Risk assessment does not explain high prevalence of gestational diabetes mellitus in a large group of Sardinian women

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Zedda Pierina

2008-07-01

Full Text Available Abstract Background A very high prevalence (22.3% of gestational diabetes mellitus (GDM was recently reported following our study on a large group of Sardinian women. In order to explain such a high prevalence we sought to characterise our obstetric population through the analysis of risk factors and their association with the development of GDM. Methods The prevalence of risk factors and their association with the development of GDM were evaluated in 1103 pregnancies (247 GDM and 856 control women. The association of risk factors with GDM was calculated according to logistic regression. Sensitivity and specificity of risk assessment strategy were also calculated. Results None of the risk factors evaluated showed an elevated frequency in our population. The high risk patients were 231 (20.9%. Factors with a stronger association with GDM development were obesity (OR 3.7, 95% CI 2.08–6.8, prior GDM (OR 3.1, 95% CI 1.69–5.69, and family history of Type 2 diabetes (OR 2.6, 95% CI 1.81–3.86. Only patients over 35 years of age were more represented in the GDM group (38.2% vs 22.6% in the non-GDM cases, P P Conclusion Such a high prevalence of GDM in our population does not seem to be related to the abnormal presence of some known risk factors, and appears in contrast with the prevalence of Type 2 diabetes in Sardinia. Further studies are needed to explain the cause such a high prevalence of GDM in Sardinia. The "average risk" definition is not adequate to predict GDM in our population.

Patients who reattend after head injury: a high risk group.

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Voss, M.; Knottenbelt, J. D.; Peden, M. M.

1995-01-01

OBJECTIVE--To assess risk factors for important neurosurgical effects in patients who reattend after head injury. DESIGN--Retrospective study. SUBJECTS--606 patients who reattended a trauma unit after minor head injury. MAIN OUTCOME MEASURES--Intracranial abnormality detected on computed tomography or the need for neurosurgical intervention. RESULTS--Five patients died: two from unrelated causes and three from raised intracranial pressure. On multiple regression analysis the only significant predictor for both abnormality on computed tomography (14.4% of reattenders) and the need for operation (5% of reattenders) was vault fracture seen on the skull radiograph (P personality change, and seizures were significantly associated only with abnormality on computed tomography. Headache, dizziness, nausea, and vomiting were common in reattenders but were found to have no independent significance. CONCLUSIONS--All patients who reattend after head injury should undergo computed tomography as at least 14% of scans can be expected to yield positive results. Where this facility is not available patients with predictors for operation should be urgently referred for neurosurgical opinion. Other patients can be readmitted and need referral only if symptoms persist despite symptomatic treatment or there is neurological deterioration while under observation. These patients are a high risk group and should be treated seriously. PMID:8520273

Improving antenatal risk assessment in women exposed to high risks.

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Perry, Natasha; Newman, Louise K; Hunter, Mick; Dunlop, Adrian

2015-01-01

Antenatal substance use and related psychosocial risk factors are known to increase the likelihood of child protection involvement; less is known about the predictive nature of maternal reflective functioning (RF) in this population. This preliminary study assessed psychosocial and psychological risk factors for a group of substance dependent women exposed to high risks in pregnancy, and their impact on child protection involvement. Pregnant women on opiate substitution treatment (n = 11) and a comparison group (n = 15) were recruited during their third trimester to complete measures of RF (Pregnancy Interview), childhood trauma, mental health and psychosocial assessments. At postnatal follow-up, RF was reassessed (Parent Development Interview - Revised Short Version) and mother-infant dyads were videotaped to assess emotional availability (EA). Child protection services were contacted to determine if any concerns had been raised for infant safety. Significant between-group differences were observed for demographics, psychosocial factors, trauma and mental health symptoms. Unexpectedly, no significant differences were found for RF or EA between groups. Eight women in the 'exposed to high risks' group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, and therefore did not mediate the outcome of child protection involvement. Women 'exposed to high risks' were equally able to generate a model of their own and their infants' mental states and should not be seen within a deficit perspective. Further research is required to better understand the range of risk factors that predict child protection involvement in high risk groups. © The Author(s) 2013.

Sero-epidemiological study of Lyme disease among high-risk population groups in eastern Slovakia.

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Zákutná, Ľubica; Dorko, Erik; Mattová, Eva; Rimárová, Kvetoslava

2015-01-01

IIntroduction and objective. The aim of the presented cross-sectional sero-epidemiological study was to determine the current presence of antibodies against B. burgdorferi s.l. in the high-risk groups of the Slovak population, and to identify potential risk factors to LB infections. A group of 277 agricultural and forestry workers - persons with frequent stay in the countryside and employees of State Border and Customs Police - from years 2011-2012 in the Eastern Slovakia were examined in order to assess the seroprevalence of anti-Borrelia antibodies. Sera were screened by commercial enzyme-linked immunosorbent assay (ELISA). The study subjects completed a questionnaires with general demographic, epidemiological and clinical data. The results were evaluated statistically. A 25.3% presence of positive and 8.7% presence of borderline IgG antibodies was detected in all investigated groups. The seroprevalence of B. burgdorferi s.l. was significantly higher (P<0.05) among the agricultural and forestry workers when compared to employees of State Border and Customs Police. Higher seropositivity was observed in older subjects over 30 years of age (P=0.004) than those who were younger, and also in males (P=0.045). A significant number of persons with rheumatologic conditions was statistically higher (P=0.020) in the group with seropositivity than in the group with seronegativity. The presented study confirms the higher risk of Borrelia infection in individuals with frequent exposure to ticks in eastern Slovakia. The seropositivity tests confirmed the highest seropositivity in agriculture and forestry workers, middle positivity was confirmed among other sector workers, and lowest positivity in policemen and employees of the Customs and Border Inspection. The outputs also simultaneously filling the gap of missing seroprevalence data among these exposed groups.

A metaanalysis of perceptual organization in schizophrenia, schizotypy, and other high-risk groups based on variants of the Embedded Figures Task.

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Kirsten Rebecca Panton

2016-02-01

Full Text Available Current research on perceptual organization in schizophrenia frequently employs shapes with regularly sampled contours (fragmented stimuli, in noise fields composed of similar elements, to elicit visual abnormalities. However, perceptual organization is multi-factorial and, in earlier studies, continuous contours have also been employed in tasks assessing the ability to extract shapes from a background. We conducted a systematic review and meta-analysis of studies using closed-contour stimuli, including the Embedded Figures Test (EFT and related tasks, both in people with schizophrenia and in healthy schizotypes and relatives, considered at increased risk for psychosis. Eleven studies met the selection criteria for inclusion in the meta-analysis, including six that used a between-groups study design (i.e. perceptual organization abilities of schizophrenia/high-risk groups were compared to healthy or clinical controls, and five that treated schizophrenia symptoms or schizotypy traits and indices of perceptual organization as continuous variables. Effect sizes and heterogeneity statistics were calculated, and the risk of publication bias was explored. A significant, moderate effect for EFT performance was found with studies that compared performance of schizophrenia/high-risk groups to a healthy or patient comparison group (d = -.523, p<.001. However, significant heterogeneity was also found amongst the schizotypy, but not schizophrenia studies, as well as studies using accuracy, but not reaction time as a measure of performance. A non-significant correlation was found for the studies that examined schizophrenia symptoms or schizotypy traits as continuous variables (r = .012, p = .825. These results suggest that deficits in perceptual organization of non-fragmented stimuli are found when differences between schizophrenia/high-risk groups and comparison groups are maximized. These findings should motivate further investigation of perceptual

Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation

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Hyun-Soo Kim

2016-01-01

Full Text Available Objectives: The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. Methods: Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. Results: The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. Conclusions: It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation.

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Kim, Hyun-Soo; Lee, Moo-Sik; Hong, Jee-Young

2016-01-01

The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

Chronic bronchitis is an independently associated factor for more symptom and high-risk groups

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Choi JY

2016-06-01

Full Text Available Joon Young Choi,1 Hyoung Kyu Yoon,2 Seoung Ju Park,3 Yong Bum Park,4 Kyeong-Cheol Shin,5 Ju Ock Na,6 Kwang Ha Yoo,7 Ki-Suck Jung,8 Young Kyoon Kim,1 Chin Kook Rhee1 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 3Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, 4Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, 5Regional Center for Respiratory Disease, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 8Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Republic of Korea Background: The chronic bronchitis (CB phenotype has been associated with poor quality of life and an increased risk of disease in patients with COPD. However, little information exists regarding the relationship between the CB phenotype and the COPD assessment test (CAT score. The goal of this study was to reveal the different pattern of CAT scores between CB and non-CB patients. Moreover, we aimed to investigate whether the CB phenotype is an independently associated factor for more symptom and high-risk groups.Methods: Data were obtained from the Korea COPD Subgroup Study cohort recruited from 46 centers in South

Suicide among older psychiatric inpatients: an evidence-based study of a high risk group

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Erlangsen, Annette; Zarit, Steven H; Tu, Xin

2006-01-01

.1-0.3). In combination with other types of disorder, affective disorders were found to modify an increased risk of suicide. First versus later admission for depression was a better predictor for suicide than age at first hospitalization for depression (before or after age 60 years). More than half of suicides occurred......OBJECTIVE: Older adults have elevated suicide rates, especially in the presence of a psychiatric disorder, yet not much is known about predictors for suicide within this high-risk group. The current study examines the characteristics associated with suicide among older adults who are admitted...... to a psychiatric hospital. METHOD: All persons aged 60 and older living in Denmark who were hospitalized with psychiatric disorders during 1990-2000 were included in the study. Using a case-control design and logistic regression analysis, the authors calculated the suicide risk associated with specific patient...

The high-risk plaque initiative

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Falk, Erling; Sillesen, Henrik; Muntendam, Pieter

2011-01-01

The High-Risk Plaque (HRP) Initiative is a research and development effort to advance the understanding, recognition, and management of asymptomatic individuals at risk for a near-term atherothrombotic event such as myocardial infarction or stroke. Clinical studies using the newest technologies...... have been initiated, including the BioImage Study in which novel approaches are tested in a typical health plan population. Asymptomatic at-risk individuals were enrolled, including a survey-only group (n = 865), a group undergoing traditional risk factor scoring (n = 718), and a group in which all...

Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

International Nuclear Information System (INIS)

Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok

2001-01-01

To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

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Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

2001-04-01

To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

School-related risk factors for drunkenness among adolescents: risk factors differ between socio-economic groups

DEFF Research Database (Denmark)

Andersen, Anette; Holstein, Bjørn E; Due, Pernille

2006-01-01

Purpose: To examine, separately for boys and girls, whether socio-economic differences in drunkenness exist in adolescence, whether the level of exposure to school-related risk factors differ between socio-economic groups, and whether the relative contribution of school-related risk factors......) was measured by parental occupation. RESULTS: Among girls, exposures to school-related risk factors were more prevalent in lower socio-economic groups. Poor school satisfaction was associated with drunkenness among girls from high SEP, odds ratio (OR) = 2.98 (0.73-12.16). Among boys from high SEP autonomy...

Sports injuries: population based representative data on incidence, diagnosis, sequelae, and high risk groups.

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Schneider, S; Seither, B; Tönges, S; Schmitt, H

2006-04-01

To generate national representative data on the incidence, diagnosis, severity, and nature of medically treated sports injuries and to identify high risk groups. The first national health survey for the Federal Republic of Germany, conducted in the format of a standardised, written, cross sectional survey in the period October 1997 to March 1999, gathered data on the incidence of accident and injury and information on social demographics, injury related disability/time off work, and injury location/setting. The net sample comprised 7124 people aged 18-79. 3.1% of adult Germans said they sustained a sports injury during the previous year, corresponding to an annual injury rate of 5.6% among those engaging in regular recreational physical activity and ranking sports injuries as the second most common type of accident. About 62% of all sports injuries result in time taken off work. The period of occupational disability is 14 days or less in around two thirds of these cases. The occupational disability rate after occupational and traffic accidents is much higher by comparison. Dislocations, distortions, and/or torn ligaments make up 60% of all sports injuries, followed by fractures (18%), contusions, surface wounds, or open wounds (12%). Three out of four sports injury casualties are male. The incidence declines noticeably in higher age groups. Future injury prevention measures should focus on the high risk group of young male recreational athletes. The data indicate that the fear of damage to health and injury, believed to be significant internal psychological barriers to participation in sports, is largely unwarranted for the female population and/or older age groups. Sporting injuries are a marginal phenomenon among the female population and mobile seniors actively engaged in sports.

NEWBORNS OF HIGH RISK GROUPS AND ELECTROPHYSIOLOGICAL CARDIAC ACTIVITY DURING THE PERIOD OF EARLY ADAPTATION

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T. S. Tumaeva

2014-01-01

Full Text Available Aim: to study characteristics of electrophysiological cardiac activity in children of risk groups and to assess possibilities of Holter-electrocardiography (H-ECG in revealing of cardiac dysfunction during the period of early adaptation. Patients and methods: 250 newborns were examined. The main group consisted of 200 children with cerebral ischemia (CI. This group was divided into 2 subgroups: 100 full-term and 100 premature (at various gestation age infants. Control group contained 50 children born at 38–40th weeks of gestation with physiological course of pregnancy and delivery, APGAR score of 8–9 points. Complex examination included H-ECG according the standard technic with evaluation of the hearth rate (HR during sleep and wakefulness; HRmin, HRmax; arrhythmias, conductivity disorders, duration of the intervals; rhythm variability. Results: according to the ECG children with CI, especially premature ones, and children delivered via Cesarean section more often had ST-T disturbances, arrhythmias (sinus tachycardia, less often — sinus bradycardia and conductivity disorders, Q-Tc prolongation. H-EGC revealed decrease of sleep HR, HRmin and HRmax in children with CI especially in delivered via Cesarean section. The most common arrhythmia was supraventricular extrasystole.  Pauses in rhythms and variability were the highest in premature children delivered via Cesarean section. Conclusions: hypoxia/ischemia is a trigger for development of cardiovascular dysfuncion in newborns. Premature and children delivered via Cesarean section form a group of high risk. H-ECG widens possibilities of revealing of symptoms of cardiac dysfunction (disturbances at the basal level of functioning, of adaptation resources of the sinus node, electric instability of the myocardium and heart rate variability in children of risk group for development of cardiovascular disorders. 

An epidemiological study of diabetes mellitus amongst high risk age group population in urban and Rural areas of kanpur

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Nadeem Ahmad

2003-12-01

Full Text Available Research Question : - What is the magnitude of Diabetes mellitus in the urban and rural areas of Kanpur.Objectives:To study the prevalence of diabetes mellitus amongst high risk age group population in urban and rural areas of Kanpur.To compare the magnitude of problem of diabetes mellitus between urban and rural areas of Kanpur.To study the possible associates and socio-demographic variables related to diabetes mellitus.Study Design : Cross sectional study.Setting : The study was performed on three thousand population each in urban and rural areas of Kanpur.Participants : High risk age group population i.e. 45 years and above.Study variables : Age, Sex. impaired glucose tolerance. Body mass index, Education, Working status. Social class, family history of diabetes.Statistical analysis : Chi-square lest, percentagesResults From a total of 676 persons of high risk age group i.e. 45 years and above, the overall prevalence of diabetes mellitus in the study areas was observed lobe 7. l%with 9.94% in urban and 3.61% in rural areas, the maximum percetage of diabetes cases (41.66% was in the age group of 56-60 years. Higher prevalence of diabetes was observed in the obese (56.25% and sedentary (87.5% persons. The family history' of diabetes mellitus was present in (35.41% of diabetes mellitus cases.

A balanced hazard ratio for risk group evaluation from survival data.

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Branders, Samuel; Dupont, Pierre

2015-07-30

Common clinical studies assess the quality of prognostic factors, such as gene expression signatures, clinical variables or environmental factors, and cluster patients into various risk groups. Typical examples include cancer clinical trials where patients are clustered into high or low risk groups. Whenever applied to survival data analysis, such groups are intended to represent patients with similar survival odds and to select the most appropriate therapy accordingly. The relevance of such risk groups, and of the related prognostic factors, is typically assessed through the computation of a hazard ratio. We first stress three limitations of assessing risk groups through the hazard ratio: (1) it may promote the definition of arbitrarily unbalanced risk groups; (2) an apparently optimal group hazard ratio can be largely inconsistent with the p-value commonly associated to it; and (3) some marginal changes between risk group proportions may lead to highly different hazard ratio values. Those issues could lead to inappropriate comparisons between various prognostic factors. Next, we propose the balanced hazard ratio to solve those issues. This new performance metric keeps an intuitive interpretation and is as simple to compute. We also show how the balanced hazard ratio leads to a natural cut-off choice to define risk groups from continuous risk scores. The proposed methodology is validated through controlled experiments for which a prescribed cut-off value is defined by design. Further results are also reported on several cancer prognosis studies, and the proposed methodology could be applied more generally to assess the quality of any prognostic markers. Copyright © 2015 John Wiley & Sons, Ltd.

Client experiences with perinatal healthcare for high-risk and low-risk women

NARCIS (Netherlands)

van Stenus, Cherelle M.V.; Boere-Boonekamp, Magda M.; Kerkhof, Erna F.G.M.; Need, Ariana

2018-01-01

Problem: It is unknown if client experiences with perinatal healthcare differ between low-risk and high-risk women. Background: In the Netherlands, risk selection divides pregnant women into low- and high-risk groups. Receiving news that a pregnancy or childbirth has an increased likelihood of

Parent Training with High-Risk Immigrant Chinese Families: A Pilot Group Randomized Trial Yielding Practice-Based Evidence

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Lau, Anna S.; Fung, Joey J.; Ho, Lorinda Y.; Liu, Lisa L.; Gudino, Omar G.

2011-01-01

We studied the efficacy and implementation outcomes of a culturally responsive parent training (PT) program. Fifty-four Chinese American parents participated in a wait-list controlled group randomized trial (32 immediate treatment, 22 delayed treatment) of a 14-week intervention designed to address the needs of high-risk immigrant families.…

Zaire program expands to cover high-risk groups in two cities.

Science.gov (United States)

1989-01-01

This article announces the expansion of Zaire's social marketing program for condoms to high-risk groups in the cities of Goma and Matadi. The program will use proven marketing techniques from Kinshasha, printed materials, and direct marketing to retail outlets, emphasizing hotels, bars, and other areas frequented by prostitutes, migrants, and other travelers. In addition to retail outlets such as pharmacies, 50 taxis will be tested as additional retail sources for Prudence condoms. Once under way, this effort could reach as many as 96,000 people/day. 5 new AIDS information spots are being televised, and an anti-AIDS song and jingle are on the air. Condom social marketing representatives report a 357% increase in condom sales through March, 1989, over 1988, and that products are now available in 85% of Kinshasha pharmacies. Medical center coverage has increased to 14 from 9 zones, while products reach 11 additional cities and 5 interior provinces.

Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review

Science.gov (United States)

Abd ElHafeez, Samar; Bolignano, Davide; D’Arrigo, Graziella; Dounousi, Evangelia; Tripepi, Giovanni; Zoccali, Carmine

2018-01-01

Objectives While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent. Design, setting and participants We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis. Outcome measurement The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations. Results In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%–90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%–51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality). Conclusion In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies. PMID:29326180

Mom Power: preliminary outcomes of a group intervention to improve mental health and parenting among high-risk mothers.

Science.gov (United States)

Muzik, Maria; Rosenblum, Katherine L; Alfafara, Emily A; Schuster, Melisa M; Miller, Nicole M; Waddell, Rachel M; Stanton Kohler, Emily

2015-06-01

Maternal psychopathology and traumatic life experiences may adversely impact family functioning, the quality of the parent-child relationship and the attachment bond, placing the child's early social-emotional development at risk. Attachment-based parenting interventions may be particularly useful in decreasing negative outcomes for children exposed to risk contexts, yet high risk families frequently do not engage in programs to address mental health and/or parenting needs. This study evaluated the effects of Mom Power (MP), a 13-session parenting and self-care skills group program for high-risk mothers and their young children (age parenting competence, and engagement in treatment. Mothers were referred from community health providers for a phase 1 trial to assess feasibility, acceptability, and pilot outcomes. At baseline, many reported several identified risk factors, including trauma exposure, psychopathology, poverty, and single parenthood. Ninety-nine mother-child pairs were initially recruited into the MP program with 68 women completing and providing pre- and post-self-report measures assessing demographics and trauma history (pre-assessment only), maternal mental health (depression and post-traumatic stress disorder (PTSD)), parenting, and intervention satisfaction. Results indicate that MP participation was associated with reduction in depression, PTSD, and caregiving helplessness. A dose response relationship was evident in that, despite baseline equivalence, women who attended ≥70 % of the 10 groups (completers; N = 68) improved on parenting and mental health outcomes, in contrast to non-completers (N = 12). Effects were most pronounced for women with a mental health diagnosis at baseline. The intervention was perceived as helpful and user-friendly. Results indicate that MP is feasible, acceptable, and holds promise for improving maternal mental health and parenting competence among high-risk dyads. Further research is warranted to evaluate

Detection of high GS risk group prostate tumors by diffusion tensor imaging and logistic regression modelling.

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Ertas, Gokhan

2018-07-01

To assess the value of joint evaluation of diffusion tensor imaging (DTI) measures by using logistic regression modelling to detect high GS risk group prostate tumors. Fifty tumors imaged using DTI on a 3 T MRI device were analyzed. Regions of interests focusing on the center of tumor foci and noncancerous tissue on the maps of mean diffusivity (MD) and fractional anisotropy (FA) were used to extract the minimum, the maximum and the mean measures. Measure ratio was computed by dividing tumor measure by noncancerous tissue measure. Logistic regression models were fitted for all possible pair combinations of the measures using 5-fold cross validation. Systematic differences are present for all MD measures and also for all FA measures in distinguishing the high risk tumors [GS ≥ 7(4 + 3)] from the low risk tumors [GS ≤ 7(3 + 4)] (P Logistic regression modelling provides a favorable solution for the joint evaluations easily adoptable in clinical practice. Copyright © 2018 Elsevier Inc. All rights reserved.

A Policy Intervention Study to Identify High-Risk Groups to Prevent Industrial Accidents in Republic of Korea

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Kwan Hyung Yi

2016-09-01

Conclusion: The manufacturing industry, age over 50 years and workplaces with more than 50 employees showed a high severity level of occupational accidents. Male workers showed a higher severity level of occupational accidents than female workers. The employment period of < 3 years and newly hired workers with a relatively shorter working period are likely to have more occupational accidents than others. Overall, an industrial accident prevention policy must be established by concentrating all available resources and capacities of these high-risk groups.

Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review.

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Abd ElHafeez, Samar; Bolignano, Davide; D'Arrigo, Graziella; Dounousi, Evangelia; Tripepi, Giovanni; Zoccali, Carmine

2018-01-10

While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent. We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis. The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations. In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%-90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%-51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality). In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights

Gender-associated analysis of high-risk groups for mental health problems in law-enforcement officers

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Vitaliy Omelyanovich

2017-11-01

Full Text Available Background. Mental disorders prevention in specific professional groups is impossible without scientifically substantiated allocation of groups with increased neuropsychiatric and psychosomatic disorders risk. This fact indicates the need to study the gender, age and professional characteristics in law enforcement workers who already have problems with psychological adaptation. Methods and materials. The study involved 1630 law enforcement officers (1,301 men and 329 women who were evaluated with the Symptom Checklist-90-R (SCL-90-R. As the statistical methods were used the partial regression calculation coefficient η2, cohort calculation risk measures, φ*-total Fischer transformation method, and single-factor dispersion Fisher's analysis. Results. According to gender characteristics, the problems with psychological adaptation in men were significantly less pronounced than in women (φ*=1.79; p=0.37. These data were confirmed by the cohort calculation and risk measures results: men – 0.261, women – 0.349 (the psychological disadaptation risk in women was 1.3 times higher than men. There weren’t any statistically significant age differences between the representatives of both gender groups with psychological adaptation disturbances and healthy ones (φ* ≤1.19; p≥0.1. Among patients who suffered from psychosomatic diseases, were men over the age of 35 (φ* ≥2.28; p≤0.0001 and women over 26 years old (φ*= 2.16; p=0.014 prevailed. There were significantly fewer people among men with psychosomatic illnesses with 4-9 years of professional working experience than in a healthy group. On the contrary, there were significantly more patients in a law enforcement workers group with 10-15 years working experience than in the healthy one (φ*>1.73; p<0.0001. Conclusion. The risk of mental health problems in female police officers is much higher than in men. Disadaptation development is not related to the age and length of working

The clinical profile of high-risk mentally disordered offenders.

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Yiend, Jenny; Freestone, Mark; Vazquez-Montes, Maria; Holland, Josephine; Burns, Tom

2013-07-01

High-risk mentally disordered offenders present a diverse array of clinical characteristics. To contain and effectively treat this heterogeneous population requires a full understanding of the group's clinical profile. This study aimed to identify and validate clusters of clinically coherent profiles within one high-risk mentally disordered population in the UK. Latent class analysis (a statistical technique to identify clustering of variance from a set of categorical variables) was applied to 174 cases using clinical diagnostic information to identify the most parsimonious model of best fit. Validity analyses were performed. Three identified classes were a 'delinquent' group (n = 119) characterised by poor educational history, strong criminal careers and high recidivism risk; a 'primary psychopathy' group (n = 38) characterised by good educational profiles and homicide offences and an 'expressive psychopathy' group (n = 17) presenting the lowest risk and characterised by more special educational needs and sexual offences. Individuals classed as high-risk mentally disordered offenders can be loosely segregated into three discrete subtypes: 'delinquent', 'psychopathic' or 'expressive psychopathic', respectively. These groups represent different levels of risk to society and reflect differing treatment needs.

Continuous glucose monitoring system and new era of early diagnosis of diabetes in high risk groups

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Ashraf Soliman

2014-01-01

Full Text Available Continuous glucose monitoring (CGM systems are an emerging technology that allows frequent glucose measurements to monitor glucose trends in real time. Their use as a diagnostic tool is still developing and appears to be promising. Combining intermittent glucose self-monitoring (SGM and CGM combines the benefits of both. Significant improvement in the treatment modalities that may prevent the progress of prediabetes to diabetes have been achieved recently and dictates screening of high risk patients for early diagnosis and management of glycemic abnormalities. The use of CGMS in the diagnosis of early dysglycemia (prediabetes especially in high risk patients appears to be an attractive approach. In this review we searched the literature to investigate the value of using CGMS as a diagnostic tool compared to other known tools, namely oral glucose tolerance test (OGTT and measurement of glycated hemoglobin (HbA1C in high risk groups. Those categories of patients include adolescents and adults with obesity especially those with family history of type 2 diabetes mellitus, polycystic ovary syndrome (PCO, gestational diabetes, cystic fibrosis, thalassemia major, acute coronary syndrome (ACS, and after renal transplantation. It appears that the ability of the CGMS for frequently monitoring (every 5 min glucose changes during real-life settings for 3 to 5 days stretches the chance to detect more glycemic abnormalities during basal and postprandial conditions compared to other short-timed methods.

