Results indicate significant, positive effects of the intervention on students' decoding and first semester fluent reading and potentially positive effects on reading comprehension and total reading achievement. © Hammill Institute on Disabilities 2014.

A comparison of modified versions of the Static-99 and the Sex Offender Risk Appraisal Guide.

PubMed

Nunes, Kevin L; Firestone, Philip; Bradford, John M; Greenberg, David M; Broom, Ian

2002-07-01

The predictive validity of 2 risk assessment instruments for sex offenders, modified versions of the Static-99 and the Sex Offender Risk Appraisal Guide, was examined and compared in a sample of 258 adult male sex offenders. In addition, the independent contributions to the prediction of recidivism made by each instrument and by various phallometric indices were explored. Both instruments demonstrated moderate levels of predictive accuracy for sexual and violent (including sexual) recidivism. They were not significantly different in terms of their predictive accuracy for sexual or violent recidivism, nor did they contribute independently to the prediction of sexual or violent recidivism. Of the phallometric indices examined, only the pedophile index added significantly to the prediction of sexual recidivism, but not violent recidivism, above the Static-99 alone.

Evaluation of Additively Manufactured Metals for Use in Oxygen Systems Project

NASA Technical Reports Server (NTRS)

Tylka, Jonathan; Cooper, Ken; Peralta, Stephen; Wilcutt, Terrence; Hughitt, Brian; Generazio, Edward

2016-01-01

Space Launch System, Commercial Resupply, and Commercial Crew programs have published intent to use additively manufactured (AM) components in propulsion systems and are likely to include various life support systems in the future. Parts produced by these types of additive manufacturing techniques have not been fully evaluated for use in oxygen systems and the inherent risks have not been fully identified. Some areas of primary concern in the SLS process with respect to oxygen compatibility may be the porosity of the printed parts, fundamental differences in microstructure of an AM part as compared to traditional materials, or increased risk of shed metal particulate into an oxygen system. If an ignition were to occur the printed material could be more flammable than components manufactured from a traditional billet of raw material and/or present a significant hazards if not identified and rigorously studied in advance of implementation into an oxygen system.

A Genome-Wide Association Analysis Reveals Epistatic Cancellation of Additive Genetic Variance for Root Length in Arabidopsis thaliana.

PubMed

Lachowiec, Jennifer; Shen, Xia; Queitsch, Christine; Carlborg, Örjan

2015-01-01

Efforts to identify loci underlying complex traits generally assume that most genetic variance is additive. Here, we examined the genetics of Arabidopsis thaliana root length and found that the genomic narrow-sense heritability for this trait in the examined population was statistically zero. The low amount of additive genetic variance that could be captured by the genome-wide genotypes likely explains why no associations to root length could be found using standard additive-model-based genome-wide association (GWA) approaches. However, as the broad-sense heritability for root length was significantly larger, and primarily due to epistasis, we also performed an epistatic GWA analysis to map loci contributing to the epistatic genetic variance. Four interacting pairs of loci were revealed, involving seven chromosomal loci that passed a standard multiple-testing corrected significance threshold. The genotype-phenotype maps for these pairs revealed epistasis that cancelled out the additive genetic variance, explaining why these loci were not detected in the additive GWA analysis. Small population sizes, such as in our experiment, increase the risk of identifying false epistatic interactions due to testing for associations with very large numbers of multi-marker genotypes in few phenotyped individuals. Therefore, we estimated the false-positive risk using a new statistical approach that suggested half of the associated pairs to be true positive associations. Our experimental evaluation of candidate genes within the seven associated loci suggests that this estimate is conservative; we identified functional candidate genes that affected root development in four loci that were part of three of the pairs. The statistical epistatic analyses were thus indispensable for confirming known, and identifying new, candidate genes for root length in this population of wild-collected A. thaliana accessions. We also illustrate how epistatic cancellation of the additive genetic variance explains the insignificant narrow-sense and significant broad-sense heritability by using a combination of careful statistical epistatic analyses and functional genetic experiments.

Pregnant patients' risk perception of prenatal test results with uncertain fetal clinical significance: ultrasound versus advanced genetic testing.

PubMed

Richards, Elliott G; Sangi-Haghpeykar, Haleh; McGuire, Amy L; Van den Veyver, Ignatia B; Fruhman, Gary

2015-12-01

A common concern of utilizing prenatal advanced genetic testing is that a result of uncertain clinical significance will increase patient anxiety. However, prenatal ultrasound may also yield findings of uncertain significance, such as 'soft markers' for fetal aneuploidy, or findings with variable prognosis, such as mild ventriculomegaly. In this study we compared risk perception following uncertain test results from each modality. A single survey with repeated measures design was administered to 133 pregnant women. It included 'intolerance of uncertainty' questions, two hypothetical scenarios involving prenatal ultrasound or advanced genetic testing, and response questions. The primary outcome was risk perception score. Risk perception did not vary significantly between ultrasound and genetic scenarios (p = 0.17). The genetic scenario scored a higher accuracy (p = 0.04) but lower sense of empowerment (p = 0.01). Furthermore, patients were more likely to seek additional testing after an ultrasound than after genetic testing (p = 0.05). There were no differences in other secondary outcomes including perception of life-altering consequences and hypothetical worry, anxiety, confusion, or medical care decisions. Our data suggest that uncertain findings on prenatal genetic testing do not elicit a higher perception of risk or anxiety when compared to ultrasound findings of comparable uncertainty. © 2015 John Wiley & Sons, Ltd. © 2015 John Wiley & Sons, Ltd.

A third of systematic reviews changed or did not specify the primary outcome: a PROSPERO register study.

PubMed

Tricco, Andrea C; Cogo, Elise; Page, Matthew J; Polisena, Julie; Booth, Alison; Dwan, Kerry; MacDonald, Heather; Clifford, Tammy J; Stewart, Lesley A; Straus, Sharon E; Moher, David

2016-11-01

To examine outcome reporting bias of systematic reviews registered in PROSPERO. Retrospective cohort study. The primary outcomes from systematic review publications were compared with those reported in the corresponding PROSPERO records; discrepancies in the primary outcomes were assessed as upgrades, additions, omissions, or downgrades. Relative risks (RRs) and 95% confidence intervals (CI) were calculated to determine the likelihood of having a change in primary outcome when the meta-analysis result was favorable and statistically significant. Ninety-six systematic reviews were published. A discrepancy in the primary outcome occurred in 32% of the included reviews and 39% of the reviews did not explicitly specify a primary outcome(s); 6% of the primary outcomes were omitted. There was no significant increased risk of adding/upgrading (RR, 2.14; 95% CI: 0.53, 8.63) or decreased risk of downgrading (RR, 0.76; 95% CI: 0.27, 2.17) an outcome when the meta-analysis result was favorable and statistically significant. As well, there was no significant increased risk of adding/upgrading (RR, 0.89; 95% CI: 0.31, 2.53) or decreased risk of downgrading (RR, 0.56; 95% CI: 0.29, 1.08) an outcome when the conclusion was positive. We recommend review authors carefully consider primary outcome selection, and journals are encouraged to focus acceptance on registered systematic reviews. Copyright © 2016 Elsevier Inc. All rights reserved.

CD14 and IL18 gene polymorphisms associated with colorectal cancer subsite risks among atomic bomb survivors.

PubMed

Hu, Yiqun; Yoshida, Kengo; Cologne, John B; Maki, Mayumi; Morishita, Yukari; Sasaki, Keiko; Hayashi, Ikue; Ohishi, Waka; Hida, Ayumi; Kyoizumi, Seishi; Kusunoki, Yoichiro; Tokunaga, Katsushi; Nakachi, Kei; Hayashi, Tomonori

2015-01-01

Colorectal cancer (CRC) is a common malignancy worldwide, and chronic inflammation is a risk factor for CRC. In this study, we carried out a cohort study among the Japanese atomic bomb (A-bomb) survivor population to investigate any association between immune- and inflammation-related gene polymorphisms and CRC. We examined the effects of six single-nucleotide polymorphisms of CD14 and IL18 on relative risks (RRs) of CRC. Results showed that RRs of CRC, overall and by anatomic subsite, significantly increased with increasing radiation dose. The CD14-911A/A genotype showed statistically significant higher risks for all CRC and distal CRC compared with the other two genotypes. In addition, the IL18-137 G/G genotype showed statistically significant higher risks for proximal colon cancer compared with the other two genotypes. In phenotype-genotype analyses, the CD14-911A/A genotype presented significantly higher levels of membrane and soluble CD14 compared with the other two genotypes, and the IL18-137 G/G genotype tended to be lower levels of plasma interleukin (IL)-18 compared with the other two genotypes. These results suggest the potential involvement of a CD14-mediated inflammatory response in the development of distal CRC and an IL18-mediated inflammatory response in the development of proximal colon cancer among A-bomb survivors.

CD14 and IL18 gene polymorphisms associated with colorectal cancer subsite risks among atomic bomb survivors

PubMed Central

Hu, Yiqun; Yoshida, Kengo; Cologne, John B; Maki, Mayumi; Morishita, Yukari; Sasaki, Keiko; Hayashi, Ikue; Ohishi, Waka; Hida, Ayumi; Kyoizumi, Seishi; Kusunoki, Yoichiro; Tokunaga, Katsushi; Nakachi, Kei; Hayashi, Tomonori

2015-01-01

Colorectal cancer (CRC) is a common malignancy worldwide, and chronic inflammation is a risk factor for CRC. In this study, we carried out a cohort study among the Japanese atomic bomb (A-bomb) survivor population to investigate any association between immune- and inflammation-related gene polymorphisms and CRC. We examined the effects of six single-nucleotide polymorphisms of CD14 and IL18 on relative risks (RRs) of CRC. Results showed that RRs of CRC, overall and by anatomic subsite, significantly increased with increasing radiation dose. The CD14–911A/A genotype showed statistically significant higher risks for all CRC and distal CRC compared with the other two genotypes. In addition, the IL18–137 G/G genotype showed statistically significant higher risks for proximal colon cancer compared with the other two genotypes. In phenotype–genotype analyses, the CD14–911A/A genotype presented significantly higher levels of membrane and soluble CD14 compared with the other two genotypes, and the IL18–137 G/G genotype tended to be lower levels of plasma interleukin (IL)-18 compared with the other two genotypes. These results suggest the potential involvement of a CD14-mediated inflammatory response in the development of distal CRC and an IL18-mediated inflammatory response in the development of proximal colon cancer among A-bomb survivors. PMID:27081544

Risk factors of refeeding syndrome in malnourished older hospitalized patients.

PubMed

Pourhassan, Maryam; Cuvelier, Ingeborg; Gehrke, Ilse; Marburger, Christian; Modreker, Mirja Katrin; Volkert, Dorothee; Willschrei, Hans-Peter; Wirth, Rainer

2017-06-10

Despite the high prevalence of malnutrition among older hospitalized persons, it is unknown how many of these malnourished patients are at risk of developing the refeeding syndrome (RFS). In this study, we sought to compare the prevalence and severity of malnutrition among older hospitalized patients with prevalence of known risk factors of RFS. This cross-sectional multicenter-study investigated older participants who were consecutively admitted to the geriatric acute care ward. Malnutrition screening was conducted using Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment-Short Form (MNA-SF). The National Institute for Health and Clinical Excellence (NICE) criteria were applied for assessing patients at risk of RFS. Weight and height were measured. Degree of weight loss (WL) was obtained by interview. Serum phosphate, magnesium, potassium, sodium, calcium, creatinine and urea were analyzed according to standard procedures. The study group comprised 342 participants (222 females) with a mean age of 83.1 ± 6.8 and BMI range of 14.7-43.6 kg/m 2 . More participants were assessed at risk of malnutrition using NRS-2002 (n = 253, 74.0%) compared to MUST (n = 170, 49.7%) and MNA-SF (n = 191, 55.8%). Of total participants, 239 (69.9%; 157 females) were considered to be at risk of RFS. Based on NRS-2002, 75.9% (n = 192) of patients at risk of malnutrition are at risk of RFS whereas according to MUST and MNA-SF, 85.9% (n = 146) and 69.1% (n = 132) of patients at risk of malnutrition are exposed to high risk of RFS, respectively. In addition, the prevalence of risk of RFS is significantly increased with higher score of NRS-2002 and MUST and lower score of MNA-SF. In a stepwise multiple regression analysis, disease severity (38.2%), WL in 3 months (20.3%) and BMI (33.3%) mainly explained variance in NRS-2002, MUST and MNA-SF scores, respectively, in patients with risk of RFS. Nearly three-quarters of geriatric hospitalized patients with risk of malnutrition demonstrated significant risk of RFS. Therefore, additional screening for risk of RFS in patients screened for malnutrition appears to be abdicable among this population. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

LOW-COST ZEOLITE MEMBRANE MODULES FOR SOLVENT DEHYDRATION - PHASE I

EPA Science Inventory

A number of very high-volume liquid chemicals form azeotropes with water and can be dehydrated to required purity levels only through the use of entrainers or drying agents. The handling and disposal of these additional chemicals present significant environmental risk...

Mate preference and disease risk in Zootermopsis angusticollis (Isoptera:Termopsidae

USDA-ARS?s Scientific Manuscript database

Termites face significant and chronic intranidal selection pressures from parasites and pathogens that colonize their nests. They also encounter microbes outside their nest while foraging and during dispersal of winged primary reproductives to establish new colonies. The latter run the additional ri...

39 CFR 3020.72 - Supporting justification.

Code of Federal Regulations, 2010 CFR

2010-07-01

...(c); (c) Explain why, as to competitive products, the addition, subtraction, or transfer will not... classify as competitive a product over which the Postal Service exercises sufficient market power that it can, without risk of losing a significant level of business to other firms offering similar products...

What matters in type 2 diabetes mellitus oral treatment? A discrete choice experiment to evaluate patient preferences.

PubMed

Mühlbacher, Axel; Bethge, Susanne

2016-12-01

The aim of this empirical study is to evaluate patient preferences for different characteristics of oral type 2 diabetes mellitus (T2DM) treatment. As T2DM treatment requires strict adherence, patient needs and preferences should be taken into consideration. Based on a qualitative and quantitative analysis, a discrete choice experiment (DCE) was applied to identify patient preferences. Apart from six identical attributes (adjustment of glycated hemoglobin [HbA1c], prevention of hypoglycemia, risk of genital infection, risk of gastrointestinal problems, risk of urinary tract infection, and weight change), one continuous variable of either "additional healthy life years" (AHY) or "additional costs" attribute (AC) was included. The DCE was conducted using a fractional factorial design, and the statistical data analysis used random effect logit models. In total, N = 626 (N = 318 AHY + N = 308 AC) T2DM patients participated in the survey. The estimation revealed a clear dominance for prevention of hypoglycemia (coefficient 0.937) and adjustment of HbA1c (coefficient 0.541). The attributes, "additional healthy life years" (coefficient 0.458) or "additional costs" (coefficient 0.420), were in the middle rank and both of significant impact. The side effects, risk of genital infection (coefficient 0.301), risk of gastrointestinal problems (coefficient 0.296), and risk of urinary tract infection (coefficient 0.241) followed in this respective order. Possible weight change (coefficient 0.047) was of less importance (last rank) to the patients in this evaluation. These survey results demonstrate how much a (hypothetical) T2DM oral treatment characteristic affects the treatment decision. The preference data can be used for risk-benefit assessment, cost-benefit assessment, and the establishment of patient-oriented evidence. Understanding how patients perceive and value different aspects of diabetes oral treatment is vital to the optimal design and evaluation of treatment options. The present results can be an additional source of information for design, assessment, and decision in T2DM treatment regimes. As such, more effective and efficient care of patients can be achieved, thereby increasing adherence.

The risk of coronary artery disease estimated non-invasively in patients with essential hypertension environmentally exposed to cigarette smoke.

PubMed

Gać, Paweł; Jaźwiec, Przemysław; Poręba, Małgorzata; Mazur, Grzegorz; Pawlas, Krystyna; Sobieszczańska, Małgorzata; Poręba, Rafał

2017-12-01

The relationship between environmental exposure of non-smokers to cigarette smoke and the coronary artery calcium scores has not been sufficiently documented. The aim of the study was to identify the relationship between environmental exposure to cigarette smoke and the risk of coronary artery disease (CAD) estimated non-invasively through measurement of coronary artery calcium score by computed tomography in patients with essential hypertension. The study was conducted on 67 patients with essential hypertension, non-smokers environmentally exposed to cigarette smoke (group A) and on 67 patients with essential hypertension, non-smokers not exposed to cigarette smoke (group B), selected using the case to case. Environmental exposure to cigarette smoke was evaluated using a questionnaire. The risk of development of coronary artery disease was estimated non-invasively through measurement of coronary artery calcium score (CA CS ) by computed tomography. Group A was characterised by significantly higher CA CS and left anterior descending (LAD CS ) calcium scores than group B. Compared to group B, group A had significantly higher percentage of patients with significant risk of CAD estimated on the basis of CA CS values, and significantly lower percentage of patients with practically no risk of CAD estimated with the same method. Advanced age, peripheral artery diseases and environmental exposure to cigarette smoke are independent risk factors associated with increased CA CS and LAD CS values. In addition, higher BMI and hypercholesterolemia are independent risk factors for increased values of LAD CS . In patients with essential hypertension environmental exposure to cigarette smoke may result in elevated risk of coronary artery disease estimated non-invasively through measurement of coronary artery calcium score by computed tomography. Copyright © 2017 Elsevier B.V. All rights reserved.

Modulation of Coronary Heart Disease Risk by Insulin Resistance in Subjects With Normal Glucose Tolerance or Prediabetes

PubMed Central

Ariel, Danit; Reaven, Gerald

2014-01-01

Aims/hypothesis This study is based on the hypothesis that: 1)coronary heart disease (CHD) risk is accentuated in the insulin resistant subset of persons with normal glucose tolerance (NGT) or prediabetes (PreDM); 2)the prevalence of insulin resistance, and associated abnormalities, is greater in subjects with PreDM; and 3)insulin resistance is the major contributor to increased CHD risk in these individuals. Methods A 75 g oral glucose challenge was used to classify volunteers as having NGT or PreDM. Steady-state plasma glucose (SSPG) concentrations during the insulin suppression test subdivided both groups into insulin sensitive (IS=SSPG <8.4 mmol/L) or resistant (IR=SSPG ≥8.4 mmol/L). Measurements were made of demographic characteristics, blood pressure, and lipid and lipoprotein concentrations, and comparisons made between the subgroups. Results Subjects with PreDM (n=127) were somewhat older, more likely to be non-Hispanic men, with increased adiposity than those with NGT (n=315). In addition, they had higher FPG concentrations, were insulin resistant (SSPG concentration; 11.4 vs. 7.2 mmol/L), with higher blood pressures, and a significantly more adverse CHD risk lipid profile (p<0.001). Twice as many subjects with PreDM were IR (72% vs. 35 %), and the CHD risk profile was significantly worse in the IR subgroups in those with either NGT or PreDM. Conclusions/interpretation CHD risk profile is significantly more adverse in subjects with PreDM as compared to individuals with NGT. However, glucose tolerance status is not the only determinant of CHD risk in nondiabetic individuals, and differences in degree of insulin resistance significantly modulate CHD risk in subjects with NGT or PreDM. PMID:25358836

Occupational and genetic risk factors associated with intervertebral disc disease.

PubMed

Virtanen, Iita M; Karppinen, Jaro; Taimela, Simo; Ott, Jürg; Barral, Sandra; Kaikkonen, Kaisu; Heikkilä, Olli; Mutanen, Pertti; Noponen, Noora; Männikkö, Minna; Tervonen, Osmo; Natri, Antero; Ala-Kokko, Leena

2007-05-01

Cross-sectional epidemiologic study. To evaluate the interaction between known genetic risk factors and whole-body vibration for symptomatic intervertebral disc disease (IDD) in an occupational sample. Risk factors of IDD include, among others, whole-body vibration and heredity. In this study, the importance of a set of known genetic risk factors and whole-body vibration was evaluated in an occupational sample of train engineers and sedentary controls. Eleven variations in 8 genes (COL9A2, COL9A3, COL11A2, IL1A, IL1B, IL6, MMP-3, and VDR) were genotyped in 150 male train engineers with an average of 21-year exposure to whole-body vibration and 61 male paper mill workers with no exposure to vibration. Subjects were classified into IDD-phenotype and asymptomatic groups, based on the latent class analysis. The number of individuals belonging to the IDD-phenotype was significantly higher among train engineers (42% of train engineers vs. 17.5% of sedentary workers; P = 0.005). IL1A -889T allele represented a significant risk factor for the IDD-phenotype both in the single marker allelic association test (P = 0.043) and in the logistic regression analysis (P = 0.01). None of the other allele markers was significantly associated with symptoms when analyzed independently. However, for all the SNP markers considered, whole-body vibration represents a nominally significant risk factor. The results suggest that whole-body vibration is a risk factor for symptomatic IDD. Moreover, whole-body vibration had an additive effect with genetic risk factors increasing the likelihood of belonging to the IDD-phenotype group. Of the independent genetic markers, IL1A -889T allele had strongest association with IDD-phenotype.

Chemotherapy effectiveness and mortality prediction in surgically treated osteosarcoma dogs: A validation study.

PubMed

Schmidt, A F; Nielen, M; Withrow, S J; Selmic, L E; Burton, J H; Klungel, O H; Groenwold, R H H; Kirpensteijn, J

2016-03-01

Canine osteosarcoma is the most common bone cancer, and an important cause of mortality and morbidity, in large purebred dogs. Previously we constructed two multivariable models to predict a dog's 5-month or 1-year mortality risk after surgical treatment for osteosarcoma. According to the 5-month model, dogs with a relatively low risk of 5-month mortality benefited most from additional chemotherapy treatment. In the present study, we externally validated these results using an independent cohort study of 794 dogs. External performance of our prediction models showed some disagreement between observed and predicted risk, mean difference: -0.11 (95% confidence interval [95% CI]-0.29; 0.08) for 5-month risk and 0.25 (95%CI 0.10; 0.40) for 1-year mortality risk. After updating the intercept, agreement improved: -0.0004 (95%CI-0.16; 0.16) and -0.002 (95%CI-0.15; 0.15). The chemotherapy by predicted mortality risk interaction (P-value=0.01) showed that the chemotherapy compared to no chemotherapy effectiveness was modified by 5-month mortality risk: dogs with a relatively lower risk of mortality benefited most from additional chemotherapy. Chemotherapy effectiveness on 1-year mortality was not significantly modified by predicted risk (P-value=0.28). In conclusion, this external validation study confirmed that our multivariable risk prediction models can predict a patient's mortality risk and that dogs with a relatively lower risk of 5-month mortality seem to benefit most from chemotherapy. Copyright © 2016 Elsevier B.V. All rights reserved.

Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes: Evidence from a long-term controlled trial

PubMed Central

Rosenstock, Julio; Fonseca, Vivian; Schinzel, Stefan; Dain, Marie-Paule; Mullins, Peter; Riddle, Matthew

2016-01-01

Aims This analysis evaluated HbA1c-adjusted hypoglycemia risk with glargine versus neutral protamine Hagedorn (NPH) over a 5-year study in patients with Type 2 diabetes mellitus (T2DM). Clinical significance was assessed using number needed to harm (NNH) to demonstrate the risk of one additional patient experiencing at least one hypoglycemic event. Methods Individual patient-level data for symptomatic documented hypoglycemia and HbA1c values from a 5-year randomized study comparing once-daily glargine (n = 513) with twice-daily NPH (n = 504) were analyzed. Symptomatic hypoglycemia was categorized according to concurrent self-monitoring blood glucose levels and need for assistance. Hypoglycemic events per patient-year as a function of HbA1c were fitted by negative binomial regression using treatment and HbA1c at endpoint as independent variables. An estimate of NNH was derived from logistic regression models. Results The cumulative number of symptomatic hypoglycemia events was consistently lower with glargine compared with NPH over 5 years. Compared with twice-daily NPH, once-daily glargine treatment resulted in significantly lower adjusted odds ratios (OR) for all daytime hypoglycemia (OR 0.74; p = 0.030) and any severe event (OR 0.64; p = 0.035), representing a 26% and 36% reduction in the odds of daytime and severe hypoglycemia, respectively. Our model predicts that, if 25 patients were treated with NPH instead of glargine, then one additional patient would experience at least one severe hypoglycemic event. Conclusions This analysis of long-term insulin treatment confirms findings from short-term studies and demonstrates that glargine provides sustained, clinically meaningful reductions in risk of hypoglycemia compared with NPH in patients with T2DM. PMID:24856612

Should Age at Diagnosis Be Included as an Additional Variable in the Risk of Recurrence Classification System in Patients with Differentiated Thyroid Cancer.

PubMed

Pitoia, Fabián; Jerkovich, Fernando; Smulever, Anabella; Brenta, Gabriela; Bueno, Fernanda; Cross, Graciela

2017-07-01

To evaluate the influence of age at diagnosis on the frequency of structural incomplete response (SIR) according to the modified risk of recurrence (RR) staging system from the American Thyroid Association guidelines. We performed a retrospective analysis of 268 patients with differentiated thyroid cancer (DTC) followed up for at least 3 years after initial treatment (total thyroidectomy and remnant ablation). The median follow-up in the whole cohort was 74.3 months (range: 36.1-317.9) and the median age at diagnosis was 45.9 years (range: 18-87). The association between age at diagnosis and the initial and final response to treatment was assessed with analysis of variance (ANOVA). Patients were also divided into several groups considering age younger and older than 40, 50, and 60 years. Age at diagnosis was not associated with either an initial or final statistically significant different SIR to treatment ( p = 0.14 and p = 0.58, respectively). Additionally, we did not find any statistically significant differences when the percentages of SIR considering the classification of RR were compared between different groups of patients by using several age cutoffs. When patients are correctly risk stratified, it seems that age at diagnosis is not involved in the frequency of having a SIR at the initial evaluation or at the final follow-up, so it should not be included as an additional variable to be considered in the RR classifications.

Dysregulated Arginine Metabolism and Cardiopulmonary Dysfunction in Patients with Thalassaemia

PubMed Central

Morris, Claudia R.; Kim, Hae-Young; Klings, Elizabeth S.; Wood, John; Porter, John B.; Trachtenberg, Felicia; Sweeters, Nancy; Olivieri, Nancy F; Kwiatkowski, Janet L; Virzi, Lisa; Hassell, Kathryn; Taher, Ali; Neufeld, Ellis J; Thompson, Alexis A.; Larkin, Sandra; Suh, Jung H.; Vichinsky, Elliott P; Kuypers, Frans A.

2015-01-01

Pulmonary hypertension (PH) commonly develops in thalassaemia syndromes, but is poorly characterized. The goal of this study was to provide a comprehensive description of the cardiopulmonary and biological profile of patients with thalassaemia at risk for PH. A case-control study of thalassaemia patients at high versus low PH-risk was performed. A single cross-sectional measurement for variables reflecting cardiopulmonary status and biological pathophysiology were obtained, including Doppler-echocardiography, 6-minute-walk-test, Borg Dyspnea Score, New York Heart Association functional class, cardiac magnetic resonance imaging (MRI), chest-computerized tomography, pulmonary function testing and laboratory analyses targeting mechanism of coagulation, inflammation, haemolysis, adhesion and the arginine-nitric oxide pathway. Twenty-seven thalassaemia patients were evaluated, 14 with an elevated tricuspid-regurgitant-jet-velocity (TRV) ≥2.5m/s. Patients with increased TRV had a higher frequency of splenectomy, and significantly larger right atrial size, left atrial volume and left septal-wall thickness on echocardiography and/or MRI, with elevated biomarkers of abnormal coagulation, lactate dehydrogenase levels and arginase concentration, and lower arginine-bioavailability compared to low-risk patients. Arginase concentration correlated significantly to several echocardiography/MRI parameters of cardiovascular function in addition to global-arginine-bioavailability and biomarkers of haemolytic rate, including lactate dehydrogenase, haemoglobin and bilirubin. Thalassaemia patients with a TRV ≥2.5m/s have additional echocardiography and cardiac-MRI parameters suggestive of right and left-sided cardiac dysfunction. In addition, low arginine bioavailability may contribute to cardiopulmonary dysfunction in β-thalassaemia. PMID:25907665

Differential Effects of Estrogen and Progesterone on Genetic and Environmental Risk for Emotional Eating in Women

PubMed Central

Klump, Kelly L.; O’Connor, Shannon M.; Hildebrandt, Britny A.; Keel, Pamela K.; Neale, Michael; Sisk, Cheryl L.; Boker, Steven; Burt, S. Alexandra

2016-01-01

Recent data show shifts in genetic and environmental influences on emotional eating across the menstrual cycle, with significant shared environmental influences during pre-ovulation, and primarily genetic effects during post-ovulation. Factors driving differential effects are unknown, although increased estradiol during pre-ovulation and increased progesterone during post-ovulation are thought to play a role. We indirectly investigated this possibility by examining whether overall levels of estradiol and progesterone differentially impact genetic and environmental risk for emotional eating in adult female twins (N = 571) drawn from the MSU Twin Registry. Emotional eating, estradiol levels, and progesterone levels were assessed daily and then averaged to create aggregate measures for analysis. As predicted, shared environmental influences were significantly greater in twins with high estradiol levels, whereas additive genetic effects increased substantially across low versus high progesterone groups. Results highlight significant and differential effects of ovarian hormones on etiologic risk for emotional eating in adulthood. PMID:27747142

Epidemiology of inflammatory bowel disease among participants of the Millennium Cohort: incidence, deployment-related risk factors, and antecedent episodes of infectious gastroenteritis.