HIV prevalence by ethnic group covaries with prevalence of herpes simplex virus-2 and high-risk sex in Uganda: An ecological study.

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Kenyon, Chris R

2018-01-01

HIV prevalence varies from 1.7% to 14.8% between ethnic groups in Uganda. Understanding the factors responsible for this heterogeneity in HIV spread may guide prevention efforts. We evaluated the relationship between HIV prevalence by ethnic group and a range of risk factors as well as the prevalence of herpes simplex virus-2 (HSV-2), syphilis and symptomatic STIs in the 2004/2005 Uganda HIV/AIDS Sero-Behavioural Survey-a two stage, nationally representative, population based survey of 15-59-year-olds. Spearman's correlation was used to assess the relationship between HIV prevalence and each variable. There was a positive association between HIV prevalence and HSV-2, symptomatic STIs and high-risk sex (sex with a non-cohabiting, non-marital partner) for women. Non-significant positive associations were present between HIV and high-risk sex for men and lifetime number of partners for men and women. Variation in sexual behavior may contribute to the variations in HIV, HSV-2 and other STI prevalence by ethnic group in Uganda. Further work is necessary to delineate which combinations of risk factors determine differential STI spread in Uganda.

Screening in high-risk group of gestational diabetes mellitus with its maternal and fetal outcomes

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Angadi Rajasab Nilofer

2012-01-01

Full Text Available Background: Gestational diabetes mellitus (GDM is a metabolic disorder defined as glucose intolerance with the onset or first recognition during pregnancy. Women with GDM are at increased risk for adverse obstetric and perinatal outcome. The complications associated with GDM can be prevented by early recognition, intense monitoring and proper treatment. Aims: The present study was done to screen the high-risk pregnancy group for GDM, to find the incidence of abnormal results on screening and to correlate the abnormal results with the maternal and fetal outcomes. The study was done in a tertiary care hospital and teaching institute. It was a prospective cohort study. Materials and Methods: Selective screening for GDM was done in 150 pregnant women with high-risk factors. Screening was done with 50 g glucose challenge test (GCT after 18 weeks, and if GCT was negative then the test was repeated after 28 weeks of pregnancy. The patients who were having an abnormal GCT were subjected to 100 g oral glucose tolerance test (OGTT. All GDM patients were followed up and treated with diet and/or insulin therapy till delivery to know maternal and fetal outcomes. The period of study was from April 2008 to March 2009. Results: 7.3% of study population was OGCT positive. 6% of the study population was OGTT positive. Age >25 years, obesity, family history of DM, and past history of GDM were the risk factors significantly associated with GDM. One newborn had hypoglycemia and one had hyperbilirubinemia. The fetal and maternal outcome in GDM patients was good in our study due to early diagnosis and intervention. Conclusion: Women with GDM are at an increased risk for adverse obstetric and perinatal outcome. The increased morbidity in GDM is preventable by meticulous antenatal care.

Psychological characteristics in high-risk MSM in China

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Chen Guanzhi

2012-01-01

Full Text Available Abstract Background Men who have sex with men (MSM have become a high-risk group of HIV infection in China. To date, little is known regarding the behavioral, social and psychological characteristics in Chinese MSM, which makes the implementation of preventive and therapeutic strategies for this high-risk subpopulation of people extremely difficult. Methods A total of 714 questionnaires were retrieved from the database of a Chinese government-sponsored National Key Research Project titled "Risk Analysis and Strategic Prevention of HIV Transmission from MSM to the General Population in China". The respondents were categorized into a high-risk group and a control group. Their behavioral, social and psychological characteristics were comparatively analyzed. Results Of the 714 MSM analyzed, 59 (8.26% had high-risk homosexual behaviors. This sub-group of MSM had a higher in-marriage rate, a higher monthly income, heavier alcohol consumption and more serious problems with sexual abuse in childhood, intentional suicide attempts and mistaken assumption on condom's role in protecting HIV infection, as compared with the control group (P P > 0.05. A vast majority of the individuals in both behavior categories expressed support of legally protected gay clubs as well as gay marriage legislation in China. There was a strong correlation between high-risk behaviors and sexual abuse in childhood, alcohol drinking, income level and a mistaken belief in perfect HIV protection through the use of condoms. Conclusions MSM with and without high-risk homosexual behaviors have different social and psychological characteristics, which should be taken into account when implementing behavioral and therapeutic interventions aimed at preventing HIV/AIDS transmission among MSM as well as from MSM to the general population in China.

Hepatitis C infection in risk groups

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Sead Ahmetagić

2006-11-01

Full Text Available Hepatitis C infection is important global health problem with wide spectrum of health, social and economic consequences. The goal of this research was to estimate prevalence of hepatitis C virus infection in risk groups, and to determine association hepatitis C virus (HCV infection and risk factors. Research included 4627 subjects divided in two groups. Test group included 2627 subjects divided in 4 subgroups with risk for HCV infection: those who received blood transfusion without screening on HCV (it was introduced in 1995 (700; intravenous drug users (60; patients on hemodialysis (168 and health care workers (1699. Control group included 2000 healthy volunteer blood donors. In all subjects anti-HCV antibodies were tested with third generation ELISA test. Positive serum samples were tested for presence of HCVRNA, using reaction of reverse transcription and polymerase chain reaction. In all anti-HCV positive subjects further epidemiological and clinical workup was performed. Prevalence of HCV infection in risk groups was: 4.6% in subjects who have received blood transfusions without HCV blood screening, 35% in intravenous drug users, 58.9% in patients on chronic dialysis, and 0.4% in health care workers. In control group prevalence was low (0.2%. In the group of 158 anti-HCV positive subjects, 73.4% had HCVRNA. The largest number of subjects with HCV infection was in the age group of 30-49 years (45.8%. This study showed that multiple blood transfusions before introducing the blood screening for HCV, longer duration of intravenous drug abuse, longer duration of hemodialysis treatment, larger number of accidental injuries in health care workers are independent and statistically significant risk factors for those groups examined. Results of this study confirm that general screening for HCV infection is recommended in risk groups for HCV infection in order to identify to prevent and to treat it.

Factors Influencing Cancer Risk Perception in High Risk Populations: A Systematic Review

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2011-01-01

Background Patients at higher than average risk of heritable cancer may process risk information differently than the general population. However, little is known about clinical, demographic, or psychosocial predictors that may impact risk perception in these groups. The objective of this study was to characterize factors associated with perceived risk of developing cancer in groups at high risk for cancer based on genetics or family history. Methods We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, and Scopus from inception through April 2009 for English-language, original investigations in humans using core concepts of "risk" and "cancer." We abstracted key information and then further restricted articles dealing with perceived risk of developing cancer due to inherited risk. Results Of 1028 titles identified, 53 articles met our criteria. Most (92%) used an observational design and focused on women (70%) with a family history of or contemplating genetic testing for breast cancer. Of the 53 studies, 36 focused on patients who had not had genetic testing for cancer risk, 17 included studies of patients who had undergone genetic testing for cancer risk. Family history of cancer, previous prophylactic tests and treatments, and younger age were associated with cancer risk perception. In addition, beliefs about the preventability and severity of cancer, personality factors such as "monitoring" personality, the ability to process numerical information, as well as distress/worry also were associated with cancer risk perception. Few studies addressed non-breast cancer or risk perception in specific demographic groups (e.g. elderly or minority groups) and few employed theory-driven analytic strategies to decipher interrelationships of factors. Conclusions Several factors influence cancer risk perception in patients at elevated risk for cancer. The science of characterizing and improving risk perception in cancer for high risk groups, although evolving, is still

Factors Influencing Cancer Risk Perception in High Risk Populations: A Systematic Review

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Tilburt Jon C

2011-05-01

Full Text Available Abstract Background Patients at higher than average risk of heritable cancer may process risk information differently than the general population. However, little is known about clinical, demographic, or psychosocial predictors that may impact risk perception in these groups. The objective of this study was to characterize factors associated with perceived risk of developing cancer in groups at high risk for cancer based on genetics or family history. Methods We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, and Scopus from inception through April 2009 for English-language, original investigations in humans using core concepts of "risk" and "cancer." We abstracted key information and then further restricted articles dealing with perceived risk of developing cancer due to inherited risk. Results Of 1028 titles identified, 53 articles met our criteria. Most (92% used an observational design and focused on women (70% with a family history of or contemplating genetic testing for breast cancer. Of the 53 studies, 36 focused on patients who had not had genetic testing for cancer risk, 17 included studies of patients who had undergone genetic testing for cancer risk. Family history of cancer, previous prophylactic tests and treatments, and younger age were associated with cancer risk perception. In addition, beliefs about the preventability and severity of cancer, personality factors such as "monitoring" personality, the ability to process numerical information, as well as distress/worry also were associated with cancer risk perception. Few studies addressed non-breast cancer or risk perception in specific demographic groups (e.g. elderly or minority groups and few employed theory-driven analytic strategies to decipher interrelationships of factors. Conclusions Several factors influence cancer risk perception in patients at elevated risk for cancer. The science of characterizing and improving risk perception in cancer for high risk groups, although

Raising awareness of carrier testing for hereditary haemoglobinopathies in high-risk ethnic groups in the Netherlands: a pilot study among the general public and primary care providers

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Cornel Martina C

2009-09-01

Full Text Available Abstract Background In the Netherlands no formal recommendations exist concerning preconceptional or antenatal testing for carriership of hereditary haemoglobinopathies. Those at highest risk may be unaware of the possibility of carrier screening. While universal newborn screening has recently been introduced, neither preconceptional nor antenatal carrier testing is routinely offered by health care services to the general public. A municipal health service and a foundation for public information on medical genetics undertook a pilot project with the aim of increasing knowledge and encouraging informed choice. Two groups were targeted: members of the public from ethnic groups at increased risk, and primary health care providers. This study examines the effectiveness of culturally specific 'infotainment' to inform high-risk ethnic groups about their increased risk for haemoglobinopathies. In addition, the study explores attitudes and intentions of primary care providers towards haemoglobinopathy carrier testing of their patients from high-risk ethnic groups. Methods Informational sessions tailored to the public or professionals were organised in Amsterdam, and evaluated for their effect. Psychological parameters were measured using structured questionnaires based on the Theory of Planned Behaviour. Results The pre-test/post-test questionnaire showed that members of the public gained understanding of inheritance and carriership of haemoglobinopathies from the "infotainment" session (p Conclusion The "infotainment" programme may have a positive effect on people from high-risk groups, but informed general practitioners and midwives were reluctant to facilitate their patients' getting tested. Additional initiatives are needed to motivate primary care providers to facilitate haemoglobinopathy carrier testing for their patients from high-risk backgrounds.

A Policy Intervention Study to Identify High-Risk Groups to Prevent Industrial Accidents in Republic of Korea.

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Yi, Kwan Hyung; Lee, Seung Soo

2016-09-01

The objective of this study is to identify high-risk groups for industrial accidents by setting up 2003 as the base year and conducting an in-depth analysis of the trends of major industrial accident indexes the index of industrial accident rate, the index of occupational injury rate, the index of occupational illness and disease rate per 10,000 people, and the index of occupational injury fatality rate per 10,000 people for the past 10 years. This study selected industrial accident victims, who died or received more than 4 days of medical care benefits, due to occupational accidents and diseases occurring at workplaces, subject to the Industrial Accident Compensation Insurance Act, as the study population. According to the trends of four major indexes by workplace characteristics, the whole industry has shown a decreasing tendency in all four major indexes since the base year (2003); as of 2012, the index of industrial accident rate was 67, while the index of occupational injury fatality rate per 10,000 people was 59. The manufacturing industry, age over 50 years and workplaces with more than 50 employees showed a high severity level of occupational accidents. Male workers showed a higher severity level of occupational accidents than female workers. The employment period of working period are likely to have more occupational accidents than others. Overall, an industrial accident prevention policy must be established by concentrating all available resources and capacities of these high-risk groups.

Brucellosis in a high risk occupational group: sero prevalence and analysis of risk factors

International Nuclear Information System (INIS)

Mukhtar, F.

2010-01-01

Objectives: To estimate Brucella sero positivity among slaughterhouse workers of Lahore district and to elucidate risk factors associated with sero positivity to Brucella. Method: During the year 2008, a cross-sectional study was conducted in four slaughterhouses of Lahore district. A sample of 360 workers was selected from these slaughterhouses through stratified random sampling on proportional basis. Workers were interviewed using a structured questionnaire to obtain risk factor information and their blood samples were collected to be screened for the presence of anti-Brucella IgG using Enzyme Linked Immunosorbent Assay (ELISA) technique. Data management and analysis were performed using SPSS (statistical package for social sciences) version 16. Risk factors associated with sero positivity to anti-Brucella IgG were identified by constructing a logistic regression model. Results: Of the 360 serum samples tested, 21.7% (95% CI 17.44% - 25.96%) were positive by ELISA test. The logistic regression model identified age (OR 0.96, 95% CI 0.94-0.99), assistance in parturition of animal (OR 0.47, 95% CI 0.23-0.96), consuming raw milk (OR 2.25, 95% CI 1.04-4.87) and handling sheep (OR 0.30, 95% CI 0.09- 0.92) as risk factors for Brucella sero positivity among slaughterhouse workers of Lahore district. Conclusion: To reduce the burden of brucellosis, a national brucellosis control programme should be initiated with special emphasis on the high risk population of slaughterhouse workers. (author)

Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groups.

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Huang, Hsiang; Chan, Ya-Fen; Katon, Wayne; Tabb, Karen; Sieu, Nida; Bauer, Amy M; Wasse, Jessica Knaster; Unützer, Jürgen

2012-08-01

PURPOSE. To examine variations in depression care and outcomes among high-risk pregnant and parenting women from different racial/ethnic groups served in community health centres. As part of a collaborative care programme that provides depression treatment in primary care clinics for high-risk mothers, 661 women with probable depression (Patient Health Questionnaire-9 ≥ 10), who self-reported race/ethnicity as Latina (n = 393), White (n = 126), Black (n = 75) or Asian (n = 67), were included in the study. Primary outcomes include quality of depression care and improvement in depression. A Cox proportional hazard model adjusting for sociodemographic and clinical characteristics was used to examine time to treatment response. We observed significant differences in both depression processes and outcomes across ethnic groups. After adjusting for other variables, Blacks were found to be significantly less likely to improve than Latinas [hazard ratio (HR): 0.53, 95% confidence interval (CI): 0.44-0.65]. Other factors significantly associated with depression improvement were pregnancy (HR: 1.52, 95% CI: 1.27-1.82), number of clinic visits (HR: 1.26, 95% CI: 1.17-1.36) and phone contacts (HR: 1.45, 95% CI: 1.32-1.60) by the care manager in the first month of treatment. After controlling for depression severity, having suicidal thoughts at baseline was significantly associated with a decreased likelihood of depression improvement (HR: 0.75, 95% CI: 0.67-0.83). In this racially and ethnically diverse sample of pregnant and parenting women treated for depression in primary care, the intensity of care management was positively associated with improved depression. There was also appreciable variation in depression outcomes between Latina and Black patients.

A newly identified group of adolescents at "invisible" risk for psychopathology and suicidal behavior: findings from the SEYLE study.

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Carli, Vladimir; Hoven, Christina W; Wasserman, Camilla; Chiesa, Flaminia; Guffanti, Guia; Sarchiapone, Marco; Apter, Alan; Balazs, Judit; Brunner, Romuald; Corcoran, Paul; Cosman, Doina; Haring, Christian; Iosue, Miriam; Kaess, Michael; Kahn, Jean Pierre; Keeley, Helen; Postuvan, Vita; Saiz, Pilar; Varnik, Airi; Wasserman, Danuta

2014-02-01

This study explored the prevalence of risk behaviors (excessive alcohol use, illegal drug use, heavy smoking, reduced sleep, overweight, underweight, sedentary behavior, high use of Internet/TV/videogames for reasons not related to school or work, and truancy), and their association with psychopathology and self-destructive behaviors, in a sample of 12,395 adolescents recruited in randomly selected schools across 11 European countries. Latent class analysis identified three groups of adolescents: a low-risk group (57.8%) including pupils with low or very low frequency of risk behaviors; a high-risk group (13.2%) including pupils who scored high on all risk behaviors, and a third group ("invisible" risk, 29%) including pupils who were positive for high use of Internet/TV/videogames for reasons not related to school or work, sedentary behavior and reduced sleep. Pupils in the "invisible" risk group, compared with the high-risk group, had a similar prevalence of suicidal thoughts (42.2% vs. 44%), anxiety (8% vs. 9.2%), subthreshold depression (33.2% vs. 34%) and depression (13.4% vs. 14.7%). The prevalence of suicide attempts was 5.9% in the "invisible" group, 10.1% in the high-risk group and 1.7% in the low-risk group. The prevalence of all risk behaviors increased with age and most of them were significantly more frequent among boys. Girls were significantly more likely to experience internalizing (emotional) psychiatric symptoms. The "invisible" group may represent an important new intervention target group for potentially reducing psychopathology and other untoward outcomes in adolescence, including suicidal behavior. Copyright © 2014 World Psychiatric Association.

Screening for TB by sputum culture in high-risk groups in Copenhagen, Denmark

DEFF Research Database (Denmark)

Jensen, Sidse Graff; Wrona Olsen, Nete; Seersholm, Niels

2015-01-01

. METHODS: On seven occasions, from September 2012 through June 2014, we offered TB screening to all persons present at 11 locations where socially marginalised people gather in Copenhagen. Spot sputum samples from participants were examined by smear microscopy and culture. Genotype, nucleic acid......INTRODUCTION: Evidence on screening high-risk groups for TB by mobile X-ray in low-incidence countries is building, but knowledge on other possible screening methods is limited. In this retrospective study we report results from a community based programme screening for TB by spot sputum culture...... amplification test and chest X-ray were done if TB was found. RESULTS: Among 1075 participants, we identified 36 cases of TB. Twenty-four cases (66.7%) were identified at the first screening of each participant, that is, the prevalence of TB was 2233/100 000. Thirty-five (97%) of the TB cases were culture...

High risk of non-sentinel node metastases in a group of breast cancer patients with micrometastases in the sentinel node.

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Tvedskov, Tove Filtenborg; Jensen, Maj-Britt; Lisse, Ida Marie; Ejlertsen, Bent; Balslev, Eva; Kroman, Niels

2012-11-15

Axillary lymph node dissection (ALND) in breast cancer patients with positive sentinel nodes is under debate. We aimed to establish two models to predict non-sentinel node (NSN) metastases in patients with micrometastases or isolated tumor cells (ITC) in sentinel nodes, to guide the decision for ALND. A total of 1,577 breast cancer patients with micrometastases and 304 with ITC in sentinel nodes, treated by sentinel lymph node dissection and ALND in 2002-2008 were identified in the Danish Breast Cancer Cooperative Group database. Risk of NSN metastases was calculated according to clinicopathological variables in a logistic regression analysis. We identified tumor size, proportion of positive sentinel nodes, lymphovascular invasion, hormone receptor status and location of tumor in upper lateral quadrant of the breast as risk factors for NSN metastases in patients with micrometastases. A model based on these risk factors identified 5% of patients with a risk of NSN metastases on nearly 40%. The model was however unable to identify a subgroup of patients with a very low risk of NSN metastases. Among patients with ITC, we identified tumor size, age and proportion of positive sentinel nodes as risk factors. A model based on these risk factors identified 32% of patients with risk of NSN metastases on only 2%. Omission of ALND would be acceptable in this group of patients. In contrast, ALND may still be beneficial in the subgroup of patients with micrometastases and a high risk of NSN metastases. Copyright © 2012 UICC.

Raising awareness of carrier testing for hereditary haemoglobinopathies in high-risk ethnic groups in the Netherlands: a pilot study among the general public and primary care providers.

Science.gov (United States)

Weinreich, Stephanie S; de Lange-de Klerk, Elly Sm; Rijmen, Frank; Cornel, Martina C; de Kinderen, Marja; Plass, Anne Marie C

2009-09-15

In the Netherlands no formal recommendations exist concerning preconceptional or antenatal testing for carriership of hereditary haemoglobinopathies. Those at highest risk may be unaware of the possibility of carrier screening. While universal newborn screening has recently been introduced, neither preconceptional nor antenatal carrier testing is routinely offered by health care services to the general public. A municipal health service and a foundation for public information on medical genetics undertook a pilot project with the aim of increasing knowledge and encouraging informed choice. Two groups were targeted: members of the public from ethnic groups at increased risk, and primary health care providers. This study examines the effectiveness of culturally specific 'infotainment' to inform high-risk ethnic groups about their increased risk for haemoglobinopathies. In addition, the study explores attitudes and intentions of primary care providers towards haemoglobinopathy carrier testing of their patients from high-risk ethnic groups. Informational sessions tailored to the public or professionals were organised in Amsterdam, and evaluated for their effect. Psychological parameters were measured using structured questionnaires based on the Theory of Planned Behaviour. The pre-test/post-test questionnaire showed that members of the public gained understanding of inheritance and carriership of haemoglobinopathies from the "infotainment" session (p Perceived behavioural control, i.e. the feeling that they could actually get tested if they wanted to, increased in the targeted age group of 18-45 years (N = 41; p ethnic groups was positive, yet they did not show strong intention to effectuate carrier testing of their patients on the basis of ethnicity. The main factor which explained their (lack of) intention was social norm, i.e. their perception of negative peer opinion (41% variance explained). The majority of primary health care providers felt that policy change was

CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY

DEFF Research Database (Denmark)

Elenius Madsen, Daniel

2012-01-01

Title: CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY Objectives: Orthognathic surgery involves surgical manipulation of jaw and face skeletal structure. A subgroup of patients undergoing orthognathic surgery suffers from excessive...... into account the complex interplay between coagulation factors, blood platelets and components of the fibrinolytic system. Patients undergoing orthognathic surgery were included in this prospective study, and their preoperative thrombelastographic data were collected and compared to their intraoperative blood...... predictive values. An α angleex above 67o did with 95% certainty predict a blood loss below 400 mL, and a receiver-operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.8. Conclusion: By means of the α angleex it is possible to separate orthognathic surgery patients according...

Attitudes and beliefs among high- and low-risk population groups towards β-thalassemia prevention: a cross-sectional descriptive study from India.

Science.gov (United States)

Chawla, Swati; Singh, Rajnish Kumar; Lakkakula, Bhaskar V K S; Vadlamudi, Raghavendra Rao

2017-07-01

β-thalassemia is an autosomal recessive blood disorder caused by gene mutations that affect all aspects of β-globin production. In majority of Asian countries including India, the frequency of β-thalassemia is closely intertwined with social, cultural, and religious issues of the respective country. Several national level screening programs imparted education regarding β-thalassemia, but follow-up evaluation revealed that education was not effective. It has been hypothesized that the beliefs and attitudes, carrier screening, and education among "high risk communities" will have far-reaching implications towards β-thalassemia prevention in the country. The present study is aimed to investigate attitudes, intention, and behavior of β-thalassemia high- and low-risk ethnic groups towards carrier screening and education. A structured questionnaire on knowledge, attitude, and practice regarding β-thalassemia was administered on 926 individuals belong to Arora, a high-risk ethnic group for β-thalassemia (347 rural (AR) and 202 urban (AU)) and 377 cosmopolitan commoners (CC) aged above 18 years of both sexes. To understand the relationship between various questions, Pearson's correlation test and factor analysis was performed. The responses were further categorized into the theory of planned behavior (TPB) constructs with the measures of the main constructs reported as a mean. Various dimensions of knowledge, attitude, and practice reveal that the urban groups (AU and CC) are better aware of the disease "β-thalassemia" than the rural group (AR) who witness suffering at close quarters. The AR group is more positive for preventive measures than the urban groups. Significant correlations and factor analysis show "intentions" for premarital and prenatal screening highly loaded as outcome behaviors. The Ajzen's "Theory of planned behavior" support that the "intention" and "perceived behavior control" are better predictors of "outcome behavior" compared to "attitude

7 CFR 407.17 - Group risk plan for wheat.

Science.gov (United States)

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Group risk plan for wheat. 407.17 Section 407.17..., DEPARTMENT OF AGRICULTURE GROUP RISK PLAN OF INSURANCE REGULATIONS § 407.17 Group risk plan for wheat. The provisions of the Group Risk Plan for Wheat for the 2000 and succeeding crop years are as follows: 1...

7 CFR 407.11 - Group risk plan for corn.

Science.gov (United States)

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Group risk plan for corn. 407.11 Section 407.11..., DEPARTMENT OF AGRICULTURE GROUP RISK PLAN OF INSURANCE REGULATIONS § 407.11 Group risk plan for corn. The provisions of the Group Risk Plan for Corn for the 2000 and succeeding crop years are as follows: 1...

A newly identified group of adolescents at “invisible” risk for psychopathology and suicidal behavior: findings from the SEYLE study

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Carli, Vladimir; Hoven, Christina W; Wasserman, Camilla; Chiesa, Flaminia; Guffanti, Guia; Sarchiapone, Marco; Apter, Alan; Balazs, Judit; Brunner, Romuald; Corcoran, Paul; Cosman, Doina; Haring, Christian; Iosue, Miriam; Kaess, Michael; Kahn, Jean Pierre; Keeley, Helen; Postuvan, Vita; Saiz, Pilar; Varnik, Airi; Wasserman, Danuta

2014-01-01

This study explored the prevalence of risk behaviors (excessive alcohol use, illegal drug use, heavy smoking, reduced sleep, overweight, underweight, sedentary behavior, high use of Internet/TV/videogames for reasons not related to school or work, and truancy), and their association with psychopathology and self-destructive behaviors, in a sample of 12,395 adolescents recruited in randomly selected schools across 11 European countries. Latent class analysis identified three groups of adolescents: a low-risk group (57.8%) including pupils with low or very low frequency of risk behaviors; a high-risk group (13.2%) including pupils who scored high on all risk behaviors, and a third group (“invisible” risk, 29%) including pupils who were positive for high use of Internet/TV/videogames for reasons not related to school or work, sedentary behavior and reduced sleep. Pupils in the “invisible” risk group, compared with the high-risk group, had a similar prevalence of suicidal thoughts (42.2% vs. 44%), anxiety (8% vs. 9.2%), subthreshold depression (33.2% vs. 34%) and depression (13.4% vs. 14.7%). The prevalence of suicide attempts was 5.9% in the “invisible” group, 10.1% in the high-risk group and 1.7% in the low-risk group. The prevalence of all risk behaviors increased with age and most of them were significantly more frequent among boys. Girls were significantly more likely to experience internalizing (emotional) psychiatric symptoms. The “invisible” group may represent an important new intervention target group for potentially reducing psychopathology and other untoward outcomes in adolescence, including suicidal behavior. PMID:24497256

Excessive infant crying: Definitions determine risk groups

NARCIS (Netherlands)

Reijneveld, S.A.; Brugman, E.; Hirasing, R.A.