PubMed

Porter, C K; Welsh, M; Riddle, M S; Nieh, C; Boyko, E J; Gackstetter, G; Hooper, T I

2017-04-01

Crohn's disease (CD) and ulcerative colitis (UC) are two pathotypes of inflammatory bowel disease (IBD) with unique pathology, risk factors and significant morbidity. To estimate incidence and identify IBD risk factors in a US military population, a healthy subset of the US population, using information from the Millennium Cohort Study. Incident IBD was identified from medical encounters from 2001 to 2009 or by self-report. Our primary risk factor of interest, infectious gastroenteritis, was identified from medical encounters and self-reported post-deployment health assessments. Other potential risk factors were assessed using self-reported survey responses and military personnel files. Hazard ratios were estimated using Cox proportional hazards analysis. We estimated 23.2 and 21.9 diagnoses per 100 000 person-years, respectively, for CD and UC. For CD, significant risk factors included [adjusted hazard ratio (aHR), 95% confidence interval]: current smoking (aHR: 2.7, 1.4-5.1), two life stressors (aHR: 2.8, 1.4-5.6) and prior irritable bowel syndrome (aHR: 4.7, 1.5-15.2). There was no significant association with prior infectious gastroenteritis. There was an apparent dose-response relationship between UC risk and an increasing number of life stressors. In addition, antecedent infectious gastroenteritis was associated with almost a three-fold increase in UC risk (aHR: 2.9, 1.4-6.0). Moderate alcohol consumption (aHR: 0.4, 0.2-0.6) was associated with lower UC risk. Stressful conditions and the high risk of infectious gastroenteritis in deployment operations may play a role in the development of IBD in military populations. However, observed differences in risk factors for UC and CD warrant further investigation. © 2017 John Wiley & Sons Ltd.

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

Public perception of the terms "cosmetic," "plastic," and "reconstructive" surgery.

PubMed

Hamilton, Grant S; Carrithers, Jeffrey S; Karnell, Lucy H

2004-01-01

To investigate potential differences in perception of the terms "cosmetic," "plastic," and "reconstructive" as descriptors for surgery. An anonymous questionnaire was offered to subjects over 18 years of age throughout the Unites States via the Internet and in person. The multiple-choice survey measured variables including permanence, risk, expense, recovery, reversibility, pain, technical difficulty, and surgeon training. The questionnaire also included several open-ended questions to capture qualitative perceptions. Semantic differential data were analyzed to measure statistical significance. For most variables--permanence, risk, recovery, reversibility, pain, and surgeon training--the 216 subjects had significantly lower mean responses for cosmetic surgery than those for plastic or reconstructive surgery (P < .002). Overall, the results of this study support the authors' hypothesis that there is a significant difference in perception of cosmetic surgery and plastic or reconstructive surgery. Cosmetic surgery is perceived to be more temporary and less technically difficult than plastic or reconstructive surgery. In addition, cosmetic surgery is believed to be associated with less risk, shorter recovery time, and less pain. Subjects also thought that cosmetic surgeons required significantly less training than plastic or reconstructive surgeons.

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

Castle, Katherine O., E-mail: kocastle@mdanderson.org; Hoffman, Karen E.; Levy, Lawrence B.

Purpose: The benefit of adding androgen deprivation therapy (ADT) to dose-escalated radiation therapy (RT) for men with intermediate-risk prostate cancer is unclear; therefore, we assessed the impact of adding ADT to dose-escalated RT on freedom from failure (FFF). Methods: Three groups of men treated with intensity modulated RT or 3-dimensional conformal RT (75.6-78 Gy) from 1993-2008 for prostate cancer were categorized as (1) 326 intermediate-risk patients treated with RT alone, (2) 218 intermediate-risk patients treated with RT and ≤6 months of ADT, and (3) 274 low-risk patients treated with definitive RT. Median follow-up was 58 months. Recursive partitioning analysis basedmore » on FFF using Gleason score (GS), T stage, and pretreatment PSA concentration was applied to the intermediate-risk patients treated with RT alone. The Kaplan-Meier method was used to estimate 5-year FFF. Results: Based on recursive partitioning analysis, intermediate-risk patients treated with RT alone were divided into 3 prognostic groups: (1) 188 favorable patients: GS 6, ≤T2b or GS 3+4, ≤T1c; (2) 71 marginal patients: GS 3+4, T2a-b; and (3) 68 unfavorable patients: GS 4+3 or T2c disease. Hazard ratios (HR) for recurrence in each group were 1.0, 2.1, and 4.6, respectively. When intermediate-risk patients treated with RT alone were compared to intermediate-risk patients treated with RT and ADT, the greatest benefit from ADT was seen for the unfavorable intermediate-risk patients (FFF, 74% vs 94%, respectively; P=.005). Favorable intermediate-risk patients had no significant benefit from the addition of ADT to RT (FFF, 94% vs 95%, respectively; P=.85), and FFF for favorable intermediate-risk patients treated with RT alone approached that of low-risk patients treated with RT alone (98%). Conclusions: Patients with favorable intermediate-risk prostate cancer did not benefit from the addition of ADT to dose-escalated RT, and their FFF was nearly as good as patients with low-risk disease. In patients with GS 4+3 or T2c disease, the addition of ADT to dose-escalated RT did improve FFF.« less

Risk Factors and Characteristics of Low Pathogenic Avian Influenza Virus Isolated from Commercial Poultry in Tunisia

PubMed Central

Tombari, Wafa; Paul, Mathilde; Bettaieb, Jihene; Larbi, Imen; Nsiri, Jihene; Elbehi, Imen; Gribaa, Latifa; Ghram, Abdeljelil

2013-01-01

Objective Estimate the seroprevalence of influenza A virus in various commercial poultry farms and evaluate specific risk factors as well as analyze their genetic nature using molecular assays. Materials and Methods This report summarizes the findings of a national survey realized from October 2010 to May 2011 on 800 flocks in 20 governorates. Serum samples were screened for the presence of specific influenza virus antibodies using cELISA test. Additionally, swab samples were tested by real time and conventional RT-PCR and compared with results obtained by others assays. Phylogenetic and genetic analyses of the glycoproteins were established for some strains. Results Out of the 800 chicken and turkey flocks tested by cELISA, 223 showed positive anti-NP antibodies (28.7%, 95% CI: 25.6–32.1). Significantly higher seroprevalence was found among the coastal areas compared to inland and during the autumn and winter. Broiler flocks showed significantly lower seroprevalence than layers and broiler breeders. The influenza virus infection prevalence increased after the laying phase among layer flocks. In addition, AIV seropositivity was significantly associated with low biosecurity measures. The Ag EIA and rRT-PCR tests revealed significantly higher numbers of AI positive samples as compared to cell cultures or egg inoculation. All new strains were subtyped as H9N2 by real time and conventional RT-PCR. Drift mutations, addition or deletion of glycosylation sites were likely to have occurred in the HA and NA glycoproteins of Tunisian strains resulting in multiple new amino acid substitutions. This fact may reflect different evolutionary pressures affecting these glycoproteins. The role of these newly detected substitutions should be tested. Conclusion Our findings highlight the potential risk of AIV to avian health. Strict enforcement of biosecurity measures and possible vaccination of all poultry flocks with continuous monitoring of poultry stations may ensure reduction of AIV prevalence and avoid emergence of more pathogenic strains. PMID:23326449

The association between suicide risk and self-esteem in Japanese university students with major depressive episodes of major depressive disorder.

PubMed

Mitsui, Nobuyuki; Asakura, Satoshi; Shimizu, Yusuke; Fujii, Yutaka; Toyomaki, Atsuhito; Kako, Yuki; Tanaka, Teruaki; Kitagawa, Nobuki; Inoue, Takeshi; Kusumi, Ichiro

2014-01-01

The suicide risk among young adults is related to multiple factors; therefore, it is difficult to predict and prevent suicidal behavior. We conducted the present study to reveal the most important factors relating to suicidal ideation in Japanese university students with major depressive episodes (MDEs) of major depressive disorder (MDD). The subjects were 30 Japanese university students who had MDEs of MDD, and were aged between 18 and 26 years old. They were divided into two groups - without suicide risk group (n=15), and with suicide risk group (n=15) - based on the results of the Mini-International Neuropsychiatric Interview. Additionally, healthy controls were recruited from the same population (n=15). All subjects completed the self-assessment scales including the Beck Depression Inventory 2nd edition (BDI-II), the Beck Hopelessness Scale (BHS), Rosenberg's Self-Esteem Scale (RSES), and SF-36v2™ (The Medical Outcomes Study 36-item short-form health survey version 2), and they were all administered a battery of neuropsychological tests. The RSES score of the suicide risk group was significantly lower than the RSES score of the without suicide risk group, whereas the BDI-II score and the BHS score were not significantly different between the two groups. The mean social functioning score on the SF-36v2 of the with suicide risk group was significantly lower than that of the without suicide risk group. The individual's self-esteem and social functioning may play an important role in suicide risk among young adults with MDEs of MDD.

Awareness of ovarian cancer risk factors among women in Malaysia: a preliminary study.

PubMed

Keng, Soon Lean; Abdul Wahab, Syakirah Bainun; Chiu, Lim Bee; Yusuf, Azlina

2015-01-01

Ovarian cancer is recognized as the fourth leading cancer in Malaysia. However, women do not always seek help in a timely manner and gaps in awareness may influence screening uptake and presentation. The purpose of this study was to determine levels of awareness of ovarian cancer risk factors in female population in Penang, Malaysia. A cross-sectional study was conducted in Penang, Malaysia from January until February 2014. Eighty-seven women were selected by convenient sampling. Awareness of risk factors of ovarian cancer was assessed using a self-administered questionnaire. Data were analyzed using statistical package for the social sciences (SPSS) version 20.0 for descriptive statistics and Pearson chi-square test for the association between socio-demographic data and awareness. A p value ≤0.05 was considered statistically significant. In all, 74.7% of participants answered correctly for the risk factor of increasing age, although 94.3% were unaware of increased risk of tall women. A majority, 71.3%, had a low level of awareness of ovarian cancer risk factors. There was a significant association between age and knowledge (p=0.047). Additionally, there was a significant association between higher education level and level of awareness of ovarian cancer risk factors (p=0.039). This study revealed that awareness of ovarian cancer risk factors among Malaysian women is low. The results show a need for improved public understanding about ovarian cancer risks and provision of important information for health professionals about initiatives needed for future awareness, prevention and screening programs.

Planning for hazardous campus waste collection.

PubMed

Liu, Kun-Hsing; Shih, Shao-Yang; Kao, Jehng-Jung

2011-05-15

This study examines a procedure developed for planning a nation-wide hazardous campus waste (HCW) collection system. Alternative HCW plans were designed for different collection frequencies, truckloads, storage limits, and also for establishing an additional transfer station. Two clustering methods were applied to group adjacent campuses into clusters based on their locations, HCW quantities, the type of vehicles used and collection frequencies. Transportation risk, storage risk, and collection cost are the major criteria used to evaluate the feasibility of each alternative. Transportation risk is determined based on the accident rates for each road type and collection distance, while storage risk is calculated by estimating the annual average HCW quantity stored on campus. Alternatives with large trucks can reduce both transportation risk and collection cost, but their storage risks would be significantly increased. Alternatives that collect neighboring campuses simultaneously can effectively reduce storage risks as well as collection cost if the minimum quantity to collect for each group of neighboring campuses can be properly set. The three transfer station alternatives evaluated for northern Taiwan are cost effective and involve significantly lower transportation risk. The procedure proposed is expected to facilitate decision making and to support analyses for formulating a proper nation-wide HCW collection plan. Copyright © 2011 Elsevier B.V. All rights reserved.

Can subsyndromal manifestations of major depression be identified in children at risk?

PubMed

Uchida, M; Fitzgerald, M; Lin, K; Carrellas, N; Woodworth, H; Biederman, J

2017-02-01

Children of parents with major depression are at significantly increased risk for developing major depression themselves; however, not all children at genetic risk will develop major depressive disorder (MDD). We investigated the utility of subsyndromal scores on the Child Behavior Checklist (CBCL) Anxiety/Depression scale in identifying children at the highest risk for pediatric MDD from among the pool of children of parents with MDD or bipolar disorder. The sample was derived from two previously conducted longitudinal case-control family studies of psychiatrically and pediatrically referred youth and their families. For this study, probands were stratified based on the presence or absence of a parental mood disorder. Subsyndromal scores on the CBCL Anxiety/Depression scale significantly separated the children at high risk for pediatric MDD from those at low risk in a variety of functional areas, including social and academic functioning. Additionally, children at genetic risk without elevated CBCL Anxiety/Depression scale scores were largely indistinguishable from controls. These results suggest that the CBCL Anxiety/Depression scale can help identify children at highest risk for pediatric MDD. If implemented clinically, this scale would cost-effectively screen children and identify those most in need of early intervention resources to impede the progression of depression. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Attributional style as a mediator between parental abuse risk and child internalizing symptomatology.

PubMed

Rodriguez, Christina M

2006-05-01

This study examined a model wherein children's attributional style mediates the relationship between parental physical child-abuse risk and children's internalizing problems. Using structural equation modeling, three indices of abuse risk were selected (child abuse potential, physical discipline use, and dysfunctional parenting style) and two indices of children's internalizing problems (depression and anxiety). The sample included 75 parent-child dyads, in which parents reported on their abuse risk and children independently completed measures of depressive and anxious symptomatology and a measure on their attributional style. Findings supported the model that children's attributional style for positive events (but not negative events) partially mediated the relationship between abuse risk and internalizing symptoms, with significant direct and indirect effects of abuse risk on internalizing symptomatology. Future directions to continue evaluating additional mediators and other possible contextual variables are discussed.

Does specific psychopathology predict development of psychosis in ultra high-risk (UHR) patients?

PubMed

Thompson, Andrew; Nelson, Barnaby; Bruxner, Annie; O'Connor, Karen; Mossaheb, Nilufar; Simmons, Magenta B; Yung, Alison

2013-04-01

Studies have attempted to identify additional risk factors within the group identified as 'ultra high risk' (UHR) for developing psychotic disorders in order to characterise those at highest risk. However, these studies have often neglected clinical symptom types as additional risk factors. We aimed to investigate the relationship between baseline clinical psychotic or psychotic-like symptoms and the subsequent transition to a psychotic disorder in a UHR sample. A retrospective 'case-control' methodology was used. We identified all individuals from a UHR clinic who had subsequently developed a psychotic disorder (cases) and compared these to a random sample of individuals from the clinic who did not become psychotic within the sampling time frame (controls). The sample consisted of 120 patients (60 cases, 60 controls). An audit tool was used to identify clinical symptoms reported at entry to the clinic (baseline) using the clinical file. Diagnosis at transition was assessed using the Operational Criteria for Psychotic Illness (OPCRIT) computer program. The relationship between transition to a psychotic disorder and baseline symptoms was explored using survival analysis. Presence of thought disorder, any delusions and elevated mood significantly predicted transition to a psychotic disorder. When other symptoms were adjusted for, only the presence of elevated mood significantly predicted subsequent transition (hazard ratio 2.69, p = 0.002). Thought disorder was a predictor of transition to a schizophrenia-like psychotic disorder (hazard ratio 3.69, p = 0.008). Few individual clinical symptoms appear to be predictive of transition to a psychotic disorder in the UHR group. Clinicians should be cautious about the use of clinical profile alone in such individuals when determining who is at highest risk.

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

PubMed

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

2018-05-04

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

Persistent hemifacial spasm after microvascular decompression: a risk assessment model.

PubMed

Shah, Aalap; Horowitz, Michael

2017-06-01

Microvascular decompression (MVD) for hemifacial spasm (HFS) provides resolution of disabling symptoms such as eyelid twitching and muscle contractions of the entire hemiface. The primary aim of this study was to evaluate the predictive value of patient demographics and spasm characteristics on long-term outcomes, with or without intraoperative lateral spread response (LSR) as an additional variable in a risk assessment model. A retrospective study was undertaken to evaluate the associations of pre-operative patient characteristics, as well as intraoperative LSR and need for a staged procedure on the presence of persistent or recurrent HFS at the time of hospital discharge and at follow-up. A risk assessment model was constructed with the inclusion of six clinically or statistically significant variables from the univariate analyses. A receiving operator characteristic curve was generated, and area under the curve was calculated to determine the strength of the predictive model. A risk assessment model was first created consisting of significant pre-operative variables (Model 1) (age >50, female gender, history of botulinum toxin use, platysma muscle involvement). This model demonstrated borderline predictive value for persistent spasm at discharge (AUC .60; p=.045) and fair predictive value at follow-up (AUC .75; p=.001). Intraoperative variables (e.g. LSR persistence) demonstrated little additive value (Model 2) (AUC .67). Patients with a higher risk score (three or greater) demonstrated greater odds of persistent HFS at the time of discharge (OR 1.5 [95%CI 1.16-1.97]; p=.035), as well as greater odds of persistent or recurrent spasm at the time of follow-up (OR 3.0 [95%CI 1.52-5.95]; p=.002) Conclusions: A risk assessment model consisting of pre-operative clinical characteristics is useful in prognosticating HFS persistence at follow-up.

Evolving biomarkers improve prediction of long-term mortality in patients with stable coronary artery disease: the BIO-VILCAD score.

PubMed

Kleber, M E; Goliasch, G; Grammer, T B; Pilz, S; Tomaschitz, A; Silbernagel, G; Maurer, G; März, W; Niessner, A

2014-08-01

Algorithms to predict the future long-term risk of patients with stable coronary artery disease (CAD) are rare. The VIenna and Ludwigshafen CAD (VILCAD) risk score was one of the first scores specifically tailored for this clinically important patient population. The aim of this study was to refine risk prediction in stable CAD creating a new prediction model encompassing various pathophysiological pathways. Therefore, we assessed the predictive power of 135 novel biomarkers for long-term mortality in patients with stable CAD. We included 1275 patients with stable CAD from the LUdwigshafen RIsk and Cardiovascular health study with a median follow-up of 9.8 years to investigate whether the predictive power of the VILCAD score could be improved by the addition of novel biomarkers. Additional biomarkers were selected in a bootstrapping procedure based on Cox regression to determine the most informative predictors of mortality. The final multivariable model encompassed nine clinical and biochemical markers: age, sex, left ventricular ejection fraction (LVEF), heart rate, N-terminal pro-brain natriuretic peptide, cystatin C, renin, 25OH-vitamin D3 and haemoglobin A1c. The extended VILCAD biomarker score achieved a significantly improved C-statistic (0.78 vs. 0.73; P = 0.035) and net reclassification index (14.9%; P < 0.001) compared to the original VILCAD score. Omitting LVEF, which might not be readily measureable in clinical practice, slightly reduced the accuracy of the new BIO-VILCAD score but still significantly improved risk classification (net reclassification improvement 12.5%; P < 0.001). The VILCAD biomarker score based on routine parameters complemented by novel biomarkers outperforms previous risk algorithms and allows more accurate classification of patients with stable CAD, enabling physicians to choose more personalized treatment regimens for their patients.

Factoring attitudes towards armed conflict risk into selection of protected areas for conservation

PubMed Central

Hammill, E.; Tulloch, A. I. T.; Possingham, H. P.; Strange, N.; Wilson, K. A.

2016-01-01

The high incidence of armed conflicts in biodiverse regions poses significant challenges in achieving international conservation targets. Because attitudes towards risk vary, we assessed different strategies for protected area planning that reflected alternative attitudes towards the risk of armed conflicts. We find that ignoring conflict risk will deliver the lowest return on investment. Opting to completely avoid conflict-prone areas offers limited improvements and could lead to species receiving no protection. Accounting for conflict by protecting additional areas to offset the impacts of armed conflicts would not only increase the return on investment (an effect that is enhanced when high-risk areas are excluded) but also increase upfront conservation costs. Our results also demonstrate that fine-scale estimations of conflict risk could enhance the cost-effectiveness of investments. We conclude that achieving biodiversity targets in volatile regions will require greater initial investment and benefit from fine-resolution estimates of conflict risk. PMID:27025894

A Team Mental Model Perspective of Pre-Quantitative Risk

NASA Technical Reports Server (NTRS)

Cooper, Lynne P.

2011-01-01

This study was conducted to better understand how teams conceptualize risk before it can be quantified, and the processes by which a team forms a shared mental model of this pre-quantitative risk. Using an extreme case, this study analyzes seven months of team meeting transcripts, covering the entire lifetime of the team. Through an analysis of team discussions, a rich and varied structural model of risk emerges that goes significantly beyond classical representations of risk as the product of a negative consequence and a probability. In addition to those two fundamental components, the team conceptualization includes the ability to influence outcomes and probabilities, networks of goals, interaction effects, and qualitative judgments about the acceptability of risk, all affected by associated uncertainties. In moving from individual to team mental models, team members employ a number of strategies to gain group recognition of risks and to resolve or accept differences.

Factoring attitudes towards armed conflict risk into selection of protected areas for conservation.

PubMed

Hammill, E; Tulloch, A I T; Possingham, H P; Strange, N; Wilson, K A

2016-03-30

The high incidence of armed conflicts in biodiverse regions poses significant challenges in achieving international conservation targets. Because attitudes towards risk vary, we assessed different strategies for protected area planning that reflected alternative attitudes towards the risk of armed conflicts. We find that ignoring conflict risk will deliver the lowest return on investment. Opting to completely avoid conflict-prone areas offers limited improvements and could lead to species receiving no protection. Accounting for conflict by protecting additional areas to offset the impacts of armed conflicts would not only increase the return on investment (an effect that is enhanced when high-risk areas are excluded) but also increase upfront conservation costs. Our results also demonstrate that fine-scale estimations of conflict risk could enhance the cost-effectiveness of investments. We conclude that achieving biodiversity targets in volatile regions will require greater initial investment and benefit from fine-resolution estimates of conflict risk.

Genetic variants in pigmentation genes, pigmentary phenotypes, and risk of skin cancer in Caucasians

PubMed Central

Nan, Hongmei; Kraft, Peter; Hunter, David J.; Han, Jiali

2009-01-01

Human pigmentation is a polygenic quantitative trait with high heritability. Although a large number of single nucleotide polymorphisms (SNPs) have been identified in pigmentation genes, very few SNPs have been examined in relation to human pigmentary phenotypes and skin cancer risk. We evaluated the associations between fifteen SNPs in eight candidate pigmentation genes (TYR, TYRP1, OCA2, SLC24A5, SLC45A2, POMC, ASIP, and ATRN) and both pigmentary phenotypes (hair color, skin color, and tanning ability) and skin cancer risk in a nested case-control study of Caucasians within the Nurses’ Health Study (NHS) among 218 melanoma cases, 285 squamous cell carcinoma (SCC) cases, 300 basal cell carcinoma (BCC) cases, and 870 common controls. We found that the TYR Arg402Gln variant was significantly associated with skin color (p-value =7.7×10−4) and tanning ability (p-value =7.3×10−4); the SLC45A2 Phe374Leu variant was significantly associated with hair color (black to blonde) (p-value =2.4×10−7), skin color (p-value =1.1×10−7), and tanning ability (p-value =2.5×10−4). These associations remained significant after controlling for MC1R variants. No significant associations were found between these polymorphisms and the risk of skin cancer. We observed that the TYRP1 rs1408799 and SLC45A2 -1721 C>G were associated with melanoma risk (OR, 0.77; 95% CI, 0.60–0.98 and OR, 0.75; 95% CI, 0.60–0.95, respectively). The TYR Ser192Tyr was associated with SCC risk (OR, 1.23; 95% CI, 1.00–1.50). The TYR haplotype carrying only the Arg402Gln variant allele was significantly associated with SCC risk (OR, 1.35; 95% CI, 1.04–1.74). The OCA2 Arg419Gln and ASIP g.8818 A>G were associated with BCC risk (OR, 1.50; 95% CI, 1.06–2.13 and OR, 0.73; 95% CI, 0.53–1.00, respectively). The haplotype near ASIP (rs4911414[T] and rs1015362[G]) was significantly associated with fair skin color (OR, 2.28; 95% CI, 1.46–3.57) as well as the risks of melanoma (OR, 1.68; 95% CI, 1.18–2.39) and SCC (OR, 1.54; 95% CI, 1.08–2.19). These associations remained similar after adjusting for pigmentary phenotypes and MC1R variants. The statistical power of this study was modest and additional studies are warranted to confirm the associations observed in the present study. This study provides evidence for the contribution of pigmentation genetic variants, in addition to the MC1R variants, to variation in human pigmentary phenotypes and possibly the development of skin cancer. PMID:19384953

Responses to false physiological feedback in individuals with panic attacks and elevated anxiety sensitivity.

PubMed

Story, Tyler J; Craske, Michelle G

2008-09-01

Participants with elevated anxiety sensitivity and a history of panic attacks were compared to a low anxiety comparison group with respect to physiological and subjective reactivity to false heart-rate feedback and reactivity to a priming procedure. Whereas accurate heart-rate feedback elicited minimal responses, participants across groups showed significant physiological and subjective responses to false feedback. High risk and low risk participants did not differ in heart-rate responses to false feedback, though panic attack frequency did predict physiological and subjective reactions to false feedback in the high risk group. Self-reported nonspecific anxiety was significantly higher in high risk female participants than in low risk female participants, while males did not different in general subjective anxiety. However, high risk participants reported more panic-specific symptoms during the false feedback task than low risk participants, regardless of the sex of the participant. Therefore, although the experimental paradigm appeared to trigger nonspecific anxiety in high risk female participants, panic attack symptoms in reaction to the task were specific to risk group, not sex, and consistent with hypotheses. Surprisingly, the priming procedure did not influence physiological or subjective responses to false feedback in either group. These results raise additional questions regarding the process and impact of interception in individuals with panic attacks, and suggest that false perception of internal changes may contribute to risk for panic disorder when exposed to believable cues.

Posttraumatic stress disorder, alone or additively with early life adversity, is associated with obesity and cardiometabolic risk.

PubMed

Farr, O M; Ko, B-J; Joung, K E; Zaichenko, L; Usher, N; Tsoukas, M; Thakkar, B; Davis, C R; Crowell, J A; Mantzoros, C S

2015-05-01

There is some evidence that posttraumatic stress disorder (PTSD) and early life adversity may influence metabolic outcomes such as obesity, diabetes, and cardiovascular disease. However, whether and how these interact is not clear. We analyzed data from a cross-sectional and longitudinal study to determine how PTSD severity influences obesity, insulin sensitivity, and key measures and biomarkers of cardiovascular risk. We then looked at how PTSD and early life adversity may interact to impact these same outcomes. PTSD severity is associated with increasing risk of obesity, diabetes, and cardiovascular disease, with higher symptoms correlating with higher values of BMI, leptin, fibrinogen, and blood pressure, and lower values of insulin sensitivity. PTSD and early life adversity have an additive effect on these metabolic outcomes. The longitudinal study confirmed findings from the cross sectional study and showed that fat mass, leptin, CRP, sICAM-1, and sTNFRII were significantly increased with higher PTSD severity during a 2.5 year follow-up period. Individuals with early life adversity and PTSD are at high risk and should be monitored carefully for obesity, insulin resistance, and cardiometabolic risk. Copyright © 2015 Elsevier B.V. All rights reserved.

An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007-2016).

PubMed

Fox, Mary A; Brewer, L Elizabeth; Martin, Lawrence

2017-04-07

Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications.

An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007–2016)

PubMed Central

Fox, Mary A.; Brewer, L. Elizabeth; Martin, Lawrence

2017-01-01

Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications. PMID:28387705

[Carbetocin and oxytocin: Prevention of postpartum hemorrhage in patients with risk factors for uterine atony].

PubMed

Carrillo-Gaucín, Santiago; Torres-Gómez, Luis Guillermo

2016-01-01

In Mexico, during 2010, obstetric hemorrhage was second (19.6%) as a direct cause of maternal death. The aim of this paper is to evaluate the effect of oxytocin and carbetocin, in preventing postpartum hemorrhage in patients with risk factors for uterine atony. Study type clinical trial, patients experiencing at least one of the risk factors for uterine atony included. Randomly, they were divided into two groups: one was given Oxytocin and other received Carbetocin. The following variables were determined: risk factors for uterine atony, hemoglobin and hematocrit, vital signs, trans-surgical bleeding, whether or not presented uterine atony, uresis, need for additional tonics uterus and need for blood transfusion. A total of 120 patients were studied in 6 months were excluded 3, 60 were treated with Carbetocin, and 57 with Oxytocin. It was determined that there is a greater number of events of uterine atony (p = 0.007, with RR 11.06) and therefore greater need for additional tonic uterus (p = 0.027, with RR 5.44) in the group of Oxytocin. There was no statistically significant difference in the other variables. Carbetocin is recommended as prophylaxis of obstetric hemorrhage in patients with risk factors for uterine atony.

Risk Factors for Antimicrobial Resistance in Escherichia coli in Pigs Receiving Oral Antimicrobial Treatment: A Systematic Review.

PubMed

Burow, Elke; Käsbohrer, Annemarie

2017-03-01

The aim of this literature review was to identify risk factors in addition to antimicrobial treatment for antimicrobial resistance (AMR) occurrence in commensal Escherichia coli in pigs. A variety of studies were searched in 2014 and 2015. Studies identified as potentially relevant were assessed against eligibility criteria such as observation or experiment (no review), presentation of risk factors in addition to (single dosage) antimicrobial use, risk factors for but not resulting from AMR, and the same antimicrobial used and tested. Thirteen articles (nine on observational, four on experimental studies) were finally selected as relevant. It was reported that space allowance, production size/stage, cleanliness, entry of animals and humans into herds, dosage/frequency/route of administration, time span between treatment and sampling date, herd size, distance to another farm, coldness, and season had an impact on AMR occurrence. Associations were shown by one to four studies per factor and differed in magnitude, direction, and level of significance. The risk of bias was unclear in nearly half of the information of observational studies and in most of the information from experimental studies. Further research on the effects of specific management practices is needed to develop well-founded management advice.

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

PubMed

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

2016-09-01

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

Inflammatory cytokine levels and breast cancer risk factors: racial differences of healthy Caucasian and African American women.

PubMed

Park, Na-Jin; Kang, Duck-Hee

2013-09-01

To examine racial differences in inflammatory cytokine levels (interleukin [IL]-6 and interferon-gamma [IFN-γ]) and breast cancer (BC) risk factors between healthy Caucasian and African American women; to examine differences in relationships of inflammatory cytokine levels with BC risk factors between these groups of women; and to determine the independent contribution of race to IL-6 and IFN-γ after controlling for relevant covariates. Cross-sectional and correlational descriptive design. Community surrounding a state university health system in the southeastern United States. 113 healthy women (65 Caucasians and 48 African Americans) aged 20 years or older and not pregnant. Secondary analysis of data collected from self-report questionnaires and blood samples. Inflammatory cytokine levels, BC risk factors (age, age at menarche, age at first live birth, family history of BC, breast biopsy, breastfeeding history and duration, body mass index, and physical activity), and race. Significant racial differences were noted in IL-6 and IFN-γ levels, reproductive or hormonal and lifestyle BC risk factors, and relationships between African American and Caucasian women. Controlling for all other effects, race appeared to be a significant predictor for IL-6 and IFN-γ. Racial differences in inflammatory cytokines and BC risk factors may provide partial evidence for existing racial disparities in BC for African American and Caucasian women. Additional studies are needed to confirm that potential. Additional biobehavioral research in racial disparities in BC may help to inform nurses to target race-specific modifications of lifestyle and behavioral factors to reduce BC health disparity between African American and Caucasian women. Being an African American woman predicted a higher level of inflammatory cytokine production after controlling for selected BC risk factors. Great potential exists for inflammatory responses as one of the underlying biologic mechanisms for existing BC disparity and for culturally tailored lifestyle or behavioral modification interventions for reducing BC risk and racial disparity.

Association between Helicobacter pylori infection and increased risk of typhoid fever.

PubMed

Bhan, Maharaj K; Bahl, Rajiv; Sazawal, Sunil; Sinha, Anju; Kumar, Ramesh; Mahalanabis, Dilip; Clemens, John D

2002-12-15

Helicobacter pylori infection has been reported to increase the risk of cholera. This nested case-control study was conducted to determine whether H. pylori infection is associated with occurrence of typhoid fever. Eighty-three case subjects of culture-proven typhoid fever were identified through a 1-year surveillance of subjects aged 0-40 years in an urban slum. Two age- and sex-matched neighborhood control subjects were concurrently selected for each case subject. Serum anti-H. pylori immunoglobulin G antibodies were measured in case and neighborhood control subjects. For determining other risk factors, 2 additional community control subjects per case were selected. There was a significant association between the presence of serum anti-H. pylori immunoglobulin G antibodies and typhoid fever (adjusted odds ratio, 2.03; 95% confidence interval, 1.02-4.01). Illiteracy, being part of a nuclear family, nonuse of soap, and consumption of ice cream were also associated with a significantly greater risk of typhoid fever. This study provides the first empiric evidence that H. pylori infection is associated with an increased risk of typhoid fever.

Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials.

PubMed

Wang, Li; Johnston, Bradley; Kaushal, Alka; Cheng, Davy; Zhu, Fang; Martin, Janet

2016-03-01

To determine whether ketamine added to morphine or hydromorphone patient-controlled analgesia (PCA) provides clinically relevant reductions in postoperative pain, opioid requirements, and adverse events when compared with morphine or hydromorphone PCA in adults undergoing surgery. We systematically searched six databases up to June 2, 2015 for randomized controlled trials (RCTs) comparing ketamine plus morphine/hydromorphone PCA vs morphine/hydromorphone PCA for postoperative pain in adults. Thirty-six RCTs including 2,502 patients proved eligible, and 22 of these were at low risk of bias. The addition of ketamine to morphine/hydromorphone PCA decreased postoperative pain intensity at six to 72 hr when measured at rest (weighted mean difference [WMD] on a 10-cm visual analogue scale ranged from -0.4 to -1.3 cm) and during mobilization (WMD ranged from -0.4 to -0.5 cm). Adjunctive ketamine also significantly reduced cumulative morphine consumption at 24-72 hr by approximately 5-20 mg. Predefined subgroup analyses and meta-regression did not detect significant differences across subgroups, including a dose-response relationship. There was no significant difference in patient satisfaction scores at 24 and 48 hr. Nevertheless, the addition of ketamine to morphine/hydromorphone PCA significantly reduced postoperative nausea and vomiting (relative risk, 0.71; 95% confidence interval [CI], 0.60 to 0.85; absolute risk reduction, 8.9%; 95% CI, 4.6 to 12.2). Significant effects on other adverse events (e.g., hallucinations, vivid dreams) were not detected, though only a few studies reported on them. Adding ketamine to morphine/hydromorphone PCA provides a small improvement in postoperative analgesia while reducing opioid requirements. Adjunctive ketamine also reduces postoperative nausea and vomiting without a detected increase in other adverse effects; however, adverse events were probably underreported.

Associations of oxidative stress status parameters with traditional cardiovascular disease risk factors in patients with schizophrenia.

PubMed

Vidović, Bojana; Stefanović, Aleksandra; Milovanović, Srđan; Ðorđević, Brižita; Kotur-Stevuljević, Jelena; Ivanišević, Jasmina; Miljković, Milica; Spasić, Slavica

2014-04-01

The purpose of this study was to assess oxidative stress status parameters and their possible associations with traditional cardiovascular risk factors in patients with schizophrenia, as well as their potential for patient-control discrimination. Fasting glucose, lipid profile and oxidative stress status parameters were assessed in 30 schizophrenic patients with atypical antipsychotic therapy and 60 control subjects. Malondialdehyde (MDA), pro-oxidant/antioxidant balance (PAB) and total anti-oxidant status (TAS) were significantly higher whereas total sulfhydryl (SH) groups were significantly lower in schizophrenic patients vs. control group. Higher serum PAB values showed an independent association with schizophrenia. The addition of PAB to conventional risk factors improved discrimination between healthy control subjects and patients. Increased oxidative stress and changed lipid profile parameters are associated in schizophrenic patients and may indicate risk for atherosclerosis. The serum PAB level may reflect the levels of oxidative stress in schizophrenia and improve discrimination of patients from controls.

Epidemiology of multiple sclerosis in US veterans: VII. Risk factors for MS.

PubMed

Kurtzke, J F; Page, W F

1997-01-01

In previous papers of this series, we explored the epidemiology of MS, examining the effects of race, sex, geography, latitude and climate, migration, age at onset, population ancestry, and individual ethnicity on the risk of MS, using an unusually large cohort of MS cases and pre-illness matched controls comprising US veterans of World War II (WWII) and the Korean Conflict (KC). In this paper, we examine primarily the effect of other factors on the risk of MS in this cohort and their relation to those previously studied. We found here that latitude tier of residence at entry into active duty (EAD), years of education, and socioeconomic class (coded from occupation) were similarly associated with MS risk among white men, black men, and white women. Higher levels of each factor showed increased MS risk. Multivariate analyses indicated that for white male WWII subjects an urban address, 9 or more years of education, uncorrected visual acuity less than 20/20 at EAD, a more northern latitude, and a higher proportion of the subject's EAD state population reporting Swedish ancestry each significantly increased the risk of MS. White male KC subjects showed roughly the same patterns, except that uncorrected visual acuity less than 20/20 was associated with lower MS risk (ancestry/ethnicity was not studied). For black male WWII and KC subjects combined, a similar analysis (omitting ancestry/ethnicity) showed that only latitude at EAD and 9 or more years of education were independently associated with a significantly higher MS risk, and for WWII plus KC white women (also without ancestry/ethnicity), only latitude was a significant risk factor in these multivariate analyses. The smaller number of subjects, especially in these last two groups, limited the power to detect statistically significant risks in these last analyses. Similarities to white men of WWII in univariate analyses for all other groups suggest that findings for the former would otherwise apply to the latter. Although the interpretations of these associations may be obscure, in addition to geography, age, sex, and race, per se, higher socioeconomic status is significantly associated with higher MS risk in black and white men and in white women in the United States.

Major histocompatibility complex harbors widespread genotypic variability of non-additive risk of rheumatoid arthritis including epistasis.

PubMed

Wei, Wen-Hua; Bowes, John; Plant, Darren; Viatte, Sebastien; Yarwood, Annie; Massey, Jonathan; Worthington, Jane; Eyre, Stephen

2016-04-25

Genotypic variability based genome-wide association studies (vGWASs) can identify potentially interacting loci without prior knowledge of the interacting factors. We report a two-stage approach to make vGWAS applicable to diseases: firstly using a mixed model approach to partition dichotomous phenotypes into additive risk and non-additive environmental residuals on the liability scale and secondly using the Levene's (Brown-Forsythe) test to assess equality of the residual variances across genotype groups per marker. We found widespread significant (P < 2.5e-05) vGWAS signals within the major histocompatibility complex (MHC) across all three study cohorts of rheumatoid arthritis. We further identified 10 epistatic interactions between the vGWAS signals independent of the MHC additive effects, each with a weak effect but jointly explained 1.9% of phenotypic variance. PTPN22 was also identified in the discovery cohort but replicated in only one independent cohort. Combining the three cohorts boosted power of vGWAS and additionally identified TYK2 and ANKRD55. Both PTPN22 and TYK2 had evidence of interactions reported elsewhere. We conclude that vGWAS can help discover interacting loci for complex diseases but require large samples to find additional signals.

Attention-deficit/hyperactivity disorder in adolescence predicts onset of major depressive disorder through early adulthood.

PubMed

Meinzer, Michael C; Lewinsohn, Peter M; Pettit, Jeremy W; Seeley, John R; Gau, Jeff M; Chronis-Tuscano, Andrea; Waxmonsky, James G

2013-06-01

The aim of this study was to examine the prospective relationship between a history of attention-deficit/hyperactivity disorder (ADHD) assessed in mid-adolescence and the onset of major depressive disorder (MDD) through early adulthood in a large school-based sample. A secondary aim was to examine whether this relationship was robust after accounting for comorbid psychopathology and psychosocial impairment. One thousand five hundred seven participants from the Oregon Adolescent Depression Project completed rating scales in adolescence and structured diagnostic interviews up to four times from adolescence to age 30. Adolescents with a lifetime history of ADHD were at significantly higher risk of MDD through early adulthood relative to those with no history of ADHD. ADHD remained a significant predictor of MDD after controlling for gender, lifetime history of other psychiatric disorders in adolescence, social and academic impairment in adolescence, stress and coping in adolescence, and new onset of other psychiatric disorders through early adulthood (hazard ratio, 1.81; 95% confidence interval, 1.04, 3.06). Additional significant, robust predictors of MDD included female gender, a lifetime history of an anxiety disorder, and poor coping skills in mid-adolescence, as well as the onset of anxiety, oppositional defiant disorder, and substance-use disorder after mid-adolescence. A history of ADHD in adolescence was associated with elevated risk of MDD through early adulthood and this relationship remained significant after controlling for psychosocial impairment in adolescence and co-occurring psychiatric disorders. Additional work is needed to identify the mechanisms of risk and to inform depression prevention programs for adolescents with ADHD. © 2013 Wiley Periodicals, Inc.

Prophylactic isopropyl alcohol inhalation and intravenous ondansetron versus ondansetron alone in the prevention of postoperative nausea and vomiting in high-risk patients.

PubMed

Radford, Kennett D; Fuller, Thomas N; Bushey, Brent; Daniel, Carole; Pellegrini, Joseph E

2011-08-01

Patients identified as high risk for postoperative nausea and vomiting (PONV) are often treated prophylactically with intravenous (IV) ondansetron and an additional agent. Limited options exist for a second agent with no adverse effects. The purpose of this investigation was to determine if combining the prophylactic inhalation of isopropyl alcohol (IPA) vapors, an agent with no adverse effects, with IV ondansetron would be more effective than IV ondansetron alone in the prevention of PONV in high-risk patients. A total of 76 patients at high risk for PONV were randomized into control (n = 38) and experimental (n = 38) groups. All patients received IV ondansetron before emergence from general anesthesia. In addition, the experimental group inhaled IPA vapors before induction. Severity of PONV was measured using a 0 to 10 verbal numeric rating scale. Other measured variables included time to onset and incidence of PONV, 24-hour composite nausea score, and satisfaction with nausea control. No significant differences in demographics, surgical or anesthesia time, number of risk factors, severity or incidence of PONV, or satisfaction scores were noted. Prophylactic inhalation of IPA vapors in combination with IV ondansetron was no more efficacious than IV ondansetron alone in the prevention of PONV in a high-risk population.

46 CFR 308.104 - Additional war risk insurance.

Code of Federal Regulations, 2012 CFR

2012-10-01

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46 CFR 308.104 - Additional war risk insurance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Additional war risk insurance. 308.104 Section 308.104 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.104 Additional war risk insurance. Owners or charterers may...

46 CFR 308.104 - Additional war risk insurance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Additional war risk insurance. 308.104 Section 308.104 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.104 Additional war risk insurance. Owners or charterers may...

46 CFR 308.104 - Additional war risk insurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Additional war risk insurance. 308.104 Section 308.104 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.104 Additional war risk insurance. Owners or charterers may...

46 CFR 308.104 - Additional war risk insurance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Additional war risk insurance. 308.104 Section 308.104 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.104 Additional war risk insurance. Owners or charterers may...

Risk of Behaviors Associated with Lethal Violence and Functional Outcomes for Abused Women Who Do and Do Not Return to the Abuser Following a Community-Based Intervention

PubMed Central

Nava, Angeles; Gilroy, Heidi; Maddoux, John

2015-01-01

Abstract Background: To determine the differential risk of behaviors associated with lethal violence and functioning outcomes for abused women with children who received an intervention of shelter or justice services and return to the abuser were compared with women who did not return. Methods: The study was carried out using a matched-pair analysis of 152 women. Measures of risk of behaviors associated with lethal violence, type, and severity of abuse, and poor mental health symptoms were measured every 4 months for 24 months. Results: Irrespective of service used, women returning to the abuser reported significantly (p<0.001) more risk of behaviors associated with lethal violence compared to women who did not return. Additionally, severity of physical abuse was significantly higher (p<0.01) for women returning to the abuser who had been in a shelter but not for women who received a protection order. Similarly, levels of depression, posttraumatic stress disorder, and anxiety were significantly higher (p<0.01) for sheltered women who returned to the abuser but not for women using a protection order who returned. Conclusions: Risk of behaviors associated with lethal violence increases when abused women return to live with the abuser. Abused women should be informed of the heightened risk and greater probability for poor mental health. PMID:25714332

Risk factors associated with nasopharyngeal cicatrix syndrome in horses.

PubMed

Norman, Tracy E; Chaffin, M Keith; Bissett, Wesley T; Thompson, James A

2013-05-01

To determine risk factors associated with the development of nasopharyngeal cicatrix syndrome (NCS) in horses. Retrospective case-control study. 242 horses referred for endoscopic evaluation of the upper portion of the respiratory tract (121 horses with NCS and 121 control horses). Medical records of horses that had an endoscopic evaluation of the upper airway performed between January 2003 and December 2008 were reviewed. Signalment, housing management, and season of evaluation were recorded and reviewed for each horse. The associations between clinical signs and endoscopic findings were evaluated by the use of a prospective logistic model that included a Bayesian method for inference. Results-Breed and sex had no significant effect on the risk of having NCS. The risk that a horse had NCS increased significantly with age. Exclusive housing in a stall was protective against the development of NCS. In addition, the amount of pasture turnout had a dose-related effect, with exclusive pasture turnout positively correlated with increased risk of developing NCS, compared with a mixture of pasture turnout and stall confinement. Horses were significantly more likely to be evaluated because of clinical signs of the syndrome during the warm months of the year. The risk factors for NCS identified in this study may support chronic environmental exposure to an irritant or infectious agent as the cause of NCS. Information gained from this study should be useful for investigating the cause of NCS.

Risk of behaviors associated with lethal violence and functional outcomes for abused women who do and do not return to the abuser following a community-based intervention.

PubMed

McFarlane, Judith; Nava, Angeles; Gilroy, Heidi; Maddoux, John

2015-04-01

To determine the differential risk of behaviors associated with lethal violence and functioning outcomes for abused women with children who received an intervention of shelter or justice services and return to the abuser were compared with women who did not return. The study was carried out using a matched-pair analysis of 152 women. Measures of risk of behaviors associated with lethal violence, type, and severity of abuse, and poor mental health symptoms were measured every 4 months for 24 months. Irrespective of service used, women returning to the abuser reported significantly (p<0.001) more risk of behaviors associated with lethal violence compared to women who did not return. Additionally, severity of physical abuse was significantly higher (p<0.01) for women returning to the abuser who had been in a shelter but not for women who received a protection order. Similarly, levels of depression, posttraumatic stress disorder, and anxiety were significantly higher (p<0.01) for sheltered women who returned to the abuser but not for women using a protection order who returned. Risk of behaviors associated with lethal violence increases when abused women return to live with the abuser. Abused women should be informed of the heightened risk and greater probability for poor mental health.

Smoking increases the risk of diabetic foot amputation: A meta-analysis.

PubMed

Liu, Min; Zhang, Wei; Yan, Zhaoli; Yuan, Xiangzhen

2018-02-01

Accumulating evidence suggests that smoking is associated with diabetic foot amputation. However, the currently available results are inconsistent and controversial. Therefore, the present study performed a meta-analysis to systematically review the association between smoking and diabetic foot amputation and to investigate the risk factors of diabetic foot amputation. Public databases, including PubMed and Embase, were searched prior to 29th February 2016. The heterogeneity was assessed using the Cochran's Q statistic and the I 2 statistic, and odds ratio (OR) and 95% confidence interval (CI) were calculated and pooled appropriately. Sensitivity analysis was performed to evaluate the stability of the results. In addition, Egger's test was applied to assess any potential publication bias. Based on the research, a total of eight studies, including five cohort studies and three case control studies were included. The data indicated that smoking significantly increased the risk of diabetic foot amputation (OR=1.65; 95% CI, 1.09-2.50; P<0.0001) compared with non-smoking. Sensitivity analysis demonstrated that the pooled analysis did not vary substantially following the exclusion of any one study. Additionally, there was no evidence of publication bias (Egger's test, t=0.1378; P=0.8958). Furthermore, no significant difference was observed between the minor and major amputation groups in patients who smoked (OR=0.79; 95% CI, 0.24-2.58). The results of the present meta-analysis suggested that smoking is a notable risk factor for diabetic foot amputation. Smoking cessation appears to reduce the risk of diabetic foot amputation.

Interaction of maternal smoking and preterm birth on future risk of maternal cardiovascular disease: A population-based record linkage study.

PubMed

Ngo, Anh D; Roberts, Christine L; Chen, Jian S; Figtree, Gemma

2016-04-01

While associations of smoking and preterm birth (PTB) with maternal cardiovascular disease (CVD) risks have been established, it is unknown whether the coexistence of these two conditions could synergistically increase the risks. We linked birth records of 902,008 mothers with singleton infants during 1994-2011 in New South Wales, Australia to the mothers' subsequent CVD hospitalisation or death. Multiplicative interaction was tested through an interaction term in a multivariate Cox-proportional hazard regression model, while additive interaction was assessed by calculating the synergy index. Relative to never-smokers with term babies, the CVD risk in ever-smokers with PTBs (hazard ratio (HR) 3.35, 95% confidence interval (CI) 2.96-3.80) was significantly greater than the sum of risks in ever-smokers with term babies (HR 2.10, 95% CI 1.96-2.24) and in never-smokers with PTBs (HR 1.73, 95% CI 1.55-1.93), indicating an additive interaction (synergy index = 1.29, 95% CI 1.05-1.58). In ever-smokers, the association was stronger for extremely PTB (HR 3.83, 95% CI 3.23-4.69) than moderately PTB (HR 3.18, 95% CI 2.76-3.66), and for ≥2 PTB (HR 4.47, 95% CI 3.39-5.88) than one PTB (HR 3.20, 95% CI 2.81-3.64). Maternal smoking and PTB interact on the additive scale to synergistically increase maternal CVD risks. The interaction was dose-dependent according to both the severity and number of PTBs. © The European Society of Cardiology 2015.

Genetics and risk factors for basal cell carcinoma.

PubMed

Madan, V; Hoban, P; Strange, R C; Fryer, A A; Lear, J T

2006-05-01

Nonmelanoma skin cancer (NMSC) is the commonest cancer in whites and its incidence is increasing worldwide. The prevalence of this cancer is predicted to equal that of all others combined and it was estimated that there were over 2 million cases diagnosed in the U.S.A. in 2004. Patients exhibit marked differences in clinical phenotype with variations in tumour numbers, rate of tumour accrual, site and histological subtype. Furthermore, patients are at increased risk of other cutaneous and noncutaneous cancers. The factors accounting for this variation are complex and still not completely understood. Clearly, ultraviolet light (UV) exposure is a major influence but its relationship to clinical phenotype is not yet clear. In addition, immunosuppression is a significant risk factor. Our group has identified high-risk groups for the development of further basal cell carcinoma (BCC), namely patients with truncal BCC and those presenting with tumour clusters. This presentation will concentrate on these clinical subgroups as well as immunosuppressed patients. These groups represent significant management challenges and are areas where novel, nonsurgical treatment options may make a significant clinical impact in patient care. The risk factors predisposing to these clinical phenotypes will be discussed, including genetic factors and UV exposure. Potential clinical applications, including predictive indices, will be considered.

The Impact of Operative Approach on Postoperative Complications Following Colectomy for Colon Caner.

PubMed

Mungo, Benedetto; Papageorge, Christina M; Stem, Miloslawa; Molena, Daniela; Lidor, Anne O

2017-08-01

Colectomy is one of the most common major abdominal procedures performed in the USA. A better understanding of risk factors and the effect of operative approach on adverse postoperative outcomes may significantly improve quality of care. Adult patients with a primary diagnosis of colon cancer undergoing colectomy were selected from the National Surgical Quality Improvement Program 2013-2015 targeted colectomy database. Patients were stratified into five groups based on specific operative approach. Univariate and multivariate analyses were used to compare the five groups and identify risk factors for 30-day anastomotic leak, readmission, and mortality. In total, 25,097 patients were included in the study, with a 3.32% anastomotic leak rate, 1.20% mortality rate, and 9.57% readmission rate. After adjusting for other factors, open surgery and conversion to open significantly increased the odds for leak, mortality, and readmission compared to laparoscopy. Additionally, smoking and chemotherapy increased the risk for leak and readmission, while total resection was associated with increased mortality and leak. Operative approach and several other potentially modifiable perioperative factors have a significant impact on risk for adverse postoperative outcomes following colectomy. To improve quality of care for these patients, efforts should be made to identify and minimize the influence of such risk factors.

Fall-risk prediction in older adults with cancer: an unmet need.

PubMed

Wildes, Tanya M; Depp, Brittany; Colditz, Graham; Stark, Susan

2016-09-01

Falls in older adults with cancer are more common than in noncancer controls, yet no fall-risk screening tool has been validated in this population. We undertook a cross-sectional pilot study of the Falls Risk Questionnaire (FRQ) in 21 adults aged ≥65 receiving systemic cancer therapy. Participants completed the FRQ, geriatric assessment measures, and a measure of fear-of-falling. The recruitment rate was 87.5 %, with 95.2 % completion of the FRQ and additional geriatric assessment and quality of life measures. The FRQ correlated significantly with the Timed Up and Go test (Pearson r 0.479, p = 0.028). In addition, the FRQ score correlated directly with fear-of-falling and inversely with QOL, particularly physical health and neurotoxicity subscales. In conclusion, the FRQ was feasible in older adults receiving cancer therapy and correlates with measures of physical performance, functional status, and fear-of-falling. The FRQ may prove to be a valuable fall-risk screening tool to implement fall-prevention interventions in this vulnerable population of older adults with cancer.

Familial and temperamental predictors of resilience in children at risk for conduct disorder and depression

PubMed Central

Shannon, Katherine E.; Beauchaine, Theodore P.; Brenner, Sharon L.; Neuhaus, Emily; Gatzke-Kopp, Lisa

2009-01-01

In this study, we evaluated predictors of resilience among 8- to 12-year-old children recruited from primarily low socioeconomic status neighborhoods, 117 of whom suffered from clinical levels of conduct problems and/or depression, and 63 of whom suffered from no significant symptoms. Tests of interactions were conducted between (a) paternal antisocial behavior and maternal depression and (b) several physiological indices of child temperament and emotionality in predicting (c) children’s conduct problems and depression. Both internalizing and externalizing outcomes among children were associated specifically with maternal melancholic depression, and not with nonmelancholic depression. In addition, low levels of respiratory sinus arrhythmia (RSA) among children conferred significant risk for depression, regardless of maternal melancholia, whereas high RSA offered partial protection. Furthermore, high levels of maternal melancholia conferred significant risk for child depression, regardless of paternal antisocial behavior, whereas low levels of maternal melancholia offered partial protection. Finally, low levels of electrodermal responding (EDR) conferred significant risk for conduct problems, regardless of paternal antisocial behavior, whereas high EDR offered partial protection. None of the identified protective factors offered complete immunity from psychopathology. These findings underscore the complexity of resilience and resilience-related processes, and suggest several potential avenues for future longitudinal research. PMID:17705899

Neck circumference and early stage atherosclerosis: the cardiometabolic risk in Chinese (CRC) study.

PubMed

Liang, Jun; Wang, Yu; Li, Hongyan; Liu, Xuekui; Qiu, Qinqin; Qi, Lu

2014-07-08

Neck circumference (NC) has been previously related to cardiometabolic risk factors. In this study we examined the association between NC and early stage atherosclerosis in Chinese adults. The study samples were from a community-based health examination survey in central China. In total 2,318 men and women (18-64 y) were included in the final analyses. Carotid radial pulse wave velocity (crPWV), carotid femoral PWV (cfPWV), carotid artery dorsalis pedis PWV (cdPWV) and NC were measured. After adjustment for age, sex, lipids, glucose, blood pressure, heart rate, body mass index (BMI), high NC was significantly associated with an increasing trend of cfPWV, cdPWV and crPWV (P = 0.001, 0.049, and 0.038; respectively). In addition, we found significant interaction between hypertension status and NC level in relation to cfPWV, adjusted for age, sex, BMI, fasting glucose, lipids and heart rate(P for interaction = 0.034). The associations between NC and cfPWV were significant (P = 0.02) among those with hypertension, but not significant among those without hypertension. Our data showed that high NC was associated with an increased risk of early stage atherosclerosis in Chinese adults, independent of other metabolic risk factors. Hypertension might modify the association between NC and cfPWV.

Hepatitis E Virus Seroprevalence in Austrian Adults: A Nationwide Cross-Sectional Study among Civilians and Military Professionals

PubMed Central

Lagler, Heimo; Poeppl, Wolfgang; Winkler, Heidi; Herkner, Harald; Faas, Angelus; Mooseder, Gerhard; Burgmann, Heinz

2014-01-01

Background Hepatitis E Virus (HEV) infection is globally increasing. The present study was performed to investigate the HEV seroprevalence, exposure risks as well as occupational risks for military personnel in Austria, a Central European country. Methods and Findings A nationwide cross-sectional seroprevalence study was performed in 997 healthy Austrian adults, professional soldiers and civilians. Routine laboratory and HEV specific antibodies were determined. In addition, epidemiological information on possible risk factors for exposure to HEV was obtained. The overall seropositivity for HEV antibodies was 14.3% and significantly increased with age. Seroprevalence was significantly higher among individuals with previous military employments abroad (21.4% vs. 9.9%) and among professional soldiers aged 30–39 years (20.2% vs. 7.3%). No association was found for private travel, occupational or private animal contact or regular outdoor activities. Individuals who tested positive for antibodies against HEV had significantly higher laboratory values regarding liver enzymes, lipid levels and blood fasting glucose. Conclusions Exposure to HEV is common in Austria. Military employment abroad could be a potential risk factor for HEV infection. Further studies are required to investigate the significance of pathological laboratory results found among asymptomatic individuals previously exposed to HEV. PMID:24498349

Independent effects of sleep duration and body mass index on the risk of a work-related injury: evidence from the US National Health Interview Survey (2004-2010).