2002-01-01

We assessed risk groups for excessive infant crying using 10 published definitions, in 3179 children aged 1-6 months (response: 96.5%). Risk groups regarding parental employment, living area, lifestyle, and obstetric history varied by definition. This may explain the existence of conflicting

Did our current initial treatment practice change after EAU/ESPU vesicoureteral reflux risk grouping?

Science.gov (United States)

Tokat, Eda; Gurocak, Serhat; Ure, Iyimser; Acar, Cenk; Sınık, Zafer; Tan, Mustafa Ozgur

2018-06-02

The "European Association of Urology (EAU) Guidelines on Vesicoureteral Reflux (VUR) in Children (September 2012)" established risk classification by analyzing and defining risk factors for each patient. In this study we aimed to investigate how our initial treatment procedures were affected by EAU/ESPU guideline vesicoureteral reflux risk grouping and to compare the early clinical results of treatments performed before and after the risk classification in our patients with VUR. 334 renal units with regular clinical follow-up who were treated owing to VUR (vesicoureteral reflux) between years 2009 and 2017 were retrospectively reviewed. Preoperative clinical parameters such as grade and laterality of reflux, presence of renal scar, initial and follow-up treatments, findings of medical treatment and surgical procedures were analyzed. The initial medical and surgical methods were compared by categorizing patients according to risk groups before and after 2013. Mean age and follow-up duration were 71.4(6-216) months and 47(4-141) months, respectively. Among the preoperative parameters, only high EAU risk group (p = 0.01) and treating lower urinary tract symptoms (p age, sex, and presence of renal scar at DMSA were not affecting the success of treatment significantly. While no significant difference in medical and surgical treatment rates is observed after risk grouping system in low risk group, the percentages of patients who are treated with surgical methods initially were significantly decreased in moderate and high risk groups (p = 0.002 and p = 0.012, respectively). We determined that VUR risk grouping did not change clinical success significantly in all risk groups. Despite the fact that EAU/ESPU VUR risk classification changed our current practice in terms of initial treatment method, this different approach did not seem to affect early clinical success positively. There is still an absolute need for studies with larger sample size and long

ABO blood group and risk of cancer

DEFF Research Database (Denmark)

Vasan, Senthil K; Hwang, Jinseub; Rostgaard, Klaus

2016-01-01

groups and site-specific cancer risk in a large cohort of healthy blood donors from Sweden and Denmark. RESULTS: A total of 1.6 million donors were followed over 27 million person-years (20 million in Sweden and 7 million in Denmark). We observed 119,584 cancer cases. Blood groups A, AB and B were......INTRODUCTION: The associations between ABO blood group and cancer risk have been studied repeatedly, but results have been variable. Consistent associations have only been reported for pancreatic and gastric cancers. MATERIALS AND METHODS: We estimated associations between different ABO blood...... associated either with increased or decreased risk of cancer at 13 anatomical sites (p≤0.05), compared to blood group O. Consistent with assessment using a false discovery rate approach, significant associations with ABO blood group were observed for cancer of the pancreas, breast, and upper gastrointestinal...

Biomarkers of Tobacco Smoke Exposure in Racial/Ethnic Groups at High Risk for Lung Cancer

Science.gov (United States)

Moolchan, Eric T.; Pokhrel, Pallav; Herzog, Thaddeus; Cassel, Kevin D.; Pagano, Ian; Franke, Adrian A.; Kaholokula, Joseph Keawe’aimoku; Sy, Angela; Alexander, Linda A.; Trinidad, Dennis R.; Sakuma, Kari-Lyn; Johnson, C. Anderson; Antonio, Alyssa; Jorgensen, Dorothy; Lynch, Tania; Kawamoto, Crissy; Clanton, Mark S.

2015-01-01

Objectives. We examined biomarkers of tobacco smoke exposure among Native Hawaiians, Filipinos, and Whites, groups that have different lung cancer risk. Methods. We collected survey data and height, weight, saliva, and carbon monoxide (CO) levels from a sample of daily smokers aged 18–35 (n = 179). Mean measures of nicotine, cotinine, cotinine/cigarettes per day ratio, trans 3′ hydroxycotinine, the nicotine metabolite ratio (NMR), and expired CO were compared among racial/ethnic groups. Results. The geometric means for cotinine, the cotinine/cigarettes per day ratio, and CO did not significantly differ among racial/ethnic groups in the adjusted models. After adjusting for gender, body mass index, menthol smoking, Hispanic ethnicity, and number of cigarettes smoked per day, the NMR was significantly higher among Whites than among Native Hawaiians and Filipinos (NMR = 0.33, 0.20, 0.19, P ≤ .001). The NMR increased with increasing White parental ancestry. The NMR was not significantly correlated with social–environmental stressors. Conclusions. Racial/ethnic groups with higher rates of lung cancer had slower nicotine metabolism than Whites. The complex relationship between lung cancer risk and nicotine metabolism among racial/ethnic groups needs further clarification. PMID:25880962

Long-term survival in pre-specified groups at risk in the Oslo Study, 1972-1973.

Science.gov (United States)

Holme, Ingar

2015-03-01

Using the Oslo Study of 1972-1973, we wished to compare the long-term mortality pattern up to 40 years, in both the healthy cardiovascular groups at supposedly high and low risk, and in some groups having cardiovascular disease at screening. At the screening, 16,203 (63% of those invited) men aged 40-49 years participated. Study groups were identified by means of questionnaires regarding diseases, blood pressure and measurements of total cholesterol, triglycerides and glucose. We identified six groups: very high cholesterol, very high blood pressure, very high glucose, non-smoking with non-elevated such risk factors, from a randomized diet and antismoking trial, and a randomized drug treatment in mild-to-moderate hypertension. Statistical analyses were by Cox regression analysis, with Kaplan-Meier graphs. The supposedly low-risk group had a total mortality of one-third of other groups, such as: men with hypertension, diabetes or hypercholesterolemia, or those whom participated in the two trials. Between these latter groups, we found 2-5 years of difference in their median survival time, but their absolute risk stayed at rather high levels through all the years, with the median remaining a lifetime that was 3-8 years shorter than the men whom were free of known cardiovascular disease, diabetes or hypertension. The long-term preventive effects on total mortality seem large, if the levels of the classical risk factors of blood pressure, total cholesterol and glucose can be adequately controlled, concurrently with a non-smoking behavior. The study indicated that non-smoking and a low total cholesterol value were the most important contributors to extended survival. © 2015 the Nordic Societies of Public Health.

Modified risk stratification grouping using standard clinical and biopsy information for patients undergoing radical prostatectomy: Results from SEARCH.

Science.gov (United States)

Zumsteg, Zachary S; Chen, Zinan; Howard, Lauren E; Amling, Christopher L; Aronson, William J; Cooperberg, Matthew R; Kane, Christopher J; Terris, Martha K; Spratt, Daniel E; Sandler, Howard M; Freedland, Stephen J

2017-12-01

Prostate cancer is a heterogeneous disease, and risk stratification systems have been proposed to guide treatment decisions. However, significant heterogeneity remains for those with unfavorable-risk disease. This study included 3335 patients undergoing radical prostatectomy without adjuvant radiotherapy in the SEARCH database. High-risk patients were dichotomized into standard and very high-risk (VHR) groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), number of NCCN high-risk factors, and stage T3b-T4 disease. Similarly, intermediate-risk prostate cancer was separated into favorable and unfavorable groups based on primary Gleason pattern, PPBC, and number of NCCN intermediate-risk factors. Median follow-up was 78 months. Patients with VHR prostate cancer had significantly worse PSA relapse-free survival (PSA-RFS, P < 0.001), distant metastasis (DM, P = 0.004), and prostate cancer-specific mortality (PCSM, P = 0.015) in comparison to standard high-risk (SHR) patients in multivariable analyses. By contrast, there was no significant difference in PSA-RFS, DM, or PCSM between SHR and unfavorable intermediate-risk (UIR) patients. Therefore, we propose a novel risk stratification system: Group 1 (low-risk), Group 2 (favorable intermediate-risk), Group 3 (UIR and SHR), and Group 4 (VHR). The c-index of this new grouping was 0.683 for PSA-RFS and 0.800 for metastases, compared to NCCN-risk groups which yield 0.666 for PSA-RFS and 0.764 for metastases. Patients classified as VHR have markedly increased rates of PSA relapse, DM, and PCSM in comparison to SHR patients, whereas UIR and SHR patients have similar prognosis. Novel therapeutic strategies are needed for patients with VHR, likely involving multimodality therapy. © 2017 Wiley Periodicals, Inc.

Urban adolescent high-risk sexual behavior: corroboration of focus group discussions through pile-sorting. The AIDS Youth Research Team.

Science.gov (United States)

Stanton, B F; Aronson, R; Borgatti, S; Galbraith, J; Feigelman, S

1993-01-01

Risk activities for acquisition of the human immunodeficiency virus (HIV) remain prevalent among urban adolescents. While interdisciplinary approaches to examine the variables contributing to risk/protective behaviors have been promoted, strategies for such explorations require further formulation. Recently we employed focus group discussions to explore factors placing urban adolescents at risk for engaging in HIV risk behaviors. The focus group format enables substantial interaction on a topic in a limited time period, but does not always provide expression of the full range of behavioral options. In this study we investigated the use of pile-sorts for confirmation of impressions from focus group discussions among 57 urban youths aged 10-14. The pile-sorts revealed some support for most of the views expressed in the group discussions. However, the sorts revealed more variability in views than was expressed in the group discussions. Substantial gender and age-based differences in perceptions were revealed with potentially important intervention implications.

Successful Reach and Adoption of a workplace health promotion RCT targeting a group of high-risk workers

Directory of Open Access Journals (Sweden)

Ekner Dorte

2010-06-01

Full Text Available Abstract Background Cleaners are rarely introduced to workplace health promotion programs. The study's objective was to evaluate the reach and adoption of a workplace randomized controlled trial (RCT among cleaners in Denmark. Methods Cleaning businesses with at least 30 employees, that could offer a weekly 1-hour intervention during working hours, were invited to participate. Employees working at least 20 hours/week were invited to answer a screening questionnaire and consent to participate. Analyses determined the differences in health variables between responders and non-responders, consenters and non-consenters, participants and non-participants and between participants of the RCT's three groups: physical coordination training, cognitive-behavioural theory-based training and reference group. Results From 16 eligible workplaces, a representative sample of 50% adopted the trial. Of 758 eligible employees, 78% responded to the screening questionnaire and 49% consented to participate. Consenters and participants differed from non-consenters and non-participants by having higher BMI, more chronic diseases and poorer musculoskeletal health. Conclusions This study indicates that workplace health promotion programs directed at health risk factors among cleaners enable significant adoption and reach to a high-risk subgroup of the Danish workforce. Trial registration Trial registration ISRCTN96241850

Awareness of preventive medication among women at high risk for breast cancer and their willingness to consider transdermal or oral tamoxifen: a focus group study.

Science.gov (United States)

Karavites, Lindsey C; Allu, Subhashini; Khan, Seema A; Kaiser, Karen

2015-11-09

Despite demonstrated efficacy, acceptance of selective estrogen receptor modulators (SERMs), such as tamoxifen, for breast cancer risk reduction remains low. Delivering SERMs via local transdermal therapy (LTT) could significantly reduce systemic effects and therefore may increase acceptance. We aim to assess women's knowledge of breast cancer prevention medications and views on LTT of SERMs. Focus groups were conducted with healthy women identified through the comprehensive breast center of a large urban cancer institution. Group discussions covered risk perceptions, knowledge of and concerns about risk reducing medications. Participants reported their perceived risk for breast cancer (average, below/above average), preference for SERMs in a pill or gel form, risk factors, and prior physician recommendations regarding risk-reducing medicines. Participants' breast cancer risk was estimated using tools based on the Gail Model. Trained personnel examined all qualitative results systematically; risk perceptions and preferred method of medication delivery were tallied quantitatively. Four focus groups (N = 32) were conducted. Most participants had at least a college degree (78.2 %) and were of European (50 %) or African ancestry (31 %). The majority (72 %) were at elevated risk for breast cancer; approximately half of these women perceived themselves to be at elevated risk. Few participants had prior knowledge of preventive medications. The women noted a number of concerns about LTT, including dosage, impact on day-to-day life, and side effects; nonetheless, over 90 % of the women stated they would prefer LTT to a pill. Awareness of preventive medications was low even in a highly educated sample of high-risk women. If given a choice in the route of administration, most women preferred a gel to a pill, anticipating fewer side effects. Future work should focus on demonstrating equivalent efficacy and reduced toxicity of topical over oral medications and on raising

Awareness of preventive medication among women at high risk for breast cancer and their willingness to consider transdermal or oral tamoxifen: a focus group study

International Nuclear Information System (INIS)

Karavites, Lindsey C.; Allu, Subhashini; Khan, Seema A.; Kaiser, Karen

2015-01-01

Despite demonstrated efficacy, acceptance of selective estrogen receptor modulators (SERMs), such as tamoxifen, for breast cancer risk reduction remains low. Delivering SERMs via local transdermal therapy (LTT) could significantly reduce systemic effects and therefore may increase acceptance. We aim to assess women’s knowledge of breast cancer prevention medications and views on LTT of SERMs. Focus groups were conducted with healthy women identified through the comprehensive breast center of a large urban cancer institution. Group discussions covered risk perceptions, knowledge of and concerns about risk reducing medications. Participants reported their perceived risk for breast cancer (average, below/above average), preference for SERMs in a pill or gel form, risk factors, and prior physician recommendations regarding risk-reducing medicines. Participants’ breast cancer risk was estimated using tools based on the Gail Model. Trained personnel examined all qualitative results systematically; risk perceptions and preferred method of medication delivery were tallied quantitatively. Four focus groups (N = 32) were conducted. Most participants had at least a college degree (78.2 %) and were of European (50 %) or African ancestry (31 %). The majority (72 %) were at elevated risk for breast cancer; approximately half of these women perceived themselves to be at elevated risk. Few participants had prior knowledge of preventive medications. The women noted a number of concerns about LTT, including dosage, impact on day-to-day life, and side effects; nonetheless, over 90 % of the women stated they would prefer LTT to a pill. Awareness of preventive medications was low even in a highly educated sample of high-risk women. If given a choice in the route of administration, most women preferred a gel to a pill, anticipating fewer side effects. Future work should focus on demonstrating equivalent efficacy and reduced toxicity of topical over oral medications and on raising

High risk Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a trans-Tasman radiation oncology group study

International Nuclear Information System (INIS)

Poulsen, M.G.; Rischin, D.; Ainslie, J.; Walpole, E.; Harvey, J.; Mackintosh, J.; Hamilton, C.; Tripcony, L.

2003-01-01

The effectiveness of synchronous carboplatin, etoposide and radiation therapy was prospectively assessed in a group of patients with high risk Merkel Cell Carcinoma of the skin. Patients were eligible if they had disease localised to the primary site and nodes and were required to have at least one of the following high risk features: recurrence after initial therapy, involved nodes, primary size greater than 1 cm, gross residual disease after surgery or occult primary with nodes. Radiation was delivered to the primary site and nodes to a dose of 50 Gy in 25 fractions over 5 weeks and synchronous carboplatin (AUC 4.5) and etoposide 80 mg/M2 intravenously days 1-3 was given in weeks 1, 4, 7 and 10. The median age of the group was 67 [43-86] years and there were 39 males and 14 females. Involved nodes (stageII) were present in 33 (62%) cases. The sites involved in decreasing order were head and neck (22), occult primary (13), upper limb (8), lower limb (8) and trunk (2). Fifty-three patients were entered between 1996 and 2001.The median potential follow up was 48 months. There were no treatment related deaths. The 3 year overall survival, loco-regional control and distant control were 76%, 75% and 76% respectively. Factors that were predictive for local control and survival were tumour site and the presence of nodes. Multivariate analysis indicated that the major factor influencing survival was the presence of nodes. However this was not a significant factor in loco-regional control. High levels of loco-regional control and survival have been achieved with the addition of chemotherapy to radiation treatment for high risk Merkel cell carcinoma of skin. The role of chemo-radiotherapy for high risk MCC warrants further investigation

Patterns and Factors of High School Dropout Risks of Racial and Linguistic Groups

Science.gov (United States)

Kim, Sunha; Chang, Mido; Singh, Kusum; Allen, Katherine R.

2015-01-01

This study examined the dropout trajectories of racial and linguistic minority students and explored the effects of students' contextual factors on their high school dropout risks. Our motivation was to identify the dropout patterns of Black, Hispanic, and Hispanic English language learner (ELL) students, who have comparatively high dropout rates,…

Gambling Risk Groups are Not All the Same: Risk Factors Amongst Sports Bettors.

Science.gov (United States)

Russell, Alex M T; Hing, Nerilee; Li, En; Vitartas, Peter

2018-03-20

Sports betting is increasing worldwide, with an associated increase in sports betting-related problems. Previous studies have examined risk factors for problem gambling amongst sports bettors and have identified demographic, behavioural, marketing, normative and impulsiveness factors. These studies have generally compared those in problem gambling, or a combination of moderate risk and problem gambling, groups to non-problem gamblers, often due to statistical power issues. However, recent evidence suggests that, at a population level, the bulk of gambling-related harm stems from low risk and moderate risk gamblers, rather than problem gamblers. Thus it is essential to understand the risk factors for each level of gambling-related problems (low risk, moderate risk, problem) separately. The present study used a large sample (N = 1813) to compare each gambling risk group to non-problem gamblers, first using bivariate and then multivariate statistical techniques. A range of demographic, behavioural, marketing, normative and impulsiveness variables were included as possible risk factors. The results indicated that some variables, such as gambling expenditure, number of accounts with different operators, number of different types of promotions used and impulsiveness were significantly higher for all risk groups, while others such as some normative factors, age, gender and particular sports betting variables only applied to those with the highest level of gambling-related problems. The results generally supported findings from previous literature for problem gamblers, and extended these findings to low risk and moderate risk groups. In the future, where statistical power allows, risk factors should be assessed separately for all levels of gambling problems.

Renal transplantation in high cardiovascular risk patients.

Science.gov (United States)

Bittar, Julio; Arenas, Paula; Chiurchiu, Carlos; de la Fuente, Jorge; de Arteaga, Javier; Douthat, Walter; Massari, Pablo U

2009-10-01

Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. The concept of high-risk patient has changed since the first stages of transplantation. In the first studies, the high-risk concept was based on probability of early graft failure or on a patient's clinical condition to cope with high perioperatory morbimortality. Later on, this concept implied immunological factors that were crucial to ensure transplant success because hypersensitized or polytransfused patients experienced a higher risk of acute rejection and subsequent graft loss. Afterward, the presence of various comorbidities would redefine the high-risk concept for renal transplant mainly considering recipient's clinical aspects. Currently, the change in epidemiological characteristics of patients starting dialysis causes that we now deal with a greater increase of elderly patients, diabetic patients, and patients with history of cardiovascular disease. Today, high-risk patients are those with clinical features that predict an increase in the risk of perioperative morbimortality or death with functioning graft. In this review, we will attempted to analyze currents results of renal transplant outcomes in terms of patients and graft survival in elderly patients, diabetic patients, and patients with previous cardiovascular disease from the most recent experiences in the literature and from experiences in our center. In any of the groups previously analyzed, survival offered by renal transplant is significantly higher compared to dialysis. Besides, these patients are the recipient group that benefit the most with the transplant because their mortality while remaining on dialysis is extremely high. Hence, renal transplantation should be offered more frequently to older patients, diabetic patients, and patients with pretransplant cardiac and peripheral vascular disease. A positive attitude toward renal

Frequency of diabetes, impaired fasting glucose, and glucose intolerance in high-risk groups identified by a FINDRISC survey in Puebla City, Mexico

Directory of Open Access Journals (Sweden)

Hirales-Tamez O

2012-11-01

Full Text Available Hector García-Alcalá, Christelle Nathalie Genestier-Tamborero, Omara Hirales-Tamez, Jorge Salinas-Palma, Elena Soto-VegaFaculty of Medicine, Universidad Popular Autónoma del Estado de Puebla, Puebla Pue, MexicoBackground: As a first step in the prevention of diabetes, the International Diabetes Federation recommends identification of persons at risk using the Finnish type 2 Diabetes Risk Assessment (FINDRISC survey. The frequency of diabetes mellitus, impaired fasting glucose, and glucose intolerance in high-risk groups identified by FINDRISC is unknown in our country. The aim of this study was to determine the frequency of diabetes mellitus, impaired fasting glucose, and glucose intolerance in higher-risk groups using a FINDRISC survey in an urban population.Methods: We used a television program to invite interested adults to fill out a survey at a television station. An oral glucose tolerance test was performed in all persons with a FINDRISC score ≥ 15 points (high-risk and very high-risk groups. Patients were classified as normal (fasting glucose < 100 mg/dL and 2-hour glucose < 140 mg/dL, or having impaired fasting glucose (fasting glucose 100–125 mg/dL and 2-hour glucose < 140 mg/dL, glucose intolerance (fasting glucose < 126 mg/dL and 2-hour glucose 140–199 mg/dL, and diabetes mellitus (fasting glucose ≥ 126 mg/dL or 2-hour glucose ≥ 200 mg/dL. We describe the frequency of each diagnostic category in this selected population according to gender and age.Results: A total of 186 patients had a score ≥ 15. The frequencies of diabetes mellitus, impaired fasting glucose, glucose intolerance, and normal glucose levels were 28.6%, 25.9%, 29.2%, and 16.2%, respectively. We found a higher frequency of diabetes mellitus and impaired fasting glucose in men than in women (33% versus 27% and 40% versus 21%, respectively and more glucose intolerance in women than in men (34% versus 16%, P < 0.05. Patients with diabetes mellitus (52.55 ± 9

Characteristics of high- and low-risk individuals in the PRIORITY study

DEFF Research Database (Denmark)

Tofte, N; Lindhardt, M; Adamova, K

2018-01-01

variable. In a logistic regression model including clinical variables known to be associated with diabetic kidney disease, estimated GFR, gender, log urinary albumin:creatinine ratio and use of renin-angiotensin system-blocking agents remained significant determinants of the CKD273 high-risk group: area......AIM: To compare clinical baseline data in individuals with Type 2 diabetes and normoalbuminuria, who are at high or low risk of diabetic kidney disease based on the urinary proteomics classifier CKD273. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled international...... multicentre clinical trial and observational study in participants with Type 2 diabetes and normoalbuminuria, stratified into high- or low-risk groups based on CKD273 score. Clinical baseline data for the whole cohort and stratified by risk groups are reported. The associations between CKD273 and traditional...

Reducing sexual risk behavior among high-risk couples in Northern India.

Science.gov (United States)

Jones, Deborah; Bagga, Rashmi; Nehra, Ritu; Deepika; Sethi, Sunil; Walia, Kamini; Kumar, Mahendra; Villar-Loubet, Olga; Lopez, Maria; Weiss, Stephen M

2013-09-01

With a population of 1.1 billion, India is considered to be a country in which effective prevention interventions could contain the development of a human immunodeficiency virus (HIV) epidemic. Heterosexual transmission accounts for 85 % of the extant HIV infections. This study sought to assess the feasibility of conducting a group, culturally tailored behavioral intervention and its impact on sexual barrier use, self-efficacy, knowledge, conflict resolution, and coping among high-risk heterosexual couples in Northern India. This pilot study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India from February 2008 to January 2009. Thirty sexually active high-risk couples were drawn from a convenience sample of PGIMER patients attending infectious disease and family planning clinics. Couples participated in 1 month of three weekly gender-concordant behavioral intervention groups and were individually administered assessments preintervention and post-intervention. The intervention was tailored to the Northern Indian context and addressed sexual barrier use, human immunodeficiency virus (HIV)/sexually transmitted infection transmission, and cognitive behavioral skill building focusing on sexual negotiation and communication. The participants had a mean age of 32 years (men) and 29 years (women), and the majority had at least 10 years of education. At baseline, the majority reported inconsistent condom use (knowledge, and women increased their use of positive coping tactics. The results highlight the potential to successfully utilize a group intervention to discuss sensitive issues such as sexual risk behavior among both men and women. Strategies to improve condom use and communication without increasing intimate partner violence in high-risk couples may be an important adjunct to preventing the development of a generalized epidemic in India.

Trial of a "credit card" asthma self-management plan in a high-risk group of patients with asthma.

Science.gov (United States)

D'Souza, W; Burgess, C; Ayson, M; Crane, J; Pearce, N; Beasley, R

1996-05-01

The "credit card" asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma, which are based on the self-assessment of peak expiratory flow rate recordings and symptoms. The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients. In this "before-and-after" trial, patients discharged from the emergency department of Wellington Hospital, after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced. Questionnaires were used to compare markers of asthma morbidity, requirement for emergency medical care, and medication use during the 6-month period before and after intervention with the credit card plan. Of the 30 patients with asthma who attended the first outpatient clinic, 26 (17 women and 9 men) completed the program. In these 26 participants, there was a reduction in both morbidity and requirement for acute medical services: specifically, the proportion waking with asthma more than once a week decreased from 65% to 23% (p = 0.005) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58% to 15% (p = 0.004). The patients attending the clinics commented favorably on the plan, in particular on its usefulness as an educational tool for monitoring and treating their asthma. Although the interpretation of this study is limited by the lack of a randomized control group, the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma.

Patients with eating disorders. A high-risk group for fractures

DEFF Research Database (Denmark)

Vestergaard, Peter; Emborg, C.; Stoving, R.K.

2003-01-01

PURPOSE: To analyze fracture risk and bone mineral density in patients with eating disorders (anorexia nervosa, bulimia nervosa, and other eating disorders). DESIGN: Clinical overview. FINDINGS: Bone mineral density is decreased and fracture risk increased in patients with anorexia nervosa....... In patients with bulimia nervosa, bone mineral is only marginally decreased and fracture risk marginally increased. In patients with other eating disorders (eating disorders not otherwise specified), bone mineral density is decreased and fracture risk increased. CONCLUSIONS: Fracture risk is increased...