PubMed

Lombardi, David A; Wirtz, Anna; Willetts, Joanna L; Folkard, Simon

2012-06-01

Fatigue has been linked to adverse safety outcomes, and poor quality or decreased sleep has been associated with obesity (higher body mass index, BMI). Additionally, higher BMI is related to an increased risk for injury; however, it is unclear whether BMI modifies the effect of short sleep or has an independent effect on work-related injury risk. To answer this question, the authors examined the risk of a work-related injury as a function of total daily sleep time and BMI using the US National Health Interview Survey (NHIS). The NHIS is an in-person household survey using a multistage, stratified, clustered sample design representing the US civilian population. Data were pooled for the 7-yr survey period from 2004 to 2010 for 101 891 "employed" adult subjects (51.7%; 41.1 ± yrs of age [mean ± SEM]) with data on both sleep and BMI. Weighted annualized work-related injury rates were estimated across a priori defined categories of BMI: healthy weight (BMI: <25), overweight (BMI: 25-29.99), and obese (BMI: ≥30) and also categories of usual daily sleep duration: <6, 6-6.99, 7-7.99, 8-8.99, and ≥9 h. To account for the complex sampling design, including stratification, clustering, and unequal weighting, weighted multiple logistic regression was used to estimate the risk of a work-related injury. The initial model examined the interaction among daily sleep duration and BMI, controlling for weekly working hours, age, sex, race/ethnicity, education, type of pay, industry, and occupation. No significant interaction was found between usual daily sleep duration and BMI (p = .72); thus, the interaction term of the final logistic model included these two variables as independent predictors of injury, along with the aforementioned covariates. Statistically significant covariates (p ≤ .05) included age, sex, weekly work hours, occupation, and if the worker was paid hourly. The lowest categories of usual sleep duration (<6 and 6-6.9 h) showed significantly (p ≤ .05) elevated injury risks than the referent category (7-8 h sleep), whereas sleeping >7-8 h did not significantly elevate risk. The adjusted injury risk odds ratio (OR) for a worker with a usual daily sleep of <6 h was 1.86 (95% confidence interval [CI]: 1.37-2.52), and for 6-6.9 h it was 1.46 (95% CI: 1.18-1.80). With regards to BMI, the adjusted injury risk OR comparing workers who were obese (BMI: ≥30) to healthy weight workers (BMI: <25) was 1.34 (95% CI: 1.09-1.66), whereas the risk in comparing overweight workers (BMI: 25-29.99) to healthy weight risk was elevated, but not statistically significant (OR = 1.08; 95% CI: .88-1.33). These results from a large representative sample of US workers suggest increase in work-related injury risk for reduced sleep regardless of worker's body mass. However, being an overweight worker also increases work-injury risk regardless of usual daily sleep duration. The independent additive risk of these factors on work-related injury suggests a substantial, but at least partially preventable, risk.

Bankruptcy prediction for credit risk using neural networks: a survey and new results.

PubMed

Atiya, A F

2001-01-01

The prediction of corporate bankruptcies is an important and widely studied topic since it can have significant impact on bank lending decisions and profitability. This work presents two contributions. First we review the topic of bankruptcy prediction, with emphasis on neural-network (NN) models. Second, we develop an NN bankruptcy prediction model. Inspired by one of the traditional credit risk models developed by Merton (1974), we propose novel indicators for the NN system. We show that the use of these indicators in addition to traditional financial ratio indicators provides a significant improvement in the (out-of-sample) prediction accuracy (from 81.46% to 85.5% for a three-year-ahead forecast).

Some factors involved in alcohol consumption of first-year undergraduates.

PubMed

Leeman, R F; Wapner, S

2001-01-01

Three studies were conducted with samples of first-year undergraduates in order to assess relationships among college drinking, adjustment, recent life-changing events, interpersonal factors, self-control, and perceived risk. Significant correlations were found between alcohol use and life-change, but not between alcohol use and college adjustment. In addition, several significant findings linked alcohol use to social factors. Responses to open-ended interview questions suggest that self-control and risk may play a role in students' decisions regarding consumption, after initial experience with alcohol use. Non-social factors, namely stressful events, appear to play a role in consumption behavior; however, students more frequently report on social factors as motivating their decisions regarding alcohol intake.

[Comorbidities as risk factors of chronic kidney disease in HIV-infected persons].

PubMed

Marchewka, Zofia; Szymczak, Aleksandra; Knysz, Brygida

2015-12-16

Significant survival prolongation in HIV-infected patients due to effective antiretroviral therapy is connected with increasing prevalence of chronic non-infective diseases in this population, among them chronic kidney disease. The pathogenesis of kidney disease in the setting of HIV includes conditions specific for HIV infection: direct effect of the virus, stage of immunodeficiency and drug toxicity. Chronic comorbidities, such as diabetes mellitus, hypertension, and hyperlipidemia, are additional significant risk factors of kidney disease. In HIV-infected individuals some distinct features of these conditions are observed, which are partly related to the virus and antiretroviral therapy. The article summarizes the effect of comorbidities on kidney function in HIV-infected persons.

The psychosocial profile of adolescent risk of homelessness.

PubMed

Bearsley-Smith, Cate A; Bond, Lyndal M; Littlefield, Lyn; Thomas, Lyndal R

2008-06-01

To contrast the psychosocial profile of adolescents with risk factors for homelessness, identified using Chamberlain and MacKenzie's self-report scale, compared to the profiles of homeless adolescents. Multinomial logistic regression analyses were conducted contrasting profiles for (a) 137 homeless adolescents, (b) 766 secondary students reporting risk factors for homelessness, and (c) 4,844 students not reporting risks for homelessness. Fourteen percent of a representative population of at-school adolescents, from Victoria, Australia, showed elevated risk of homelessness. These adolescents showed depressive symptoms at least equivalent to homeless adolescents (RR 6.0, 95% CI: 4.9, 7.3, and RR 3.5, 95% CI: 2.1, 5.8, respectively). In multivariate analyses, homeless and at risk adolescents reported equivalent levels of family conflict, early problem behaviour and low opportunities and rewards for family involvement. Compared to adolescents not at risk, at risk adolescents were more likely to be female and to show poorer social skills/assertiveness and depressive symptoms. Compared to at risk adolescents, homeless adolescents showed additional family, school, peer and individual risks, but lower depressive symptomatology. The findings highlight the potential we have to quickly and simply detect adolescents showing significant risk of homelessness. This sizable minority of adolescents report risks often equivalent to homeless adolescents. It is hoped that stakeholders working with young people will utilise this screening potential to identify and intervene effectively with this significant subpopulation of youth, and their families, while they are still at home and school.

Major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban or warfarin: a "real-world" observational study in the United States.

PubMed

Lip, Gregory Y H; Pan, Xianying; Kamble, Shital; Kawabata, Hugh; Mardekian, Jack; Masseria, Cristina; Bruno, Amanda; Phatak, Hemant

2016-09-01

Limited data are available about the real-world safety of non-vitamin K antagonist oral anticoagulants (NOACs). To compare the major bleeding risk among newly anticoagulated non-valvular atrial fibrillation (NVAF) patients initiating apixaban, warfarin, dabigatran or rivaroxaban in the United States. A retrospective cohort study was conducted to compare the major bleeding risk among newly anticoagulated NVAF patients initiating warfarin, apixaban, dabigatran or rivaroxaban. The study used the Truven MarketScan(®) Commercial & Medicare supplemental US database from 1 January 2013 through 31 December 2013. Major bleeding was defined as bleeding requiring hospitalisation. Cox model estimated hazard ratios (HRs) of major bleeding were adjusted for age, gender, baseline comorbidities and co-medications. Among 29 338 newly anticoagulated NVAF patients, 2402 (8.19%) were on apixaban; 4173 (14.22%) on dabigatran; 10 050 (34.26%) on rivaroxaban; and 12 713 (43.33%) on warfarin. After adjusting for baseline characteristics, initiation on warfarin [adjusted HR (aHR): 1.93, 95% confidence interval (CI): 1.12-3.33, P=.018] or rivaroxaban (aHR: 2.19, 95% CI: 1.26-3.79, P=.005) had significantly greater risk of major bleeding vs apixaban. Dabigatran initiation (aHR: 1.71, 95% CI: 0.94-3.10, P=.079) had a non-significant major bleeding risk vs apixaban. When compared with warfarin, apixaban (aHR: 0.52, 95% CI: 0.30-0.89, P=.018) had significantly lower major bleeding risk. Patients initiating rivaroxaban (aHR: 1.13, 95% CI: 0.91-1.41, P=.262) or dabigatran (aHR: 0.88, 95% CI: 0.64-1.21, P=.446) had a non-significant major bleeding risk vs warfarin. Among newly anticoagulated NVAF patients in the real-world setting, initiation with rivaroxaban or warfarin was associated with a significantly greater risk of major bleeding compared with initiation on apixaban. When compared with warfarin, initiation with apixaban was associated with significantly lower risk of major bleeding. Additional observational studies are required to confirm these findings. © 2016 The Authors International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

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.

Use of benzodiazepine and risk of cancer: A meta-analysis of observational studies.

PubMed

Kim, Hong-Bae; Myung, Seung-Kwon; Park, Yon Chul; Park, Byoungjin

2017-02-01

Several observational epidemiological studies have reported inconsistent results on the association between the use of benzodiazepine and the risk of cancer. We investigated the association by using a meta-analysis. We searched PubMed, EMBASE, and the bibliographies of relevant articles to locate additional publications in January 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria. Of 796 articles meeting our initial criteria, a total of 22 observational epidemiological studies with 18 case-control studies and 4 cohort studies were included in the final analysis. Benzodiazepine use was significantly associated with an increased risk of cancer (odds ratio [OR] or relative risk [RR] 1.19; 95% confidence interval 1.16-1.21) in a random-effects meta-analysis of all studies. Subgroup meta-analyses by various factors such as study design, type of case-control study, study region, and methodological quality of study showed consistent findings. Also, a significant dose-response relationship was observed between the use of benzodiazepine and the risk of cancer (p for trend <0.01). The current meta-analysis of observational epidemiological studies suggests that benzodiazepine use is associated with an increased risk of cancer. © 2016 UICC.

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

PubMed

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

2014-05-01

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

Acute nonlymphocytic leukemia and residential exposure to power frequency magnetic fields

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

Severson, R.K.

1986-01-01

A population-based case-control study of adult acute nonlymphocytic leukemia (ANLL) and residential exposure to power frequency magnetic fields was conducted in King, Pierce and Snohomish Counties in Washington state. Of 164 cases who were diagnosed from January 1, 1981 through December 31, 1984, 114 were interviewed. Controls were selected from the study area on the basis of random digit dialing and frequency matched to the cases by age and sex. Analyses were undertaken to evaluate whether exposure to high levels of power frequency magnetic fields in the residence were associated with an increased risk of ANLL. Neither the directly measuredmore » magnetic fields nor the surrogate values based on the wiring configurations were associated with ANLL. Additional analyses suggested that persons with prior allergies were at decreased risk of acute myelocytic leukemia (AML). Also, persons with prior autoimmune diseases were at increased risk of AML. The increase in AML risk in rheumatoid arthritics was of borderline statistical significance. Finally, cigarette smoking was associated with an increased risk of AML. The risk of AML increased significantly with the number of years of cigarette smoking.« less

Revisiting the association between pornography use and risky sexual behaviors: the role of early exposure to pornography and sexual sensation seeking.

PubMed

Sinković, Matija; Stulhofer, Aleksandar; Božić, Jasmina

2013-01-01

Among the suggested problems and harms associated with widespread pornography use among young people, risky sexual behaviors have been frequently mentioned. To further explore this public health concern, this article analyzed sexual sensation seeking (SSS) as a potential confounder of the association between pornography use and sexual risks using data collected in 2010 from a population-based sample of young Croatian adults aged 18 to 25 (n = 1,005). Significant, but small, correlations were found between the indicators of pornography use (age at first exposure, frequency of use in the past 12 months, and personal importance of pornography) and sexual risk taking. However, in a multivariate analysis, only age at first exposure to pornography remained a significant, albeit weak, predictor of sexual risk taking among both women and men. SSS, defined as the dispositional tendency toward the impulsive pursuit of sexual arousal and stimulation, neither confounded nor moderated this association. Overall, the findings do not support the notion that pornography use is substantially associated with sexual risk taking among young adults, but suggest that early exposure to sexually explicit material and high SSS are additive risk factors for sexual risk taking.

46 CFR 308.204 - Additional war risk protection and indemnity insurance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Additional war risk protection and indemnity insurance. 308.204 Section 308.204 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.204 Additional war risk...

46 CFR 308.204 - Additional war risk protection and indemnity insurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Additional war risk protection and indemnity insurance. 308.204 Section 308.204 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.204 Additional war risk...

46 CFR 308.204 - Additional war risk protection and indemnity insurance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Additional war risk protection and indemnity insurance. 308.204 Section 308.204 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.204 Additional war risk...

46 CFR 308.204 - Additional war risk protection and indemnity insurance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Additional war risk protection and indemnity insurance. 308.204 Section 308.204 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.204 Additional war risk...

46 CFR 308.204 - Additional war risk protection and indemnity insurance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Additional war risk protection and indemnity insurance. 308.204 Section 308.204 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.204 Additional war risk...

Pulmonary infections and risk of lung cancer among persons with AIDS.

PubMed

Shebl, Fatma M; Engels, Eric A; Goedert, James J; Chaturvedi, Anil K

2010-11-01

Lung cancer risk is significantly increased among persons with AIDS (PWA), and increased smoking may not explain all of the elevated risk, suggesting a role for additional cofactors. We investigated whether AIDS-defining pulmonary infections (recurrent pneumonia, Pneumocystis jirovecii pneumonia, and pulmonary tuberculosis) affected the risk of subsequent lung cancer over 10 years after AIDS onset among 322,675 PWA, whose records were linked with cancer registries in 11 US regions. We assessed lung cancer hazard ratios (HRs) using Cox regression and indirectly adjusted HRs for confounding by smoking. Individuals with recurrent pneumonia (n = 5317) were at significantly higher lung cancer risk than those without [HR = 1.63, 95% confidence interval (CI) = 1.08 to 2.46, adjusted for age, race, sex, HIV acquisition mode, CD4 count, and AIDS diagnosis year]. This association was especially strong among young PWA (<50 years HR = 1.99 vs. ≥50 years HR = 1.10) and was significantly elevated during 5-10 years after recurrent pneumonia diagnosis (HR = 2.41; 95% CI = 1.07 to 5.47). Although attenuated, HRs for recurrent pneumonia remained nonsignificantly elevated after indirect adjustment for smoking. Lung cancer risk was unrelated to tuberculosis [(n = 13,878) HR = 1.12, 95% CI = 0.82 to 1.53] or Pneumocystis jirovecii pneumonia [(n = 69,771) HR = 0.97, 95% CI = 0.80 to 1.18]. The increased lung cancer risk associated with recurrent pneumonia supports the hypothesis that chronic pulmonary inflammation arising from infections contributes to lung carcinogenesis.

Predictability and extended-range prognosis in natural hazard risk mitigation process: A case study over west Greece

NASA Astrophysics Data System (ADS)

Matsangouras, Ioannis T.; Nastos, Panagiotis T.

2014-05-01

Natural hazards pose an increasing threat to society and new innovative techniques or methodologies are necessary to be developed, in order to enhance the risk mitigation process in nowadays. It is commonly accepted that disaster risk reduction is a vital key for future successful economic and social development. The systematic improvement accuracy of extended-range prognosis products, relating with monthly and seasonal predictability, introduced them as a new essential link in risk mitigation procedure. Aiming at decreasing the risk, this paper presents the use of seasonal and monthly forecasting process that was tested over west Greece from September to December, 2013. During that season significant severe weather events occurred, causing significant impact to the local society (severe storms/rainfalls, hail, flash floods, etc). Seasonal and monthly forecasting products from European Centre for Medium-Range Weather Forecasts (ECMWF) depicted, with probabilities stratified by terciles, areas of Greece where significant weather may occur. As atmospheric natural hazard early warning systems are able to deliver warnings up to 72 hours in advance, this study illustrates that extended-range prognosis could be introduced as a new technique in risk mitigation. Seasonal and monthly forecast products could highlight extended areas where severe weather events may occur in one month lead time. In addition, a risk mitigation procedure, that extended prognosis products are adopted, is also presented providing useful time to preparedness process at regional administration level.

Identifying risk factors of highly pathogenic avian influenza (H5N1 subtype) in Indonesia

PubMed Central

Leo, Loth; Marius, Gilbert; Jianmei, Wu; Christina, Czarnecki; Muhammad, Hidayat; Xiangming, Xiao

2016-01-01

Highly pathogenic avian influenza (HPAI), subtype H5N1, was first officially reported in Indonesia in 2004. Since then the disease has spread and is now endemic in large parts of the country. This study investigated the statistical relationship between a set of risk factors and the presence or absence of HPAI in Indonesia during 2006 and 2007. HPAI was evaluated through participatory disease surveillance (PDS) in backyard village chickens (the study population), and risk factors included descriptors of people and poultry distribution (separating chickens, ducks and production sectors), poultry movement patterns and agro-ecological conditions. The study showed that the risk factors “elevation”, “human population density” and “rice cropping” were significant in accounting for the spatial variation of the PDS-defined HPAI cases. These findings were consistent with earlier studies in Thailand and Vietnam. In addition “commercial poultry population”, and two indicators of market locations and transport; “human settlements” and “road length”, were identified as significant risk factors in the models. In contrast to several previous studies carried out in Southeast Asia, domestic backyard ducks were not found to be a significant risk factor in Indonesia. The study used surrogate estimates of market locations and marketing chains and further work should focus on the actual location of the live bird markets, and on the flow of live poultry and poultry products between them, so that patterns of possible transmission, and regions of particular risk could be better inferred. PMID:21813198

Perturbed threat monitoring following a traumatic event predicts risk for post-traumatic stress disorder.

PubMed

Naim, R; Wald, I; Lior, A; Pine, D S; Fox, N A; Sheppes, G; Halpern, P; Bar-Haim, Y

2014-07-01

Post-traumatic stress disorder (PTSD) is a chronic and difficult to treat psychiatric disorder. Objective, performance-based diagnostic markers that uniquely index risk for PTSD above and beyond subjective self-report markers could inform attempts to improve prevention and early intervention. We evaluated the predictive value of threat-related attention bias measured immediately after a potentially traumatic event, as a risk marker for PTSD at a 3-month follow-up. We measured the predictive contribution of attentional threat bias above and beyond that of the more established marker of risk for PTSD, self-reported psychological dissociation. Dissociation symptoms and threat-related attention bias were measured in 577 motor vehicle accident (MVA) survivors (mean age = 35.02 years, 356 males) within 24 h of admission to an emergency department (ED) of a large urban hospital. PTSD symptoms were assessed at a 3-month follow-up using the Clinician-Administered PTSD Scale (CAPS). Self-reported dissociation symptoms significantly accounted for 16% of the variance in PTSD at follow-up, and attention bias toward threat significantly accounted for an additional 4% of the variance in PTSD. Threat-related attention bias can be reliably measured in the context of a hospital ED and significantly predicts risk for later PTSD. Possible mechanisms underlying the association between threat bias following a potentially traumatic event and risk for PTSD are discussed. The potential application of an attention bias modification treatment (ABMT) tailored to reduce risk for PTSD is suggested.

Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study.

PubMed

Vakil, P; Ansari, S A; Cantrell, C G; Eddleman, C S; Dehkordi, F H; Vranic, J; Hurley, M C; Batjer, H H; Bendok, B R; Carroll, T J

2015-05-01

Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability (K(trans), VL) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K(trans) would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors. Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters (K(trans), VL) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K(trans) and VL were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics. Interobserver agreement was strong as shown in regression analysis (R(2) > 0.84) and intraclass correlation (intraclass correlation coefficient >0.92), indicating that the K(trans) can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA (P < .001). Regression analysis demonstrated a significant trend toward an increased K(trans) with increasing aneurysm size (P < .001). Logistic regression showed that K(trans) also predicted risk in anatomic (P = .02) and combined anatomic/clinical (P = .03) groups independent of size. We report the first evidence of dynamic contrast-enhanced MR imaging-modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K(trans) was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms. © 2015 by American Journal of Neuroradiology.

OSHA's approach to risk assessment for setting a revised occupational exposure standard for 1,3-butadiene.

PubMed Central

Grossman, E A; Martonik, J

1990-01-01

In its 1980 benzene decision [Industrial Union Department, ALF-CIO v. American Petroleum Institute, 448 U.S. 607 (1980)], the Supreme Court ruled that "before he can promulgate any permanent health or safety standard, the Secretary [of Labor] is required to make a threshold finding that a place of employment is unsafe--in the sense that significant risks are present and can be lessened by a change in practices" (448 U.S. at 642). The Occupational Safety and Health Administration (OSHA) has interpreted this to mean that whenever possible, it must quantify the risk associated with occupational exposure to a toxic substance at the current permissible exposure limit (PEL). If OSHA determines that there is significant risk to workers' health at its current standard, then it must quantify the risk associated with a variety of alternative standards to determine at what level, if any, occupational exposure to a substance no longer poses a significant risk. For rulemaking on occupational exposure to 1,3-butadiene, there are two studies that are suitable for quantitative risk assessment. One is a mouse inhalation bioassay conducted by the National Toxicology Program (NTP), and the other is a rat inhalation bioassay conducted by Hazelton Laboratories Europe. Of the four risk assessments that have been submitted to OSHA, all four have used the mouse and/or rat data with a variety of models to quantify the risk associated with occupational exposure to 1,3-butadiene. In addition, OSHA has performed its own risk assessment using the female mouse and female rat data and the one-hit and multistage models.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2401254

Default Mode Network Connectivity as a Function of Familial and Environmental Risk for Psychotic Disorder

PubMed Central

Peeters, Sanne C. T.; van de Ven, Vincent; Gronenschild, Ed H. B. M; Patel, Ameera X.; Habets, Petra; Goebel, Rainer; van Os, Jim; Marcelis, Machteld

2015-01-01

Background Research suggests that altered interregional connectivity in specific networks, such as the default mode network (DMN), is associated with cognitive and psychotic symptoms in schizophrenia. In addition, frontal and limbic connectivity alterations have been associated with trauma, drug use and urban upbringing, though these environmental exposures have never been examined in relation to DMN functional connectivity in psychotic disorder. Methods Resting-state functional MRI scans were obtained from 73 patients with psychotic disorder, 83 non-psychotic siblings of patients with psychotic disorder and 72 healthy controls. Posterior cingulate cortex (PCC) seed-based correlation analysis was used to estimate functional connectivity within the DMN. DMN functional connectivity was examined in relation to group (familial risk), group × environmental exposure (to cannabis, developmental trauma and urbanicity) and symptomatology. Results There was a significant association between group and PCC connectivity with the inferior parietal lobule (IPL), the precuneus (PCu) and the medial prefrontal cortex (MPFC). Compared to controls, patients and siblings had increased PCC connectivity with the IPL, PCu and MPFC. In the IPL and PCu, the functional connectivity of siblings was intermediate to that of controls and patients. No significant associations were found between DMN connectivity and (subclinical) psychotic/cognitive symptoms. In addition, there were no significant interactions between group and environmental exposures in the model of PCC functional connectivity. Discussion Increased functional connectivity in individuals with (increased risk for) psychotic disorder may reflect trait-related network alterations. The within-network “connectivity at rest” intermediate phenotype was not associated with (subclinical) psychotic or cognitive symptoms. The association between familial risk and DMN connectivity was not conditional on environmental exposure. PMID:25790002

Setting Single or Multiple Goals for Diet and Physical Activity Behaviors Improves Cardiovascular Disease Risk Factors in Adults With Type 2 Diabetes: A Pragmatic Pilot Randomized Trial.

PubMed

Swoboda, Christine M; Miller, Carla K; Wills, Celia E

2016-08-01

The purpose of this study was to evaluate a 4-month telephone-based goal-setting and decision support intervention among adults with type 2 diabetes mellitus (T2DM) and multiple risk factors for cardiovascular disease (CVD). A randomized pretest-posttest control group design was employed. Overweight or obese adults aged 40 to 75 years with T2DM and ≥1 additional CVD risk factor were provided with individualized CVD risk information. At baseline and each biweekly telephone call, the multiple-goal group self-selected both diet- and physical activity-related goals, the single goal group set a single goal, and the control group received information about community health resources. Dietary intake was assessed via a food frequency questionnaire, physical activity via questionnaire, and A1C and blood lipids via fasting fingerstick sample. Between-group differences for clinical (ie, A1C, blood pressure, and blood lipids), physical activity, and dietary variables were evaluated using Kruskal-Wallis, Mann-Whitney U, analysis of variance, and t tests. From pre- to postintervention, the single-goal group demonstrated significant improvement in systolic blood pressure and intake of servings of fruits, vegetables, and refined grains (all P < .05). The multiple-goal group reported significant reduction in percent energy from total, saturated, monounsaturated, and trans fat intake and significant increase in leisure time walking (all P < .05). A multiple-goal approach over 4 months can improve dietary and physical activity outcomes, while a single-goal approach may facilitate improvement in one behavioral domain. Additional research is needed to evaluate maintenance of the achieved changes. © 2016 The Author(s).

Improving risk assessment of color additives in medical device polymers.

PubMed

Chandrasekar, Vaishnavi; Janes, Dustin W; Forrey, Christopher; Saylor, David M; Bajaj, Akhil; Duncan, Timothy V; Zheng, Jiwen; Riaz Ahmed, Kausar B; Casey, Brendan J

2018-01-01

Many polymeric medical device materials contain color additives which could lead to adverse health effects. The potential health risk of color additives may be assessed by comparing the amount of color additive released over time to levels deemed to be safe based on available toxicity data. We propose a conservative model for exposure that requires only the diffusion coefficient of the additive in the polymer matrix, D, to be specified. The model is applied here using a model polymer (poly(ether-block-amide), PEBAX 2533) and color additive (quinizarin blue) system. Sorption experiments performed in an aqueous dispersion of quinizarin blue (QB) into neat PEBAX yielded a diffusivity D = 4.8 × 10 -10 cm 2  s -1 , and solubility S = 0.32 wt %. On the basis of these measurements, we validated the model by comparing predictions to the leaching profile of QB from a PEBAX matrix into physiologically representative media. Toxicity data are not available to estimate a safe level of exposure to QB, as a result, we used a Threshold of Toxicological Concern (TTC) value for QB of 90 µg/adult/day. Because only 30% of the QB is released in the first day of leaching for our film thickness and calculated D, we demonstrate that a device may contain significantly more color additive than the TTC value without giving rise to a toxicological concern. The findings suggest that an initial screening-level risk assessment of color additives and other potentially toxic compounds found in device polymers can be improved. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 310-319, 2018. © 2017 Wiley Periodicals, Inc.

Effects of Moderate Alcohol Consumption on Gene Expression Related to Colonic Inflammation and Antioxidant Enzymes in Rats

PubMed Central

Klarich, DawnKylee S.; Penprase, Jerrold; Cintora, Patricia; Medrano, Octavio; Erwin, Danielle; Brasser, Susan M.; Hong, Mee Young

2017-01-01

Excessive alcohol consumption is a risk factor associated with colorectal cancer; however, some studies have reported that moderate alcohol consumption may not contribute additional risk for developing colorectal cancer while others suggest that moderate alcohol consumption provides a protective effect that reduces colorectal cancer risk. The purpose of this study was to determine the effects of moderate voluntary alcohol (20% ethanol) intake on alternate days for 3 months in outbred Wistar rats on risk factors associated with colorectal cancer development. Colonic gene expression of cyclooxygenase-2, RelA, 8-oxoguanine DNA glycosylase 1, superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, glutathione-S-transferase M1, and aldehyde dehydrogenase 2 were determined. Blood alcohol content, liver function enzyme activities, and 8-oxo-deoxyguanosine DNA adducts were also assessed. Alcohol-treated rats were found to have significantly lower 8-oxo-deoxyguanosine levels in blood, a marker of DNA damage. Alanine aminotransferase and lactate dehydrogenase were both significantly lower in the alcohol group. Moderate alcohol significantly decreased cyclooxygenase-2 gene expression, an inflammatory marker associated with colorectal cancer risk. The alcohol group had significantly increased glutathione-S-transferase M1 expression, an antioxidant enzyme that helps detoxify carcinogens, such as acetaldehyde, and significantly increased aldehyde dehydrogenase 2 expression, which allows for greater acetaldehyde clearance. Increased expression of glutathione-S-transferase M1 and aldehyde dehydrogenase 2 likely contributed to reduce mucosal damage that is caused by acetaldehyde accumulation. These results indicate that moderate alcohol may reduce the risk for colorectal cancer development, which was evidenced by reduced inflammation activity and lower DNA damage after alcohol exposure. PMID:28599714

Distribution of ABO blood groups in the patients with intracranial aneurysm and association of different risk factors with particular blood type.

PubMed

Bir, Shyamal Chandra; Bollam, Papireddy; Nanda, Anil

2015-01-01

The association between ABO blood groups and intracranial aneurysms is not well-known. Many co-morbid factors are associated with intracranial aneurysms. Our objective was to assess the prevalence of different blood group in patients with intracranial aneurysm and to look for associations between risk factors and these groups. This retrospective study includes 1,491 cases who underwent surgical operations for intracranial aneurysms from 1993-2014. We have evaluated the information related to clinical history, ABO blood groups and associated risk factors in the patients both ruptured and unruptured intracranial aneurysms by chart review of the cases. In our study, out of 1,491 cases, the most common ABO blood groups were group O (668 cases, 44.80%) and Group A (603 cases, 40.44%), and Rh(+) in 1,319 (88.4%) and Rh(-) in 147 (11.6%). Blood Group A (43% vs. 36%) and Group B (16.2% vs. 8.6%) were significantly higher in Caucasian and African Americans respectively. However, in general population, there was no significant difference in blood groups between Caucasians and African Americans. Rh(-) factor was significantly higher in Caucasians compared to African Americans. Incidence of smoking was significantly higher in aneurysm patients with O group compared to others. In addition, incidence of hypercholesterolemia was significantly higher in aneurysm patients with A group compared to others. The racial disparity in the distribution of blood groups, and risk factor association with blood groups in the development of intracranial aneurysm needs to be considered. The findings from our study may be useful in identifying patients at increased risk. Further study may be required to establish the risks from multiple centers studies around the world.

Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone: the Jackson Heart Study12

PubMed Central

Chatterjee, Ranee; Davenport, Clemontina A; Svetkey, Laura P; Batch, Bryan C; Lin, Pao-Hwa; Ramachandran, Vasan S; Fox, Ervin R; Harman, Jane; Yeh, Hsin-Chieh; Selvin, Elizabeth; Correa, Adolfo; Butler, Kenneth; Edelman, David

2017-01-01

Background: Low-normal potassium is a risk factor for diabetes and may account for some of the racial disparity in diabetes risk. Aldosterone affects serum potassium and is associated with insulin resistance. Objectives: We sought to confirm the association between potassium and incident diabetes in an African-American cohort, and to determine the effect of aldosterone on this association. Design: We studied participants from the Jackson Heart Study, an African-American adult cohort, who were without diabetes at baseline. With the use of logistic regression, we characterized the associations of serum, dietary, and urinary potassium with incident diabetes. In addition, we evaluated aldosterone as a potential effect modifier of these associations. Results: Of 2157 participants, 398 developed diabetes over 8 y. In a minimally adjusted model, serum potassium was a significant predictor of incident diabetes (OR: 0.83; 95% CI: 0.74, 0.92 per SD increment in serum potassium). In multivariable models, we found a significant interaction between serum potassium and aldosterone (P = 0.046). In stratified multivariable models, in those with normal aldosterone (<9 ng/dL, n = 1163), participants in the highest 2 potassium quartiles had significantly lower odds of incident diabetes than did those in the lowest potassium quartile [OR (95% CI): 0.61 (0.39, 0.97) and 0.54 (0.33, 0.90), respectively]. Among those with high-normal aldosterone (≥9 ng/dL, n = 202), we found no significant association between serum potassium and incident diabetes. In these stratified models, serum aldosterone was not a significant predictor of incident diabetes. We found no statistically significant associations between dietary or urinary potassium and incident diabetes. Conclusions: In this African-American cohort, we found that aldosterone may modify the association between serum potassium and incident diabetes. In participants with normal aldosterone, high-normal serum potassium was associated with a lower risk of diabetes than was low-normal serum potassium. Additional studies are warranted to determine whether serum potassium is a modifiable risk factor that could be a target for diabetes prevention. This trial was registered at clinicaltrials.gov as NCT00415415. PMID:27974310

Childhood Obesity is Associated With Osteochondritis Dissecans of the Knee, Ankle, and Elbow in Children and Adolescents.

PubMed

Kessler, Jeffrey I; Jacobs, John C; Cannamela, Peter C; Shea, Kevin G; Weiss, Jennifer M

Osteochondritis dissecans (OCD) is a joint disorder of the subchondral bone and articular cartilage whose association with obesity in children is not clearly known. The purpose of this study was to assess the magnitude of the association between childhood obesity and the occurrence of OCD of the knee, ankle, and elbow in children. A retrospective chart review of an integrated health system was performed on OCD patients aged 2 to 19 from 2007 to 2011, with over 1 million patients in this cohort. Lesion location, laterality, and all patient demographics were recorded. The body mass index (BMI) for each patient in the cohort was used to stratify patients into 5 weight classes (underweight, normal weight, overweight, moderately obese, and extremely obese) based on BMI-for-age. The associations between the 5 weight classes and OCD of the ankle, knee, and elbow were assessed using multiple logistic regression models to estimate odds ratios (OR) and 95% confidence intervals using multivariate analysis to adjust for patient demographic variables. In total, 269 patients fit the inclusion criteria. Mean BMI, both absolute and percentile, was significantly higher for patients with OCD of the knee, elbow, and ankle than patients without OCD. In the multivariate analysis, extremely obese patients were found to have an increased OR of OCD for all patients, with an 86% increased risk of any OCD compared with normal weight patients. In addition, assessment by different types of OCD revealed that extremely obese patients had an increased OR of OCD of the elbow and ankle individually, with a 3.1 times increased OCD elbow risk and 3.0 times increased risk of ankle OCD in extremely obese patients. Although extremely obese patients did not have a statistically significant increased risk of knee OCD, moderately obese patients did have a 1.8 times increased risk of knee OCD as compared with normal weight children. There were no significantly different risks of any type of OCD seen in overweight or underweight patients as compared with normal weight patients. In this population-based cohort study, extreme obesity is strongly associated with an increased risk of OCD overall and OCD of the elbow and ankle specifically. In addition, moderate obesity is associated with an increased risk of knee OCD. All types of OCD were also found to have a significantly greater average BMI when compared with patients without OCD. Level IV-descriptive epidemiology study.

Time distortion when users at-risk for social media addiction engage in non-social media tasks.

PubMed

Turel, Ofir; Brevers, Damien; Bechara, Antoine

2018-02-01

There is a growing concern over the addictiveness of Social Media use. Additional representative indicators of impaired control are needed in order to distinguish presumed social media addiction from normal use. (1) To examine the existence of time distortion during non-social media use tasks that involve social media cues among those who may be considered at-risk for social media addiction. (2) To examine the usefulness of this distortion for at-risk vs. low/no-risk classification. We used a task that prevented Facebook use and invoked Facebook reflections (survey on self-control strategies) and subsequently measured estimated vs. actual task completion time. We captured the level of addiction using the Bergen Facebook Addiction Scale in the survey, and we used a common cutoff criterion to classify people as at-risk vs. low/no-risk of Facebook addiction. The at-risk group presented significant upward time estimate bias and the low/no-risk group presented significant downward time estimate bias. The bias was positively correlated with Facebook addiction scores. It was efficacious, especially when combined with self-reported estimates of extent of Facebook use, in classifying people to the two categories. Our study points to a novel, easy to obtain, and useful marker of at-risk for social media addiction, which may be considered for inclusion in diagnosis tools and procedures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk-taking related to drug use: an application of the shift-to-risk design.

PubMed

Deren, S; Des Jarlais, D C

1977-01-01

The utility of the shift-to-risk design for studying the influence of peer groups on drug taking was investigated. Two studies using this design with drug content were conducted, varying the level of information provided about a drug. Subjects were from two college classes consisting of 26 and 28 students. Results indicated that the specification of possible harmful drug effects which are somewhat minimal lead to a significantly greater willingness to recommend trying the drug. In addition, a tendency for a shift-to-caution was found. It was concluded that the shift-to-risk designwas useful for studying decision-making regarding drug use, and that both users and nonusers of drugs should be included in future research.

Decision-making, financial risk aversion, and behavioral biases: The role of testosterone and stress.

PubMed

Nofsinger, John R; Patterson, Fernando M; Shank, Corey A

2018-05-01

We examine the relation between testosterone, cortisol, and financial decisions in a sample of naïve investors. We find that testosterone level is positively related to excess risk-taking, whereas cortisol level is negatively related to excess risk-taking (correlation coefficient [r]: 0.75 and -0.21, respectively). Additionally, we find support for the dual-hormone hypothesis in a financial context. Specifically, the testosterone-to-cortisol ratio is significantly related to loss aversion. Individuals with a higher ratio are 3.4 times more likely to sell losing stocks (standard error [SE]: 1.63). Furthermore, we find a positive feedback loop between financial success, testosterone, and cortisol. Specifically, financial success is significantly related to higher post-trial testosterone and cortisol by a factor of 0.53 (SE: 0.14). Finally, we find that in a competitive environment, testosterone level increases significantly, leading to greater risk-taking than in noncompetitive environment. Overall, this study underscores the importance of the endocrine system on financial decision-making. The results of this study are relevant to a broad audience, including investors looking to optimize financial performance, industry human resources, market regulators, and researchers. Copyright © 2018 Elsevier B.V. All rights reserved.

[Role of the independent microbiology laboratory in supporting infection control programs in small to mid-sized hospitals].

PubMed

Yanagisawa, Hideji

2009-05-01

With the revision of the Medical Service Law in 2006 by the Japanese Ministry of Health, Labour and Welfare (MHLW), all healthcare institutions are now required to implement a healthcare risk management program including infection control program. At a national level, an infection control surveillance program (JANIS) was implemented in July 2007. Regular weekly, monthly, and yearly infection control surveillance reports from independent microbiology laboratories can make significant contributions to infection control programs in small to mid-sized hospitals; furthermore, such programs are consistent with the framework of the MHLW's objective of strengthening risk management in healthcare institutions. Against the backdrop of current efforts to improve risk management, independent laboratories can make a significant contribution. Independent laboratories must play a role beyond merely receiving and processing specimens for microbiological examination. In addition to generating results for patients, hospital epidemiological data that contribute to local infection control programs must be a value-added component of the service. A major obstacle for independent laboratories to make a significant contribution to risk management is the current reimbursement system, which makes it economically impossible for independent laboratories to support infection control programs in healthcare institutions.

Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death

PubMed Central

Ghasemzadeh, Nima; Hayek, Salim S.; Ko, Yi-An; Eapen, Danny J.; Patel, Riyaz S.; Manocha, Pankaj; Kassem, Hatem Al; Khayata, Mohamed; Veledar, Emir; Kremastinos, Dimitrios; Thorball, Christian W.; Pielak, Tomasz; Sikora, Sergey; Zafari, A. Maziar; Lerakis, Stamatios; Sperling, Laurence; Vaccarino, Viola; Epstein, Stephen E.; Quyyumi, Arshed A.

2018-01-01

Background Inflammation, coagulation, and cell stress contribute to atherosclerosis and its adverse events. A biomarker risk score (BRS) based on the circulating levels of biomarkers C-reactive protein, fibrin degradation products, and heat shock protein-70 representing these 3 pathways was a strong predictor of future outcomes. We investigated whether soluble urokinase plasminogen activator receptor (suPAR), a marker of immune activation, is predictive of outcomes independent of the aforementioned markers and whether its addition to a 3-BRS improves risk reclassification. Methods and Results C-reactive protein, fibrin degradation product, heat shock protein-70, and suPAR were measured in 3278 patients undergoing coronary angiography. The BRS was calculated by counting the number of biomarkers above a cutoff determined using the Youden’s index. Survival analyses were performed using models adjusted for traditional risk factors. A high suPAR level ≥3.5 ng/mL was associated with all-cause death and myocardial infarction (hazard ratio, 1.83; 95% confidence interval, 1.43–2.35) after adjustment for risk factors, C-reactive protein, fibrin degradation product, and heat shock protein-70. Addition of suPAR to the 3-BRS significantly improved the C statistic, integrated discrimination improvement, and net reclassification index for the primary outcome. A BRS of 1, 2, 3, or 4 was associated with a 1.81-, 2.59-, 6.17-, and 8.80-fold increase, respectively, in the risk of death and myocardial infarction. The 4-BRS was also associated with severity of coronary artery disease and composite end points. Conclusions SuPAR is independently predictive of adverse outcomes, and its addition to a 3-BRS comprising C-reactive protein, fibrin degradation product, and heat shock protein-70 improved risk reclassification. The clinical utility of using a 4-BRS for risk prediction and management of patients with coronary artery disease warrants further study. PMID:28280039

Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death.

PubMed

Ghasemzedah, Nima; Hayek, Salim S; Ko, Yi-An; Eapen, Danny J; Patel, Riyaz S; Manocha, Pankaj; Al Kassem, Hatem; Khayata, Mohamed; Veledar, Emir; Kremastinos, Dimitrios; Thorball, Christian W; Pielak, Tomasz; Sikora, Sergey; Zafari, A Maziar; Lerakis, Stamatios; Sperling, Laurence; Vaccarino, Viola; Epstein, Stephen E; Quyyumi, Arshed A

2017-03-01

Inflammation, coagulation, and cell stress contribute to atherosclerosis and its adverse events. A biomarker risk score (BRS) based on the circulating levels of biomarkers C-reactive protein, fibrin degradation products, and heat shock protein-70 representing these 3 pathways was a strong predictor of future outcomes. We investigated whether soluble urokinase plasminogen activator receptor (suPAR), a marker of immune activation, is predictive of outcomes independent of the aforementioned markers and whether its addition to a 3-BRS improves risk reclassification. C-reactive protein, fibrin degradation product, heat shock protein-70, and suPAR were measured in 3278 patients undergoing coronary angiography. The BRS was calculated by counting the number of biomarkers above a cutoff determined using the Youden's index. Survival analyses were performed using models adjusted for traditional risk factors. A high suPAR level ≥3.5 ng/mL was associated with all-cause death and myocardial infarction (hazard ratio, 1.83; 95% confidence interval, 1.43-2.35) after adjustment for risk factors, C-reactive protein, fibrin degradation product, and heat shock protein-70. Addition of suPAR to the 3-BRS significantly improved the C statistic, integrated discrimination improvement, and net reclassification index for the primary outcome. A BRS of 1, 2, 3, or 4 was associated with a 1.81-, 2.59-, 6.17-, and 8.80-fold increase, respectively, in the risk of death and myocardial infarction. The 4-BRS was also associated with severity of coronary artery disease and composite end points. SuPAR is independently predictive of adverse outcomes, and its addition to a 3-BRS comprising C-reactive protein, fibrin degradation product, and heat shock protein-70 improved risk reclassification. The clinical utility of using a 4-BRS for risk prediction and management of patients with coronary artery disease warrants further study. © 2017 American Heart Association, Inc.

T wave alternans as a predictor of recurrent ventricular tachyarrhythmias in ICD recipients: prospective comparison with conventional risk markers

NASA Technical Reports Server (NTRS)

Hohnloser, S. H.; Klingenheben, T.; Li, Y. G.; Zabel, M.; Peetermans, J.; Cohen, R. J.

1998-01-01

INTRODUCTION: The current standard for arrhythmic risk stratification is electrophysiologic (EP) testing, which, due to its invasive nature, is limited to patients already known to be at high risk. A number of noninvasive tests, such as determination of left ventricular ejection fraction (LVEF) or heart rate variability, have been evaluated as additional risk stratifiers. Microvolt T wave alternans (TWA) is a promising new risk marker. Prospective evaluation of noninvasive risk markers in low- or moderate-risk populations requires studies involving very large numbers of patients, and in such studies, documentation of the occurrence of ventricular tachyarrhythmias is difficult. In the present study, we identified a high-risk population, recipients of an implantable cardioverter defibrillator (ICD), and prospectively compared microvolt TWA with invasive EP testing and other risk markers with respect to their ability to predict recurrence of ventricular tachyarrhythmias as documented by ICD electrograms. METHODS AND RESULTS: Ninety-five patients with a history of ventricular tachyarrhythmias undergoing implantation of an ICD underwent EP testing, assessment of TWA, as well as determination of LVEF, baroreflex sensitivity, signal-averaged ECG, analysis of 24-hour Holter monitoring, and QT dispersion from the 12-lead surface ECG. The endpoint of the study was first appropriate ICD therapy for electrogram-documented ventricular fibrillation or tachycardia during follow-up. Kaplan-Meier survival analysis revealed that TWA (P < 0.006) and LVEF (P < 0.04) were the only significant univariate risk stratifiers. EP testing was not statistically significant (P < 0.2). Multivariate Cox regression analysis revealed that TWA was the only statistically significant independent risk factor. CONCLUSIONS: Measurement of microvolt TWA compared favorably with both invasive EP testing and other currently used noninvasive risk assessment methods in predicting recurrence of ventricular tachyarrhythmias in ICD recipients. This study suggests that TWA might also be a powerful tool for risk stratification in low- or moderate-risk patients, and needs to be prospectively evaluated in such populations.

ACSNSQIP Risk Calculator in Indian Patients Undergoing Surgery for Head and Neck Cancers: Is It Valid?

PubMed

Subramaniam, Narayana; Balasubramanian, Deepak; Rka, Pradeep; Murthy, Samskruthi; Rathod, Priyank; Vidhyadharan, Sivakumar; Thankappan, Krishnakumar; Iyer, Subramania

2018-06-01

Pre-operative assessment is vital to determine patient-specific risks and minimize them in order to optimize surgical outcomes. The American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP) Surgical Risk Calculator is the most comprehensive surgical risk assessment tool available. We performed this study to determine the validity of ACSNSQIP calculator when used to predict surgical complications in a cohort of patients with head and neck cancer treated in an Indian tertiary care center. Retrospective data was collected for 150 patients with head and neck cancer who were operated in the Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, in the year 2016. The predicted outcome data was compared with actual documented outcome data for the variables mentioned. Brier's score was used to estimate the predictive value of the risk assessment generated. Pearson's r coefficient was utilized to validate the prediction of length of hospital stay. Brier's score for the entire calculator was 0.32 (not significant). Additionally, when the score was determined for individual parameters (surgical site infection, pneumonia, etc.), none were significant. Pearson's r value for length of stay was also not significant ( p  = .632). The ACSNSQIP risk assessment tool did not accurately reflect surgical outcomes in our cohort of Indian patients. Although it is the most comprehensive tool available at present, modifications that may improve accuracy are allowing for input of multiple procedure codes, risk stratifying for previous radiation or surgery, and better risk assessment for microvascular flap reconstruction.

Work-based predictors of mortality: a 20-year follow-up of healthy employees.

PubMed

Shirom, Arie; Toker, Sharon; Alkaly, Yasmin; Jacobson, Orit; Balicer, Ran

2011-05-01

This study investigated the effects of the Job-Demand-Control-Support (JDC-S) model's components, workload, control, peer and supervisor social support, on the risk of all-cause mortality. Also examined was the expectation that the above work-based components interact in predicting all-cause mortality. The study's hypotheses were tested after controlling for physiological variables and health behaviors known to be risk factors for mortality. The design used was prospective. Baseline data were obtained from healthy employees (N = 820) who underwent periodic health examinations in 1988. Follow-up data on all-cause mortality were obtained from the participants' computerized medical file, kept by their HMO, in 2008. The baseline data covered socioeconomic, behavioral, and biological risk factors in addition to the components of the JDC-S model. During the period of follow-up, 53 deaths were recorded. Data were analyzed using Cox regressions. Only one main effect was found: the risk of mortality was significantly lower for those reporting high levels of peer social support. The study found two significant interactions. Higher levels of control reduced the risk of mortality for the men and increased it for the women. The main effect of peer social support on mortality risk was significantly higher for those whose baseline age ranged from 38 to 43 but not for the older than 43 or the younger than 38 participants. Peer social support is a protective factor, reducing the risk of mortality, while perceived control reduces the risk of mortality among men but increases it among women. (c) 2011 APA, all rights reserved.

A prediction model for colon cancer surveillance data.

PubMed

Good, Norm M; Suresh, Krithika; Young, Graeme P; Lockett, Trevor J; Macrae, Finlay A; Taylor, Jeremy M G

2015-08-15

Dynamic prediction models make use of patient-specific longitudinal data to update individualized survival probability predictions based on current and past information. Colonoscopy (COL) and fecal occult blood test (FOBT) results were collected from two Australian surveillance studies on individuals characterized as high-risk based on a personal or family history of colorectal cancer. Motivated by a Poisson process, this paper proposes a generalized nonlinear model with a complementary log-log link as a dynamic prediction tool that produces individualized probabilities for the risk of developing advanced adenoma or colorectal cancer (AAC). This model allows predicted risk to depend on a patient's baseline characteristics and time-dependent covariates. Information on the dates and results of COLs and FOBTs were incorporated using time-dependent covariates that contributed to patient risk of AAC for a specified period following the test result. These covariates serve to update a person's risk as additional COL, and FOBT test information becomes available. Model selection was conducted systematically through the comparison of Akaike information criterion. Goodness-of-fit was assessed with the use of calibration plots to compare the predicted probability of event occurrence with the proportion of events observed. Abnormal COL results were found to significantly increase risk of AAC for 1 year following the test. Positive FOBTs were found to significantly increase the risk of AAC for 3 months following the result. The covariates that incorporated the updated test results were of greater significance and had a larger effect on risk than the baseline variables. Copyright © 2015 John Wiley & Sons, Ltd.

Adjuvant chemotherapy for endometrial cancer after hysterectomy

PubMed Central

Johnson, Nick; Bryant, Andrew; Miles, Tracie; Hogberg, Thomas; Cornes, Paul

2014-01-01

Background Endometrial adenocarcinoma (womb cancer) is a malignant growth of the lining (endometrium) of the womb (uterus). It is distinct from sarcomas (tumours of the uterine muscle). Survival depends the risk of microscopic metastases after surgery. Adjuvant (postoperative) chemotherapy improves survival from some other adenocarcinomas, and there is evidence that endometrial cancer is sensitive to cytotoxic therapy. This systematic review examines the effect of chemotherapy on survival after hysterectomy for endometrial cancer. Objectives To assess efficacy of adjuvant (postoperative) chemotherapy for endometrial cancer. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 3), MEDLINE and EMBASE up to August 2010, registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) comparing adjuvant chemotherapy with any other adjuvant treatment or no other treatment. Data collection and analysis We used a random-effects meta-analysis to assess hazard ratios (HR) for overall and progression-free survival and risk ratios (RR) to compare death rates and site of initial relapse. Main results Five RCTs compared no additional treatment with additional chemotherapy after hysterectomy and radiotherapy. Four trials compared platinum based combination chemotherapy directly with radiotherapy. Indiscriminate pooling of survival data from 2197 women shows a significant overall survival advantage from adjuvant chemotherapy (RR (95% CI) = 0.88 (0.79 to 0.99)). Sensitivity analysis focused on trials of modern platinum based chemotherapy regimens and found the relative risk of death to be 0.85 ((0.76 to 0.96); number needed to treat for an additional beneficial outcome (NNT) = 25; absolute risk reduction = 4% (1% to 8%)). The HR for overall survival is 0.74 (0.64 to 0.89), significantly favouring the addition of postoperative platinum based chemotherapy. The HR for progression-free survival is 0.75 (0.64 to 0.89). This means that chemotherapy reduces the risk of being dead at any censorship by a quarter. Chemotherapy reduces the risk of developing the first recurrence outside the pelvis (RR = 0.79 (0.68 to 0.92), 5% absolute risk reduction; NNT = 20). The analysis of pelvic recurrence rates is underpowered but the trend suggests that chemotherapy may be less effective than radiotherapy in a direct comparison (RR = 1.28 (0.97 to 1.68)) but it may have added value when used with radiotherapy (RR = 0.48 (0.20 to 1.18)). Authors’ conclusions Postoperative platinum based chemotherapy is associated with a small benefit in progression-free survival and overall survival irrespective of radiotherapy treatment. It reduces the risk of developing a metastasis, could be an alternative to radiotherapy and has added value when used with radiotherapy. PMID:21975736

[Epidemiological transition and cardiovascular risk factors in Tunisia].

PubMed

Ghannem, H; Fredj, A H

1997-09-01

In Tunisia a growing extension of chronic diseases has resulted from the environmental and behavioral changes such as the adoption of new dietary habits, sedentarity habitat, stress of urbanization and work conditions. To illustrate this trend, we undertook a household epidemiologic survey of a representative sample of the adult urban population of Soussa (n = 957) to assess the main cardiovascular risk factors except the lipid profile distribution. This study showed a high prevalence of hypertension (> 160/95 mm Hg): 18.8% with an adjusted rate of 15.6%. History of diabetes 10.2%, obesity (BMI > 30) 27.7% significantly higher in women (34.4%), android obesity 36%, smoking habits 21.5% significantly higher in men (61.4%). With this risk factor profile, Tunisia has to implement a national strategy of primary prevention and heart health promotion in addition to the efforts recently made in secondary prevention of some chronic diseases such as hypertension and diabetes.

Fatal falls in the US construction industry, 1990 to 1999.

PubMed

Derr, J; Forst, L; Chen, H Y; Conroy, L

2001-10-01

The Occupational Safety and Health Administration's (OSHA's) Integrated Management Information System (IMIS) database allows for the detailed analysis of risk factors surrounding fatal occupational events. This study used IMIS data to (1) perform a risk factor analysis of fatal construction falls, and (2) assess the impact of the February 1995 29 CFR Part 1926 Subpart M OSHA fall protection regulations for construction by calculating trends in fatal fall rates. In addition, IMIS data on fatal construction falls were compared with data from other occupational fatality surveillance systems. For falls in construction, the study identified several demographic factors that may indicate increased risk. A statistically significant downward trend in fatal falls was evident in all construction and within several construction categories during the decade. Although the study failed to show a statistically significant intervention effect from the new OSHA regulations, it may have lacked the power to do so.

Sodium-glucose co-transporter 2 inhibitors in addition to insulin therapy for management of type 2 diabetes mellitus: A meta-analysis of randomized controlled trials.

PubMed

Tang, Huilin; Cui, Wei; Li, Dandan; Wang, Tiansheng; Zhang, Jingjing; Zhai, Suodi; Song, Yiqing

2017-01-01

Given inconsistent trial results of sodium-glucose cotransporter 2 (SGLT2) inhibitors in addition to insulin therapy for treating type 2 diabetes mellitus (T2DM), a meta-analysis was performed to evaluate the efficacy and safety of this combination for T2DM by searching available randomized trials from PubMed, Embase, CENTRAL and ClinicalTrials.gov. Our meta-analysis included seven eligible placebo-controlled trials involving 4235 patients. Compared with placebo, SGLT2 inhibitor treatment was significantly associated with a mean reduction in HbA1c of -0.56%, fasting plasma glucose of -0.95 mmol/L, body weight of -2.63 kg and insulin dose of -8.79 IU, but an increased risk of drug-related adverse events by 36%, urinary tract infections by 29% and genital infections by 357%. No significant increase was observed in risk of overall adverse events [risk ratio (RR), 1.00], serious adverse events (RR, 0.90), adverse events leading to discontinuation (RR, 1.16), hypoglycaemia events (RR, 1.07) and severe hypoglycaemia events (RR, 1.24). No diabetic ketoacidosis events were reported. Further studies are needed to establish optimal combination type and dose. © 2016 John Wiley & Sons Ltd.

Modification of Occupational Exposures on Bladder Cancer Risk by Common Genetic Polymorphisms.

PubMed

Figueroa, Jonine D; Koutros, Stella; Colt, Joanne S; Kogevinas, Manolis; Garcia-Closas, Montserrat; Real, Francisco X; Friesen, Melissa C; Baris, Dalsu; Stewart, Patricia; Schwenn, Molly; Johnson, Alison; Karagas, Margaret R; Armenti, Karla R; Moore, Lee E; Schned, Alan; Lenz, Petra; Prokunina-Olsson, Ludmila; Banday, A Rouf; Paquin, Ashley; Ylaya, Kris; Chung, Joon-Yong; Hewitt, Stephen M; Nickerson, Michael L; Tardón, Adonina; Serra, Consol; Carrato, Alfredo; García-Closas, Reina; Lloreta, Josep; Malats, Núria; Fraumeni, Joseph F; Chanock, Stephen J; Chatterjee, Nilanjan; Rothman, Nathaniel; Silverman, Debra T

2015-11-01

Few studies have demonstrated gene/environment interactions in cancer research. Using data on high-risk occupations for 2258 case patients and 2410 control patients from two bladder cancer studies, we observed that three of 16 known or candidate bladder cancer susceptibility variants displayed statistically significant and consistent evidence of additive interactions; specifically, the GSTM1 deletion polymorphism (P interaction ≤ .001), rs11892031 (UGT1A, P interaction = .01), and rs798766 (TMEM129-TACC3-FGFR3, P interaction = .03). There was limited evidence for multiplicative interactions. When we examined detailed data on a prevalent occupational exposure associated with increased bladder cancer risk, straight metalworking fluids, we also observed statistically significant additive interaction for rs798766 (TMEM129-TACC3-FGFR3, P interaction = .02), with the interaction more apparent in patients with tumors positive for FGFR3 expression. All statistical tests were two-sided. The interaction we observed for rs798766 (TMEM129-TACC3-FGFR3) with specific exposure to straight metalworking fluids illustrates the value of integrating germline genetic variation, environmental exposures, and tumor marker data to provide insight into the mechanisms of bladder carcinogenesis. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

From Inpatient to Ambulatory Care: The Introduction of a Rapid Access Transient Ischaemic Attack Service.

PubMed

Maddula, Mohana; Adams, Laura; Donnelly, Jonathan

2018-06-01

Background : Transient Ischaemic Attacks (TIA) should be treated as a medical emergency. While high-risk TIAs have higher stroke risks than low-risk patients, there is an inherent limitation to this risk stratification, as some low-risk patients may have undiagnosed high-risk conditions. Inequity of care for TIA patients was observed, such that high-risk patients received urgent assessment through acute admission, while low-risk patients faced long waits for clinical consultation. A redesign of the TIA service was planned to offer timely assessment for all patients and avoid acute admission for high-risk patients. Methods : Service reconfiguration was undertaken to set up a daily weekday rapid access TIA clinic where patients would be assessed, investigated, and treated. Results : A re-audit of clinic performance showed a significant increase in the number of patients seen in the ages of 18 to 52. The median time from referral to clinical consultation improved from 10 days to 1. There were similar significant improvements seen in median time to brain imaging (from 10.5 days to 1), and carotid ultrasound (from 10 days to all scans being performed on the same day). Conclusions : The redesigned service achieved the objective of offering urgent assessment and investigations for all TIA patients, including low-risk patients, while avoiding the acute admission for high-risk patients. We share our experience of establishing a successful rapid access ambulatory service without any additional resources.