Comparison of frequency of obesity in high risk non diabetic young individuals with low risk non diabetic young individuals

International Nuclear Information System (INIS)

Shaikh, M.A.; Kumar, R.; Ghori, R.A.

2011-01-01

Objective: To assess the body mass index and waist circumferences of high risk non diabetic young individuals and compare them with low risk non diabetic young individuals. Method: A cross sectional, case control comparative study was conducted in the department of medicine, LUMHS from January 2008 to March 2009. Five hundred individuals 20-40 years of age were selected and divided into two groups i.e. Group A: high risk (250 individuals) and Group B: low risk (250 individuals) on the basis of same age and gender. Group A included those who had positive family history of type 2 DM in first degree relatives while group B had no family history of type 2 DM in first degree relatives. The blood pressure, BMI and Waist Circumference was measured and Fasting Blood Sugar was estimated in each individual. In each group 125 (50%) were males and 125 (50%) were females. Results: In group A 58% and in group B 28.8% individuals represented raised BMI whereas 42% in group A and 36% in group B individuals showed an increased waist circumference. Mean fasting blood glucose was significantly higher in Group A than in Group B (P=0.001). Conclusion: Impaired Fasting Glucose is strongly associated with family history of type 2 diabetes mellitus. Presence of obesity specially in high risk non-diabetic young individuals emphasize the need for routine health screening for early institution of preventive measures. (author)

Risk Analysis Group annual progress report 1984

International Nuclear Information System (INIS)

1985-06-01

The activities of the Risk Analysis Group at Risoe during 1984 are presented. These include descriptions in some detail of work on general development topics and risk analysis performed as contractor. (author)

Metabolic syndrome in family practice in Jordan: a study of high-risk groups.

Science.gov (United States)

Yasein, N; Masa'd, D

2011-12-01

This study assessed the prevalence of the metabolic syndrome, and its components, as defined by Adult Treatment Panel III criteria in Jordanian patients attending a family practice clinic for management of cardiovascular risk factors. The sample was 730 randomly selected patients aged > or = 25 years. The prevalence of metabolic syndrome was 37.4% (31.7% in men; 41.0% in women). The prevalence increased with age in the total sample and in both sexes. High waist circumference showed the highest prevalence in the total sample (61.6%). Among females it ranked as the first criterion (73.5%). High serum triglyceride level showed the highest prevalence in males (50.2%). Differences between the sexes were significant. Family practitioners should be alerted to the importance of multiple risk factors in the metabolic syndrome.

Primary prevention of stroke by a healthy lifestyle in a high-risk group.

Science.gov (United States)

Larsson, Susanna C; Åkesson, Agneta; Wolk, Alicja

2015-06-02

To examine the impact of a healthy lifestyle on stroke risk in men at higher risk of stroke because of other cardiovascular diseases or conditions. Our study population comprised 11,450 men in the Cohort of Swedish Men who had a history of hypertension, high cholesterol levels, diabetes, heart failure, or atrial fibrillation. Participants had completed a questionnaire about diet and lifestyle and were free from stroke and ischemic heart disease at baseline (January 1, 1998). We defined a healthy lifestyle as a low-risk diet (≥5 servings/d of fruits and vegetables and 0 to ≤30 g/d). Ascertainment of stroke cases was accomplished through linkage with the National Inpatient Register and the Swedish Cause of Death Register. During a mean follow-up of 9.8 years, we ascertained 1,062 incident stroke cases. The risk of total stroke and stroke types decreased with increasing number of healthy lifestyle factors. The multivariable relative risk of total stroke for men who achieved all 5 healthy lifestyle factors compared with men who achieved 0 or 1 factor was 0.28 (95% confidence interval 0.14-0.55). The corresponding relative risks (95% confidence interval) were 0.31 (0.15-0.66) for ischemic stroke and 0.32 (0.04-2.51) for hemorrhagic stroke. A healthy lifestyle is associated with a substantially reduced risk of stroke in men at higher risk of stroke. © 2015 American Academy of Neurology.

An approach to grouping species for ecological risk assessment

International Nuclear Information System (INIS)

Hampton, N.L.; VanHorn, R.L.; Morris, R.; Brewer, R.

1994-01-01

The ecological risk assessment (ERA) paradigm acknowledges all levels of ecological organization as having potential for defining assessment and measurement endpoints. However, assessment goals and endpoints are generally concentrated at individual species and population levels. As part of a sitewide, screening-level ERA process at the Idaho National Engineering Laboratory (INEL), a ''functional group'' approach was developed to incorporate assessment at a higher level of ecological organization into the risk analysis process. Functional groups demonstrating biological similarity and similar potential for contaminant exposure were developed using taxonomic, trophic and habitat parameters. As defined, all species are potential surrogates for the other members of the same functional group. Measurement endpoint data for several species may be integrated to address the risk to the group as a whole. The functional group concept was applied throughout the problem formulation, analysis, and risk characterization phases of the assessment process. This approach allows the ERA to be focused on risk to the integrity of individual functional groups, which can subsequently be related to guild and community integrity

Use of focus groups in explaining environmental risks

International Nuclear Information System (INIS)

Wong, J.W.

1994-01-01

Risk assessors need to remember their job is to determine risks which are then balanced against the cost of remediation. Since the ultimate customer is the public, they must be an integral part of both key risk assessment as well as remediation decisions. Focus groups offer a cost effective means to open-quotes get a feelclose quotes for what publics want and don't want. This paper is a kit for using focus groups to test and translate into common language, the risk assessor's ideas and methods. Explaining Monte Carlo methods for a simple aspect of ecological risk assessment is included as an example along with practical tips and a list of what the public equates to risk as they perceive it

Facial emotion perception differs in young persons at genetic and clinical high-risk for psychosis.

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Kohler, Christian G; Richard, Jan A; Brensinger, Colleen M; Borgmann-Winter, Karin E; Conroy, Catherine G; Moberg, Paul J; Gur, Ruben C; Gur, Raquel E; Calkins, Monica E

2014-05-15

A large body of literature has documented facial emotion perception impairments in schizophrenia. More recently, emotion perception has been investigated in persons at genetic and clinical high-risk for psychosis. This study compared emotion perception abilities in groups of young persons with schizophrenia, clinical high-risk, genetic risk and healthy controls. Groups, ages 13-25, included 24 persons at clinical high-risk, 52 first-degree relatives at genetic risk, 91 persons with schizophrenia and 90 low risk persons who completed computerized testing of emotion recognition and differentiation. Groups differed by overall emotion recognition abilities and recognition of happy, sad, anger and fear expressions. Pairwise comparisons revealed comparable impairments in recognition of happy, angry, and fearful expressions for persons at clinical high-risk and schizophrenia, while genetic risk participants were less impaired, showing reduced recognition of fearful expressions. Groups also differed for differentiation of happy and sad expressions, but differences were mainly between schizophrenia and control groups. Emotion perception impairments are observable in young persons at-risk for psychosis. Preliminary results with clinical high-risk participants, when considered along findings in genetic risk relatives, suggest social cognition abilities to reflect pathophysiological processes involved in risk of schizophrenia. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

How young people communicate risks of snowmobiling in northern Norway: a focus group study.

Science.gov (United States)

Mehus, Grete; Germeten, Sidsel; Henriksen, Nils

2011-04-01

This study aims to understand how the risks of snowmobiling are communicated among northern Norwegian youths. Study design. A qualitative design with focus group interviews was chosen. Interviews centred on safety precautions and estimation of risks related to snowmobiling and driving patterns. Eighty-one students (31 girls and 50 boys) aged between 16 and 23 years from 8 high schools were interviewed in 17 focus groups that were segregated by gender. Interview data were analysed using qualitative content analysis. Boys and girls communicated differently about risks. Peer-group conformity appeared stronger among boys than girls. Boys did not spontaneously relate risks to their snowmobile activities, while girls did. Boys focused upon training, coping and balance between control and lack of control while driving. Girls talked about risks, were aware of risks and sought to avoid risky situations, in contrast to boys. Boys' risk communication in groups was about how to manage challenging situations. Their focus overall was on trying to maintain control while simultaneously testing their limits. Three risk categories emerged: those who drive as they ought to (mostly girls), those who occasionally take some risks (boys and girls) and those who are extreme risk-takers (a smaller number of boys). Perceptions of and communication about risk are related to gender, peer group and familiarity with risk-taking when snowmobiling. Northern Norwegian boys' driving behaviour highlights a specific need for risk reduction, but this must also draw upon factors such as acceptance of social and cultural codes and common sense related to snowmobiling.

Safe Reentry for False Aneurysm Operations in High-Risk Patients.

Science.gov (United States)

Martinelli, Gian Luca; Cotroneo, Attilio; Caimmi, Philippe Primo; Musica, Gabriele; Barillà, David; Stelian, Edmond; Romano, Angelo; Novelli, Eugenio; Renzi, Luca; Diena, Marco

2017-06-01

In the absence of a standardized safe surgical reentry strategy for high-risk patients with large or anterior postoperative aortic false aneurysm (PAFA), we aimed to describe an effective and safe approach for such patients. We prospectively analyzed patients treated for PAFA between 2006 and 2015. According to the preoperative computed tomography scan examination, patients were divided into two groups according to the anatomy and extension of PAFA: in group A, high-risk PAFA (diameter ≥3 cm) developed in the anterior mediastinum; in group B, low-risk PAFA (diameter <3 cm) was situated posteriorly. For group A, a safe surgical strategy, including continuous cerebral, visceral, and coronary perfusion was adopted before resternotomy; group B patients underwent conventional surgery. We treated 27 patients (safe reentry, n = 13; standard approach, n = 14). Mean age was 60 years (range, 29 to 80); 17 patients were male. Mean interval between the first operation and the last procedure was 4.3 years. Overall 30-day mortality rate was 7.4% (1 patient in each group). No aorta-related mortality was observed at 1 and 5 years in either group. The Kaplan-Meier overall survival estimates at 1 and 5 years were, respectively, 92.3% ± 7.4% and 73.4% ± 13.4% in group A, and 92.9% ± 6.9% and 72.2% ± 13.9% in group B (log rank test, p = 0.830). Freedom from reoperation for recurrent aortic disease was 100% at 1 year and 88% at 5 years. The safe reentry technique with continuous cerebral, visceral, and coronary perfusion for high-risk patients resulted in early and midterm outcomes similar to those observed for low-risk patients undergoing conventional surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Seasonal variation in cause-specific mortality: are there high-risk groups? 25-year follow-up of civil servants from the first Whitehall study

NARCIS (Netherlands)

C.T.M. van Rossum (Caroline); M.J. Shipley; H. Hemingway; D.E. Grobbee (Diederick); J.P. Mackenbach (Johan); M.G. Marmot

2001-01-01

textabstractOBJECTIVES: To determine the seasonal effect on all-cause and cause-specific mortality and to identify high-risk groups. METHODS: A 25-year follow-up of 19,019 male civil servants aged 40-69 years. RESULTS: All-cause mortality was seasonal (ratio of highest mortality

Value of high-risk HPV-DNA testing in the triage of ASCUS.

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Silverloo, Iréne; Andrae, Bengt; Wilander, Erik

2009-01-01

OBJECTIVE. Atypical squamous cells of undetermined significance (ASCUS) cells, occurring in organized cytological screening, may be either high-risk human papillomavirus (HPV) positive or negative. To refine the assessment of women with ASCUS, a high-risk HPV-DNA test is recommended as triage in Sweden. A total of 197 consecutive women (mean age 39 years, range 21-60) with a diagnosis of ASCUS from the primary screening were selected for triage. Their cervical smears were collected and evaluated by using conventional cytological examination in combination with a high-risk HPV-DNA test (hybrid capture 2). The women were categorized into four groups: Group A, Cytology + /HPV + ; Group B, Cytology-/HPV + ; Group C, Cytology + /HPV-; and Group D, Cytology-/ HPV-. Women within Groups A-C were admitted for colposcopy and cervical biopsy. The women in Group D were considered as a low-risk group for tumor development, and were re-examined after three years in the next round of the organized screening. In women in Group A (n=58) the prevalence of histological verified CIN2-3 was 41%, in Group B (n=41) 20%, and in Group C (n=9) 0%. In Group D (n=89), repeated primary screening three years later revealed CIN2-3 in two biopsies from 74 women studied (age in women with ASCUS. It was 74% in women or =50 years. Adding a high-risk HPV test in secondary screening increased the identification of women with CIN2-3 lesions by 33% in comparison with repeat cytology (p=0.01). The clinical significance of the ASCUS diagnosis varied with age of the women.

Imaging Frontostriatal Function in Ultra-High-Risk, Early, and Chronic Schizophrenia During Executive Processing

Science.gov (United States)

Morey, Rajendra A.; Inan, Seniha; Mitchell, Teresa V.; Perkins, Diana O.; Lieberman, Jeffrey A.; Belger, Aysenil

2009-01-01

Context Individuals experiencing prodromal symptoms of schizophrenia (ultra-high-risk group) demonstrate impaired performance on tasks of executive function, attention, and working memory. The neurobiological underpinnings of such executive deficits in ultra-high-risk individuals remains unclear. Objective We assessed frontal and striatal functions during a visual oddball continuous performance task, in ultra-high-risk, early, and chronic schizophrenic patients with the use of functional magnetic resonance imaging. Design Cross-sectional case-control design. Setting Community; outpatient clinic. Patients Fifty-two individuals (control, n = 16; ultra-high risk, n = 10; early, n = 15; chronic, n = 11) from a referred clinical sample and age- and sex-matched control volunteers underwent scanning. Main Outcome Measures Percentage of active voxels and percentage signal change calculated for the anterior cingulate gyrus (ACG), middle frontal gyrus (MFG), inferior frontal gyrus (IFG), basal ganglia, and thalamus. Performance on the visual oddball task was measured with percentage of hits and d′ (a measure based on the hit rate and the false-alarm rate). Results The ultra-high-risk group showed significantly smaller differential activation between task-relevant and task-irrelevant stimuli in the frontal regions (ACG, IFG, MFG) than the control group. Frontostriatal activation associated with target stimuli in the early and chronic groups was significantly lower than the control group, while the ultra-high-risk group showed a trend toward the early group. Conclusions Our findings suggest that prefrontal function begins to decline before the onset of syndromally defined illness and hence may represent a vulnerability marker in assessing the risk of developing psychotic disorders among ultra-high-risk individuals. PMID:15753238

Targeted cardiopulmonary resuscitation training focused on the family members of high-risk patients at a regional medical center: A comparison between family members of high-risk and no-risk patients.

Science.gov (United States)

Han, Kap Su; Lee, Ji Sung; Kim, Su Jin; Lee, Sung Woo

2018-05-01

We developed a hospital-based cardiopulmonary resuscitation (CPR) training model focused on the target population (family members of patients with potential risks for cardiac arrest) and compared the outcome of CPR training between target and non-target populations for validity. Family members of patients in training were divided into three groups on the basis of patients' diseases, as follows: 1) the cardio-specific (CS) risk group, including family members of patients with cardiac disease at risk of cardiac arrest; 2) the cardiovascular (CV) risk group, including family members of patients with risk factors for cardiovascular disease; and 3) the no-risk group. Pre- and posttraining surveys and skill tests as well as a post-training 3-month telephone survey were conducted. Educational outcomes were analyzed. A total of 203 family members were enrolled into 21 CPR training classes. The CS group (n=88) included elderly persons and housewives with a lower level of education compared with the CV (n=79) and no-risk groups (n=36). The CS group was motivated by healthcare professionals and participated in the training course. The CS, CV, and no-risk groups showed improvements in knowledge, willingness to perform CPR, and skills. Despite the older age and lower level of education in the CS group, the effects of education were similar to those in the other groups. A high rate of response and secondary propagation of CPR training were observed in the CS group. Family members of patients with heart disease could be an appropriate target population for CPR training, particularly in terms of recruitment and secondary propagation. Targeted intervention may be an effective training strategy to improve bystander CPR rates.

Off-pump coronary surgery: surgical strategy for the high-risk patient.

Science.gov (United States)

Van Belleghem, Y; Caes, F; Maene, L; Van Overbeke, H; Moerman, A; Van Nooten, G

2003-02-01

In a retrospective study, we compared two groups of consecutive patients operated by the same team during the year 2000 for coronary artery disease with the use of extracorporeal circulation (group 1, n=230) or on the beating heart using the Octopus II plus stabiliser (group 2, n=228). High-risk patients were identified by a EuroSCORE plus 6. EuroSCORE definitions and predicted risk models were utilized to compare the variables of the groups. There were no significant differences between the preoperative variables of the groups in age, gender, left ventricular function, diabetes and peripheral vascular and renal disease as is indicated by the Euroscore (resp. 4.7/5.1 p=0.107). Calcification of the ascending aorta and chronic obstructive lung disease were statistically significant more prevalent in the beating heart group. No differences in preoperative variables in the high-risk patients group (Euroscore 8.5/8.1 p=0.356) except for calcification of the ascending aorta. All patients underwent a full revascularisation through a midline sternotomy. Significant more distal anastomoses were performed in group 1 (3.7 per patient (1-6)) with regard to group 2 (2.9 per patient (1-6)). Anesthesia, postoperative treatment and follow up were equal for both groups. A significant lower incidence of atrial fibrillation (p=0.010), shorter ICU stay (p=0.031) and renal insufficiency (p=0.033) was reported in group 2. In the low risk group, we could not diagnose any difference between the two groups, except for atrial fibrillation. The benefits of the beating heart surgery however were more pronounced in the high-risk patient as is indicated by a significant reduction of the ICU stay by 1 day (3.5d/2.5d (p=0.028)), better preservation of the renal function (p=0.017) and a significant reduction of the length of hospital stay by more than two days (p=0.040). A lower incidence of atrial fibrillation, however not significant. In our experience, beating heart surgery is a safe

The joint effects of risk status, gender, early literacy and cognitive skills on the presence of dyslexia among a group of high-risk Chinese children.

Science.gov (United States)

Wong, Simpson W L; McBride-Chang, Catherine; Lam, Catherine; Chan, Becky; Lam, Fanny W F; Doo, Sylvia

2012-02-01

This study sought to examine factors that are predictive of future developmental dyslexia among a group of 5-year-old Chinese children at risk for dyslexia, including 62 children with a sibling who had been previously diagnosed with dyslexia and 52 children who manifested clinical at-risk factors in aspects of language according to testing by paediatricians. The age-5 performances on various literacy and cognitive tasks, gender and group status (familial risk or language delayed) were used to predict developmental dyslexia 2 years later using logistic regression analysis. Results showed that greater risk of dyslexia was related to slower rapid automatized naming, lower scores on morphological awareness, Chinese character recognition and English letter naming, and gender (boys had more risk). Three logistic equations were generated for estimating individual risk of dyslexia. The strongest models were those that included all print-related variables (including speeded number naming, character recognition and letter identification) and gender, with about 70% accuracy or above. Early identification of those Chinese children at risk for dyslexia can facilitate better dyslexia risk management. Copyright © 2012 John Wiley & Sons, Ltd.

Analysis of risk factors for persistent infection of asymptomatic women with high-risk human papilloma virus.

Science.gov (United States)

Shi, Nianmin; Lu, Qiang; Zhang, Jiao; Li, Li; Zhang, Junnan; Zhang, Fanglei; Dong, Yanhong; Zhang, Xinyue; Zhang, Zheng; Gao, Wenhui

2017-06-03

This study aims to prevent persistentinfection, reduce the incidence of cervical cancer, and improve women's health by understanding the theoretical basis of the risk factors for continuous infection of asymptomatic women with high-risk human papilloma virus (HPV) strains via information collected, which includes the persistent infection rate and the most prevalent HPV strain types of high risk to asymptomatic women in the high-risk area of cervical cancer in Linfen, Shanxi Province. Based on the method of cluster sampling, locations were chosen from the industrial county and agricultural county of Linfen, Shanxi Province, namely the Xiangfen and Quwo counties. Use of the convenience sampling (CS) method enables the identification of women who have sex but without symptoms of abnormal cervix for analyzing risk factors of HPV-DNA detection and performing a retrospective questionnaire survey in these 2 counties. Firstly, cervical exfoliated cell samples were collected for thin-layer liquid-based cytology test (TCT), and simultaneously testing high-risk type HPV DNA, then samples with positive testing results were retested to identify the infected HPV types. The 6-month period of testing was done to derive the 6-month persistent infection rate. The retrospective survey included concepts addressed in the questionnaire: basic situation of the research objects, menstrual history, marital status, pregnancy history, sexual habits and other aspects. The questionnaire was divided into a case group and a comparison group, which are based on the high-risk HPV-DNA testing result to ascertain whether or not there is persistent infection. Statistical analysis employed Epidate3.1 software for date entry, SPSS17.0 for date statistical analysis. Select statistic charts, Chi-Square Analysis, single-factor analysis and multivariate Logistic regression analysis to analyze the protective factors and risk factors of high-risk HPV infection. Risk factors are predicted by using the

Maternal and foetal outcome of 206 high risk pregnancy cases in border guard hospital, dhaka.

Science.gov (United States)

Shapla, N R; Islam, M A; Shahida, S M; Parveen, Z; Lipe, Y S

2015-04-01

This observational study was carried out to identify the various types of high risk pregnancy and to determine the maternal and foetal outcome. The study was carried out on 206 pregnant high risk women in the Gynecology and Obstetrics department of Border Guard Hospital, Dhaka from January 2012 to December 2012. During mentioned period among 598 pregnant women 206 high risk pregnancy cases were randomly selected. Pregnant women (gestational age from 34 weeks upto 40 weeks) having medical condition and pregnancy related high risk factors were included and uncomplicated pregnancy, pregnancy before 37 weeks, post dated pregnancy were excluded from this study. Data was collected from semi structured history sheet and data analysis done by percentage. High risk pregnant women were grouped into three. Group A and Group B includes pregnant women having medical condition before and during pregnancy respectively. Group C consists of pregnant women had pregnancy related high risk issues. Among 206 high risk pregnancy cases majority 47.57% women had medical condition during pregnancy, 31.55% patient had medical condition before pregnancy. Among them majority 30.58% of the patient suffered from pregnancy induced hypertension, 15.04% patients suffered from gestational Diabetes Mellitus and premature rupture of membranes were 12.13%. In this study majority 43.68% of high risk pregnant patients were in age group of 30-35 years, 19.90% pregnant women were in age group of >35 years and 19.40% were in age group of upto 20 years. Among study groups maximum 65.04% of the patients were multiparous. Among 206 study population 60.19% high risk pregnant women were at term at the time of delivery and 39.8% women delivered their babies preterm. Caesarean section was done in 69.41% of high risk pregnant women. After delivery majority 77.66% women had no complication, only 10.19%, 8.25%, 2.91% and 0.97% high risk pregnant women suffered from fever, UTI, abdominal wound infection and post

Assessing the role of syringe dispensing machines and mobile van outlets in reaching hard-to-reach and high-risk groups of injecting drug users (IDUs: a review

Directory of Open Access Journals (Sweden)

Islam Md Mofizul

2007-10-01

Full Text Available Abstract Reaching hard-to-reach and high-risk injecting drug users (IDUs is one of the most important challenges for contemporary needle syringe programs (NSPs. The aim of this review is to examine, based upon the available international experience, the effectiveness of syringe vending machines and mobile van/bus based NSPs in making services more accessible to these hard-to-reach and high-risk groups of IDUs. A literature search revealed 40 papers/reports, of which 18 were on dispensing machines (including vending and exchange machines and 22 on mobile vans. The findings demonstrate that syringe dispensing machines and mobile vans are promising modalities of NSPs, which can make services more accessible to the target group and in particular to the harder-to-reach and higher-risk groups of IDUs. Their anonymous and confidential approaches make services attractive, accessible and acceptable to these groups. These two outlets were found to be complementary to each other and to other modes of NSPs. Services through dispensing machines and mobile vans in strategically important sites are crucial elements in continuing efforts in reducing the spread of HIV and other blood borne viruses among IDUs.

At-risk high school seniors: Science remediation for Georgia's High School Graduation Test

Science.gov (United States)

Carroll, Carolyn M.

State departments of education have created a system of accountability for the academic achievement of students under the mandate of the No Child Left Behind Act of 2001. The Georgia Department of Education established the Georgia High School Graduation Test (GHSGT) as their method of evaluating the academic achievement of high school students. The GHSGT consist of five sections and students must pass all five sections before students they are eligible to receive a diploma. The purpose of the study was to examine the effects of teacher-lead and computer based remediation for a group of high school seniors who have been unsuccessful in passing the science portion of the GHSGT. The objectives of this study include (a) Identify the most effective method of remediation for at-risk students on the science section of the GHSGT, and (b) evaluate the methods of remediation for at-risk students on the science section of GHSGT available to high school students. The participants of this study were at-risk seniors enrolled in one high school during the 2007-2008 school year. The findings of this research study indicated that at-risk students who participated in both types of remediation, teacher-led and computer-based, scored significantly higher than the computer-based remediation group alone. There was no significant relationship between the test scores and the number of times the students were tested.

Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India: an analysis of clinical records from six states

Directory of Open Access Journals (Sweden)

Gurung Anup

2011-12-01

Full Text Available Abstract Background Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. Methods The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. Results A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p Conclusions The programme demonstrated that acceptable and accessible services with marginalised and often difficult–to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.

High Framingham risk score decreases quality of life in adults

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Christian Yosaputra

2010-04-01

Full Text Available Cardiovascular disease (CVD risk factors, such as diabetes, hypertension, hypercholesterolemia, smoking, and obesity tend to occur together in the general population. Increasing prevalence of multiple CVD risk factors has been related to increased risk of death from coronary heart disease and stroke. Studies have suggested that people with several risk factors of CVD may have impaired health-related quality of life. The objective of this study was to assess the association of CVD risk factors with quality of life (QOL among adults aged 40 to 65 years. A cross-sectional study was conducted involving 220 subjects 40 - 65 years of age at a health center. The CVD risk factors were assessed using the Framingham risk score that is the standard instrument for assessment of the risk of a first cardiac event. The risk factors assessed were age, smoking, blood pressure, total cholesterol and high density lipoprotein cholesterol concentrations. QOL was assessed by means of the WHOQOL-BREF instrument that had been prevalidated. The results of the study showed that 28.2% of subjects were smokers, 56.4% had stage 1 hypertension, 42.8% high total cholesterol and 13.6% low HDL cholesterol. The high risk group amounted to 45.5% and 42.3% constitued an intermediate risk group. High CVD risk scores were significantly associated with a low QOL for all domains (physical, psychological, social and environment (p=0.000. Preventing or reducing the multiple CVD risk factors to improve QOL is necessary among adults.