Toxicological Risks During Human Space Exploration

NASA Technical Reports Server (NTRS)

James, John T.; Limero, T. F.; Lam, C. W.; Billica, Roger (Technical Monitor)

2000-01-01

The goal of toxicological risk assessment of human space flight is to identify and quantify significant risks to astronaut health from air pollution inside the vehicle or habitat, and to develop a strategy for control of those risks. The approach to completing a toxicological risk assessment involves data and experience on the frequency and severity of toxicological incidents that have occurred during space flight. Control of these incidents depends on being able to understand their cause from in-flight and ground-based analysis of air samples, crew reports of air quality, and known failures in containment of toxic chemicals. Toxicological risk assessment in exploration missions must be based on an evaluation of the unique toxic hazards presented by the habitat location. For example, lunar and Martian dust must be toxicologically evaluated to determine the appropriate control measures for exploration missions. Experience with near-earth flights has shown that the toxic products from fires present the highest risk to crew health from air pollution. Systems and payload leaks also present a significant hazard. The health risk from toxicity associated with materials offgassing or accumulation of human metabolites is generally well controlled. Early tests of lunar and Martian dust simulants have shown that each posses the potential to cause fibrosis in the lung in a murine model. Toxicological risks from air pollutants in space habitats originate from many sources. A number of risks have been identified through near-earth operations; however, the evaluation of additional new risks present during exploration missions will be a challenge.

Prevention of Dating Violence on College Campuses: An Innovative Program

ERIC Educational Resources Information Center

Schwartz, Jonathan P.; Griffin, Linda D.; Russell, Melani M.; Frontaura-Duck, Sarannette

2006-01-01

Dating violence is a significant problem on college campuses that requires preventive interventions. In addition, sexist and stereotypical attitudes that support abusive dating behavior have been recognized as potential risk factors. Previous research has found that fraternity and sorority membership is related to stereotypical beliefs concerning…

Annual Research Review: Resilient Functioning in Maltreated Children--Past, Present, and Future Perspectives

ERIC Educational Resources Information Center

Cicchetti, Dante

2013-01-01

Background: Through a process of probabilistic epigenesis, child maltreatment progressively contributes to compromised adaptation on a variety of developmental domains central to successful adjustment. These developmental failures pose significant risk for the emergence of psychopathology across the life course. In addition to the psychological…

39 CFR 3020.32 - Supporting justification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... factors of 39 U.S.C. 3622(c); (c) Explain why, as to competitive products, the addition, deletion, or... change does not classify as competitive a product over which the Postal Service exercises sufficient market power that it can, without risk of losing a significant level of business to other firms offering...

Intergenerational and Partner Influences on Fathers' Negative Discipline

ERIC Educational Resources Information Center

Capaldi, Deborah M.; Pears, Katherine C.; Kerr, David C. R.; Owen, Lee D.

2008-01-01

Recent studies have found significant but relatively modest associations in parenting across generations, suggesting additional influences on parenting beyond experiences in the family of origin. The present prospective, cross-generational study of at-risk men (Oregon Youth Study) focuses on fathers' negative discipline practices with their 2- to…

Zolpidem is independently associated with increased risk of inpatient falls.

PubMed

Kolla, Bhanu Prakash; Lovely, Jenna K; Mansukhani, Meghna P; Morgenthaler, Timothy I

2013-01-01

Inpatient falls are associated with significant morbidity and increased healthcare costs. Zolpidem has been reported to decrease balance and is associated with falls. Yet, it is a commonly used hypnotic agent in the inpatient setting. Zolpidem use in hospitalized patients may be a significant and potentially modifiable risk factor for falling. To determine whether inpatients administered zolpidem are at greater risk of falling. Retrospective cohort study. Adult non-intensive care unit (non-ICU) inpatients at a tertiary care center. Adult inpatients who were prescribed zolpidem were identified. Electronic medical records were reviewed to capture demographics and other risk factors for falls. The fall rate was compared in those administered zolpidem versus those only prescribed zolpidem. Multivariate analyses were performed to determine whether zolpidem was independently associated with falls. The fall rate among patients who were prescribed and received zolpidem (n = 4962) was significantly greater than among patients who were prescribed but did not receive zolpidem (n = 11,358) (3.04% vs 0.71%; P < 0.001). Zolpidem use continued to remain significantly associated with increased fall risk after accounting for age, gender, insomnia, delirium status, dose of zolpidem, Charlson comorbidity index, Hendrich's fall risk score, length of hospital stay, presence of visual impairment, gait abnormalities, and dementia/cognitive impairment (adjusted odds ratio [OR] 4.37, 95% confidence interval [CI] = 3.34-5.76; P < 0.001). Additionally, patients taking zolpidem who experienced a fall did not differ from other hospitalized adult patients who fell in terms of age, opioids, antidepressants, sedative-antidepressants, antipsychotics, benzodiazepine, or antihistamine use. Zolpidem use was a strong, independent, and potentially modifiable risk factor for inpatient falls. Copyright © 2012 Society of Hospital Medicine.

Protective factors for youth considered at risk of criminal behaviour: does participation in extracurricular activities help?

PubMed

Burton, Jodi M; Marshall, Lisa A

2005-01-01

There is a lack of research investigating the potential protective effect of participation in extracurricular activities on youth who are at risk of engaging in delinquent activity. This study examined the potential for participation in extracurricular activities to act as a protective factor for youth deemed at risk of engaging in delinquent activity. One hundred and sixty-nine secondary students from Glasgow, Scotland completed two questionnaires (the Youth Self-Report and an additional information sheet) requesting information about their participation in extracurricular and delinquent activities as well as their possible risk factors. Activities included sports, non-sports (hobbies and games), current activities (youth clubs and other organisations) and previous involvement in activities. Risk factors included residing in a broken home, having four or more siblings, academic failure and lacking a non-parental very important person. Delinquent activities included rule-breaking and aggressive behaviours. Independent samples t-tests found that females participated in significantly more non-sports and previous activities than males and that males participated in significantly more rule-breaking behaviour than females. Hierarchical multiple regression analyses found that gender and participation in sports were strong predictors of rule-breaking behaviour. A significant positive correlation was found between participation in sports and involvement in aggressive behaviour. The results suggest that participation in extracurricular activities does not act as a protective factor for youth, regardless of whether or not they are considered to be at risk of engaging in delinquent activity. The significant correlation found between participation in sports and involvement in aggressive behaviour suggests that youth participation in sports may act as a risk factor.

Exploring the safety implications of young drivers' behavior, attitudes and perceptions.

PubMed

Hassan, Hany M; Abdel-Aty, Mohamed A

2013-01-01

The present study aims at identifying and quantifying significant factors (i.e., demographic, aberrant driving behavior) associated with young drivers' involvement in at-fault crashes or traffic citations at the ages of 16-17 (while having the Operational License) and 18-24 years old (while having the Full License). A second objective was to investigate the main reason(s) for involvement in risky driving behavior by young drivers. The data used for the analyses were obtained from a self-reported questionnaire survey carried out among 680 young drivers in Central Florida. To achieve these goals, the structural equation modeling approach was adopted. The results revealed that aggressive violations, in-vehicle distractions and demographic characteristics were the significant factors affecting young drivers' involvement in at-fault crashes or traffic violations at the age of 16-17. However, in-vehicle distractions, attitudes toward speeding and demographic characteristics were the significant factors affecting young drivers' crash risk at 18-24. Additionally, the majority of participants reported that "running late" is the main reason for taking risk while driving (i.e., speeding, accept short gaps, or drive so close to the car in front) followed by "racing other cars". Additionally, "exceed speed limits" was the main reason for receiving traffic citations at 16-17 and 18-24 age groups. Practical suggestions on how to reduce crash risk and promote safe driving among young drivers are also discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

TV Time but Not Computer Time Is Associated with Cardiometabolic Risk in Dutch Young Adults

PubMed Central

Altenburg, Teatske M.; de Kroon, Marlou L. A.; Renders, Carry M.; HiraSing, Remy; Chinapaw, Mai J. M.

2013-01-01

Background TV time and total sedentary time have been positively related to biomarkers of cardiometabolic risk in adults. We aim to examine the association of TV time and computer time separately with cardiometabolic biomarkers in young adults. Additionally, the mediating role of waist circumference (WC) is studied. Methods and Findings Data of 634 Dutch young adults (18–28 years; 39% male) were used. Cardiometabolic biomarkers included indicators of overweight, blood pressure, blood levels of fasting plasma insulin, cholesterol, glucose, triglycerides and a clustered cardiometabolic risk score. Linear regression analyses were used to assess the cross-sectional association of self-reported TV and computer time with cardiometabolic biomarkers, adjusting for demographic and lifestyle factors. Mediation by WC was checked using the product-of-coefficient method. TV time was significantly associated with triglycerides (B = 0.004; CI = [0.001;0.05]) and insulin (B = 0.10; CI = [0.01;0.20]). Computer time was not significantly associated with any of the cardiometabolic biomarkers. We found no evidence for WC to mediate the association of TV time or computer time with cardiometabolic biomarkers. Conclusions We found a significantly positive association of TV time with cardiometabolic biomarkers. In addition, we found no evidence for WC as a mediator of this association. Our findings suggest a need to distinguish between TV time and computer time within future guidelines for screen time. PMID:23460900

Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS.

PubMed

Depa, Julia; Schweizer, Jenny; Bekers, Sandra-Kristin; Hilzendegen, Carolin; Stroebele-Benschop, Nanette

2017-03-01

Orthorexia nervosa (ON) describes the constant pathological preoccupation with "healthy" nutrition. The current results regarding the prevalence of ON differ widely possibly because of invalid measurement tools. This study aimed to investigate ON prevalence in a sample of German students and to examine age, gender, semester, and nutritional knowledge as potential predictors of ON by comparing nutrition science (NS) with economics (ES) students. A total of 446 university students participated in the survey (NS 188, ES 268). ON was determined using the 21-item-DOS, which is a well-constructed, validated, and reliability-tested questionnaire. Age, gender, and semester were also assessed. Of the total sample, 3.3 % were classified as having ON and 9.0 % were at risk of developing ON. Older students scored significantly higher on the subscale "avoidance of additives" compared with younger students and students of lower semester suffered significantly more often from ON than students of higher semester. In addition, comparing field of study showed no significant difference in the prevalence of ON or the risk of developing ON between female NS and ES students. However, mean values for the three DOS subscales were higher among female NS students, albeit far below values indicating pathological behavior. The prevalence of ON appears to be low in this sample of German university students. Female NS students do not seem to have higher prevalence of ON or risk of developing ON.

Risk factors for antenatal depression, postnatal depression and parenting stress

PubMed Central

Leigh, Bronwyn; Milgrom, Jeannette

2008-01-01

Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them. Methods Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program [1]. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26–32 weeks gestation. A subsample of these women (N = 161) also completed questionnaires at 10–12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI). Results Regression analyses identified significant risk factors for the three outcome measures. (1). Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2). Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3). Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator for other risk factors. Conclusion Risk factor profiles for antenatal depression, postnatal depression and parenting stress differ but are interrelated. Antenatal depression was the strongest predictor of postnatal depression, and in turn postnatal depression was the strongest predictor for parenting stress. These results provide clinical direction suggesting that early identification and treatment of perinatal depression is important. PMID:18412979

Cardiovascular risks in firefighters: implications for occupational health nurse practice.

PubMed

Byczek, Lance; Walton, Surrey M; Conrad, Karen M; Reichelt, Paul A; Samo, Daniel G

2004-02-01

Limited cardiovascular risk data are available for firefighters. This cross sectional study of data collected during annual physical examinations described the prevalence of cardiovascular risk factors among firefighters (N = 200) and examined relationships between body mass index (BMI) and other cardiovascular risk factors. Evidence based guidelines were used to determine prevalence of cardiovascular risk factors and Framingham risk scoring was used to estimate probability of coronary heart disease (CHD). Firefighters ranged in age from 22 to 64 with a mean of 41. The prevalence of obesity, elevated total cholesterol, and elevated blood pressure in firefighters exceeded Healthy People 2010 targets. In addition, their prevalence of obesity, low high density lipoprotein (HDL), high low density lipoprotein (LDL), and high total cholesterol levels was higher relative to the general population. Elevated body mass index (BMI) values had positive significant (p < or = .01) associations with elevated blood pressures, triglycerides, and glucose levels, and a negative significant (p < .05) association with lower HDL cholesterol levels. Fire department worksite health and fitness policies and programs should proactively target firefighters' cardiovascular risks. Future firefighter related intervention research will benefit from considering not only the individual determinants of cardiovascular disease, but also the ecological framework that includes the influences of workplace and external environmental factors.

OPPT workplan risk assessment 1,3,4,6,7,8-Hexahydro-4,6,6 ...

EPA Pesticide Factsheets

HHCB (Galaxolide) is a synthetic polycyclic musk used as an ingredient in a wide range of consumer products including perfumes, cosmetics, shampoos, lotions, detergents, fabric softeners, and cleaning agents. It is one of the largest-volume chemicals of the polycyclic musks and is imported into the U.S. by 4 known importers. HHCB is considered one of the more important compounds to the fragrance industry because, as a musk, it imparts unique odor properties, has the ability to improve the fixation of fragrance compounds, and binds fragrances to fabrics. The assessment will focus on environmental risk due to release of HHCB to the aquatic and terrestrial environment from all combined uses. Human health risks have been evaluated previously and will be summarized in this assessment. EPA anticipates issuing draft risk assessments for public review and comment as they are completed. At the conclusion of the review process, if an assessment of specific uses indicates significant risk, EPA will evaluate and pursue appropriate risk reduction actions, as warranted. If an assessment indicates no significant risk, EPA will conclude its current work on assessment of those specified targeted uses of that chemical. Over time, additional chemicals will be added to the work plan as more data are developed and more chemicals screened.

Effects of acute hyperinsulinaemia on total and high-molecular-weight adiponectin concentration in metabolically healthy but obese postmenopausal women: a Montreal-Ottawa New Emerging Team (MONET) study.

PubMed

Elisha, B; Karelis, A D; Imbeault, P; Rabasa-Lhoret, R

2010-09-01

The aim of this study was to determine the differences and changes in total and high-molecular-weight (HMW) adiponectin levels among metabolically healthy but obese (MHO) postmenopausal women in response to acute hyperinsulinaemia. In this cross-sectional study, 55 non-diabetic overweight and obese postmenopausal women underwent a hyperinsulinaemic-euglycaemic clamp test to evaluate insulin sensitivity. Subjects within the upper tertile of insulin sensitivity were described as 'MHO' (n=18), whereas those within the lowest tertile were considered 'at risk' (n=18). Plasma total and HMW adiponectin levels were measured by ELISA at 0 (baseline), 90, 160 and 180 min during the clamp. At baseline and at all time points during the clamp, MHO individuals had significantly higher total and HMW adiponectin levels than at-risk subjects (AUC: total adiponectin=2506 ± 1010 vs 1616 ± 830; HMW adiponectin=909 ± 307 vs 604 ± 349; P<0.05). In addition, a significant reduction in total adiponectin was observed at 160 min and 180 min in at-risk and MHO subjects, respectively, while HMW adiponectin significantly decreased at 160 min in at-risk subjects, and at 90 min as well as 160 min in MHO women. MHO postmenopausal women had higher levels of plasma total and HMW adiponectin than at-risk subjects at baseline and during the clamp. Furthermore, significant decreases in total and HMW adiponectin were observed at certain time points in both the MHO and at-risk subjects. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Assessing university students' sexual risk behaviors as predictors of human papillomavirus (HPV) vaccine uptake behavior.

PubMed

Rohde, Rebecca L; Adjei Boakye, Eric; Christopher, Kara M; Geneus, Christian J; Walker, Ronald J; Varvares, Mark A; Osazuwa-Peters, Nosayaba

2018-06-14

There exists a significant gap in vaccine coverage of the human papillomavirus (HPV) among college-aged students. This study assessed sexual risk-taking behavior among university students and analyzed predictors of HPV vaccine initiation and completion in this population. Data (n = 746) were from an anonymous online, cross-sectional survey distributed to university students, between the ages of 19-26 years, at a private Midwestern university. Both chi-square and multivariable logistics regression models estimated the association between sociodemographic characteristics and sexual risk factors (including number of vaginal sexual partners, number of oral sexual partners, initiation of oral sex, and initiation of vaginal sex), with HPV vaccine initiation and completion. A significant number of participants (40%) had not received a single dose of the HPV vaccine series. Of those who initiated the series, more than half (51%) did not achieve completion. Additionally, a greater number of participants have had multiple (4 or more) oral sexual partners than vaginal sexual partners (25.7% vs. 20.3%). After adjusting for covariates, it was found that sexual risk factors were not significantly associated with HPV vaccine initiation or completion. HPV vaccine initiation and completion rates are suboptimal among university students. High levels of sexual-risk taking behaviors associated with HPV infection persist, yet are not significant predictors of HPV vaccine behaviors in this age group. To increase uptake among 18-26-year-old students, future public health interventions should focus on HPV vaccine education and uptake across the entire population, irrespective of sexual risk profile. Copyright © 2018 Elsevier Ltd. All rights reserved.

Explaining poorer stroke outcomes in women: women surviving 3 months have more severe strokes than men despite a lower 3-month case fatality.

PubMed

Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae

2012-06-01

Women who survive stroke are more disabled and more often institutionalized than men. We explore this phenomenon by studying case fatality and stroke severity in stroke survivors separately for men and women. A Danish stroke registry (2000-2007) contains information about 26,818 patients with first-ever ischemic stroke, including stroke severity (Scandinavian Stroke Scale, 0 worst to 58 best), computed tomography scan, cardiovascular risk factors, and death 3 months after stroke. We modeled stroke severity by generalized additive linear model and 3-month case fatality with logistic model adjusting for age and cardiovascular risk factors. Male to female ratio was 51.5% to 48.5%. Mean age was 68.8 (SD 12.6) years in men; 73.7 (13.8) years in women. Stroke was more severe in women (mean [SD] Scandinavian Stroke Scale, 42.2 [16.0]) than in men (mean [SD] Scandinavian Stroke Scale, 45.6 [14.2]) also after adjustment for age and cardiovascular risk factors; significant in patients older than 75 years. In survivors at 3 months, stroke was more severe in women than men, given same age and cardiovascular risk factor profile; significant in patients older than 75 years. More women (11.9%) had died within 3 months than men (8.6%). However, adjusting for age, stroke severity, and risk factor profile, 3-month case fatality was lower in women than men; significant in patients older than 78 years. Although 3-month case fatality was lower in women than men, strokes were more severe among survivors at 3 months in women than in men. In addition, strokes were more severe in women. Our data help elucidate why women survive stroke better but have poorer functional outcomes that require more care than men. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Screening strategies for tubal factor subfertility.

PubMed

den Hartog, J E; Lardenoije, C M J G; Severens, J L; Land, J A; Evers, J L H; Kessels, A G H

2008-08-01

Different screening strategies exist to estimate the risk of tubal factor subfertility, preceding laparoscopy. Three screening strategies, comprising Chlamydia trachomatis IgG antibody testing (CAT), high-sensitivity C-reactive protein (hs-CRP) testing and hysterosalpingography (HSG), were explored using laparoscopy as reference standard and the occurrence of a spontaneous pregnancy as a surrogate marker for the absence of tubal pathology. In this observational study, 642 subfertile women, who underwent tubal testing, participated. Data on serological testing, HSG, laparoscopy and interval conception were collected. Multiple imputations were used to compensate for missing data. Strategy A (HSG) has limited value in estimating the risk of tubal pathology. Strategy B (CAT-->HSG) shows that CAT significantly discerns patients with a high versus low risk of tubal pathology, whereas HSG following CAT has no additional value. Strategy C (CAT-->hs-CRP-->HSG) demonstrates that hs-CRP may be valuable in CAT-positive patients only and HSG has no additional value. CAT is proposed as first screening test for tubal factor subfertility. In CAT-negative women, HSG may be performed because of its high specificity and fertility-enhancing effect. In CAT-positive women, hs-CRP seems promising, whereas HSG has no additional value. The position and timing of laparoscopy deserves critical reappraisal.

Validity of Self-reported Sexual Behavior Among Adolescents: Where Do We Go from Here?

PubMed

DiClemente, Ralph J

2016-01-01

Adolescents have high rates of sexually transmitted infections (STIs). Adolescents consuming alcohol and using drugs have markedly greater HIV/STI risk and are a priority population for intervention. Accurate measurement of sexual risk behavior is critical for understanding individual's risk for HIV/STI, transmission dynamics of HIV/STI, and evaluating the efficacy of interventions designed reduce HIV/STI risk. However, significant challenges to accurately measuring adolescents' self-reported sexual behavior are well-documented. Recent advances in microbiology, such as the use of less invasive specimen collection for DNA assays, can assist researchers in more accurately measuring adolescents' sexual risk behavior. However, the majority of studies of adolescents' sexual risk rely solely on self-reported behavior; therefore, methods to improve the validity of adolescents' self-reported sexual behavior are needed. In addition, integrating biologic measures to complement self-reported measures are recommended, when appropriate and feasible.

Psychosocial distress affecting patients with ductal carcinoma in situ compared to patients with early invasive breast cancer.

PubMed

Sanders, Judith Brown; Loftin, Adam; Seda, Julia S; Ehlenbeck, Chris

2014-12-01

Psychological distress in patients with a diagnosis of ductal carcinoma in situ (DCIS) or early invasive breast cancer (EIBC) can emanate from perceived risk of recurrence and is accompanied by perceived risk of death from the diseases. These factors can impart a lower quality of life that can result in poorer health outcomes. In addition, inaccurate risk perceptions can have an effect on decision making, psychosocial outcomes, and subsequent health behaviors. The purpose of this study is to assess patients with DCIS and EIBC and their perceived risk of recurrence and perceived risk of dying, and evaluate their outlook for the future, the degree of social support from spouses and significant others of patients who have been diagnosed with DCIS and EIBC, and the relationship to the patient's perceived risk perception of recurrence and dying from the diseases.

Home and away: Area socioeconomic disadvantage and obesity risk.

PubMed

Kimbro, Rachel Tolbert; Sharp, Gregory; Denney, Justin T

2017-03-01

Although residential context is linked to obesity risk, less is known about how the additional places where we work, shop, play, and worship may influence that risk. We employ longitudinal data from the Los Angeles Family and Neighborhood Survey (LAFANS) to derive time-weighted measures of exposure to home and activity space contexts to ascertain the impacts of each on obesity risk for adults. Results show that increased exposure to socioeconomic disadvantage in the residential neighborhood significantly increases obesity risk, and although activity space disadvantage does not directly influence obesity, it reduces the association between residential disadvantage and obesity. We further explore the ways in which residential and activity space disadvantages may interact to influence obesity and discuss the value of integrating personal exposure and activity space contexts to better understand how places contribute to individual health risks. Copyright © 2017 Elsevier Ltd. All rights reserved.

Fertility drugs, reproductive strategies and ovarian cancer risk.

PubMed

Tomao, Federica; Lo Russo, Giuseppe; Spinelli, Gian Paolo; Stati, Valeria; Prete, Alessandra Anna; Prinzi, Natalie; Sinjari, Marsela; Vici, Patrizia; Papa, Anselmo; Chiotti, Maria Stefania; Benedetti Panici, Pierluigi; Tomao, Silverio

2014-01-01

Several adverse effects have been related to infertility treatments, such as cancer development. In particular, the relationship between infertility, reproductive strategies, and risk of gynecological cancers has aroused much interest in recent years. The evaluation of cancer risk among women treated for infertility is very complex, mainly because of many factors that can contribute to occurrence of cancer in these patients (including parity status). This article addresses the possible association between the use of fertility treatments and the risk of ovarian cancer, through a scrupulous search of the literature published thus far in this field. Our principal objective was to give more conclusive answers on the question whether the use of fertility drug significantly increases ovarian cancer risk. Our analysis focused on the different types of drugs and different treatment schedules used. This study provides additional insights regarding the long-term relationships between fertility drugs and risk of ovarian cancer.

Applications of Principled Search Methods in Climate Influences and Mechanisms

NASA Technical Reports Server (NTRS)

Glymour, Clark

2005-01-01

Forest and grass fires cause economic losses in the billions of dollars in the U.S. alone. In addition, boreal forests constitute a large carbon store; it has been estimated that, were no burning to occur, an additional 7 gigatons of carbon would be sequestered in boreal soils each century. Effective wildfire suppression requires anticipation of locales and times for which wildfire is most probable, preferably with a two to four week forecast, so that limited resources can be efficiently deployed. The United States Forest Service (USFS), and other experts and agencies have developed several measures of fire risk combining physical principles and expert judgment, and have used them in automated procedures for forecasting fire risk. Forecasting accuracies for some fire risk indices in combination with climate and other variables have been estimated for specific locations, with the value of fire risk index variables assessed by their statistical significance in regressions. In other cases, the MAPSS forecasts [23, 241 for example, forecasting accuracy has been estimated only by simulated data. We describe alternative forecasting methods that predict fire probability by locale and time using statistical or machine learning procedures trained on historical data, and we give comparative assessments of their forecasting accuracy for one fire season year, April- October, 2003, for all U.S. Forest Service lands. Aside from providing an accuracy baseline for other forecasting methods, the results illustrate the interdependence between the statistical significance of prediction variables and the forecasting method used.

Genetic testing for the BRCA1 gene and the need for protection from discrimination: an evolving legislative and social issue.

PubMed

Dressler, L

1998-04-01

Genetic testing for the BRCA1 gene is available commercially and clinically. The information gained from this test impacts not only on the individual tested, but on family members as well. The test can offer an individual and their family the opportunity to gain valuable information about their risks of developing certain forms of inherited breast cancer and other inherited cancers. In addition to its emotional and psychological impact, this information is associated with significant social and economic issues. This includes the potential for denial, loss, or increased rates for health insurance as well as denial and loss of employment based on genetic test information. The risk for such discrimination can lead to fear of seeking testing and can discourage participation in and potential benefit from prevention, screening, and treatment programs. Therefore, misuse of this information carries significant risk for the individual being tested and for their family members. It is imperative that the potential benefits of genetic testing and genetic information be afforded to all without this risk and fear. In addition to protecting all individuals from genetic discrimination, there is a need to protect the confidentiality of genetic information and an individual's right to privacy. This article discusses protection currently available through legislation at the federal and state level, focusing on the experience in North Carolina in developing and passing a genetic antidiscrimination bill. Although progress has been made, troublesome issues still remain.

Website Use and Effects of Online Information About Tobacco Additives Among the Dutch General Population: A Randomized Controlled Trial

PubMed Central

Crutzen, Rik; Kienhuis, Anne S; Talhout, Reinskje; de Vries, Hein

2017-01-01

Background As a legal obligation, the Dutch government publishes online information about tobacco additives to make sure that it is publicly available. Little is known about the influence this website (”tabakinfo”) has on visitors and how the website is evaluated by them. Objective This study assesses how visitors use the website and its effect on their knowledge, risk perception, attitude, and smoking behavior. The study will also assess how the website is evaluated by visitors using a sample of the Dutch general population, including smokers and nonsmokers. Methods A randomized controlled trial was conducted, recruiting participants from an online panel. At baseline, participants (N=672) were asked to fill out an online questionnaire about tobacco additives. Next, participants were randomly allocated to either one of two experimental groups and invited to visit the website providing information about tobacco additives (either with or without a database containing product-specific information) or to a control group that had no access to the website. After 3 months, follow-up measurements took place. Results At follow-up (n=492), no statistically significant differences were found for knowledge, risk perception, attitude, or smoking behavior between the intervention and control groups. Website visits were positively related to younger participants (B=–0.07, 95% CI –0.12 to –0.01; t11=–2.43, P=.02) and having a low risk perception toward tobacco additives (B=–0.32, 95% CI –0.63 to –0.02; t11=–2.07, P=.04). In comparison, having a lower education (B=–0.67, 95% CI –1.14 to –0.17; t11=–2.65, P=.01) was a significant predictor for making less use of the website. Furthermore, the website was evaluated less positively by smokers compared to nonsmokers (t324=–3.55, P<.001), and males compared to females (t324=–2.21, P=.02). Conclusions The website did not change perceptions of tobacco additives or smoking behavior. Further research is necessary to find out how online information can be used to effectively communication about the risks of tobacco additives. Trial Registration Nederlands Trial Register NTR4620; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4620 (Archived by WebCite at http://www.webcitation.org/6oW7w4Gnj) PMID:28292739

Website Use and Effects of Online Information About Tobacco Additives Among the Dutch General Population: A Randomized Controlled Trial.

PubMed

Reinwand, Dominique A; Crutzen, Rik; Kienhuis, Anne S; Talhout, Reinskje; de Vries, Hein

2017-03-14

As a legal obligation, the Dutch government publishes online information about tobacco additives to make sure that it is publicly available. Little is known about the influence this website ("tabakinfo") has on visitors and how the website is evaluated by them. This study assesses how visitors use the website and its effect on their knowledge, risk perception, attitude, and smoking behavior. The study will also assess how the website is evaluated by visitors using a sample of the Dutch general population, including smokers and nonsmokers. A randomized controlled trial was conducted, recruiting participants from an online panel. At baseline, participants (N=672) were asked to fill out an online questionnaire about tobacco additives. Next, participants were randomly allocated to either one of two experimental groups and invited to visit the website providing information about tobacco additives (either with or without a database containing product-specific information) or to a control group that had no access to the website. After 3 months, follow-up measurements took place. At follow-up (n=492), no statistically significant differences were found for knowledge, risk perception, attitude, or smoking behavior between the intervention and control groups. Website visits were positively related to younger participants (B=-0.07, 95% CI -0.12 to -0.01; t 11 =-2.43, P=.02) and having a low risk perception toward tobacco additives (B=-0.32, 95% CI -0.63 to -0.02; t 11 =-2.07, P=.04). In comparison, having a lower education (B=-0.67, 95% CI -1.14 to -0.17; t 11 =-2.65, P=.01) was a significant predictor for making less use of the website. Furthermore, the website was evaluated less positively by smokers compared to nonsmokers (t 324 =-3.55, P<.001), and males compared to females (t 324 =-2.21, P=.02). The website did not change perceptions of tobacco additives or smoking behavior. Further research is necessary to find out how online information can be used to effectively communication about the risks of tobacco additives. Nederlands Trial Register NTR4620; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4620 (Archived by WebCite at http://www.webcitation.org/6oW7w4Gnj). ©Dominique A Reinwand, Rik Crutzen, Anne S Kienhuis, Reinskje Talhout, Hein de Vries. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.03.2017.

The (FTO) gene polymorphism is associated with metabolic syndrome risk in Egyptian females: a case- control study.

PubMed

Khella, Mina S; Hamdy, Nadia M; Amin, Ashraf I; El-Mesallamy, Hala O

2017-09-16

Variations within fat mass and obesity associated (FTO) gene had crosstalk with obesity risk in European and some Asian populations. This study was designed to investigate FTO rs9939609 association with metabolic syndrome (MetS) as well as biochemical parameters as plasma glucose, serum triacylglycerol (TAG), total cholesterol (TC) and transaminases enzymes in Arab female population from Egypt. In order to achieve that, FTO gene rs9939609 (A < T) was genotyped using TaqMan SNP Genotyping Assay in a total of 197 females which were enrolled in this study. Fasting levels of serum insulin, lipid profile and plasma glucose, in addition to liver transaminases were measured. The association between the genotype distribution and MetS risk was evaluated using Chi-square and logistic regression tests in a case-control design under different genetic models. The association of genotype distribution with MetS was significant (χ2 = 8.6/P = 0.014) with an increased odds ratio under dominant model (OR = 1.97, P = 0.029 and 95%C.I = 1.07-3.6) and recessive model (OR = 2.95, P = 0.017 and 95%C.I = 1.22-7.22). Moreover, (AA) subjects showed significant lower HDL-C levels (P = 0.009) when compared to (TT) ones. In addition, interestingly subjects with (AA) genotype have significantly higher ALT levels (P = 0.02) that remained significant after correction of major confounders as body mass index and serum triacylglycerols but not after conservative Bonferroni adjustment. The present study shows for first time that FTO gene rs9939609 is genetic risk factor for metabolic syndrome in Egyptian population which may help in understanding the biology of this complex syndrome and highlighted that this association may be through HDL-C component. The association of this genetic polymorphism with ALT levels needs to be studied in other populations with larger sample size.

Clinical and Metabolic Response to Selenium Supplementation in Pregnant Women at Risk for Intrauterine Growth Restriction: Randomized, Double-Blind, Placebo-Controlled Trial.

PubMed

Mesdaghinia, Elaheh; Rahavi, Azam; Bahmani, Fereshteh; Sharifi, Nasrin; Asemi, Zatollah

2017-07-01

Data on the effects of selenium supplementation on clinical signs and metabolic profiles in women at risk for intrauterine growth restriction (IUGR) are scarce. This study was designed to assess the effects of selenium supplementation on clinical signs and metabolic status in pregnant women at risk for IUGR. This randomized double-blind placebo-controlled clinical trial was performed among 60 women at risk for IUGR according to abnormal uterine artery Doppler waveform. Participants were randomly assigned to intake either 100 μg selenium supplements as tablet (n = 30) or placebo (n = 30) for 10 weeks between 17 and 27 weeks of gestation. After 10 weeks of selenium administration, a higher percentage of women in the selenium group had pulsatility index (PI) of <1.45) (P = 0.002) than of those in the placebo group. In addition, changes in plasma levels of total antioxidant capacity (TAC) (P < 0.001), glutathione (GSH) (P = 0.008), and high-sensitivity C-reactive protein (hs-CRP) (P = 0.004) in the selenium group were significant compared with the placebo group. Additionally, selenium supplementation significantly decreased serum insulin (P = 0.02), homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (P = 0.02), and homeostatic model assessment for B-cell function (HOMA-B) (P = 0.02) and significantly increased quantitative insulin sensitivity check index (QUICKI) (P = 0.04) and HDL-C levels (P = 0.02) compared with the placebo. We did not find any significant effect of selenium administration on malondialdehyde (MDA), nitric oxide (NO), fasting plasma glucose (FPG), and other lipid profiles. Overall, selenium supplementation in pregnant women at risk for IUGR resulted in improved PI, TAC, GSH, hs-CRP, and markers of insulin metabolism and HDL-C levels, but it did not affect MDA, NO, FPG, and other lipid profiles.Clinical trial registration number http://www.irct.ir : IRCT201601045623N64.

Influence of bone mineral density measurement on fracture risk assessment tool® scores in postmenopausal Indian women.

PubMed

Daswani, Bhavna; Desai, Meena; Mitra, Sumegha; Gavali, Shubhangi; Patil, Anushree; Kukreja, Subhash; Khatkhatay, M Ikram

2016-03-01

Fracture risk assessment tool® calculations can be performed with or without addition of bone mineral density; however, the impact of this addition on fracture risk assessment tool® scores has not been studied in Indian women. Given the limited availability and high cost of bone mineral density testing in India, it is important to know the influence of bone mineral density on fracture risk assessment tool® scores in Indian women. Therefore, our aim was to assess the contribution of bone mineral density in fracture risk assessment tool® outcome in Indian women. Apparently healthy postmenopausal Indian women (n = 506), aged 40-72 years, without clinical risk factors for bone disease, were retrospectively selected, and their fracture risk assessment tool® scores calculated with and without bone mineral density were compared. Based on WHO criteria, 30% women were osteoporotic, 42.9% were osteopenic and 27.1% had normal bone mineral density. Fracture risk assessment tool® scores for risk of both major osteoporotic fracture and hip fracture significantly increased on including bone mineral density (P < 0.0001). When criteria of National Osteoporosis Foundation, US was applied number of participants eligible for medical therapy increased upon inclusion of bone mineral density, (for major osteoporotic fracture risk number of women eligible without bone mineral density was 0 and with bone mineral density was 1, P > 0.05, whereas, for hip fracture risk number of women eligible without bone mineral density was 2 and with bone mineral density was 17, P < 0.0001). Until the establishment of country-specific medication intervention thresholds, bone mineral density should be included while calculating fracture risk assessment tool® scores in Indian women. © The Author(s) 2016.

Illness, at-risk and resilience neural markers of early-stage bipolar disorder.

PubMed

Lin, Kangguang; Shao, Robin; Geng, Xiujuan; Chen, Kun; Lu, Rui; Gao, Yanling; Bi, Yanan; Lu, Weicong; Guan, Lijie; Kong, Jiehua; Xu, Guiyun; So, Kwok-Fai

2018-05-21

Current knowledge on objective and specific neural markers for bipolar risk and resilience-related processes is lacking, partly due to not subdividing high-risk individuals manifesting different levels of subclinical symptoms who possibly possess different levels of resilience. We delineated grey matter markers for bipolar illness, genetic high risk (endophenotype) and resilience, through comparing across 42 young non-comorbid bipolar patients, 42 healthy controls, and 72 diagnosis-free, medication-naive high-genetic-risk individuals subdivided into a combined-high-risk group who additionally manifested bipolar risk-relevant subsyndromes (N = 38), and an asymptomatic high-risk group (N = 34). Complementary analyses assessed the additional predictive and classification values of grey matter markers beyond those of clinical scores, through using logistic regression and support vector machine analyses. Illness-related effects manifested as reduced grey matter volumes of bilateral temporal limbic-striatal and cerebellar regions, which significantly differentiated bipolar patients from healthy controls and improved clinical classification specificity by 20%. Reduced bilateral cerebellar grey matter volume emerged as a potential endophenotype and (along with parieto-occipital grey matter changes) separated combined-high-risk individuals from healthy and high-risk individuals, and increased clinical classification specificity by approximately 10% and 27%, respectively, while the relatively normalized cerebellar grey matter volumes in the high-risk sample may confer resilience. The cross-validation procedure was not performed on an independent sample using independently-derived features. The BD group had different age and sex distributions than some other groups which may not be fully addressable statistically. Our framework can be applied in other measurement domains to derive complete profiles for bipolar patients and at-risk individuals, towards forming strategies for promoting resilience and preclinical intervention. Copyright © 2018 Elsevier B.V. All rights reserved.

Relationship between number of sexual intercourse partners and selected health risk behaviors among public high school adolescents.

PubMed

Valois, R F; Oeltmann, J E; Waller, J; Hussey, J R

1999-11-01

To examine the relationship between number of sexual partners and selected health risk behaviors in a statewide sample of public high school students. The Centers for Disease Control and Prevention Youth Risk Behavior Survey was used to secure usable sexual risk-taking, substance use, and violence/aggression data from 3805 respondents. Because simple polychotomous logistic regression analysis revealed a significant Race x Gender interaction, subsequent multivariate models were constructed separately for each race-gender group. Odds ratios and 95% confidence intervals was calculated from polychotomous logistic regression models for number of sexual intercourse partners and their potential risk behavior correlates. An increased number of sexual intercourse partners were correlated with a cluster of risk behaviors that place adolescents at risk for unintended pregnancy, human immunodeficiency virus/acquired immunodeficiency syndrome, and other sexually transmitted infections. For Black females, alcohol, tobacco, marijuana use, and dating violence behaviors were the strongest predictors of an increased number of sexual partners; white females had similar predictors with the addition of physical fighting. For white males, alcohol, tobacco, marijuana use, physical fighting, carrying weapons, and dating violence were the strongest predictors of an increased number of sexual intercourse partners. Black males had similar predictors with the addition of binge alcohol use. Prevention of adolescent sexual and other health risk behaviors calls for creative approaches in school and community settings and will require long-term intervention strategies focused on adolescent behavior changes and environmental modifications.

Development and validation of a gene profile predicting benefit of postmastectomy radiotherapy in patients with high-risk breast cancer: a study of gene expression in the DBCG82bc cohort.

PubMed

Tramm, Trine; Mohammed, Hayat; Myhre, Simen; Kyndi, Marianne; Alsner, Jan; Børresen-Dale, Anne-Lise; Sørlie, Therese; Frigessi, Arnoldo; Overgaard, Jens

2014-10-15

To identify genes predicting benefit of radiotherapy in patients with high-risk breast cancer treated with systemic therapy and randomized to receive or not receive postmastectomy radiotherapy (PMRT). The study was based on the Danish Breast Cancer Cooperative Group (DBCG82bc) cohort. Gene-expression analysis was performed in a training set of frozen tumor tissue from 191 patients. Genes were identified through the Lasso method with the endpoint being locoregional recurrence (LRR). A weighted gene-expression index (DBCG-RT profile) was calculated and transferred to quantitative real-time PCR (qRT-PCR) in corresponding formalin-fixed, paraffin-embedded (FFPE) samples, before validation in FFPE from 112 additional patients. Seven genes were identified, and the derived DBCG-RT profile divided the 191 patients into "high LRR risk" and "low LRR risk" groups. PMRT significantly reduced risk of LRR in "high LRR risk" patients, whereas "low LRR risk" patients showed no additional reduction in LRR rate. Technical transfer of the DBCG-RT profile to FFPE/qRT-PCR was successful, and the predictive impact was successfully validated in another 112 patients. A DBCG-RT gene profile was identified and validated, identifying patients with very low risk of LRR and no benefit from PMRT. The profile may provide a method to individualize treatment with PMRT. ©2014 American Association for Cancer Research.

C-reactive protein and serum creatinine, but not haemoglobin A1c, are independent predictors of coronary heart disease risk in non-diabetic Chinese.

PubMed

Salim, Agus; Tai, E Shyong; Tan, Vincent Y; Welsh, Alan H; Liew, Reginald; Naidoo, Nasheen; Wu, Yi; Yuan, Jian-Min; Koh, Woon P; van Dam, Rob M

2016-08-01

In western populations, high-sensitivity C-reactive protein (hsCRP), and to a lesser degree serum creatinine and haemoglobin A1c, predict risk of coronary heart disease (CHD). However, data on Asian populations that are increasingly affected by CHD are sparse and it is not clear whether these biomarkers can be used to improve CHD risk classification. We conducted a nested case-control study within the Singapore Chinese Health Study cohort, with incident 'hard' CHD (myocardial infarction or CHD death) as an outcome. We used data from 965 men (298 cases, 667 controls) and 528 women (143 cases, 385 controls) to examine the utility of hsCRP, serum creatinine and haemoglobin A1c in improving the prediction of CHD risk over and above traditional risk factors for CHD included in the ATP III model. For each sex, the performance of models with only traditional risk factors used in the ATP III model was compared with models with the biomarkers added using weighted Cox proportional hazards analysis. The impact of adding these biomarkers was assessed using the net reclassification improvement index. For men, loge hsCRP (hazard ratio 1.25, 95% confidence interval: 1.05; 1.49) and loge serum creatinine (hazard ratio 4.82, 95% confidence interval: 2.10; 11.04) showed statistically significantly associations with CHD risk when added to the ATP III model. We did not observe a significant association between loge haemoglobin A1c and CHD risk (hazard ratio 1.83, 95% confidence interval: 0.21; 16.06). Adding hsCRP and serum creatinine to the ATP III model improved risk classification in men with a net gain of 6.3% of cases (p-value = 0.001) being reclassified to a higher risk category, while it did not significantly reduce the accuracy of classification for non-cases. For women, squared hsCRP was borderline significantly (hazard ratio 1.01, 95% confidence interval: 1.00; 1.03) and squared serum creatinine was significantly (hazard ratio 1.81, 95% confidence interval: 1.49; 2.21) associated with CHD risk. However, the association between squared haemoglobin A1c and CHD risk was not significant (hazard ratio 1.05, 95% confidence interval: 0.99; 1.12). The addition of hsCRP and serum creatinine to the ATP III model resulted in 3.7% of future cases being reclassified to a higher risk category (p-value = 0.025), while it did not significantly reduce the accuracy of classification for non-cases. Adding hsCRP and serum creatinine, but not haemoglobin A1c, to traditional risk factors improved CHD risk prediction among non-diabetic Singaporean Chinese. The improved risk estimates will allow better identification of individuals at high risk of CHD than existing risk calculators such as the ATP III model. © The European Society of Cardiology 2016.

New developments in exposure assessment: the impact on the practice of health risk assessment and epidemiological studies.

PubMed

Nieuwenhuijsen, Mark; Paustenbach, Dennis; Duarte-Davidson, Raquel

2006-12-01

The field of exposure assessment has matured significantly over the past 10-15 years. Dozens of studies have measured the concentrations of numerous chemicals in many media to which humans are exposed. Others have catalogued the various exposure pathways and identified typical values which can be used in the exposure calculations for the general population such as amount of water or soil ingested per day or the percent of a chemical than can pass through the skin. In addition, studies of the duration of exposure for many tasks (e.g. showering, jogging, working in the office) have been conducted which allow for more general descriptions of the likely range of exposures. All of this information, as well as the development of new and better models (e.g. air dispersion or groundwater models), allow for better estimates of exposure. In addition to identifying better exposure factors, and better mathematical models for predicting the aerial distribution of chemicals, the conduct of simulation studies and dose-reconstruction studies can offer extraordinary opportunities for filling in data gaps regarding historical exposures which are critical to improving the power of epidemiology studies. The use of probabilistic techniques such as Monte Carlo analysis and Bayesian statistics have revolutionized the practice of exposure assessment and has greatly enhanced the quality of the risk characterization. Lastly, the field of epidemiology is about to undergo a sea change with respect to the exposure component because each year better environmental and exposure models, statistical techniques and new biological monitoring techniques are being introduced. This paper reviews these techniques and discusses where additional research is likely to pay a significant dividend. Exposure assessment techniques are now available which can significantly improve the quality of epidemiology and health risk assessment studies and vastly improve their usefulness. As more quantitative exposure components can now be incorporated into these studies, they can be better used to identify safe levels of exposure using customary risk assessment methodologies. Examples are drawn from both environmental and occupational studies illustrating how these techniques have been used to better understand exposure to specific chemicals. Some thoughts are also presented on what lessons have been learned about conducting exposure assessment for health risk assessments and epidemiological studies.

Increased risk of adverse drug events secondary to bevacizumab treatment in patients with advanced or metastatic breast cancer: a meta-analysis of randomized controlled trials.

PubMed

Shin, Sooyoung; Noh, Yoojin

2018-01-01

Several clinical trials have shown an increased risk of hypertension with bevacizumab when added to chemotherapy in different types of malignancy; however, the risks of other significant adverse events besides hypertension, specifically in breast cancer, have not been completely elucidated. This study was conducted with the aim, primarily, to assess the overall incidence and risk of common toxicities associated with bevacizumab in patients with advanced or metastatic breast cancer and, secondarily, to descriptively review study results concerning a potential correlation between bevacizumab-induced hypertension and its efficacy for breast cancer treatment. We carried out a meta-analysis of relevant randomized controlled trials (RCTs) identified from a database search (Cochrane Library and PubMed) and, additionally, by reviewing previous reviews and meta-analyses. Overall incidence rates, odds ratios (ORs), and 95% confidence intervals (CIs) were assessed with the random- or fixed-effect models, depending on the level of heterogeneity across the included trials. The primary clinical outcomes were high-grade adverse events commonly reported with bevacizumab therapy. We included 6,260 patients with advanced-stage breast cancer from 12 RCTs in the meta-analysis. Five types of high-grade (Grade 3 or 4) adverse drug events were identified as being correlated with bevacizumab treatment versus alternative treatment with statistical significance: hypertension (OR 5.67, 95% CI 3.02-10.65), proteinuria (OR 10.09, 95% CI 4.79-21.27), bleeding (OR 3.45, 95% CI 2.25-5.30), cardiac toxicity (OR 2.15, 95% CI 1.29-3.59), and neutropenic fever (OR 1.51, 95% CI 1.15-2.00). The prognostic value of bevacizumab-induced hypertension for its antitumor efficacy among patients with breast cancer remains controversial, with mixed results presented in the five retrospective studies that were identified from our additional literature search. The addition of bevacizumab to anticancer therapy was associated with a significant increase in the risk of high-grade adverse events, including hypertension, proteinuria, bleeding, cardiac toxicity, and neutropenic fever among patients with advanced-stage breast cancer. Although several retrospective studies suggested a predictive importance of hypertension secondary to bevacizumab therapy, the role of elevated blood pressure as a prognostic biomarker for its antitumor efficacy remains controversial, and further prospective trials are required to confirm such a correlation.

Preliminary risk benefit assessment for nuclear waste disposal in space

NASA Technical Reports Server (NTRS)

Rice, E. E.; Denning, R. S.; Friedlander, A. L.; Priest, C. C.

1982-01-01

This paper describes the recent work of the authors on the evaluation of health risk benefits of space disposal of nuclear waste. The paper describes a risk model approach that has been developed to estimate the non-recoverable, cumulative, expected radionuclide release to the earth's biosphere for different options of nuclear waste disposal in space. Risk estimates for the disposal of nuclear waste in a mined geologic repository and the short- and long-term risk estimates for space disposal were developed. The results showed that the preliminary estimates of space disposal risks are low, even with the estimated uncertainty bounds. If calculated release risks for mined geologic repositories remain as low as given by the U.S. DOE, and U.S. EPA requirements continue to be met, then no additional space disposal study effort in the U.S. is warranted at this time. If risks perceived by the public are significant in the acceptance of mined geologic repositories, then consideration of space disposal as a complement to the mined geologic repository is warranted.

Use of Risk Assessment Tool for Inpatient Traumatic Intracranial Hemorrhage after Falls in Acute Care Hospital Setting

PubMed Central

Toyabe, Shin-ichi

2012-01-01

Severe injuries such as intracranial hemorrhage (ICH) are the most serious problem after falls in hospital, but they have not been considered in risk assessment scores for falls. We tried to determine the risk factors for ICH after falls in 20,320 inpatients (696,364 patient-days) aged from 40 to 90 years who were admitted to a tertiary-care university hospital. Possible risk factors including STRATIFY risk score for falls and FRAX™ risk score for fractures were analyzed by univariate and multivariate analyses. Fallers accounted for 3.2% of the patients, and 5.0% of the fallers suffered major injuries, including peripheral bone fracture (59.6%) and ICH (23.4%). In addition to STRATIFY, FRAX™ was significantly associated not only with bone fractures but also ICH. Concomitant use of risk score for falls and risk score for fractures might be useful for the prediction of major injuries such as ICH after falls. PMID:22980233

Low Fruit/Vegetable Consumption in the Home: Cumulative Risk Factors in Early Childhood

ERIC Educational Resources Information Center

Ward, Wendy L.; Swindle, Taren M.; Kyzer, Angela L.; Whiteside-Mansell, Leanne

2015-01-01

Cumulative risk theory suggests that a variety of social risk factors would have an additive effect on obesity risk. Multiple studies have suggested that obesity is related to basic resources such as transportation and financial resources. Additional research points to parental engagement and parental monitoring as additional sources of risk. This…

Associations of herbal and specialty supplements with lung and colorectal cancer risk in the VITamins And Lifestyle (VITAL) Study

PubMed Central

Satia, Jessie A.; Littman, Alyson; Slatore, Christopher G.; Galanko, Joseph A.; White, Emily

2010-01-01

Millions of Americans use dietary supplements with little knowledge about their benefits or risks. We examined associations of various herbal/specialty supplements with lung and colorectal cancer (CRC) risk. Men and women, 50-76y, in the VITAL (VITamins And Lifestyle) cohort completed a 24-page baseline questionnaire that captured duration (years) and frequency (days/week) of use of commonly used herbal/specialty supplements. Dose was not assessed due to lack of accurate potency information. Supplement exposure was categorized as “no use” or “any use” over the previous 10 years. Hazard ratios (HR) were estimated by multivariate Cox regression models. Incident lung (n=665) and CRC cancers (n=428) were obtained from the SEER cancer registry. Any use of glucosamine and chondroitin, which have anti-inflammatory properties, over the previous 10 years, was associated with significantly lower lung cancer risk: HR: 0.74 (95% CI: 0.58, 0.94) and HR: 0.72 (95% CI: 0.54, 0.96) and CRC risk: HR: 0.73 (95% CI: 0.54, 0.98) and HR: 0.65 (95% CI: 0.45, 0.93), respectively. There were also statistically significantly inverse associations of fish oil: HR: 0.65 (95% CI: 0.42, 0.99), methylsulfonylmethane (MSM): HR: 0.46 (95% CI: 0.23, 0.93), and St. John's wort: HR: 0.35 (95% CI: 0.14, 0.85) with CRC risk. In contrast, garlic pills were associated with a statistically significant 35% elevated CRC risk. These results suggest that some herbal/specialty supplements may be associated with lung and CRC risk; however, these products should be used with caution. Additional studies examining the effects of herbal/specialty supplements on risk for cancer/other diseases are needed. PMID:19423520

Serum urate and the risk of major coronary heart disease events.

PubMed Central

Wannamethee, S. G.; Shaper, A. G.; Whincup, P. H.

1997-01-01

OBJECTIVE: To examine the relation between serum urate and the risk of major coronary heart disease events. DESIGN: A prospective study of a male cohort. SETTING: One general practice in each of 24 British towns. SUBJECTS: 7688 men aged 40-59 years at screening. MAIN OUTCOME MEASURES: Fatal and non-fatal coronary heart disease events. RESULTS: There were 1085 major coronary heart disease events during the average follow up period of 16.8 years. Serum urate was significantly associated with a wide range of cardiovascular risk factors including body mass index, alcohol intake, antihypertensive treatment, pre-existing coronary heart disease, serum triglycerides, cholesterol, and diastolic blood pressure. There was a significant positive association between serum urate and risk of coronary heart disease after adjustment for lifestyle factors and disease indicators. This relation was attenuated to non-significance upon additional adjustment for diastolic blood pressure and serum total cholesterol: cholesterol appeared to be the critical factor in attenuating this relation. When the association between serum urate and risk of coronary heart disease was examined by presence and grade of pre-existing coronary heart disease, a positive association was seen only in men with previous definite myocardial infarction, even after full adjustment (P = 0.07). CONCLUSIONS: The relation between serum urate and the risk of coronary heart disease depends heavily upon the presence of pre-existing myocardial infarction and widespread underlying atherosclerosis as well as the clustering of risk factors. Thus serum urate is not a truly independent risk factor for coronary heart disease. Raised serum urate appears to be an integral part of the cluster of risk factors associated with the insulin resistance syndrome that include obesity, raised serum triglycerides, and serum cholesterol. PMID:9326988

Risk of carotid atherosclerosis associated with genetic polymorphisms of apolipoprotein E and inflammatory genes among arsenic exposed residents in Taiwan

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

Hsieh, Y.-C.; Hsieh, F.-I; Lien, L.-M.

2008-02-15

Arsenic had been reported to be associated with carotid atherosclerosis. However, there were few studies to evaluate the association between the susceptible gene of lipid metabolism and inflammation and carotid atherosclerosis among arsenic exposure residents. The aim of the study was to investigate the associations between the genetic polymorphisms of APOE and MCP-1 and the risk of carotid atherosclerosis among residents of Lanyang Basin in Taiwan which was a newly confirmed arsenic-endemic area. In total, 479 residents who had been genotyped of these two genes and examined the severity of carotid atherosclerosis were included in this study. The study subjectsmore » with carotid intima media thickness (IMT) {>=} 1.0 mm or with the observable plaque in the extracranial carotid artery were diagnosed as carotid atherosclerosis. A significantly age- and gender-adjusted odds ratio of 2.0 for the development of carotid atherosclerosis was observed in study subjects with {epsilon}4 allele of APOE than those without {epsilon}4 allele. Compared with study subjects who carried wild genotypes of APOE and MCP-1, those with both risk genotypes of APOE and MCP-1 had 2.5-fold risk of carotid atherosclerosis after adjustment for age and gender, revealing a significant dose-response relationship between number of risk genotypes of these genes and risk of carotid atherosclerosis. Additionally, study subjects with two risk genotypes of APOE and MCP-1 and either had ingested well water contained arsenic level > 10 {mu}g/L or had arsenic exposure > 0.22 mg/L-year would have strikingly highest risk of 10.3-fold and 15.7-fold, respectively, for the development carotid atherosclerosis, showing significant joint effect of arsenic exposure and risk genotypes of APOE and MCP-1.« less

Suicide risk in relation to air pollen counts: a study based on data from Danish registers

PubMed Central

Qin, Ping; Waltoft, Berit L; Mortensen, Preben B; Postolache, Teodor T

2013-01-01

Objectives Since the well-observed spring peak of suicide incidents coincides with the peak of seasonal aeroallergens as tree-pollen, we want to document an association between suicide and pollen exposure with empirical data from Denmark. Design Ecological time series study. Setting Data on suicide incidents, air pollen counts and meteorological status were retrieved from Danish registries. Participants 13 700 suicide incidents over 1304 consecutive weeks were obtained from two large areas covering 2.86 million residents. Primary and secondary outcome measures Risk of suicide associated with pollen concentration was assessed using a time series Poisson-generalised additive model. Results We noted a significant association between suicide risk and air pollen counts. A change of pollen counts levels from 0 to ‘10–<30’ grains/m3 air was associated with a relative risk of 1.064, that is, a 6.4% increase in weekly number of suicides in the population, and from 0 to ‘30–100’ grains, a relative risk of 1.132. The observed association remained significant after controlling for effects of region, calendar time, temperature, cloud cover and humidity. Meanwhile, we observed a significant sex difference that suicide risk in men started to rise when there was a small increase of air pollen, while the risk in women started to rise until pollen grains reached a certain level. High levels of pollen had slightly stronger effect on risk of suicide in individuals with mood disorder than those without the disorder. Conclusions The observed association between suicide risk and air pollen counts supports the hypothesis that aeroallergens, acting as immune triggers, may precipitate suicide. PMID:23793651

Spatial gradient of human health risk from exposure to trace elements and radioactive pollutants in soils at the Puchuncaví-Ventanas industrial complex, Chile.

PubMed

Salmani-Ghabeshi, S; Palomo-Marín, M R; Bernalte, E; Rueda-Holgado, F; Miró-Rodríguez, C; Cereceda-Balic, F; Fadic, X; Vidal, V; Funes, M; Pinilla-Gil, E

2016-11-01

The Punchuncaví Valley in central Chile, heavily affected by a range of anthropogenic emissions from a localized industrial complex, has been studied as a model environment for evaluating the spatial gradient of human health risk, which are mainly caused by trace elemental pollutants in soil. Soil elemental profiles in 121 samples from five selected locations representing different degrees of impact from the industrial source were used for human risk estimation. Distance to source dependent cumulative non-carcinogenic hazard indexes above 1 for children (max 4.4 - min 1.5) were found in the study area, ingestion being the most relevant risk pathway. The significance of health risk differences within the study area was confirmed by statistical analysis (ANOVA and HCA) of individual hazard index values at the five sampling locations. As was the dominant factor causing unacceptable carcinogenic risk levels for children (<10 -4 ) at the two sampling locations which are closer to the industrial complex, whereas the risk was just in the tolerable range (10 -6 - 10 -4 ) for children and adults in the rest of the sampling locations at the study area. Furthermore, we assessed gamma ray radiation external hazard indexes and annual effective dose rate from the natural radioactivity elements ( 226 Ra, 232 Th and 40 K) levels in the surface soils of the study area. The highest average values for the specific activity of 232 Th (31 Bq kg -1 ), 40 K (615 Bq kg - 1 ), and 226 Ra (25 Bq kg -1 ) are lower than limit recommended by OECD, so no significant radioactive risk was detected within the study area. In addition, no significant variability of radioactive risk was observed among sampling locations. Copyright © 2016 Elsevier Ltd. All rights reserved.