High-Risk Series: An Update

Science.gov (United States)

2015-02-01

the Medicare Trustees, the Office of the Actuary , and the Congressional Budget Office have raised concerns about whether some of the Medicare... actuarially sound. For more information, see the National Flood Insurance Program section of this High-Risk report. Among other things, the report...and mathematics (STEM) functional community. In addition to the efforts of the Working Group, the President’s Fiscal Year 2013 budget—released in

Thyroid hormones and carcinoembryonic antigen in persons with a high risk of lung cancer

International Nuclear Information System (INIS)

Svetukhina, E.S.; Bukhteeva, N.F.; Sapozhkova, L.P.; Maripova, Eh.M.

1984-01-01

An attempt was made to study CEA and thyroid hormones in high risk groups as there is evidence of their change in lung cancer patients. A questionnaire to distinguish between 4 types of the probability of lung cancer development and a method of radioimmunoassay to study the concentration of CEA and thyroid hormones in the blood serum were used. A high risk group included 320 practically healthy persons, a control group 108 patients with verified lung cancer. The results of the study have shown that the concentration of CEA and thyroid hormones increases more often in persons of the high risk group with noncancerous diseases than in persons without pathological pulmonary changes. With an increase in the degree of probability the frequency of a high concentration of CEA and thyroid hormones grows. The older the persons with a high risk of lung cancer, the higher the frequency of concentration of the thyroid hormones. Studies of CEA and thyroid hormones can be used for dynamic observation of persons with a high risk of lung cancer

Distinct evolutionary mechanisms for genomic imbalances in high-risk and low-risk neuroblastomas

Directory of Open Access Journals (Sweden)

Gisselsson David

2007-09-01

Full Text Available Abstract Background Neuroblastoma (NB is the most common extracranial solid tumour of childhood. Several genomic imbalances correlate to prognosis in NB, with structural rearrangements, including gene amplification, in a near-diploid setting typically signifying high-risk tumours and numerical changes in a near-triploid setting signifying low-risk tumours. Little is known about the temporal sequence in which these imbalances occur during the carcinogenic process. Methods We have reconstructed the appearance of cytogenetic imbalances in 270 NBs by first grouping tumours and imbalances through principal component analysis and then using the number of imbalances in each tumour as an indicator of evolutionary progression. Results Tumours clustered in four sub-groups, dominated respectively by (1 gene amplification in double minute chromosomes and few other aberrations, (2 gene amplification and loss of 1p sequences, (3 loss of 1p and other structural aberrations including gain of 17q, and (4 whole-chromosome gains and losses. Temporal analysis showed that the structural changes in groups 1–3 were acquired in a step-wise fashion, with loss of 1p sequences and the emergence of double minute chromosomes as the earliest cytogenetic events. In contrast, the gains and losses of whole chromosomes in group 4 occurred through multiple simultaneous events leading to a near-triploid chromosome number. Conclusion The finding of different temporal patterns for the acquisition of genomic imbalances in high-risk and low-risk NBs lends strong support to the hypothesis that these tumours are biologically diverse entities, evolving through distinct genetic mechanisms.

Postmastectomy irradiation in high-risk breast cancer patients

International Nuclear Information System (INIS)

Overgaard, M.; Juul Christensen, J.; Johansen, H.; Nybo-Rasmussen, A.; Brincker, H.; Kooy, P. van der; Frederiksen, P.L.; Laursen, F.; Panduro, J.; Soerensen, N.E.; Gadeberg, C.C.; Hjelm-Hansen, M.; Overgaard, J.; West Andersen, K.; Zedeler, K.

1988-01-01

All pre- and postmenopausal high-risk breast cancer patients in the protocols DBCG 77 of the Danish Breast Cancer Cooperative Group received postmastectomy irradiation before randomization to either adjuvant systemic therapy or no such treatment. The actuarial loco-regional recurrence rate at 9 years was 6-17%, with the lowest rate in patients who also received additional adjuvant chemotherapy or tamoxifen. In a subsequent study (DBCG 82) the role of postmastectomy irradiation together with systemic treatment was evaluated in high-risk patients. Pre- and menopausal patients were randomized to postmastectomy irradiation+CMF (cyclophosphamide, methotrexate, 5-fluorouracil), CMF alone or CMF+TAM (tamoxifen). Postmenopausal patients were randomized to postmastectomy irradiation+TAM, TAM or CMF+TAM. At 4 years the loco-regional recurrence rate was significantly lower in the irradiated patients (5-7% vs. 23-33%). Further, disease-free survival was significantly improved in both pre- and postmenopausal irradiated patients compared with those who had only systemic treatment. At present, there are no significant differences between survival in the treatment groups. Thus, adjuvant systemic treatment alone (chemotherapy and/or tamoxifen) did not prevent loco-regional recurrences in high-risk patients after mastectomy and axillary lymph node sampling. However, a longer observation time is necessary to evaluate the consequence of primary optimal loco-regional tumour control in high-risk breast cancer patients with respect to survival. (orig.)

[Oral health status of women with normal and high-risk pregnancies].

Science.gov (United States)

Chaloupka, P; Korečko, V; Turek, J; Merglová, V

2014-01-01

The aim of this study was to compare the oral health status of women with normal pregnancies and those with high-risk pregnancies. A total of 142 women in the third trimester of pregnancy were randomly selected for this study. The pregnant women were divided into two groups: a normal pregnancy group (group F, n = 61) and a high-risk pregnancy group (group R, n = 81). The following variables were recorded for each woman: age, general health status, DMF index, CPITN index, PBI index, amounts of Streptococcus mutans in the saliva and dental treatment needs. The data obtained were analysed statistically. The Mann-Whitney test, Kruskal-Wallis test and chi square test were used, and p-values less than 0.05 were considered statistically significant. The two-sided t-test was used to compare the two cohorts. Women with high-risk pregnancies showed increased values in all measured indices and tests, but there were no statistically significant differences between the two groups in the DMF index, CPITN index and amounts of Streptococcus mutans present in the saliva. Statistically significant differences were detected between the two groups for the PBI index and dental treatment needs. In group F, the maximum PBI index value was 2.9 in group F and 3.8 in group R. Significant differences were found also in mean PBI values. Out of the entire study cohort, 94 women (66.2%) required dental treatment, including 52% (n = 32) of the women with normal pregnancies and 77% (n = 62) of the women with high-risk pregnancies. This study found that women with complications during pregnancy had severe gingivitis and needed more frequent dental treatment than women with normal pregnancies.

Radiotherapy and androgen ablation for clinically localized high-risk prostate cancer

Energy Technology Data Exchange (ETDEWEB)

Pollack, Alan; Zagars, Gunar K; Kopplin, Susan

1995-04-30

Purpose: The response of patients with clinical stages T1-4 prostate cancer to radiotherapy is variable. A particularly poor prognostic group has been found to be comprised of those with pretreatment prostate specific antigen (PSA) levels above 30 ng/ml with any tumor grade, or PSA levels > 10 and {<=} 30 with tumors grade 3 or 4. These patients have over an 80% actuarial risk of biochemical failure 3 years after definitive external beam radiotherapy. Thus, patients with these high-risk features require more aggressive therapy. During the last 3-4 years, the policy to treat such patients with radiotherapy and androgen ablation (XRT/HORM) was instituted. A retrospective comparison was made between high-risk patients treated with radiotherapy alone (XRT) vs. XRT/HORM. Methods and Materials: Between 1987 and 1991, there were 81 high-risk patients treated with XRT. There were 38 high-risk patients treated with XRT/HORM between 1990 and 1992. The median follow-up was 37 months for the XRT group and 22 months for the XRT/HORM group. No patient had clinical, radiographic, or pathologic evidence of lymph node involvement. The median dose to the prostate was 66 Gy for the XRT group and 68 Gy for the XRT/HORM group. Results: The distributions of several potential prognostic factors were analyzed. Significant differences between the groups were observed for tumor grade, pretreatment prostatic acid phosphatase, and age. The XRT/HORM group was composed of patients with worse features, including a greater proportion of patients with grade 4 tumors, more with abnormal acid phosphatase levels, and more under 60 years of age. The actuarial incidence of a rising PSA at 3 years for the XRT group was 81% vs. 15% for the XRT/HORM group (p < 0.0001). In addition, local relapse at 3 years was 34% for the XRT group and 15% for the XRT/HORM group (p < 0.02). There was no difference between the groups in terms of survival. Cox proportional hazards analyses were performed using several

Association of ABO blood groups and major ischaemic heart disease risk factors

International Nuclear Information System (INIS)

Lutf-Ullah, L.; Akhtar, B.; Noor-Us-Saba; Hanif, A.; Khan, B.Z.; Bukhshi, I.M.

2010-01-01

To study the association of ABO blood groups with major ischaemic heart disease risk factors. Setting: Department of Cardiology, Mayo hospital, Lahore over a period of two years from January 2008 to December 2009. Study Design: Analytic comparative study. Subjects and Methods: The study group included 907 patients of ischaemic heart disease (IHD). The distribution of ABO blood groups in IHD patients was compared for presence or absence of major IHD risk factors. Data was analyzed using SPSS 16. ANOVA and Chi-square tests for significance were used. P-value less than 0.05 was taken as significant. Results: In this study, the following pattern of ABO blood groups was observed in IHD patients : blood group A 251 (27.67%); blood group B 329 (36.27%); blood group O 235 (25.91%); blood group AB 92 (10.14%). We found no relation-ship of ABO blood groups with age (p-value = 0.234), gender (p-value = 0.093), hypertension (p-value = 0.230), diabetes mellitus (p-value = 0.801), family history of IHD (p-value = 0.277), transverse ear lobe crease (p-value = 0.231), total cholesterol (p-value = 0.797), triglycerides (p-value = 0.351), low density lipoprotein (p-value = 0.078), high density lipoprotein (p-value = 0.114). Similarly no relationship was found of smoking, weight, height and body mass index with ABO blood groups, p-values 0.428, 0.528, 0.908 and 0.455 respectively. Conclusion: There is no association of ABO blood groups and major ischaemic heart disease risk factors. (author)

Oral health status of women with high-risk pregnancies.

Science.gov (United States)

Merglova, Vlasta; Hecova, Hana; Stehlikova, Jaroslava; Chaloupka, Pavel

2012-12-01

The aim of this study was to investigate the oral health status of women with high-risk pregnancies. A case-control study of 142 pregnant women was conducted. The case group included 81 pregnant women with high-risk pregnancies, while 61 women with normal pregnancies served as controls. The following variables were recorded for each woman: age, general health status, DMF, CPITN, and PBI index, amounts of Streptococcus mutans in the saliva and dental treatment needs. The Mann-Whitney test, Kruskal-Wallis test, t-test and chi-squared test were used for statistical analyses. Statistically significant differences were detected between the PBI indices and dental treatment needs of the two groups. Out of the entire study cohort, 77% of the women in the case group and 52% of the women in the control group required dental treatment. In this study, women with complications during pregnancy had severe gingivitis and needed more frequent dental treatment than those in the control group.

Unification of favourable intermediate-, unfavourable intermediate-, and very high-risk stratification criteria for prostate cancer.

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Zumsteg, Zachary S; Zelefsky, Michael J; Woo, Kaitlin M; Spratt, Daniel E; Kollmeier, Marisa A; McBride, Sean; Pei, Xin; Sandler, Howard M; Zhang, Zhigang

2017-11-01

To improve on the existing risk-stratification systems for prostate cancer. This was a retrospective investigation including 2 248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into 'favourable' and 'unfavourable' groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into 'standard' and 'very high-risk' groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavourable-intermediate-risk (UIR) prostate cancer had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P prostate cancer-specific mortality (PCSM, P prostate cancer. Similarly, patients with very high-risk (VHR) prostate cancer had significantly worse PSA-RFS (P prostate cancer. Moreover, patients with FIR and low-risk prostate cancer had similar outcomes, as did patients with UIR and SHR prostate cancer. Consequently, we propose the following risk-stratification system: Group 1, low risk and FIR; Group 2, UIR and SHR; and Group 3, VHR. These groups have markedly different outcomes, with 8-year distant metastasis rates of 3%, 9%, and 29% (P < 0.001) for Groups 1, 2, and 3, respectively, and 8-year PCSM of 1%, 4%, and 13% (P < 0.001) after EBRT. This modified stratification system was significantly more accurate than the three-tiered NCCN system currently in clinical use for all outcomes. Modifying the NCCN risk-stratification system to group FIR with low-risk patients and UIR with SHR patients, results in modestly improved prediction of outcomes, potentially allowing better personalisation of therapeutic recommendations. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Schizophrenia in High-Risk Children: Sex Differences in Predisposing Factors.

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Mednick, Sarnoff A.; And Others

Reported is a research program to observe children at high risk for schizophrenia and explore possibilities of prevention. Characteristics of the high risk group (n=207) observed during 1962 are discussed, and a theory which suggests that schizophrenia is an evasion of life is explained. Among results of a diagnostic assessment conducted 10 years…

Rational group decision making in risk situations

International Nuclear Information System (INIS)

Yoon, M.H.

1987-01-01

Risk management has received increasing attention recently as methods of quantifying risk have been evolving. This is considered a legitimate tendency in the context of the entirety of risk evaluation which connotes both risk quantification and decisions making thereon. A risk-free society does not appear possible; neither could one have zero competing risks or cost versus benefit resulting out of a risk-abatement effort. What further complicates the risk-decision problem is that there exists more than a single decision maker, who claim their own interests associated with risk decision. Furthermore, their risk perceptions are not at all same that the threshold risk levels for a particular actions are varying. In this dissertation, a brief survey on existing action levels for various sort of risk situations including carcinogens, toxic chemicals, etc., is reported on, with emphasis on nuclear risk situation. A decision theoretic approach is then adopted in both individual and group-level risk management. For the purpose of exemplification, multiplicative utility theory is applied for nuclear power risk; attributes derived for this specific purpose are discussed

Differences in conventional cardiovascular risk factors in two ethnic groups in India.

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Garg, Priyanka Rani; Kabita, Salam; Singh, Huidrom Suraj; Saraswathy, Kallur Nava; Sinha, Ekata; Kalla, Aloke Kumar; Chongtham, Dhanaraj Singh

2012-01-01

Studies have been carried out at national and international levels to assess ethnic variations in the prevalence of cardiovascular diseases and their risk factors. However, ethnic variations in the contribution of various risk factors to complex diseases have been scarcely studied. Our study examined such variations in two ethnic groups in India, namely, Meiteis of Manipur (northeast India) and Aggarwals of Delhi (north India). Through random sampling, we selected 635 participants from the Meitei community and 181 Aggarwals from the Aggarwal Dharmarth Hospital, Delhi. Patients with coronary artery disease (CAD) and hypertension were identified based on their recent medical diagnostic history. Anthropometric parameters such as height, weight, waist and hip circumferences along with physiological parameters (blood pressures, both systolic and diastolic) and biochemical parameter (lipid profile) were measured for all study participants. Patient parameters were available from the medical reports recorded when patients were first diagnosed. Among CAD individuals, the Aggarwals showed higher mean values of weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TC), low density lipoprotein (LDL), and very low density lipoprotein (VLDL) but had lower high density lipoprotein (HDL) levels than the Meiteis. The same trend for weight, BMI and lipid parameters could be seen among hypertensive individuals. In step-wise regression analysis, SBP, LDL and TG were found to significantly contribute to the risk for CAD in the Aggarwals; whereas in the Meiteis, SBP, VLDL, HDL, TC and LDL were found to significantly contribute to the risk for CAD. In hypertensive Aggarwal participants, SBP, DBP and waist-to-hip ratio were significant contributors for hypertension; whereas SBP, DBP, and height contributed significantly to risk for hypertension among the Meiteis. We found marked differences in conventional risk

High-Risk List

Science.gov (United States)

2017-01-01

economy. The World Bank has said that “corruption creates an unfavorable business environment by undermining the operation efficiency of firms and... Bank Began as ‘Ponzi Scheme,’” 11/27/2012. 64 Independent Joint Anti-Corruption Monitoring and Evaluation Committee, Unfinished Business : The Follow...HIGH RISK AREA 7: Oversight 51 HIGH-RISK AREA 8: Strategy and Planning 55 CONCLUSION HIGH RISK LIST I JANUARY 11, 2017 2 EXECUTIVE SUMMARY

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

Science.gov (United States)

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

2014-08-01

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

Dietary patterns, food groups, and rectal cancer risk in Whites and African-Americans.

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Williams, Christina Dawn; Satia, Jessie A; Adair, Linda S; Stevens, June; Galanko, Joseph; Keku, Temitope O; Sandler, Robert S

2009-05-01

Associations between individual foods and nutrients and colorectal cancer have been inconsistent, and few studies have examined associations between food, nutrients, dietary patterns, and rectal cancer. We examined the relationship between food groups and dietary patterns and risk for rectal cancer in non-Hispanic Whites and African-Americans. Data were from the North Carolina Colon Cancer Study-Phase II and included 1,520 Whites (720 cases, 800 controls) and 384 African-Americans (225 cases, 159 controls). Diet was assessed using the Diet History Questionnaire. Multivariate logistic regression models were used to estimate odds ratios and 95% confidence intervals. Among Whites, non-whole grains and white potatoes were associated with elevated risk for rectal cancer whereas fruit, vegetables, dairy, fish, and poultry were associated with reduced risk. In African-Americans, high consumption of other fruit and added sugar suggested elevated risk. We identified three major dietary patterns in Whites and African-Americans. The high fat/meat/potatoes pattern was observed in both race groups but was only positively associated with risk in Whites (odds ratio, 1.84; 95% confidence interval, 1.03-3.15). The vegetable/fish/poultry and fruit/whole grain/dairy patterns in Whites had significant inverse associations with risk. In African-Americans, there was a positive dose-response for the fruit/vegetables pattern (P(trend) pattern (P(trend) dietary patterns with rectal cancer risk differ between Whites and African-Americans, highlighting the importance of examining diet and cancer relationships in racially diverse populations.

[Hemostasiological, lipidemic, and hemodynamic indicators associated with the risk of cardiovascular death in high- and very high-risk patients according to the SCORE scale].

Science.gov (United States)

Kachkovskiĭ, M A; Simerzin, V V; Rybanenko, O A; Kirichenko, N A

2014-01-01

To identify lipidemic, hemostasiological, and hemodynamic indicators associated with the risk of cardiovascular death in high- and very high-risk patients. One hundred and forty-eight patients whose mean age was 50.8 +/- 4.4 years were examined. All the patients were divided into high (1 group) and very high (2 group) cardiovascular death risk groups according to the SCORE scale. Lipid metabolism, hemostatic system parameters (fibrinogen, time of ADP-induced platelet aggregation initiation, D-dimer), endothelial dysfunction markers (von Willebrand factor), and echocardiographic findings were studied. Multivariate regression analysis showed that the odds ratio for a cardiovascular death risk was 1.8 (95% confidence interval (CI), 1.1 to 4.2; p = 0.04) in patients with a D-dimer level of greater than 1 mg/ml, 0.77 (95% CI, 0.6 to 0.97; p = 0.03) in those with an ADP-induced platelet aggregation initiation time of 13.5 sec, 1.04 (95% CI, 1.01 to 1.07; p = 0.02) in those with an end-diastolic volume of more than 123 ml, 1.1 (95% CI, 1.04 to 1.2; p = 0.003) in those with an end-diastolic dimension of more than 51 mm, 1.5 (95% CI, 1.1 to 2.0; p = 0.009) in those with a ventricular septal thickness of more than 11.5 mm, and 2.1 (95% CI, 1.03 to 3.2; p = 0.0032) in those with avon Willebrand factor level of more than 140%. The high levels of von Willebrand factor, D-dimer, ADP-induced platelet aggregation, triglycerides, end-diastolic volume, end-diastolic dimension, and ventricular septal thickness are independent predictors of cardiovascular death in very high-risk patients. These indicators bear out a close relationship between lipid metabolic and hemostatic disturbances and between endothelial dysfunction and intracardiac hemodynamic worsening in these patients.

Observed changes in cardiovascular risk factors among high-risk middle-aged men who received lifestyle counselling: a 5-year follow-up.

Science.gov (United States)

Siren, Reijo; Eriksson, Johan G; Vanhanen, Hannu

2016-12-01

To examine the long-term impact of health counselling among middle-aged men at high risk of CVD. An observational study with a 5-year follow-up. All men aged 40 years in Helsinki have been invited to a visit to evaluate CVD risk from 2006 onwards. A modified version of the North Karelia project risk tool (CVD risk score) served to assess the risk. High-risk men received lifestyle counselling based on their individual risk profile in 2006 and were invited to a follow-up visit in 2011. Of the 389 originally high-risk men, 159 participated in the follow-up visits in 2011. Based on their follow-up in relation the further risk communication, we divided the participants into three groups: primary health care, occupational health care and no control visits. Lifestyle and CVD risk score change. All groups showed improvements in lifestyles. The CVD risk score decreased the most in the group that continued the risk communication visits in their primary health care centre (6.1 to 4.8 [95% CI -1.6 to -0.6]) compared to those who continued risk communication visits in their occupational health care (6.0 to 5.4 [95% CI -1.3 to 0.3]), and to those with no risk communication visits (6.0 to 5.9 [95% CI -0.5 to 0.4]). These findings indicate that individualized lifestyle counselling improves health behaviour and reduces total CVD risk among middle-aged men at high risk of CVD. Sustained improvement in risk factor status requires ongoing risk communication with health care providers. KEY POINTS Studies of short duration have shown that lifestyle changes reduce the risk of cardiovascular disease among high-risk individuals. Sustaining these lifestyle changes and maintaining the lower disease risk attained can prove challenging. Cardiovascular disease (CVD) risk assessment and individualized health counselling for high-risk men, when implemented in primary health care, have the potential to initiate lifestyle changes that support risk reduction. Attaining a sustainable reduction in CVD

A social work study high-risk behavior among teenagers

Directory of Open Access Journals (Sweden)

Mohammad Reza Iravani

2012-01-01

Full Text Available Teenagers are believed the people who are supposed to build the world's future. High-risk behaviors such as addiction to drugs, smoking cigarettes, sex, etc. could significantly hurts teenagers and there must be some supporting programs to reduce these issues as much as possible. This paper performs an empirical investigation to study the different factors influencing high- risk behavior among teenagers who live in a city of Esfahan, Iran. The proposed study designs a questionnaire and distribute between two groups of female and male teenagers. The results indicate that while there is a meaningful relationship between high-risk behaviors and average high school marks among male students there is no meaningful relationship between high-risk behaviors and high school grades among female students. The results also indicate that there is a meaningful difference between gender and high-risk behavior. The season of birth for female and male students is another important factor for having high-risk behaviors. While the order of birth plays an important role among male students, the order of birth is not an important factor among female teenagers. Finally, the results indicate that teenagers' parental financial affordability plays a vital role on both female and male teenagers.

Consensus statement on definition, diagnosis, and management of high-risk prostate cancer patients on behalf of the Spanish Groups of Uro-Oncology Societies URONCOR, GUO, and SOGUG.

Science.gov (United States)

Henríquez, I; Rodríguez-Antolín, A; Cassinello, J; Gonzalez San Segundo, C; Unda, M; Gallardo, E; López-Torrecilla, J; Juarez, A; Arranz, J

2018-03-01

Prostate cancer (PCa) is the most prevalent malignancy in men and the second cause of mortality in industrialized countries. Based on Spanish Register of PCa, the incidence of high-risk PCa is 29%, approximately. In spite of the evidence-based beneficial effect of radiotherapy and androgen deprivation therapy in high-risk PCa, these patients (pts) are still a therapeutic challenge for all specialists involved, in part due to the absence of comparative studies to establish which of the present disposable treatments offer better results. Nowadays, high-risk PCa definition is not well consensual through the published oncology guides. Clinical stage, tumour grade, and number of risk factors are relevant to be considered on PCa prognosis. However, these factors are susceptible to change depending on when surgical or radiation therapy is considered to be the treatment of choice. Other factors, such as reference pathologist, different diagnosis biopsy schedules, surgical or radiotherapy techniques, adjuvant treatments, biochemical failures, and follow-up, make it difficult to compare the results between different therapeutic options. This article reviews important issues concerning high-risk PCa. URONCOR, GUO, and SOGUG on behalf of the Spanish Groups of Uro-Oncology Societies have reached a consensus addressing a practical recommendation on definition, diagnosis, and management of high-risk PCa.

Is the high-risk strategy to prevent cardiovascular disease equitable?

DEFF Research Database (Denmark)

Wallach Kildemoes, Helle; Diderichsen, Finn; Krasnik, Allan

2012-01-01

ABSTRACT: BACKGROUND: Statins are increasingly prescribed to prevent cardiovascular disease (CVD) in asymptomatic individuals. Yet, it is unknown whether those at higher CVD risk - i.e. individuals in lower socio-economic position (SEP) - are adequately reached by this high-risk strategy. Aim......: To examine whether the Danish implementation of the strategy to prevent cardiovascular disease (CVD) by initiating statin (HMG-CoA reductase inhibitor) therapy in high-risk individuals is equitable across socioeconomic groups. METHODS: Design: Cohort study. Setting and participants: Applying individual...

Group based prenatal care in a low-and high risk population in the Netherlands: a study protocol for a stepped wedge cluster randomized controlled trial.