Common variants at the CHEK2 gene locus and risk of epithelial ovarian cancer.

PubMed

Lawrenson, Kate; Iversen, Edwin S; Tyrer, Jonathan; Weber, Rachel Palmieri; Concannon, Patrick; Hazelett, Dennis J; Li, Qiyuan; Marks, Jeffrey R; Berchuck, Andrew; Lee, Janet M; Aben, Katja K H; Anton-Culver, Hoda; Antonenkova, Natalia; Bandera, Elisa V; Bean, Yukie; Beckmann, Matthias W; Bisogna, Maria; Bjorge, Line; Bogdanova, Natalia; Brinton, Louise A; Brooks-Wilson, Angela; Bruinsma, Fiona; Butzow, Ralf; Campbell, Ian G; Carty, Karen; Chang-Claude, Jenny; Chenevix-Trench, Georgia; Chen, Ann; Chen, Zhihua; Cook, Linda S; Cramer, Daniel W; Cunningham, Julie M; Cybulski, Cezary; Plisiecka-Halasa, Joanna; Dennis, Joe; Dicks, Ed; Doherty, Jennifer A; Dörk, Thilo; du Bois, Andreas; Eccles, Diana; Easton, Douglas T; Edwards, Robert P; Eilber, Ursula; Ekici, Arif B; Fasching, Peter A; Fridley, Brooke L; Gao, Yu-Tang; Gentry-Maharaj, Aleksandra; Giles, Graham G; Glasspool, Rosalind; Goode, Ellen L; Goodman, Marc T; Gronwald, Jacek; Harter, Philipp; Hasmad, Hanis Nazihah; Hein, Alexander; Heitz, Florian; Hildebrandt, Michelle A T; Hillemanns, Peter; Hogdall, Estrid; Hogdall, Claus; Hosono, Satoyo; Jakubowska, Anna; Paul, James; Jensen, Allan; Karlan, Beth Y; Kjaer, Susanne Kruger; Kelemen, Linda E; Kellar, Melissa; Kelley, Joseph L; Kiemeney, Lambertus A; Krakstad, Camilla; Lambrechts, Diether; Lambrechts, Sandrina; Le, Nhu D; Lee, Alice W; Cannioto, Rikki; Leminen, Arto; Lester, Jenny; Levine, Douglas A; Liang, Dong; Lissowska, Jolanta; Lu, Karen; Lubinski, Jan; Lundvall, Lene; Massuger, Leon F A G; Matsuo, Keitaro; McGuire, Valerie; McLaughlin, John R; Nevanlinna, Heli; McNeish, Iain; Menon, Usha; Modugno, Francesmary; Moysich, Kirsten B; Narod, Steven A; Nedergaard, Lotte; Ness, Roberta B; Noor Azmi, Mat Adenan; Odunsi, Kunle; Olson, Sara H; Orlow, Irene; Orsulic, Sandra; Pearce, Celeste L; Pejovic, Tanja; Pelttari, Liisa M; Permuth-Wey, Jennifer; Phelan, Catherine M; Pike, Malcolm C; Poole, Elizabeth M; Ramus, Susan J; Risch, Harvey A; Rosen, Barry; Rossing, Mary Anne; Rothstein, Joseph H; Rudolph, Anja; Runnebaum, Ingo B; Rzepecka, Iwona K; Salvesen, Helga B; Budzilowska, Agnieszka; Sellers, Thomas A; Shu, Xiao-Ou; Shvetsov, Yurii B; Siddiqui, Nadeem; Sieh, Weiva; Song, Honglin; Southey, Melissa C; Sucheston, Lara; Tangen, Ingvild L; Teo, Soo-Hwang; Terry, Kathryn L; Thompson, Pamela J; Timorek, Agnieszka; Tworoger, Shelley S; Van Nieuwenhuysen, Els; Vergote, Ignace; Vierkant, Robert A; Wang-Gohrke, Shan; Walsh, Christine; Wentzensen, Nicolas; Whittemore, Alice S; Wicklund, Kristine G; Wilkens, Lynne R; Woo, Yin-Ling; Wu, Xifeng; Wu, Anna H; Yang, Hannah; Zheng, Wei; Ziogas, Argyrios; Coetzee, Gerhard A; Freedman, Matthew L; Monteiro, Alvaro N A; Moes-Sosnowska, Joanna; Kupryjanczyk, Jolanta; Pharoah, Paul D; Gayther, Simon A; Schildkraut, Joellen M

2015-11-01

Genome-wide association studies have identified 20 genomic regions associated with risk of epithelial ovarian cancer (EOC), but many additional risk variants may exist. Here, we evaluated associations between common genetic variants [single nucleotide polymorphisms (SNPs) and indels] in DNA repair genes and EOC risk. We genotyped 2896 common variants at 143 gene loci in DNA samples from 15 397 patients with invasive EOC and controls. We found evidence of associations with EOC risk for variants at FANCA, EXO1, E2F4, E2F2, CREB5 and CHEK2 genes (P ≤ 0.001). The strongest risk association was for CHEK2 SNP rs17507066 with serous EOC (P = 4.74 x 10(-7)). Additional genotyping and imputation of genotypes from the 1000 genomes project identified a slightly more significant association for CHEK2 SNP rs6005807 (r (2) with rs17507066 = 0.84, odds ratio (OR) 1.17, 95% CI 1.11-1.24, P = 1.1×10(-7)). We identified 293 variants in the region with likelihood ratios of less than 1:100 for representing the causal variant. Functional annotation identified 25 candidate SNPs that alter transcription factor binding sites within regulatory elements active in EOC precursor tissues. In The Cancer Genome Atlas dataset, CHEK2 gene expression was significantly higher in primary EOCs compared to normal fallopian tube tissues (P = 3.72×10(-8)). We also identified an association between genotypes of the candidate causal SNP rs12166475 (r (2) = 0.99 with rs6005807) and CHEK2 expression (P = 2.70×10(-8)). These data suggest that common variants at 22q12.1 are associated with risk of serous EOC and CHEK2 as a plausible target susceptibility gene. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Validation of copy number variants associated with prostate cancer risk and prognosis.

PubMed

Blackburn, August; Wilson, Desiree; Gelfond, Jonathan; Yao, Li; Hernandez, Javier; Thompson, Ian M; Leach, Robin J; Lehman, Donna M

2014-01-01

Two recent studies have reported novel heritable copy number variants on chromosomes 2p, 15q, and 12q to be associated with prostate cancer (PCa) risk in non-Hispanic Caucasians. The goal of this study was to determine whether these findings could be independently confirmed in the Caucasian population from the South Texas area. The study subjects consisted of participants of the San Antonio Biomarkers of Risk for PCa cohort and additional cases ascertained in the same metropolitan area. We genotyped all 7 of the reported copy number variants using real-time quantitative polymerase chain reaction in 1,536 (317 cases and 1,219 controls) non-Hispanic Caucasian men, and additionally, we genotyped 632 (191 cases and 441 controls) Hispanic Caucasian men for one of these variants, a deletion on 2p24.3. Association of the deletion on 2p24.3 with overall PCa risk did not meet our significance criteria but was consistent with previous reports (odds ratio, 1.40; 95% confidence interval 0.99-2.00; P = 0.06). Among Hispanic Caucasians, this deletion is much less prevalent (minor allele frequencies of 0.059 and 0.024 in non-Hispanic and Hispanic Caucasians, respectively) and did not show evidence of association with risk for PCa. Interestingly, among non-Hispanic Caucasians, carrying a homozygous deletion of 2p24.3 was significantly associated with high-grade PCa as defined by Gleason score sum ≥8 (odds ratio, 27.99; 95% confidence interval 1.99-392.6; P = 0.007 [the Fisher exact test]). The remaining 6 copy number variable regions either were not polymorphic in our cohort of non-Hispanic Caucasians or showed no evidence of association. Our findings are consistent with the reported observation that a heritable deletion on 2p24.3 is associated with PCa risk in non-Hispanic Caucasians. Additionally, our observations indicate that the 2p24.3 variant is associated with risk for high-grade PCa in a recessive manner. We were unable to replicate any association with PCa for the variants on chromosomes 15q and 12q, which may be explained by regional population differences in low frequency variants and disease heterogeneity. Published by Elsevier Inc.

Risk-reducing surgery on the uterine adnexa: timing and type of surgical treatment, and pathology report.

PubMed

Signorelli, Mauro; Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Chiappa, Valentina; Lopez, Carlos; Scaffa, Cono; Lorusso, Domenica; Raspagliesi, Francesco

2016-10-01

Inherited mutations in BRCA1 and BRCA2 increase significantly the risk of developing breast and ovarian cancers, and they have been associated with increased risks of developing other types of cancer. Although screening programs have been implemented in order to detect cancers at the early stage, they resulted ineffective. To date, risk-reducing bilateral salpingo-oophorectomy represents the only procedure allowing reducing the incidence of ovarian cancer and increasing survival among BRCA1 and -2 mutation carriers. In the present review we will discuss the advantages and disadvantages related to the execution of prophylactic surgery, thus underlying possible beneficial and detrimental effects of this kind of surgery in premenopausal women. Additionally, we will investigate further therapeutic strategies aimed to reduce the risk of developing ovarian cancer, without affected patients' hormonal status.

Insecure attachment style as a vulnerability factor for depression: recent findings in a community-based study of Malay single and married mothers.

PubMed

Abdul Kadir, Nor Ba'yah; Bifulco, Antonia

2013-12-30

The role of marital breakdown in women's mental health is of key concern in Malaysia and internationally. A cross-sectional questionnaire study of married and separated/divorced and widowed women examined insecure attachment style as an associated risk factor for depression among 1002 mothers in an urban community in Malaysia. A previous report replicated a UK-based vulnerability-provoking agent model of depression involving negative evaluation of self (NES) and negative elements in close relationships (NECRs) interacting with severe life events to model depression. This article reports on the additional contribution of insecure attachment style to the model using the Vulnerable Attachment Style Questionnaire (VASQ). The results showed that VASQ scores were highly correlated with NES, NECR and depression. A multiple regression analysis of depression with backward elimination found that VASQ scores had a significant additional effect. Group comparisons showed different risk patterns for single and married mothers. NES was the strongest risk factor for both groups, with the 'anxious style' subset of the VASQ being the best additional predictor for married mothers and the total VASQ score (general attachment insecurity) for single mothers. The findings indicate that attachment insecurity adds to a psychosocial vulnerability model of depression among mothers cross-culturally and is important in understanding and identifying risk. © 2013 Elsevier Ireland Ltd. All rights reserved.

Identification of 64 Novel Genetic Loci Provides an Expanded View on the Genetic Architecture of Coronary Artery Disease.

PubMed

van der Harst, Pim; Verweij, Niek

2018-02-02

Coronary artery disease (CAD) is a complex phenotype driven by genetic and environmental factors. Ninety-seven genetic risk loci have been identified to date, but the identification of additional susceptibility loci might be important to enhance our understanding of the genetic architecture of CAD. To expand the number of genome-wide significant loci, catalog functional insights, and enhance our understanding of the genetic architecture of CAD. We performed a genome-wide association study in 34 541 CAD cases and 261 984 controls of UK Biobank resource followed by replication in 88 192 cases and 162 544 controls from CARDIoGRAMplusC4D. We identified 75 loci that replicated and were genome-wide significant ( P <5×10 -8 ) in meta-analysis, 13 of which had not been reported previously. Next, to further identify novel loci, we identified all promising ( P <0.0001) loci in the CARDIoGRAMplusC4D data and performed reciprocal replication and meta-analyses with UK Biobank. This led to the identification of 21 additional novel loci reaching genome-wide significance ( P <5×10 -8 ) in meta-analysis. Finally, we performed a genome-wide meta-analysis of all available data revealing 30 additional novel loci ( P <5×10 -8 ) without further replication. The increase in sample size by UK Biobank raised the number of reconstituted gene sets from 4.2% to 13.9% of all gene sets to be involved in CAD. For the 64 novel loci, 155 candidate causal genes were prioritized, many without an obvious connection to CAD. Fine mapping of the 161 CAD loci generated lists of credible sets of single causal variants and genes for functional follow-up. Genetic risk variants of CAD were linked to development of atrial fibrillation, heart failure, and death. We identified 64 novel genetic risk loci for CAD and performed fine mapping of all 161 risk loci to obtain a credible set of causal variants. The large expansion of reconstituted gene sets argues in favor of an expanded omnigenic model view on the genetic architecture of CAD. © 2017 The Authors.

Applying Latent Class Analysis to Risk Stratification for Perioperative Mortality in Patients Undergoing Intraabdominal General Surgery.

PubMed

Kim, Minjae; Wall, Melanie M; Li, Guohua

2016-07-01

Perioperative risk stratification is often performed using individual risk factors without consideration of the syndemic of these risk factors. We used latent class analysis (LCA) to identify the classes of comorbidities and risk factors associated with perioperative mortality in patients presenting for intraabdominal general surgery. The 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program was used to obtain a cohort of patients undergoing intraabdominal general surgery. Risk factors and comorbidities were entered into LCA models to identify the latent classes, and individuals were assigned to a class based on the highest posterior probability of class membership. Relative risk regression was used to determine the associations between the latent classes and 30-day mortality, with adjustments for procedure. A 9-class model was fit using LCA on 466,177 observations. After combining classes with similar adjusted mortality risks, 5 risk classes were obtained. Compared with the class with average mortality risk (class 4), the risk ratios (95% confidence interval) ranged from 0.020 (0.014-0.027) in the lowest risk class (class 1) to 6.75 (6.46-7.02) in the highest risk class. After adjusting for procedure and ASA physical status, the latent classes remained significantly associated with 30-day mortality. The addition of the risk class variable to a model containing ASA physical status and surgical procedure demonstrated a significant increase in the area under the receiver operator characteristic curve (0.892 vs 0.915; P < 0.0001). Latent classes of risk factors and comorbidities in patients undergoing intraabdominal surgery are predictive of 30-day mortality independent of the ASA physical status and improve risk prediction with the ASA physical status.

Wine and tobacco: risk factors for gastric cancer in France.

PubMed

Hoey, J; Montvernay, C; Lambert, R

1981-06-01

Cross-sectional studies in France have shown strong regional correlations between death rates from alcohol related diseases and death rates from gastric cancer. The present study involved 40 cases of newly diagnosed adenocarcinoma of the stomach and 168 control subjects with one of four other gastrointestinal diagnoses selected from the same hospital service during the same time period, 1978-1980. On the basis of a standard nutritional interview alcohol and particularly red wine were seen to be significant risk factors for this cancer (relative risks of 6.9 with 95% confidence limits (CL) of 3.3-14.3 for alcohol and 6.3 with CL 3.1-12.7 for wine). Smoking of one or more cigarettes per day was associated with a relative risk for gastric cancer of 4.8 with CL of 1.6-14.8. The presence of both risk factors was associated with a relative risk of 9.3 with 95% CL of 4.6-19.0. Possible confounding by age, smoking, and eating lettuce (a reported protective factor for gastric cancer in other studies) did not explain these results. The relative risks were consistently found and remained significant when each diagnostic group of control subjects was analyzed separately. These results suggest that alcohol, and particularly red wine, may be important risk factors for adenocarcinoma of the stomach in France. In addition, cigarette smoking, a risk factor in itself, when coupled with alcohol appears markedly to increase the risk.

Flood Risk, Flood Mitigation, and Location Choice: Evaluating the National Flood Insurance Program's Community Rating System.

PubMed

Fan, Qin; Davlasheridze, Meri

2016-06-01

Climate change is expected to worsen the negative effects of natural disasters like floods. The negative impacts, however, can be mitigated by individuals' adjustments through migration and relocation behaviors. Previous literature has identified flood risk as one significant driver in relocation decisions, but no prior study examines the effect of the National Flood Insurance Program's voluntary program-the Community Rating System (CRS)-on residential location choice. This article fills this gap and tests the hypothesis that flood risk and the CRS-creditable flood control activities affect residential location choices. We employ a two-stage sorting model to empirically estimate the effects. In the first stage, individuals' risk perception and preference heterogeneity for the CRS activities are considered, while mean effects of flood risk and the CRS activities are estimated in the second stage. We then estimate heterogeneous marginal willingness to pay (WTP) for the CRS activities by category. Results show that age, ethnicity and race, educational attainment, and prior exposure to risk explain risk perception. We find significant values for the CRS-creditable mitigation activities, which provides empirical evidence for the benefits associated with the program. The marginal WTP for an additional credit point earned for public information activities, including hazard disclosure, is found to be the highest. Results also suggest that water amenities dominate flood risk. Thus, high amenity values may increase exposure to flood risk, and flood mitigation projects should be strategized in coastal regions accordingly. © 2015 Society for Risk Analysis.

Effect of risk ladder format on risk perception in high- and low-numerate individuals.

PubMed

Keller, Carmen; Siegrist, Michael; Visschers, Vivianne

2009-09-01

Utilizing a random sample from the general population (N= 257), we examined the effect of the radon risk ladder on risk perception, as qualified by respondents' numeracy. The radon risk ladder provides comparative risk information about the radon equivalent of smoking risk. We compared a risk ladder providing smoking risk information with a risk ladder not providing this information. A 2 (numeracy; high, low) x 3 (risk level; high, medium, low) x 2 (smoking risk comparison: with/without) between subjects experimental design was used. A significant (p < 0.045) three-way interaction between format, risk level, and numeracy was identified. Participants with low numeracy skills, as well as participants with high numeracy skills, generally distinguished between low, medium, and high risk levels when the risk ladder with comparative smoking risk information was presented. When the risk ladder without the comparative information about the smoking risk was presented, low-numerate individuals differentiated between risk levels to a much lesser extent than high-numerate individuals did. These results provide empirical evidence that the risk ladder can be a useful tool in enabling people to interpret various risk levels. Additionally, these results allow us to conclude that providing comparative information within a risk ladder is particularly helpful to the understanding of different risk levels by people with low numeracy skills.

MMP9 polymorphisms and breast cancer risk: a report from the Shanghai Breast Cancer Genetics Study.

PubMed

Beeghly-Fadiel, Alicia; Lu, Wei; Shu, Xiao-Ou; Long, Jirong; Cai, Qiuyin; Xiang, Yongbin; Gao, Yu-Tang; Zheng, Wei

2011-04-01

In addition to tumor invasion and angiogenesis, matrix metalloproteinase (MMP)9 also contributes to carcinogenesis and tumor growth. Genetic variation that may influence MMP9 expression was evaluated among participants of the Shanghai Breast Cancer Genetics Study (SBCGS) for associations with breast cancer susceptibility. In stage 1, 11 MMP9 single nucleotide polymorphisms (SNPs) were genotyped by the Affymetrix Targeted Genotyping System and/or the Affymetrix Genome-Wide Human SNP Array 6.0 among 4,227 SBCGS participants. One SNP was further genotyped using the Sequenom iPLEX MassARRAY platform among an additional 6,270 SBCGS participants. Associations with breast cancer risk were evaluated by odds ratios (OR) and 95% confidence intervals (CI) from logistic regression models that included adjustment for age, education, and genotyping stage when appropriate. In Stage 1, rare allele homozygotes for a promoter SNP (rs3918241) or a non-synonymous SNP (rs2274756, R668Q) tended to occur more frequently among breast cancer cases (P value = 0.116 and 0.056, respectively). Given their high linkage disequilibrium (D' = 1.0, r (2) = 0.97), one (rs3918241) was selected for additional analysis. An association with breast cancer risk was not supported by additional Stage 2 genotyping. In combined analysis, no elevated risk of breast cancer among homozygotes was found (OR: 1.2, 95% CI: 0.8-1.8). Common genetic variation in MMP9 was not found to be significantly associated with breast cancer susceptibility among participants of the Shanghai Breast Cancer Genetics Study.

Does exposure to lahars risk affect people's risk-preferences and other attitudes? Field data from incentivized experiments and surveys in Arequipa - Peru

NASA Astrophysics Data System (ADS)

Heitz, C.; Bchir, M. A.; Willinger, M.

2012-04-01

Many individuals are exposed to risks which are either difficult to insure or hard to mitigate, such as tsunamis, floods, volcanic eruption,... Little is known about how exposure to such risks shapes individuals' risk-preferences. Are they more (less) risk-averse than people who are unexposed to such hazard risk? We provide empirical evidence about this question for the case of individuals exposed to lahars risk. Lahars are sediments laden flows from volcanic origin. We compare the risk-attitude of people exposed - versus non-exposed ones - to lahars risk. The originality of our approach is that we combine standard survey data to behavioural data collected by means of incentivized experiments. We collected data in various locations of the city of Arequipa (Peru), a densely populated area down the volcano El Misti. Participants in our experiment were identified as (non-)exposed to lahars risk based on risk zoning. Our survey questionnaire allows us to compare assessed exposure and the perceived exposure. We elicit risk-preference, time-preference, and trusting behaviour (a measure of social capital) for each respondent in addition to standard survey data. Our field experiment involved a total of 209 respondents from exposed and non-exposed areas. While respondents endow legitimacy in risk reduction (more than 74%) to a national authority (Defensa Civil) in charge of the management of risk in the city, more than 64% of them consider that they are not sufficiently informed about the behaviours to adopt in case of a disaster. Respondents are therefore poorly motivated to adopt initiatives of self-protection (23%) and express instead high expectations with respect to authorities' actions for decreasing their vulnerability (73%). The experimental data show that participants who live in exposed areas are not significantly more risk-averse than those living in non-exposed ones. Furthermore, there is no significant difference in time-preference between exposed and non-exposed areas, even after controlling for background volcanic risk (eruption, …). These findings contrast with respondents' stated risk preferences which show a significant difference of perception between exposed areas and non-exposed ones.

Should Age at Diagnosis Be Included as an Additional Variable in the Risk of Recurrence Classification System in Patients with Differentiated Thyroid Cancer

PubMed Central

Pitoia, Fabián; Jerkovich, Fernando; Smulever, Anabella; Brenta, Gabriela; Bueno, Fernanda; Cross, Graciela

2017-01-01

Objective To evaluate the influence of age at diagnosis on the frequency of structural incomplete response (SIR) according to the modified risk of recurrence (RR) staging system from the American Thyroid Association guidelines. Patients and Methods We performed a retrospective analysis of 268 patients with differentiated thyroid cancer (DTC) followed up for at least 3 years after initial treatment (total thyroidectomy and remnant ablation). The median follow-up in the whole cohort was 74.3 months (range: 36.1-317.9) and the median age at diagnosis was 45.9 years (range: 18-87). The association between age at diagnosis and the initial and final response to treatment was assessed with analysis of variance (ANOVA). Patients were also divided into several groups considering age younger and older than 40, 50, and 60 years. Results Age at diagnosis was not associated with either an initial or final statistically significant different SIR to treatment (p = 0.14 and p = 0.58, respectively). Additionally, we did not find any statistically significant differences when the percentages of SIR considering the classification of RR were compared between different groups of patients by using several age cutoffs. Conclusions When patients are correctly risk stratified, it seems that age at diagnosis is not involved in the frequency of having a SIR at the initial evaluation or at the final follow-up, so it should not be included as an additional variable to be considered in the RR classifications. PMID:28785543

Dysregulated arginine metabolism and cardiopulmonary dysfunction in patients with thalassaemia.

PubMed

Morris, Claudia R; Kim, Hae-Young; Klings, Elizabeth S; Wood, John; Porter, John B; Trachtenberg, Felicia; Sweeters, Nancy; Olivieri, Nancy F; Kwiatkowski, Janet L; Virzi, Lisa; Hassell, Kathryn; Taher, Ali; Neufeld, Ellis J; Thompson, Alexis A; Larkin, Sandra; Suh, Jung H; Vichinsky, Elliott P; Kuypers, Frans A

2015-06-01

Pulmonary hypertension (PH) commonly develops in thalassaemia syndromes, but is poorly characterized. The goal of this study was to provide a comprehensive description of the cardiopulmonary and biological profile of patients with thalassaemia at risk for PH. A case-control study of thalassaemia patients at high versus low PH-risk was performed. A single cross-sectional measurement for variables reflecting cardiopulmonary status and biological pathophysiology were obtained, including Doppler-echocardiography, 6-min-walk-test, Borg Dyspnoea Score, New York Heart Association functional class, cardiac magnetic resonance imaging (MRI), chest-computerized tomography, pulmonary function testing and laboratory analyses targeting mechanisms of coagulation, inflammation, haemolysis, adhesion and the arginine-nitric oxide pathway. Twenty-seven thalassaemia patients were evaluated, 14 with an elevated tricuspid-regurgitant-jet-velocity (TRV) ≥ 2·5 m/s. Patients with increased TRV had a higher frequency of splenectomy, and significantly larger right atrial size, left atrial volume and left septal-wall thickness on echocardiography and/or MRI, with elevated biomarkers of abnormal coagulation, lactate dehydrogenase (LDH) levels and arginase concentration, and lower arginine-bioavailability compared to low-risk patients. Arginase concentration correlated significantly to several echocardiography/MRI parameters of cardiovascular function in addition to global-arginine-bioavailability and biomarkers of haemolytic rate, including LDH, haemoglobin and bilirubin. Thalassaemia patients with a TRV ≥ 2·5 m/s have additional echocardiography and cardiac-MRI parameters suggestive of right and left-sided cardiac dysfunction. In addition, low arginine bioavailability may contribute to cardiopulmonary dysfunction in β-thalassaemia. © 2015 John Wiley & Sons Ltd.

[Self-esteem, resilience, locus of control and suicide risk in nursing students].

PubMed

Montes-Hidalgo, Javier; Tomás-Sábado, Joaquín

2016-01-01

Assuming that suicide is the result of a series of factors acting cumulatively, the aim of this paper was to study the association of self-esteem, resilience and locus of control with the risk of suicidal behavior in a sample of nursing students. Observational, cross-sectional and correlational study with 186 nursing students who answered a questionnaire that contained, in addition to demographic data, the Spanish forms of Rosenberg self-esteem scale, the brief resilient coping scale, the Plutchik scale of suicide risk and the Rotter's internal-external locus of control scale. The scores of males and females are very similar on all scales except Locus of Control, where a significantly greater tendency of females attributed to external control. 6.4% of students have scores indicating suicide risk. Suicide risk scores correlated negatively and significantly with self-esteem and resilience and positively with locus of control. The multiple linear regression analysis identified self-esteem as the main variable related to suicide risk. The results suggest that students who have low self-esteem, have difficulty in adjusting to adverse situations and tend to the external attribution of the consequences of their actions may have an increased risk of suicidal behavior. Furthermore, the identification of self-esteem as the important factor involved in suicide risk can help in designing prevention programs. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Ventral striatal response during decision making involving risk and reward is associated with future binge drinking in adolescents.

PubMed

Morales, Angelica M; Jones, Scott A; Ehlers, Alissa; Lavine, Jessye B; Nagel, Bonnie J

2018-05-07

Beginning to engage in heavy alcohol use during adolescence, as opposed to later in life, is associated with elevated risk for a variety of negative consequences, including the development of an alcohol use disorder. Behavioral studies suggest that poor decision making predicts alcohol use during adolescence; however, more research is needed to determine the neurobiological risk factors that underlie this association. Using functional magnetic resonance imaging, brain activation during decision making involving risk and reward was assessed in 47 adolescents (14-15 years old) with no significant history or alcohol or drug use. After baseline assessment, participants completed follow-up interviews every 3 months to assess the duration to onset of binge drinking. Adolescents who made a greater number of risky selections and had greater activation in the nucleus accumbens, precuneus, and occipital cortex during decision making involving greater potential for risk and reward began binge drinking sooner. Findings suggest that heightened activation of reward circuitry during decision making under risk is a neurobiological risk factor for earlier onset of binge drinking. Furthermore, brain activation was a significant predictor of onset to binge drinking, even after controlling for decision-making behavior, suggesting that neurobiological markers may provide additional predictive validity over behavioral assessments. Interventions designed to modify these behavioral and neurobiological risk factors may be useful for curbing heavy alcohol use during adolescence.

Functional Movement ScreenTM and history of injury in assessment of potential risk of injury among team handball players.

PubMed

Slodownik, Robert; Ogonowska-Slodownik, Anna; Morgulec-Adamowicz, Natalia

2017-09-29

Handball is known to be one of the team sports representing the highest risk of injury. Several investigators have tried to identify injury risk factors in team sports including handball and suggested the need to develop an optimal tool to capture and quantify the potential risk of injury. The aim of the study was to evaluate potential risk of injury among handball players. It was a mixed design study. Handball players from 1st and 2nd division were evaluated (n = 30) using the Functional Movement ScreenTM (FMSTM). Additionally, self-reported history of injury was collected during FMSTM evaluation and after 6 months. Competitive level, training experience, playing position, anthropometric features, symmetry of movement patterns and history of previous injury were analysed while assessing the potential risk of injury. Significant difference between the right and left side (upper limb) was revealed for Shoulder Mobility Test (U = 308.5, p = 0.014). Odds Ratio analysis revealed that having previous injury in the last 12 months is the only statistically significant injury risk factor (OR = 13.71, p = 0.02). Based on this study we can assume that previous injury history reports are crucial in predicting injuries. FMSTM can help in identifying a typical adaptation in throwing shoulder among handball players, but should not be used alone to assess injury risk.