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van Zwicht, Birgit S; Crone, Matty R; van Lith, Jan M M; Rijnders, Marlies E B

2016-11-15

CenteringPregnancy (CP) is a multifaceted group based care-model integrated in routine prenatal care, combining health assessment, education, and support. CP has shown some positive results on perinatal outcomes. However, the effects are less obvious when limited to the results of randomized controlled trials: as there are few trials and there is a variation in reported outcomes. Furthermore, former research was mostly conducted in the United States of America and in specific (often high risk) populations. Our study aims to evaluate the effects of CP in the Netherlands in a general population of pregnant women (low and high risk). Furthermore we aim to explore the mechanisms leading to the eventual effects by measuring potential mediating factors. We will perform a stepped wedge cluster randomized controlled trial, in a Western region in the Netherlands. Inclusion criteria are care, women in the intervention period (starting at the randomized time-point) will be offered the choice between individual care or CP. Primary outcomes are maternal and neonatal morbidity, retrieved from a national routine database. Secondary outcomes are health behavior, psychosocial outcomes, satisfaction, health care utilization and process outcomes, collected through self-administered questionnaires, group-evaluations and individual interviews. We will conduct intention-to-treat analyses. Also a per protocol analysis will be performed comparing the three subgroups: control group, CP-participants and non-CP-participants, using multilevel techniques to account for clustering effects. This study contributes to the evidence regarding the effect of CP and gives a first indication of the effect and implementation of CP in both low and high-risk pregnancies in a high-income Western society other than the USA. Also, measuring factors that are hypothesized to mediate the effect of CP will enable to explain the mechanisms that lead to effects on maternal and neonatal outcomes. Dutch Trial

Risks and injuries in laser and high-frequency applications

Science.gov (United States)

Giering, K.; Philipp, Carsten M.; Berlien, Hans-Peter

1995-01-01

An analysis of injuries and risks using high frequency (HF) and lasers in medicine based on a literature search with MEDLINE was performed. The cases reported in the literature were classified according to the following criteria: (1) Avoidable in an optimal operational procedure. These kind of injuries are caused by a chain of unfortunate incidents. They are in principle avoidable by the 'right action at the right time' which presupposes an appropriate training of the operating team, selection of the optimal parameters for procedure and consideration of all safety instructions. (2) Avoidable, caused by malfunction of the equipment and/or accessories. The injuries classified into this group are avoidable if all safety regulations were fulfilled. This includes a pre-operational check-up and the use of medical lasers and high frequency devices only which meet the international safety standards. (3) Avoidable, caused by misuse/mistake. Injuries of this group were caused by an inappropriate selection of the procedure, wrong medical indication or mistakes during application. (4) Unavoidable, fateful. These injuries can be caused by risks inherent to the type of energy used, malfunction of the equipment and/or accessories though a pre-operational check-up was done. Some risks and complications are common to high frequency and laser application. But whereas these risks can be excluded easily in laser surgery there is often a great expenditure necessary or they are not avoidable if high frequency if used. No unavoidable risks due to laser energy occur.

Group dynamics of zebra and wildebeest in a woodland savanna: effects of predation risk and habitat density.

Directory of Open Access Journals (Sweden)

Maria Thaker

Full Text Available BACKGROUND: Group dynamics of gregarious ungulates in the grasslands of the African savanna have been well studied, but the trade-offs that affect grouping of these ungulates in woodland habitats or dense vegetation are less well understood. We examined the landscape-level distribution of groups of blue wildebeest, Connochaetes taurinus, and Burchell's zebra, Equus burchelli, in a predominantly woodland area (Karongwe Game Reserve, South Africa; KGR to test the hypothesis that group dynamics are a function of minimizing predation risk from their primary predator, lion, Panthera leo. METHODOLOGY/PRINCIPAL FINDINGS: Using generalized linear models, we examined the relative importance of habitat type (differing in vegetation density, probability of encountering lion (based on utilization distribution of all individual lions in the reserve, and season in predicting group size and composition. We found that only in open scrub habitat, group size for both ungulate species increased with the probability of encountering lion. Group composition differed between the two species and was driven by habitat selection as well as predation risk. For both species, composition of groups was, however, dominated by males in open scrub habitats, irrespective of the probability of encountering lion. CONCLUSIONS/SIGNIFICANCE: Distribution patterns of wildebeest and zebra groups at the landscape level directly support the theoretical and empirical evidence from a range of taxa predicting that grouping is favored in open habitats and when predation risk is high. Group composition reflected species-specific social, physiological and foraging constraints, as well as the importance of predation risk. Avoidance of high resource open scrub habitat by females can lead to loss of foraging opportunities, which can be particularly costly in areas such as KGR, where this resource is limited. Thus, landscape-level grouping dynamics are species specific and particular to the

Evaluation of Low- Versus High-dose Valganciclovir for Prevention of Cytomegalovirus Disease in High-risk Renal Transplant Recipients.

Science.gov (United States)

Gabardi, Steven; Asipenko, Natalya; Fleming, James; Lor, Kevin; McDevitt-Potter, Lisa; Mohammed, Anisa; Rogers, Christin; Tichy, Eric M; Weng, Renee; Lee, Ruth-Ann

2015-07-01

Despite proven efficacy of prolonged cytomegalovirus (CMV) prophylaxis using valganciclovir 900 mg/day, some centers use 450 mg/day due to reported success and cost savings. This multicenter, retrospective study compared the efficacy and safety of 6 months of low-dose versus high-dose valganciclovir prophylaxis in high-risk, donor-positive/recipient-negative, renal transplant recipients (RTR). Two hundred thirty-seven high-risk RTR (low-dose group = valganciclovir 450 mg/day [n = 130]; high-dose group = valganciclovir 900 mg/day [n = s7]) were evaluated for 1-year CMV disease prevalence. Breakthrough CMV, resistant CMV, biopsy-proven acute rejection (BPAR), graft loss, opportunistic infections (OI), new-onset diabetes after transplantation (NODAT), premature valganciclovir discontinuation, renal function and myelosuppression were also assessed. Patient demographics and transplant characteristics were comparable. Induction and maintenance immunosuppression were similar, except for more early steroid withdrawal in the high-dose group. Similar proportions of patients developed CMV disease (14.6% vs 24.3%; P = 0.068); however, controlling CMV risk factor differences through multivariate logistic regression revealed significantly lower CMV disease in the low-dose group (P = 0.02; odds ratio, 0.432, 95% confidence interval, 0.211-0.887). Breakthrough and resistant CMV occurred at similar frequencies. There was no difference in renal function or rates of biopsy-proven acute rejection, graft loss, opportunistic infections, or new-onset diabetes after transplantation. The high-dose group had significantly lower mean white blood cell counts at months 5 and 6; however, premature valganciclovir discontinuation rates were similar. Low-dose and high-dose valganciclovir regimens provide similar efficacy in preventing CMV disease in high-risk RTR, with a reduced incidence of leukopenia associated with the low-dose regimen and no difference in resistant CMV. Low-dose valganciclovir

Differences in the distribution of risk factors for stroke among the high-risk population in urban and rural areas of Eastern China.

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Mi, Te; Sun, Shangwen; Du, Yifeng; Guo, Shougang; Cong, Lin; Cao, Mingfeng; Sun, Qinjian; Sun, Yi; Qu, Chuanqiang

2016-05-01

Considering the program of screening for risk factors of stroke in Eastern China, the aim of this study was to compare the distribution differences in risk factors for stroke among the high-risk population living in urban and rural areas. A total of 231,289 residents were screened and basic information collected. Risk factors for stroke among the high-risk population were compared between the urban and rural groups. A total of 117,776 high-risk residents from urban areas and 113,513 from rural areas were included in the analysis. The prevalence of hypertension was much higher in rural areas (73.3%) than that in urban areas (64.1%). Dyslipidemia (48.9% vs. 26.9%), sport lack (46.6% vs. 31.6%), diabetes mellitus (21.3% vs. 16.5%), and atrial fibrillation (18.7% vs. 9.8%) were more prevalent in the urban group, while smoking (26.5% vs. 28.8%), previous stroke (10.1% vs. 16.9%), and transient ischemic attack (20.9% vs. 24.6%) were less prevalent. Among the population at high risk of stroke, there were significant differences in the distribution of the following risk factors between the urban and rural groups: hypertension, atrial fibrillation, dyslipidemia, lack of physical exercise, and a previous stroke.

High plasma levels of high mobility group box 1 is associated with the risk of sepsis in severe blunt chest trauma patients: a prospective cohort study.

Science.gov (United States)

Wang, Xiao-Wen; Karki, Avash; Zhao, Xing-Ji; Xiang, Xiao-Yong; Lu, Zhi-Qian

2014-08-02

High mobility group box 1 (HMGB1) is a late mediator of systemic inflammation. Extracellular HMGB1 play a central pathogenic role in critical illness. The purpose of the study was to investigate the association between plasma HMGB1 concentrations and the risk of poor outcomes in patients with severe blunt chest trauma. The plasma concentrations of HMGB1 in patients with severe blunt chest trauma (AIS ≥ 3) were measured by a quantitative enzyme-linked immunosorbent assay at four time points during seven days after admission, and the dynamic release patterns were monitored. The biomarker levels were compared between patients with sepsis and non-sepsis, and between patients with multiple organ dysfunction syndrome (MODS) and non-MODS. The related factors of prognosis were analyzed by using multivariate logistic regression analysis. The short-form 36 was used to evaluate the quality of life of patients at 12 months after injury. Plasma HMGB1 levels were significantly higher both in sepsis and MODS group on post-trauma day 3, 5, and 7 compared with the non-sepsis and non-MODS groups, respectively. Multivariate analysis showed that HMGB1 levels and ISS were independent risk factors for sepsis and MODS in patients with severe blunt chest trauma. Plasma HMGB1 levels were significantly elevated in patients with severe blunt chest trauma. HMGB1 levels were associated with the risk of poor outcome in patients with severe blunt chest trauma. Daily HMGB1 levels measurements is a potential useful tool in the early identification of post-trauma complications. Further studies are needed to determine whether HMGB1 intervention could prevent the development of sepsis and MODS in patients with severe blunt chest trauma.

Biochemical failure after radical prostatectomy in intermediate-risk group men increases with the number of risk factors

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Nobuki Furubayashi

2017-01-01

Conclusion: The number of intermediate risk factors is significantly associated with the PSA failure-free survival rate after radical prostatectomy in the intermediate-risk group. Patients classified into the intermediate-risk group based on all three intermediate risk factors are less likely to achieve a complete cure through surgery alone.

Validation of the D'amico risk groups classification, valuation of high-risk patients with or without hormonal therapy and complications of patients with adenocarcinoma of the prostate, after treatment with external radiotherapy, Hospital Calderon Guardia, 2003-2004

International Nuclear Information System (INIS)

Lopez Arias, Ever Roy

2008-01-01

D'amico risk groups have been classified to estimate the probability of biochemical recurrence after treatment for localized prostate cancer. The evolution of patients that have received external radiotherapy were analyzed according to the risk group. The medical records of 50 patients between 2003 and 2004 have been assessed and has observed the evolution of Prostatic Specific Antigen after treatment ends, at Hospital Calderon Guardia. Adverse reactions resulting from radiotherapy treatment and the organs most affected by the same have been documented nith the possibility to compare the results of similar studies in the literature. The best performance is given by receiving concomitant hormonal therapy that high risk patients of D'amico without receiving. (author) [es

Association of spiritual/religious coping with depressive symptoms in high- and low-risk pregnant women.

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Vitorino, Luciano M; Chiaradia, Raíssa; Low, Gail; Cruz, Jonas Preposi; Pargament, Kenneth I; Lucchetti, Alessandra L G; Lucchetti, Giancarlo

2018-02-01

To investigate the role of spiritual/religious coping (SRC) on depressive symptoms in high- and low-risk pregnant women. Spiritual/religious coping is associated with physical and mental health outcomes. However, only few studies investigated the role of these strategies during pregnancy and whether low- and high-risk pregnant women have different coping mechanisms. This study is a cross-sectional comparative study. This study included a total of 160 pregnant women, 80 with low-risk pregnancy and 80 with high-risk pregnancy. The Beck Depression Inventory, the brief SRC scale and a structured questionnaire on sociodemographic and obstetric aspects were used. General linear model regression analysis was used to identify the factors associated with positive and negative SRC strategies in both groups of pregnant women. Positive SRC use was high, whereas negative SRC use was low in both groups. Although we found no difference in SRC strategies between the two groups, negative SRC was associated with depression in women with high-risk pregnancy, but not in those with low-risk pregnancy. Furthermore, positive SRC was not associated with depressive symptoms in both groups. Results showed that only the negative SRC strategies of Brazilian women with high-risk pregnancies were associated with worsened mental health outcomes. Healthcare professionals, obstetricians and nurse midwives should focus on the use of negative SRC strategies in their pregnant patients. © 2017 John Wiley & Sons Ltd.

Foot length measurements of newborns of high and low risk pregnancies

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Ana Karina Marques Salge

Full Text Available Abstract OBJECTIVE Comparing foot length measurements of newborns in high and low risk pregnancies at a public hospital in Goiânia, GO, Brazil. METHOD A cross-sectional study carried out between April, 2013 and May, 2015, with a sample consisting of 180 newborns; 106 infants of women from high-risk pregnancies and 74 of women from low-risk pregnancies. Data were descriptively analyzed. Foot length measurement was performed using a stiff transparent plastic ruler, graduated in millimeters. The length of both feet was measured from the tip of the hallux (big toe to the end of the heel. RESULTS A statistically significant relationship was found between the foot length and newborn’s weight, between the cephalic and thoracic perimeters in the high-risk group and between the cephalic perimeter in the control group. CONCLUSION There is a need for creating cut-off points to identify newborns with intrauterine growth disorders using foot length.

Risk and culture: variations in dioxin risk perceptions, behavioral preferences among social groups in South Korea

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Seohyun Park

2014-10-01

Full Text Available Objectives This study examined variations in the perceptions of dioxin risk among social groups defined by geographical living location, environmental education, and occupation. Dioxin risk perceptions were analyzed according to values, risk awareness, knowledge, and behavioral preferences. Methods A quasi-experimental survey was designed and conducted on individuals from seven experimental groups in Jeonju city, South Korea, including: people living near incineration facilities; people living far from incineration facilities; governmental experts; nongovernmental organization members; office workers in developmental institutes or banks; students who were enrolled in environmental-related classes; and students who were enrolled in business-related classes. Results The results show variations among groups in values, awareness and behavioral preferences. Particular attention should be given to the result that groups with higher connectedness- to-nature values show higher willingness-to-act (WTA for risk reduction. Result s can be summarized as follows. First, awareness is associated with one’s geographical setting. Second, values and WTA behaviors are related to one’s environmental-related education and occupation. Third, values are significantly related to WTA behaviors. Conclusions Different cultures, in terms of values or worldview, among groups influence their perceptions of dioxin risk and choices of risk reduction behaviors. It is important to consider values in communicating complicated long-term risk management involving public participation. Further research should be continuously conducted on the effects of multiple dimensions of values on one’s WTA for risk reduction behaviors.

Incidence of infective endocarditis among patients considered at high risk

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Østergaard, Lauge; Valeur, Nana; Ihlemann, Nikolaj

2018-01-01

Aims: Patients with prior infective endocarditis (IE), a prosthetic heart valve, or a cyanotic congenital heart disease (CHD) are considered to be at high risk of IE by guidelines. However, knowledge is sparse on the relative risk of IE between these three groups and compared controls. Methods...

Hypersexual, Sexually Compulsive, or Just Highly Sexually Active? Investigating Three Distinct Groups of Gay and Bisexual Men and Their Profiles of HIV-Related Sexual Risk

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Rendina, H. Jonathon; Ventuneac, Ana; Moody, Raymond L.; Grov, Christian

2015-01-01

Emerging research supports the notion that sexual compulsivity (SC) and hypersexual disorder (HD) among gay and bisexual men (GBM) might be conceptualized as comprising three groups—Neither SC nor HD; SC only, and Both SC and HD—that capture distinct levels of severity across the SC/HD continuum. We examined data from 370 highly sexually active GBM to assess how the three groups compare across a range of risk factors for HIV infection. Comparisons focused on psychosexual measures—temptation for condomless anal sex (CAS), self-efficacy for avoiding CAS, sexual excitation and inhibition—as well as reports of actual sexual behavior. Nearly half (48.9 %) of this highly sexually active sample was classified as Neither SC nor HD, 30 % as SC Only, and 21.1 % as Both SC and HD. While we found no significant differences between the three groups on reported number of male partners, anal sex acts, or anal sex acts with serodiscordant partners, the Both SC and HD group reported higher numbers of CAS acts and CAS acts with serodiscordant partners and also had a higher proportion of their anal sex acts without condoms compared to the SC Only group. Our findings support the validity of a three-group classification system of SC/HD severity in differentiating psychosexual and HIV-related sexual risk behavior outcomes in a sample of GBM who report similarly high levels of sexual activity. Notwithstanding the need for sex positive HIV prevention programs, interventions that attempt to help Both SC and HD men deal with distress and address their psychosexual needs specifically may derive HIV prevention benefits. PMID:25750052

Risk-matching behavior in microcredit group formation: evidence from northern Ethiopia

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Berhane Tesfay, G.; Gardebroek, C.; Moll, H.A.J.

2009-01-01

Theoretical models on group lending assume the formation of groups of homogenous risk types. Recent theoretical and empirical findings challenge this view arguing that when markets for insurance are missing, risk homogeneity may not hold any more and risk heterogeneity can be the optimal outcome.

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

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

2010-05-01

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

Cognitive and behavioural dispositions in offspring at high risk for alcoholism.

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Kumar, Rajesh; Kumar, Keshav Janakiprasad; Benegal, Vivek

2018-05-15

Offspring with family history of alcoholism are considered to be at high risk for alcoholism. The present study sought to expand our understanding of cognitive and behavioural dispositions associated with executive control and self-regulation in alcohol naïve offspring with and without family history of alcoholism. Sample comprised of alcohol naive offspring in two groups: (i) at high risk (n = 34) and (ii) at low risk for alcoholism (n = 34). Both groups were matched on age (+/-1 year), education (+/-1 year) and gender. Measures used were: Mini-International Neuropsychiatric Interview, Family Interview for Genetic Studies, Socio-demographic Data Sheet, Annett's Handedness Questionnaire, Barratt's Impulsiveness Scale-version 11, Digit Span Test, Spatial Span Test, Tower of London, Wisconsin Card Sorting Test, Iowa Gambling Task (IGT) and Game of Dice Task (GDT). Results showed that alcohol naive offspring at high risk for alcoholism reported significantly high impulsivity and demonstrated significant differences on executive functions and decision making tasks. Correlation analysis revealed that high impulsivity was significantly associated with poor performance on explicit decision making task (GDT) and executive function task (WCST). There was no significant correlation between two decision making tasks (IGT and GDT) in both groups and performance on IGT was not significantly associated with impulsivity and executive functions. The present study indicates cognitive and behavioural dispositions in alcohol naive offspring at high risk for alcoholism and support the sub-optimal balance between reflective and impulsive system responsible for addiction. Furthermore, present study supports separability between two different types of decision making tasks. Copyright © 2018. Published by Elsevier B.V.

High serum alanine aminotransferase is associated with the risk of colorectal adenoma in Korean men.

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Moon, Chang Mo; Yun, Kyung Eun; Ryu, Seungho; Chang, Yoosoo; Park, Dong Il

2017-07-01

An elevated alanine aminotransferase (ALT) is frequently observed in subjects with metabolic syndrome, which is associated with the risk of colorectal adenoma (CRA). However, the relationship between ALT and CRA remains unclear. Therefore, we aimed to investigate whether high serum ALT is associated with the risk of CRA in a metabolically healthy population. We conducted this cross-sectional study in 27,717 asymptomatic Korean adults who underwent a health checkup. Subjects were categorized as adenoma-free, hyperplastic polyp, low-risk adenoma, or high-risk adenoma. High-risk adenoma was defined as three or more adenomas, any adenoma ≥ 10 mm, or adenoma with high-grade dysplasia or villous features. Among all participants, 10.3% and 1.5% of cases were categorized as low-risk and high-risk adenoma, respectively. In multivariate analyses adjusting for age, sex, body mass index, smoking habits, alcohol intake, regular exercise, aspirin and analgesics use, family history of colon cancer, education level, fatty liver, high-sensitivity C reactive protein, homeostasis model assessment of insulin resistance, total cholesterol, and triglyceride, an increase in ALT was positively associated with the prevalence of low-risk and high-risk adenoma (P for trend = 0.029 and 0.027, respectively). The highest quartile group of ALT level showed a significantly increased prevalence in low-risk (odds ratio, 1.17) and high-risk adenoma (odds ratio, 1.48) groups compared with the lowest quartile group. This phenomenon persisted in the subgroup analysis in men, but not in women. In the asymptomatic healthy population, high serum ALT is significantly associated with the risk of CRA. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Reduction of travellers' diarrhoea by WC/rBS oral cholera vaccine in young, high-risk travellers.

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Torrell, Josep Ma Ramon; Aumatell, Cristina Masuet; Ramos, Sergi Morchon; Mestre, Laura Gavaldà; Salas, Carme Micheo

2009-06-19

A bidirectional cohort study investigates whether pre-travel vaccination with whole cell/recombinant B subunit inactivated, killed oral cholera vaccine reduces the incidence of diarrhoea in young adult travellers to high-risk areas. Risk of travellers' diarrhoea was assessed according to destination and reason for travel in high-risk travellers of a travel clinic in Barcelona, Spain. Those at high-risk between January and December 2005 were advised on water/food safety and hygiene. High-risk travellers between January and December 2006 were additionally vaccinated with WC/rBS oral cholera vaccine. Data regarding diarrhoea were gathered by structured telephone interview or e-mailed questionnaire following the travellers' return. The incidence of diarrhoea in the group vaccinated with WC/rBS oral cholera vaccine (n=321) was 17.4%, compared with 39.7% in the non-vaccinated group (n=337) (adjusted risk ratio 0.40). The first episode was significantly shorter in the vaccinated group (mean 2.3 days) than in the non-vaccinated group (mean 3.8 days) (pyoung, high-risk travellers. Vaccination with the WC/rBS oral cholera vaccine as well as food safety and hygiene advice could offer effective means of reducing the risk of diarrhoea while abroad.

Are the blood groups of women with preeclampsia a risk factor for the development of hypertension postpartum?

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Avci, Deniz; Karagoz, Hatice; Ozer, Ozerhan; Esmeray, Kubra; Bulut, Kadir; Aykas, Fatma; Cetinkaya, Ali; Uslu, Emine; Karahan, Samet; Basak, Mustafa; Erden, Abdulsamet

2016-01-01

Preeclampsia (PE) is a pregnancy-related disorder characterized by hypertension (HT) and proteinuria noticeable after 20 weeks of gestation. PE is now considered as a cardiovascular disease risk factor and a number of studies have shown that experiencing PE increases the prevalence of various cardiovascular risk factors, such as metabolic syndrome and HT. In this study, we aimed to investigate any possible relationship between the ABO/Rh blood group system and PE in Turkey. In the second part of the study, we examined the relationship between the ABO blood group system and development of HT after PE. A total of 250 patients with PE from Kayseri Training and Research Hospital between 2002 and 2012 were included in the study. Patients were classified according to blood groups (A, B, AB, and O) and Rh status (+/-). There was a significant difference between the patients with PE and the control group in terms of distribution of ABO blood groups and the percentage of group AB was found to be higher in patients with PE compared to the control group (P=0.029). The risk of developing PE was significantly higher in group AB than other blood groups (P=0.006). The risk of developing HT after PE was significantly higher in group O than other blood groups (P=0.004). In this study, we found that the patients with blood group AB have a higher risk for PE. The patients with PE of blood group O are at high risk of developing HT, and Rh factor was identified as another risk at this point and these patients should be closely followed postpartum.

The Joint Effects of Risk Status, Gender, Early Literacy and Cognitive Skills on the Presence of Dyslexia among a Group of High-Risk Chinese Children

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Wong, Simpson W. L.; McBride-Chang, Catherine; Lam, Catherine; Chan, Becky; Lam, Fanny W. F.; Doo, Sylvia

2012-01-01

This study sought to examine factors that are predictive of future developmental dyslexia among a group of 5-year-old Chinese children at risk for dyslexia, including 62 children with a sibling who had been previously diagnosed with dyslexia and 52 children who manifested clinical at-risk factors in aspects of language according to testing by…

Introduction of high risk pregnancy care in rural Cameroon: health service research approach.

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Leke, R J; Nasah, B T; Mtango, F D

1988-05-01

A 3-year study (1982-1985) in Cameroon showed that high-risk pregnancy identification and care could successfully be introduced in rural communities through inexpensive training and supervision of local nurses, particularly when motivation for use of antenatal clinics (ANCs) was provided by the local Community Women's Organization (CWO). 11 communities, all rural except Tsinga, were randomly allocated to Groups I (control) or II. A retrospective baseline survey of ANCs showed that high-risk pregnancy detection had been nonexistent. For both groups, nurses were given 2-week training courses on high-risk identification and family planning. The registers for recording prenatal consultations and deliveries were modified to include recording of risk factors. Special forms were created for reporting on each high-risk case thus identified. These forms proved more difficult for the nurses to complete than the registers. For Group II communities, CWO leaders were recruited to urge women to attend ANCs. 2548 cases of high-risk pregnancy (21.9% of pregnancies) were identified on the special forms, although the number of cases identified in clinic registers was consistently higher. Posttest attendance at ANCs was higher than pretest and significantly higher in areas where CWO motivation had been used. Major risk factors in the identified cases were grand multiparity, teenage pregnancy and previous complicated obstetrics history, although semiurban Tsinga had less grand multiparity and teenage pregnancy and more obesity, diabetes, hypertension and preclampsia. Only 23.4% of the identified cases delivered in the clinics, showing the need for more comprehensive maternal service programs. Since only 5% of the high-risk pregnancy population accepted modern contraceptives after delivery, research is needed on the determinants.

American Brachytherapy Society Task Group Report: Combination of brachytherapy and external beam radiation for high-risk prostate cancer.

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Spratt, Daniel E; Soni, Payal D; McLaughlin, Patrick W; Merrick, Gregory S; Stock, Richard G; Blasko, John C; Zelefsky, Michael J

To review outcomes for high-risk prostate cancer treated with combined modality radiation therapy (CMRT) utilizing external beam radiation therapy (EBRT) with a brachytherapy boost. The available literature for high-risk prostate cancer treated with combined modality radiation therapy was reviewed and summarized. At this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment. Several large retrospective studies and three prospective randomized trials comparing CMRT to dose-escalated EBRT have demonstrated superior biochemical control with CMRT. Longer followup of the randomized trials will be required to determine if this will translate to a benefit in metastasis-free survival, disease-specific survival, and overall survival. Although greater toxicity has been associated with CMRT compared to EBRT, recent studies suggest that technological advances that allow better definition and sparing of critical adjacent structures as well as increasing experience with brachytherapy have improved implant quality and the toxicity profile of brachytherapy. The role of androgen deprivation therapy is well established in the external beam literature for high-risk disease, but there is controversy regarding the applicability of these data in the setting of dose escalation. At this time, there is not sufficient evidence for the omission of androgen deprivation therapy with dose escalation in this population. Comparisons with surgery remain limited by differences in patient selection, but the evidence would suggest better disease control with CMRT compared to surgery alone. Due to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high-risk population. Given the evidence from recent randomized trials, combination therapy may become the standard of care for high-risk cancers. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All

Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part I. Epidemiology, high-risk groups, clinical strategies, and diagnostic technology.

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Mayer, Jonathan E; Swetter, Susan M; Fu, Teresa; Geller, Alan C

2014-10-01

While most cancers have shown both decreased incidence and mortality over the past several decades, the incidence of melanoma has continued to grow, and mortality has only recently stabilized in the United States and in many other countries. Certain populations, such as men >60 years of age and lower socioeconomic status groups, face a greater burden from disease. For any given stage and across all ages, men have shown worse melanoma survival than women, and low socioeconomic status groups have increased levels of mortality. Novel risk factors can help identify populations at greatest risk for melanoma and can aid in targeted early detection. Risk assessment tools have been created to identify high-risk patients based on various factors, and these tools can reduce the number of patients needed to screen for melanoma detection. Diagnostic techniques, such as dermatoscopy and total body photography, and new technologies, such as multispectral imaging, may increase the accuracy and reliability of early melanoma detection. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Presence of High-Risk HPV mRNA in Relation to Future High-Grade Lesions among High-Risk HPV DNA Positive Women with Minor Cytological Abnormalities.

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Hanna Johansson

Full Text Available Continuous expression of E6- and E7-oncogenes of high-risk human papillomavirus (HPV types is necessary for the development and maintenance of the dysplastic phenotype. The aim of the study was to determine the sensitivity and specificity of the APTIMA HPV mRNA assay (Hologic in predicting future development of high-grade cervical intraepithelial neoplasia (CIN among high-risk HPV-DNA-positive women with atypical squamous cells of undetermined significance (ASCUS or low-grade squamous epithelial lesion (LSIL cytology.Archived SurePath cervical samples of women ≥ 35 years of age with high-risk HPV DNA-positive ASCUS (n = 211 or LSIL, (n = 131 were tested for the presence of high-risk HPV E6/E7 mRNA using the APTIMA HPV assay, and the women were monitored for development of histopathologically verified CIN2+.Twenty-nine percent (61/211 of the women in the ASCUS group, and 34.3% (45/131 in the LSIL group developed CIN2+ within 4.5 years of follow-up. The prevalence of HPV mRNA was 90.0% (95% CI 85.9-94.0 among women with ASCUS and 95.4% (95% CI 91.8-99.0 among women with LSIL. The presence of HPV E6/E7 mRNA was associated with future development of CIN2+ among women with ASCUS and LSIL (p=0.02. The mRNA assay demonstrated high sensitivity in predicting future CIN2+ and CIN3 for index ASCUS (96.7%; 95% CI 87.6-99.4 and 100%; 95% CI 82.2-100, respectively and LSIL (97.8%, 95% CI 86.8-99.9 and 100%, 95% CI 79.9-100, respectively. The corresponding specificity was low, 12.7% (95% CI 7.9-19.3 and 5.8% (95% CI 2.2-13.6, for future CIN2+, respectively. The negative predictive value of the HPV mRNA assay for detecting future CIN3 was 100%, since no mRNA-negative woman developed CIN3 (0/27 as compared to 13.6% (43/315 of the mRNA-positive women (p = 0.03.The APTIMA mRNA assay demonstrated high sensitivity but low specificity in predicting future CIN2+ among women with minor cytological abnormalities. The assay had high negative predictive value for future

Presence of High-Risk HPV mRNA in Relation to Future High-Grade Lesions among High-Risk HPV DNA Positive Women with Minor Cytological Abnormalities

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Johansson, Hanna; Bjelkenkrantz, Kaj; Darlin, Lotten; Dilllner, Joakim; Forslund, Ola

2015-01-01

Objective Continuous expression of E6- and E7-oncogenes of high-risk human papillomavirus (HPV) types is necessary for the development and maintenance of the dysplastic phenotype. The aim of the study was to determine the sensitivity and specificity of the APTIMA HPV mRNA assay (Hologic) in predicting future development of high-grade cervical intraepithelial neoplasia (CIN) among high-risk HPV-DNA-positive women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous epithelial lesion (LSIL) cytology. Methods Archived SurePath cervical samples of women ≥ 35 years of age with high-risk HPV DNA-positive ASCUS (n = 211) or LSIL, (n = 131) were tested for the presence of high-risk HPV E6/E7 mRNA using the APTIMA HPV assay, and the women were monitored for development of histopathologically verified CIN2+. Results Twenty-nine percent (61/211) of the women in the ASCUS group, and 34.3% (45/131) in the LSIL group developed CIN2+ within 4.5 years of follow-up. The prevalence of HPV mRNA was 90.0% (95% CI 85.9-94.0) among women with ASCUS and 95.4% (95% CI 91.8-99.0) among women with LSIL. The presence of HPV E6/E7 mRNA was associated with future development of CIN2+ among women with ASCUS and LSIL (p=0.02). The mRNA assay demonstrated high sensitivity in predicting future CIN2+ and CIN3 for index ASCUS (96.7%; 95% CI 87.6-99.4 and 100%; 95% CI 82.2-100, respectively) and LSIL (97.8%, 95% CI 86.8-99.9 and 100%, 95% CI 79.9-100, respectively). The corresponding specificity was low, 12.7% (95% CI 7.9-19.3) and 5.8% (95% CI 2.2-13.6), for future CIN2+, respectively. The negative predictive value of the HPV mRNA assay for detecting future CIN3 was 100%, since no mRNA-negative woman developed CIN3 (0/27) as compared to 13.6% (43/315) of the mRNA-positive women (p = 0.03). Conclusion The APTIMA mRNA assay demonstrated high sensitivity but low specificity in predicting future CIN2+ among women with minor cytological abnormalities. The assay had

High-risk drinking is associated with dyslipidemia in a different way, based on the 2010-2012 KNHANES.

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Kwon, Yu-Jin; Kim, Sung-Eun; Park, Byoung-Jin; Bae, Jang-Whan; Kang, Hee-Taik

2016-05-01

The Alcohol Use Disorders Identification Test (AUDIT) questionnaire is a simple and useful method for the early detection of hazardous and harmful drinking. In this study, we examined the association between alcohol drinking pattern and dyslipidemia in Korean adults. This cross-sectional study included 14,308 participants who took part in the 2010-2012 Korean National Health and Nutrition Examination Survey. We categorized alcohol drinking patterns into three groups. We classified dyslipidemia into hypercholesterolemia, hypertriglyceridemia, hypo-HDL-cholesterolemia, hyper-LDL-cholesterolemia, and hyper-non-HDL-cholesterolemia. Of those who participated, 25.1% of men and 4.8% of women were high-risk drinkers. Compared with the low-risk group, Odd Ratios for hypercholesterolemia and hypertriglyceridemia in the high-risk group were 1.198 (1.001-1.434) and 1.979 (1.622-2.413) for men. Odd Ratios for hypo-HDL-cholesterolemia in the high-risk group was 0.351 (0.279-0.441) in men and 0.413 (0.291-0.586) in women. Compared with the low-risk participants, the high-risk group was associated with higher prevalence and increased risk for hyper-LDL-cholesterolemia in both sexes (1.541 [1.467-1.913] for men and 1.631 [1.034-2.575] for women). High-risk drinking was associated with higher risk for hypertriglyceridemia and hyper-LDL-cholesterolemia in both sexes and hypercholesterolemia in men but lower risk for hypo-HDL-cholesterolemia in both sexes. Copyright © 2016 Elsevier B.V. All rights reserved.

Managing Climate Risk. Integrating Adaptation into World Bank Group Operations

International Nuclear Information System (INIS)

Van Aalst, M.

2006-08-01

Climate change is already taking place, and further changes are inevitable. Developing countries, and particularly the poorest people in these countries, are most at risk. The impacts result not only from gradual changes in temperature and sea level but also, in particular, from increased climate variability and extremes, including more intense floods, droughts, and storms. These changes are already having major impacts on the economic performance of developing countries and on the lives and livelihoods of millions of poor people around the world. Climate change thus directly affects the World Bank Group's mission of eradicating poverty. It also puts at risk many projects in a wide range of sectors, including infrastructure, agriculture, human health, water resources, and environment. The risks include physical threats to the investments, potential underperformance, and the possibility that projects will indirectly contribute to rising vulnerability by, for example, triggering investment and settlement in high-risk areas. The way to address these concerns is not to separate climate change adaptation from other priorities but to integrate comprehensive climate risk management into development planning, programs, and projects. While there is a great need to heighten awareness of climate risk in Bank work, a large body of experience on climate risk management is already available, in analytical work, in country dialogues, and in a growing number of investment projects. This operational experience highlights the general ingredients for successful integration of climate risk management into the mainstream development agenda: getting the right sectoral departments and senior policy makers involved; incorporating risk management into economic planning; engaging a wide range of nongovernmental actors (businesses, nongovernmental organizations, communities, and so on); giving attention to regulatory issues; and choosing strategies that will pay off immediately under current

Prevalence of workplace bullying and risk groups

DEFF Research Database (Denmark)

Ortega, Adriana; Høgh, Annie; Pejtersen, Jan Hyld

2009-01-01

OBJECTIVES: To estimate the prevalence of bullying and to identify risk groups in a representative population sample. METHODS: The data for this study was taken from the second Danish Psychosocial Work Environment Study (DPWES). The sample consisted of 3,429 employees between 20 and 59-years......: These findings suggest that types of work and gender ratio are risk factors in the onset of workplace bullying. Future studies should take into account the type of work and the gender ratio of the organization....

Social comparison framing in health news and its effect on perceptions of group risk.

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Bigman, Cabral A

2014-01-01

News about health disparities often compares health risks faced by different demographic groups. Does this social comparison produce a contrast effect? It was hypothesized that when two racial groups are compared, people would perceive the relatively more at-risk group to be more, and the less at-risk group to be less, at-risk than if the same risk information was presented without the comparative reference group. Three experiments with Black and White respondents tested effects of intergroup social comparison framing (SCF) on perceptions of risk for sexually transmitted infections and skin cancer. SCF (including one White and two Black disparity frames) did not raise respondents' perceived risk regarding the more at-risk racial group, but consistently lowered respondents' risk ratings for the less at-risk racial group. The finding that the same statistic was perceived differently in comparative and noncomparative contexts underscores the importance of considering effects of communication about disparities.

Cardiometabolic risk in Canada: a detailed analysis and position paper by the cardiometabolic risk working group.

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Leiter, Lawrence A; Fitchett, David H; Gilbert, Richard E; Gupta, Milan; Mancini, G B John; McFarlane, Philip A; Ross, Robert; Teoh, Hwee; Verma, Subodh; Anand, Sonia; Camelon, Kathryn; Chow, Chi-Ming; Cox, Jafna L; Després, Jean-Pierre; Genest, Jacques; Harris, Stewart B; Lau, David C W; Lewanczuk, Richard; Liu, Peter P; Lonn, Eva M; McPherson, Ruth; Poirier, Paul; Qaadri, Shafiq; Rabasa-Lhoret, Rémi; Rabkin, Simon W; Sharma, Arya M; Steele, Andrew W; Stone, James A; Tardif, Jean-Claude; Tobe, Sheldon; Ur, Ehud

2011-01-01

The concepts of "cardiometabolic risk," "metabolic syndrome," and "risk stratification" overlap and relate to the atherogenic process and development of type 2 diabetes. There is confusion about what these terms mean and how they can best be used to improve our understanding of cardiovascular disease treatment and prevention. With the objectives of clarifying these concepts and presenting practical strategies to identify and reduce cardiovascular risk in multiethnic patient populations, the Cardiometabolic Working Group reviewed the evidence related to emerging cardiovascular risk factors and Canadian guideline recommendations in order to present a detailed analysis and consolidated approach to the identification and management of cardiometabolic risk. The concepts related to cardiometabolic risk, pathophysiology, and strategies for identification and management (including health behaviours, pharmacotherapy, and surgery) in the multiethnic Canadian population are presented. "Global cardiometabolic risk" is proposed as an umbrella term for a comprehensive list of existing and emerging factors that predict cardiovascular disease and/or type 2 diabetes. Health behaviour interventions (weight loss, physical activity, diet, smoking cessation) in people identified at high cardiometabolic risk are of critical importance given the emerging crisis of obesity and the consequent epidemic of type 2 diabetes. Vascular protective measures (health behaviours for all patients and pharmacotherapy in appropriate patients) are essential to reduce cardiometabolic risk, and there is growing consensus that a multidisciplinary approach is needed to adequately address cardiometabolic risk factors. Health care professionals must also consider risk factors related to ethnicity in order to appropriately evaluate everyone in their diverse patient populations. Copyright © 2011 Elsevier Inc. All rights reserved.

Risk groups for yellow fever vaccine-associated viscerotropic disease (YEL-AVD).

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Seligman, Stephen J

2014-10-07

Although previously considered as the safest of the live virus vaccines, reports published since 2001 indicate that live yellow fever virus vaccine can cause a severe, often fatal, multisystemic illness, yellow fever vaccine-associated viscerotropic disease (YEL-AVD), that resembles the disease it was designed to prevent. This review was prompted by the availability of a listing of the cumulative cases of YEL-AVD, insights from a statistical method for analyzing risk factors and re-evaluation of previously published data. The purpose of this review is to identify and analyze risk groups based on gender, age, outcome and predisposing illnesses. Using a passive surveillance system in the US, the incidence was reported as 0.3 to 0.4 cases per 100,000. However, other estimates range from 0 to 12 per 100,000. Identified and potential risk groups for YEL-AVD include elderly males, women between the ages of 19 and 34, people with a variety of autoimmune diseases, individuals who have been thymectomized because of thymoma, and infants and children ≤11 years old. All but the last group are supported by statistical analysis. The confirmed risk groups account for 77% (49/64) of known cases and 76% (32/42) of the deaths. The overall case fatality rate is 66% (42/64) with a rate of 80% (12/15) in young women, in contrast to 50% (13/26) in men ≥56 years old. Recognition of YEL-AVD raises the possibility that similar reactions to live chimeric flavivirus vaccines that contain a yellow fever virus vaccine backbone could occur in susceptible individuals. Delineation of risk groups focuses the search for genetic mutations resulting in immune defects associated with a given risk group. Lastly, identification of risk groups encourages concentration on measures to decrease both the incidence and the severity of YEL-AVD. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effects of high ambient temperature on ambulance dispatches in different age groups in Fukuoka, Japan.

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Kotani, Kazuya; Ueda, Kayo; Seposo, Xerxes; Yasukochi, Shusuke; Matsumoto, Hiroko; Ono, Masaji; Honda, Akiko; Takano, Hirohisa

2018-01-01

The elderly population has been the primary target of intervention to prevent heat-related illnesses. According to the literature, the highest risks have been observed among the elderly in the temperature-mortality relationship. However, findings regarding the temperature-morbidity relationship are inconsistent. This study aimed to examine the association of temperature with ambulance dispatches due to acute illnesses, stratified by age group. Specifically, we explored the optimum temperature, at which the relative health risks were found to be the lowest, and quantified the health risk associated with higher temperatures among different age groups. We used the data for ambulance dispatches in Fukuoka, Japan, during May and September from 2005 to 2012. The data were grouped according to age in 20-year increments. We explored the pattern of the association of ambulance dispatches with temperature using a smoothing spline curve to identify the optimum temperature for each age group. Then, we applied a distributed lag nonlinear model to estimate the risks of the 85th-95th percentile temperature relative to the overall optimum temperature, for each age group. The relative risk of ambulance dispatches at the 85th and 95th percentile temperature for all ages was 1.08 [95% confidence interval (CI): 1.05, 1.12] and 1.12 (95% CI: 1.08, 1.16), respectively. In comparison, among age groups, the optimum temperature was observed as 25.0°C, 23.2°C, and 25.3°C for those aged 0-19, 60-79, and ≥80, respectively. The optimum temperature could not be determined for those aged 20-39 and 40-59. The relative risks of high temperature tended to be higher for those aged 20-39 and 40-59 than those for other age groups. We did not find any definite difference in the effect of high temperature on ambulance dispatches for different age groups. However, more measures should be taken for younger and middle-aged people to avoid heat-related illnesses.

Group Sex Events and HIV/STI Risk in an Urban Network

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Friedman, Samuel R.; Bolyard, Melissa; Khan, Maria; Maslow, Carey; Sandoval, Milagros; Mateu-Gelabert, Pedro; Krauss, Beatrice; Aral, Sevgi O.

2012-01-01

Objectives To describe: a. the prevalence and individual and network characteristics of group sex events (GSE) and GSE attendees; and b. HIV/STI discordance among respondents who said they went to a GSE together. Methods and Design In a sociometric network study of risk partners (defined as sexual partners, persons with whom respondents attended a GSE, or drug-injection partners) in Brooklyn, NY, we recruited a high-risk sample of 465 adults. Respondents reported on GSE attendance, the characteristics of GSEs, and their own and others’ behaviors at GSEs. Sera and urines were collected and STI prevalence was assayed. Results Of the 465 participants, 36% had attended a GSE in the last year, 26% had sex during the most recent of these GSEs, and 13% had unprotected sex there. Certain subgroups (hard drug users, men who have sex with men, women who have sex with women, and sex workers) were more likely to attend and more likely to engage in risk behaviors at these events. Among 90 GSE dyads in which at least one partner named the other as someone with whom they attended a GSE in the previous three months, STI/HIV discordance was common (HSV-2: 45% of dyads, HIV: 12% of dyads, Chlamydia: 21% of dyads). Many GSEs had 10 or more participants, and multiple partnerships at GSEs were common. High attendance rates at GSEs among members of large networks may increase community vulnerability to STI/HIV, particularly since network data show that almost all members of a large sociometric risk network either had sex with a GSE attendee or had sex with someone who had sex with a GSE attended. Conclusions Self-reported GSE attendance and participation was common among this high-risk sample. STI/HIV discordance among GSE attendees was high, highlighting the potential transmission risk associated with GSEs. Research on sexual behaviors should incorporate measures of GSE behaviors as standard research protocol. Interventions should be developed to reduce transmission at GSEs. PMID

An intervention to reduce HIV risk behavior of substance-using men who have sex with men: a two-group randomized trial with a nonrandomized third group.

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Gordon Mansergh

2010-08-01

Full Text Available Substance use during sex is associated with sexual risk behavior among men who have sex with men (MSM, and MSM continue to be the group at highest risk for incident HIV in the United States. The objective of this study is to test the efficacy of a group-based, cognitive-behavioral intervention to reduce risk behavior of substance-using MSM, compared to a randomized attention-control group and a nonrandomized standard HIV-testing group.Participants (n = 1,686 were enrolled in Chicago, Los Angeles, New York City, and San Francisco and randomized to a cognitive-behavioral intervention or attention-control comparison. The nonrandomized group received standard HIV counseling and testing. Intervention group participants received six 2-h group sessions focused on reducing substance use and sexual risk behavior. Attention-control group participants received six 2-h group sessions of videos and discussion of MSM community issues unrelated to substance use, sexual risk, and HIV/AIDS. All three groups received HIV counseling and testing at baseline. The sample reported high-risk behavior during the past 3 mo prior to their baseline visit: 67% reported unprotected anal sex, and 77% reported substance use during their most recent anal sex encounter with a nonprimary partner. The three groups significantly (p0.05 from each other at 3-, 6-, and 12-mo follow-up. Outcomes for the 2-arm comparisons were not significantly different at 12-mo follow-up (e.g., unprotected anal sex, odds ratio = 1.14, confidence interval = 0.86-1.51, nor at earlier time points. Similar results were found for each outcome variable in both 2- and 3-arm comparisons.These results for reducing sexual risk behavior of substance-using MSM are consistent with results of intervention trials for other populations, which collectively suggest critical challenges for the field of HIV behavioral interventions. Several mechanisms may contribute to statistically indistinguishable reductions in risk

Deoxynivalenol Exposure in Norway, Risk Assessments for Different Human Age Groups

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Sundheim, Leif; Lillegaard, Inger Therese; Fæste, Christiane Kruse; Brantsæter, Anne-Lise; Brodal, Guro; Eriksen, Gunnar Sundstøl

2017-01-01

Deoxynivalenol (DON) is the most common mycotoxin in Norwegian cereals, and DON is detected in most samples of crude cereal grain and cereal food commodities such as flour, bran, and oat flakes. The Norwegian Scientific Committee for Food Safety assessed the risk for adverse effects of deoxynivalenol (DON) in different age groups of the domestic population. This review presents the main results from the risk assessment, supplemented with some recently published data. Impairment of the immune system together with reduced feed intake and weight gain are the critical effects of DON in experimental animals on which the current tolerable daily intake was established. Based on food consumption and occurrence data, the mean exposure to DON in years with low and high levels of DON in the flour, respectively, were in the range of or up to two times the Tolerable Daily Intake (TDI) in 1-year-old infants and 2-year-old children. In years with high mean DON concentration, the high (95th-percentile) exposure exceeded the TDI by up to 3.5 times in 1-, 2- , 4-, and 9-year-old children. The assessment concluded that exceeding the TDI in infants and children is of concern. The estimated dietary DON intakes in adolescent and adult populations are in the range of the TDI or below, and are not a health concern. Acute human exposure to DON is not of concern in any age group. PMID:28165414

Deoxynivalenol Exposure in Norway, Risk Assessments for Different Human Age Groups

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Leif Sundheim

2017-02-01

Full Text Available Deoxynivalenol (DON is the most common mycotoxin in Norwegian cereals, and DON is detected in most samples of crude cereal grain and cereal food commodities such as flour, bran, and oat flakes. The Norwegian Scientific Committee for Food Safety assessed the risk for adverse effects of deoxynivalenol (DON in different age groups of the domestic population. This review presents the main results from the risk assessment, supplemented with some recently published data. Impairment of the immune system together with reduced feed intake and weight gain are the critical effects of DON in experimental animals on which the current tolerable daily intake was established. Based on food consumption and occurrence data, the mean exposure to DON in years with low and high levels of DON in the flour, respectively, were in the range of or up to two times the Tolerable Daily Intake (TDI in 1-year-old infants and 2-year-old children. In years with high mean DON concentration, the high (95th-percentile exposure exceeded the TDI by up to 3.5 times in 1-, 2- , 4-, and 9-year-old children. The assessment concluded that exceeding the TDI in infants and children is of concern. The estimated dietary DON intakes in adolescent and adult populations are in the range of the TDI or below, and are not a health concern. Acute human exposure to DON is not of concern in any age group.

Risk Factors Associated with Rebleeding in Patients with High Risk Peptic Ulcer Bleeding: Focusing on the Role of Second Look Endoscopy.

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Kim, Sung Bum; Lee, Si Hyung; Kim, Kyeong Ok; Jang, Byung Ik; Kim, Tae Nyeun; Jeon, Seong Woo; Kwon, Joong Goo; Kim, Eun Young; Jung, Jin Tae; Park, Kyung Sik; Cho, Kwang Bum; Kim, Eun Soo; Kim, Hyun Jin; Park, Chang Keun; Park, Jeong Bae; Yang, Chang Heon

2016-02-01

Re-bleeding after initial hemostasis in peptic ulcer bleeding can be life threatening. Identification of factors associated with re-bleeding is important. The aims of this study were to determine incidence of rebleeding in patients with high risk peptic ulcer bleeding and to evaluate factors associated with rebleeding. Among patients diagnosed as upper gastrointestinal hemorrhage at seven hospitals in Daegu-Gyeongbuk, and one hospital in Gyeongnam, South Korea, from Feb 2011 to Dec 2013, 699 patients diagnosed as high risk peptic ulcer bleeding with Forrest classification above llb were included. The data were obtained in a prospective manner. Among 699 patients, re-bleeding occurred in 64 (9.2 %) patients. Second look endoscopy was significantly more performed in the non-rebleeding group than the rebleeding group (81.8 vs 62.5 %, p peptic ulcer bleeding. In our study, rebleeding was observed in 9.2 % of patients with high risk peptic ulcer bleeding. Performance of second look endoscopy seems to lower the risk of rebleeding in high risk peptic ulcer bleeding patients and caution should be paid to patients receiving high volume transfusion and on medication with NSAIDs.

Characteristics of High-Risk Pregnancy in Sanglah General Hospital 2011-2014

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Ryan Saktika Mulyana

2016-07-01

Full Text Available Background: Pregnant women with a high-risk pregnancy are women with increased risk in pregnancy or childbirth. There is no readily available data available about the characteristics of the high-risk pregnancy in Bali. Objective: Our study aimed to provide a data, to be the base of Sanglah General Hospital resource planning to reduce maternal mortality and morbidity. Method: This was an observational study using medical records of high risk pregnancy patients at Sanglah General Hospital from 2011 to 2014. Inclusion criteria were the patients with complete medical record and exclusion criteria are patient whose medical report incomplete. There was no missing data in this study.Result Over the 4 year study period at Sanglah, there were 1027 high-risk deliveries in 2011, 1590 in 2012, 1590 in 2013, and 948 in 2014. In the 4 years, there were 748 with age ≥ 35 years. The majority were in the age group of 26-30 years. As many as 2932 were multiparous. Overall, 3082 were multigravida and only 197 were grandemultipara. There were 1406 preterm (<37 week. By onset and mode of delivery, 2027 (41.50% had a caesarean section, There were 9 (0.18% Breech deliveries and Neonatal outcomes were recorded, showing that 296 (6.29% had moderate asphyxia and 2189 (4.63% had severe asphyxia. The multiple pregnancy was 197 (3.82% twin pregnancies and 5 (0.1% cases of triplets. The largest group of obstetrics complications in Sanglah hospital was premature rupture of membrane 1652 cases (30.99%. The most common medical disorder of pregnant women at our hospital was anemia, 353 cases (45.43%. The most prevalent congenital anomalies were multiple congenital abnormalities, as many as 18 infants (20.22%.Conclusion: There were a significant number of high-risk pregnancies delivered at Sanglah, with nearly 46.85% being high risk deliveries. Characteristics of these high risk pregnancies can be used to plan appropriate care to reduce the maternal mortality rate.

Lipid profiles and ischemic stroke risk: variations by sex within racial/ethnic groups.

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Gezmu, Tefera; Schneider, Dona; Demissie, Kitaw; Lin, Yong; Giordano, Christine; Gizzi, Martin S

2014-01-01

Evidence implicates lipid abnormalities as important but modifiable risk factors for stroke. This study assesses whether hypercholesterolemia can be used to predict the risk for etiologic subtypes of ischemic stroke between sexes within racial/ethnic groups. Data elements related to stroke risk, diagnosis, and outcomes were abstracted from the medical records of 3,290 acute stroke admissions between 2006 and 2010 at a regional stroke center. Sex comparison within racial/ethnic groups revealed that South Asian and Hispanic men had a higher proportion of ischemic stroke than women, while the inverse was true for Whites and African Americans (P=0.0014). All women, except South Asian women, had higher mean plasma total cholesterol and higher blood circulating low-density lipoprotein levels (≥100 mg/dL) than men at the time of their admissions. The incidence of large-artery atherosclerosis (LAA) was more common among women than men, except among Hispanics, where men tended to have higher incidences. A regression analysis that considered patients diagnosed with either LAA or small-artery occlusion etiologic subtype as the outcomes and high-density lipoproteins and triglycerides as predictors showed inconsistent associations between lipid profiles and the incidence of these subtypes between the sexes within racial/ethnic groups. In conclusion, our investigation suggests that women stroke patients may be at increased risk for stroke etiologic subtype LAA than men. Although the higher prevalence of stroke risk factors examined in this study predicts the increase in the incidence of the disease, lack of knowledge/awareness and lack of affordable treatments for stroke risk factors among women and immigrants/non-US-born subpopulations may explain the observed associations.

Establishing a Program for Individuals at High Risk for Breast Cancer

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Cadiz, Fernando; Kuerer, Henry M.; Puga, Julio; Camacho, Jamile; Cunill, Eduardo; Arun, Banu

2013-01-01

Our need to create a program for individuals at high risk for breast cancer development led us to research the available data on such programs. In this paper, we summarize our findings and our thinking process as we developed our own program. Breast cancer incidence is increasing worldwide. Even though there are known risk factors for breast cancer development, approximately 60% of patients with breast cancer have no known risk factor, although this situation will probably change with further research, especially in genetics. For patients with risk factors based on personal or family history, different models are available for assessing and quantifying risk. Assignment of risk levels permits tailored screening and risk reduction strategies. Potential benefits of specialized programs for women with high breast cancer risk include more cost -effective interventions as a result of patient stratification on the basis of risk; generation of valuable data to advance science; and differentiation of breast programs from other breast cancer units, which can result in increased revenue that can be directed to further improvements in patient care. Guidelines for care of patients at high risk for breast cancer are available from various groups. However, running a high-risk breast program involves much more than applying a guideline. Each high-risk program needs to be designed by its institution with consideration of local resources and country legislation, especially related to genetic issues. Development of a successful high-risk program includes identifying strengths, weaknesses, opportunities, and threats; developing a promotion plan; choosing a risk assessment tool; defining “high risk”; and planning screening and risk reduction strategies for the specific population served by the program. The information in this article may be useful for other institutions considering creation of programs for patients with high breast cancer risk. PMID:23833688

Brachytherapy boost and cancer-specific mortality in favorable high-risk versus other high-risk prostate cancer

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Vinayak Muralidhar

2016-02-01

Full Text Available Purpose : Recent retrospective data suggest that brachytherapy (BT boost may confer a cancer-specific survival benefit in radiation-managed high-risk prostate cancer. We sought to determine whether this survival benefit would extend to the recently defined favorable high-risk subgroup of prostate cancer patients (T1c, Gleason 4 + 4 = 8, PSA 20 ng/ml. Material and methods: We identified 45,078 patients in the Surveillance, Epidemiology, and End Results database with cT1c-T3aN0M0 intermediate- to high-risk prostate cancer diagnosed 2004-2011 treated with external beam radiation therapy (EBRT only or EBRT plus BT. We used multivariable competing risks regression to determine differences in the rate of prostate cancer-specific mortality (PCSM after EBRT + BT or EBRT alone in patients with intermediate-risk, favorable high-risk, or other high-risk disease after adjusting for demographic and clinical factors. Results : EBRT + BT was not associated with an improvement in 5-year PCSM compared to EBRT alone among patients with favorable high-risk disease (1.6% vs. 1.8%; adjusted hazard ratio [AHR]: 0.56; 95% confidence interval [CI]: 0.21-1.52, p = 0.258, and intermediate-risk disease (0.8% vs. 1.0%, AHR: 0.83, 95% CI: 0.59-1.16, p = 0.270. Others with high-risk disease had significantly lower 5-year PCSM when treated with EBRT + BT compared with EBRT alone (3.9% vs. 5.3%; AHR: 0.73; 95% CI: 0.55-0.95; p = 0.022. Conclusions : Brachytherapy boost is associated with a decreased rate of PCSM in some men with high-risk prostate cancer but not among patients with favorable high-risk disease. Our results suggest that the recently-defined “favorable high-risk” category may be used to personalize therapy for men with high-risk disease.

Different pituitary. beta. -endorphin and adrenal cortisol response to ethanol in individuals with high and low risk for future development of alcoholism

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Gianoulakis, C.G.; Beliveau, D.; Angelogianni, P.; Meaney, M.; Thavundayil, J.; Tawar, V.; Dumas, M. (McGill Univ., Quebec (Canada))

1989-01-01

The purpose of the present studies was to investigate the activity of the adrenal gland and the pituitary {beta}-endorphin system in individuals from families with a 3 generation history of alcoholism, High Risk group, or from families without history of alcoholism, Low Risk group. On the day of testing, blood sample was taken at 9:00 a.m., then the subject drank a placebo drink or an ethanol solution. Additional blood samples were taken at 15, 45 and 120 minutes post-drink. Results indicated that individuals of the High Risk group had lower basal levels of {beta}-endorphin like immunoreactivity ({beta}-EPLIR) than individuals of the Low Risk group. The dose of 0.5 g ethanol/kg B.Wt. induced an induce an increase in the plasma content of {beta}-EPLIR of the High Risk group, but not of the Low Risk group. In the Low Risk group ethanol did not induce an increase above the 9:00 a.m. levels, however, it attenuated the {beta}-endorphin decrease overtime, observed following the placebo drink. Analysis of {beta}-endorphin-like peptides in the plasma of the High Risk group, with Sephadex G-75 chromatography indicated that the major component of the plasma {beta}-EPLIR was {beta}-lipotropin. Plasma cortisol levels, following ethanol intake, presented a small increase in the High Risk group but not in the Low Risk group.

A Group Intervention for HIV/STI Risk Reduction among Indian Couples

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Ritu Nehra

2013-12-01

Full Text Available Background: HIV in India is transmitted primarily by heterosexual contact. The present study sought to test the feasibility of a group HIV/STI risk reduction intervention among heterosexual couples in India. Methods: Focus groups and key informant interviews were used in 2008 to culturally tailor the intervention. Thirty sexually active and HIV/STI negative couples were enrolled and assessed regarding risk behavior and sexual barrier acceptability. Gender-concordant group sessions used cognitive behavioral strategies for HIV/STI prevention. Results: At baseline, male condom use was low (36%; no participants reported use of female condoms or vaginal gels. HIV knowledge was low; women had more HIV knowledge and more positive attitudes towards condom use than men. Post-intervention, willingness to use all barrier products (t = 10.0, P< .001 and intentions to avoid risk behavior increased (t = 5.62, P< .001. Conclusion: This study illustrates the feasibility of utilizing a group intervention to enhance HIV/STI risk reduction among Indian couples.

Compliance with adjuvant treatment guidelines in endometrial cancer: room for improvement in high risk patients.

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Eggink, F A; Mom, C H; Boll, D; Ezendam, N P M; Kruitwagen, R F P M; Pijnenborg, J M A; van der Aa, M A; Nijman, H W

2017-08-01

Compliance of physicians with guidelines has emerged as an important indicator for quality of care. We evaluated compliance of physicians with adjuvant therapy guidelines for endometrial cancer patients in the Netherlands in a population-based cohort over a period of 10years. Data from all patients diagnosed with endometrial cancer between 2005 and 2014, without residual tumor after surgical treatment, were extracted from the Netherlands Cancer Registry (N=14,564). FIGO stage, grade, tumor type and age were used to stratify patients into risk groups. Possible changes in compliance over time and impact of compliance on survival were assessed. Patients were stratified into low/low-intermediate (52%), high-intermediate (21%) and high (20%) risk groups. Overall compliance with adjuvant therapy guidelines was 85%. Compliance was highest in patients with low/low-intermediate risk (98%, no adjuvant therapy indicated). The lowest compliance was determined in patients with high risk (61%, external beam radiotherapy with/without chemotherapy indicated). Within this group compliance decreased from 64% in 2005-2009 to 57% in 2010-2014. In high risk patients with FIGO stage III serous disease compliance was 55% (chemotherapy with/without radiotherapy indicated) and increased from 41% in 2005-2009 to 66% in 2010-2014. While compliance of physicians with adjuvant therapy guidelines is excellent in patients with low and low-intermediate risk, there is room for improvement in high risk endometrial cancer patients. Eagerly awaited results of ongoing randomized clinical trials may provide more definitive guidance regarding adjuvant therapy for high risk endometrial cancer patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption.

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Moos, Rudolf H; Schutte, Kathleen K; Brennan, Penny L; Moos, Bernice S

2011-02-01

This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high-risk alcohol consumption and identifies predictors of changes in concordance and high-risk consumption. Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low-risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high-risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high-risk alcohol consumption and the other partner did not (n = 75). At each follow-up, husbands and wives completed an inventory that assessed their personal, family and social functioning. Compared to the low-risk concordant group, husbands and wives in the high-risk concordant group were more likely to rely on tension-reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high-risk drinking included tension-reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking. High-risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long-term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high-risk drinking. © 2010 Society for the Study of Addiction. No claim to US government works.

Active case finding and treatment adherence in risk groups in the tuberculosis pre-elimination era.

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Gupta, R K; Lipman, M; Story, A; Hayward, A; de Vries, G; van Hest, R; Erkens, C; Rangaka, M X; Abubakar, I

2018-05-01

Vulnerable populations, including homeless persons, high-risk drug and alcohol users, prison inmates and other marginalised populations, contribute a disproportionate burden of tuberculosis (TB) cases in low-incidence settings. Drivers of this disease burden include an increased risk of both TB transmission in congregate settings, and progression from infection to active disease. Late diagnosis and poor treatment completion further propagate the epidemic and fuel the acquisition of drug resistance. These groups are therefore a major priority for TB control programmes in low-incidence settings. Targeted strategies include active case finding (ACF) initiatives and interventions to improve treatment completion, both of which should be tailored to local populations. ACF usually deploys mobile X-ray unit screening, which allows sensitive, high-throughput screening with immediate availability of results. Such initiatives have been found to be effective and cost-effective, and associated with reductions in proxy measures of transmission in hard-to-reach groups. The addition of point-of-care molecular diagnostics and automated X-ray readers may further streamline the screening pathway. There is little evidence to support interventions to improve adherence among these risk groups. Such approaches include enhanced case management and directly observed treatment, while video-observed therapy (currently under evaluation) appears to be a promising tool for the future. Integrating outreach services to include both case detection and case-management interventions that share a resource infrastructure may allow cost-effectiveness to be maximised. Integrating screening and treatment for other diseases that are prevalent among targeted risk groups into TB outreach interventions may further improve cost-effectiveness. This article reviews the existing literature, and highlights priorities for further research.

Sensation seeking in males involved in recreational high risk sports

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M Guszkowska

2010-09-01

Full Text Available The study examined sensation seeking intensity level in males involved in recreational high risk sports and investigated whether its level depends on type of sport practised. Additionally, in case of parachutists, sport experience of study participants were scrutinised with regard to its possible impact on the level of sensation seeking.The research involved 217 males aged 17 to 45, practising recreational high risk sports, namely: parachuting (n=98; wakeboarding (n=30; snowboarding (n=30; scuba diving (n=22; alpinism (n=20; paragliding (n=17. The control group included 54 men not involved in sports. Polish version of Sensation Seeking Scale (SSS-IV of Zuckerman was applied.Results show, that high risk sports males are featured by stronger need of sensations in comparison to control group and this concerned all but one aspect of sensation seeking variable. The only exception was the need of intellectual stimulation. Except from the thrill and adventure seeking dimension, type of sport may also be an important determinant of sensation seeking. Men practising snowboard and wakeboard presented stronger need for sensations, especially in the dimension of experience seeking, disinhibition and boredom susceptibility. Sport experience (number of jumps in parachuting did not differentiate the level of sensation seeking among investigated parachutists. Population of sport high risk male takers was not homogeneous, and therefore in future research one should analyse specific sports (or events in a certain sport separately.

Blood group genotyping: from patient to high-throughput donor screening.

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Veldhuisen, B; van der Schoot, C E; de Haas, M

2009-10-01

Blood group antigens, present on the cell membrane of red blood cells and platelets, can be defined either serologically or predicted based on the genotypes of genes encoding for blood group antigens. At present, the molecular basis of many antigens of the 30 blood group systems and 17 human platelet antigens is known. In many laboratories, blood group genotyping assays are routinely used for diagnostics in cases where patient red cells cannot be used for serological typing due to the presence of auto-antibodies or after recent transfusions. In addition, DNA genotyping is used to support (un)-expected serological findings. Fetal genotyping is routinely performed when there is a risk of alloimmune-mediated red cell or platelet destruction. In case of patient blood group antigen typing, it is important that a genotyping result is quickly available to support the selection of donor blood, and high-throughput of the genotyping method is not a prerequisite. In addition, genotyping of blood donors will be extremely useful to obtain donor blood with rare phenotypes, for example lacking a high-frequency antigen, and to obtain a fully typed donor database to be used for a better matching between recipient and donor to prevent adverse transfusion reactions. Serological typing of large cohorts of donors is a labour-intensive and expensive exercise and hampered by the lack of sufficient amounts of approved typing reagents for all blood group systems of interest. Currently, high-throughput genotyping based on DNA micro-arrays is a very feasible method to obtain a large pool of well-typed blood donors. Several systems for high-throughput blood group genotyping are developed and will be discussed in this review.

Learning to communicate risk information in groups

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Hsuchi Ting

2008-12-01

Full Text Available Despite vigorous research on risk communication, little is known about the social forces that drive these choices. Erev, Wallsten, and Neal (1991 showed that forecasters learn to select verbal or numerical probability estimates as a function of which mode yields on average the larger group payoffs. We extend the result by investigating the effect of group size on the speed with which forecasters converge on the better communication mode. On the basis of social facilitation theory we hypothesized that small groups induce less arousal and anxiety among their members than do large groups when performing new tasks, and therefore that forecasters in small groups will learn the better communication mode more quickly. This result obtained in Experiment 1, which compared groups of size 3 to groups of size 5 or 6. To test whether social loafing rather than social facilitation was mediating the effects, Experiment 2 compared social to personal feedback holding group size constant at 3 members. Learning was faster in the personal feedback condition, suggesting that social facilitation rather than loafing underlay the results.

ABO Blood Group and Dementia Risk--A Scandinavian Record-Linkage Study.

Directory of Open Access Journals (Sweden)

Senthil K Vasan

Full Text Available Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail.We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models.Among 1,598,294 donors followed over 24 million person-years of observation we ascertained 3,615 cases of Alzheimer's disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer's disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors aged 70 years or older except for a slight, but significantly decreased risk of all dementia combined in subjects with blood group A (IRR, 0.93; 95% confidence interval [CI], 0.88-0.98, compared to those with blood group O.Our results provide no evidence that ABO blood group influences the risk of dementia.

[Relationships between prevalence of youth risk behaviors and sleep duration among Japanese high school students].

Science.gov (United States)

Kataoka, Chie; Nozu, Yuji; Kudo, Masako; Sato, Yuki; Kubo, Motoyoshi; Nakayama, Naoko; Iwata, Hideki; Watanabe, Motoi

2014-01-01

This study aimed to clarify relationships between prevalence of risk behaviors and sleep duration among Japanese high school students. Data from a national survey, the Japan Youth Risk Behavior Survey 2011 (the subjects were 9,778 students: 5,027 males, 4,751 females, in the first grade to the third grade of 102 schools randomly selected among high schools throughout Japan) was used for this analysis. We focused on nine items of risk behavior in JYRBS: "lack of vigorous physical activity," "skipping breakfast," "current cigarette use," "current alcohol use," "lifetime thinner use," "ever had sexual intercourse," "rarely or never wore seatbelts," "in a physical fight," and "seriously considered attempting suicide." Students with less than six hours of sleep duration accounted for approximately 40% of males and females. The odds ratios of prevalence of each of the nine risk behaviors were calculated on the basis of the group "six hours or more and less than eight hours" of sleep, whose prevalence of risk behaviors was the lowest. In the group with "four hours or more and less than six hours," the odds ratios of "lack of vigorous physical activity" and "skipping breakfast" for both males and females were significantly high. Furthermore, in the group with shorter sleep duration of "less than four hours," the odds ratios of all nine risk behaviors for males (odds ratios: 1.47-3.28) and eight risk behaviors (except for "rarely or never wore seatbelts") for females (1.54-4.68) were significantly high. On the other hand, in the group with long sleep duration of "10 hours or more," the odds ratios of "current cigarette use" and "lifetime thinner use" for both males and females were significantly high. It was shown that short sleep duration of less than six hours and long sleep duration of 10 hours or more related to the prevalence of youth risk behaviors among Japanese high school students. It was suggested that sleep duration should be considered as an important category

Lung transplantation for high-risk patients with idiopathic pulmonary fibrosis.

Science.gov (United States)

De Oliveira, Nilto C; Julliard, Walker; Osaki, Satoru; Maloney, James D; Cornwell, Richard D; Sonetti, David A; Meyer, Keith C

2016-10-07

Survival for patients with idiopathic pulmonary fibrosis (IPF) and high lung allocation score (LAS) values may be significantly reduced in comparison to those with lower LAS values. To evaluate outcomes for high-risk IPF patients as defined by LAS values ≥46 (N=42) versus recipients with LAS values pulmonary complications was increased for the higher LAS group versus recipients with LAS <46, 30-day mortality and actuarial survival did not differ between the two cohorts. Although lung transplantation in patients with IPF and high LAS values is associated with increased risk of early post-transplant complications, long-term post-transplant survival for our high-LAS cohort was equivalent to that for the lower LAS recipients.

Group Delay of High Q Antennas

DEFF Research Database (Denmark)

Bahramzy, Pevand; Pedersen, Gert Frølund

2013-01-01

Group Delay variations versus frequency is an essential factor which can cause distortion and degradation in the signals. Usually this is an issue in wideband communication systems, such as satellite communication systems, which are used for transmitting wideband data. However, group delay can also...... become an issue, when working with high Q antennas, because of the steep phase shift over the frequency. In this paper, it is measured how large group delay variations can become, when going from a low Q antenna to a high Q antenna. The group delay of a low Q antenna is shown to be around 1.3 ns, whereas...... a high Q antenna has group delay of around 22 ns. It is due to this huge group delay variation characteristics of high Q antennas, that signal distortion might occur in the radio system with high Q antennas....

Level of anxiety in parents of high-risk premature twins.

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Zanardo, V; Freato, F; Cereda, C

1998-01-01

We attempted to define parental anxiety in a population of parents of high-risk premature twins (mean birth weight 1,493 +/- 227 kg; mean gestational age 33 +/- 3.5 weeks), admitted to III level NICU. We specifically examined the following factors; gestational age of the twins, whether or not the twins had ventilatory support, pulmonary sequelae, major malformations or intra-ventricular hemorrhage, parental gender and highest level of education obtained by the parent. In the immediate pre-discharge period and a month later, a questionnaire (State-Trait Anxiety Inventory) was given to all parents of premature twins presenting for the discharge. The parents of 30 twins entered the study twice, at the discharge of their first twin (mean postnatal age 40 +/- 32 days), and one month later. They included 15 mothers and 11 fathers, aged 33 +/- 5.5 and 33 +/- 4.2 years, and at the second evaluation 11 mothers and 10 fathers, respectively. As case-controls we examined parental anxiety of fifteen consecutive singleton high-risk prematures, with equal gestational age, discharged immediately after. Our results indicate that the parents of high-risk twin and singleton prematures present an elevated, lasting state-trait anxiety level. Pre- and post-discharge parental anxiety is more elevated (not significant) in twinning with respect to the prematurity alone. When assessed separately by parental gender, in both these groups an increased (not significant) anxiety was persistently found in the mothers. We recommend that, although neonatologists generally define the discharge of the high-risk premature based upon the acquired stabilization of vital parameters, they pay special attention to the twin group we have identified which is at increased risk for predischarge parental anxiety.

Not all risks are equal: the risk taking inventory for high-risk sports.

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Woodman, Tim; Barlow, Matt; Bandura, Comille; Hill, Miles; Kupciw, Dominika; Macgregor, Alexandra

2013-10-01

Although high-risk sport participants are typically considered a homogenous risk-taking population, attitudes to risk within the high-risk domain can vary considerably. As no validated measure allows researchers to assess risk taking within this domain, we validated the Risk Taking Inventory (RTI) for high-risk sport across four studies. The RTI comprises seven items across two factors: deliberate risk taking and precautionary behaviors. In Study 1 (n = 341), the inventory was refined and tested via a confirmatory factor analysis used in an exploratory fashion. The subsequent three studies confirmed the RTI's good model-data fit via three further separate confirmatory factor analyses. In Study 2 (n = 518) and in Study 3 (n = 290), concurrent validity was also confirmed via associations with other related traits (sensation seeking, behavioral activation, behavioral inhibition, impulsivity, self-esteem, extraversion, and conscientiousness). In Study 4 (n = 365), predictive validity was confirmed via associations with mean accidents and mean close calls in the high-risk domain. Finally, in Study 4, the self-report version of the inventory was significantly associated with an informant version of the inventory. The measure will allow researchers and practitioners to investigate risk taking as a variable that is conceptually distinct from participation in a high-risk sport.

Vigilance and iconic memory in children at high risk for alcoholism.

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Steinhauer, S R; Locke, J; Hill, S Y

1997-07-01

Previous studies report reduced visual event-related potential (ERP) amplitudes in young males at high risk for alcoholism. These findings could involve difficulties at several stages of visual processing. This study was aimed at examining vigilance performance and iconic memory functions in children at high risk or low risk for alcoholism. Sustained vigilance and retrieval from iconic memory were evaluated in 54 (29 male) white children at high risk and 47 (25 male) white children at low risk for developing alcoholism. Children were also grouped according to gender and age (younger: 8-12 years; older: 13-18 years). No differences is visual sensitivity, response criterion or reaction time were associated with risk status on the degraded visual stimulus version of the Continuous Performance Test. For the Span of Apprehension, no differences were found due to risk status when only 1 or 5 distractors were presented, although with 9 distractors a significant effect of risk status was found when it was tested as an interaction with gender and age (decreased accuracy for older high-risk boys compared to older low-risk boys). These findings suggest that ERP deviations are not attributable to stages of visual processing deficits, but represent difficulty involving more complex utilization of information. Implications of these results are that the differences between high- and low-risk children that have been reported previously for visual ERP components (e.g., P300) are not attributable to deficits of attentional or iconic memory mechanisms.

Johnson Space Center's Risk and Reliability Analysis Group 2008 Annual Report

Science.gov (United States)

Valentine, Mark; Boyer, Roger; Cross, Bob; Hamlin, Teri; Roelant, Henk; Stewart, Mike; Bigler, Mark; Winter, Scott; Reistle, Bruce; Heydorn,Dick

2009-01-01

The Johnson Space Center (JSC) Safety & Mission Assurance (S&MA) Directorate s Risk and Reliability Analysis Group provides both mathematical and engineering analysis expertise in the areas of Probabilistic Risk Assessment (PRA), Reliability and Maintainability (R&M) analysis, and data collection and analysis. The fundamental goal of this group is to provide National Aeronautics and Space Administration (NASA) decisionmakers with the necessary information to make informed decisions when evaluating personnel, flight hardware, and public safety concerns associated with current operating systems as well as with any future systems. The Analysis Group includes a staff of statistical and reliability experts with valuable backgrounds in the statistical, reliability, and engineering fields. This group includes JSC S&MA Analysis Branch personnel as well as S&MA support services contractors, such as Science Applications International Corporation (SAIC) and SoHaR. The Analysis Group s experience base includes nuclear power (both commercial and navy), manufacturing, Department of Defense, chemical, and shipping industries, as well as significant aerospace experience specifically in the Shuttle, International Space Station (ISS), and Constellation Programs. The Analysis Group partners with project and program offices, other NASA centers, NASA contractors, and universities to provide additional resources or information to the group when performing various analysis tasks. The JSC S&MA Analysis Group is recognized as a leader in risk and reliability analysis within the NASA community. Therefore, the Analysis Group is in high demand to help the Space Shuttle Program (SSP) continue to fly safely, assist in designing the next generation spacecraft for the Constellation Program (CxP), and promote advanced analytical techniques. The Analysis Section s tasks include teaching classes and instituting personnel qualification processes to enhance the professional abilities of our analysts

Can we avoid high levels of dose escalation for high-risk prostate cancer in the setting of androgen deprivation?

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Shakespeare, Thomas P; Wilcox, Shea W; Aherne, Noel J

2016-01-01

Both dose-escalated external beam radiotherapy (DE-EBRT) and androgen deprivation therapy (ADT) improve outcomes in patients with high-risk prostate cancer. However, there is little evidence specifically evaluating DE-EBRT for patients with high-risk prostate cancer receiving ADT, particularly for EBRT doses >74 Gy. We aimed to determine whether DE-EBRT >74 Gy improves outcomes for patients with high-risk prostate cancer receiving long-term ADT. Patients with high-risk prostate cancer were treated on an institutional protocol prescribing 3-6 months neoadjuvant ADT and DE-EBRT, followed by 2 years of adjuvant ADT. Between 2006 and 2012, EBRT doses were escalated from 74 Gy to 76 Gy and then to 78 Gy. We interrogated our electronic medical record to identify these patients and analyzed our results by comparing dose levels. In all, 479 patients were treated with a 68-month median follow-up. The 5-year biochemical disease-free survivals for the 74 Gy, 76 Gy, and 78 Gy groups were 87.8%, 86.9%, and 91.6%, respectively. The metastasis-free survivals were 95.5%, 94.5%, and 93.9%, respectively, and the prostate cancer-specific survivals were 100%, 94.4%, and 98.1%, respectively. Dose escalation had no impact on any outcome in either univariate or multivariate analysis. There was no benefit of DE-EBRT >74 Gy in our cohort of high-risk prostate patients treated with long-term ADT. As dose escalation has higher risks of radiotherapy-induced toxicity, it may be feasible to omit dose escalation beyond 74 Gy in this group of patients. Randomized studies evaluating dose escalation for high-risk patients receiving ADT should be considered.

Usefulness of postoperative hip irradiation in the prevention of heterotopic bone formation in a high risk group of patients

International Nuclear Information System (INIS)

MacLennan, I.; Keys, H.M.; Evarts, C.M.; Rubin, P.

1984-01-01

Heterotopic ossification is a complication of total hip arthroplasty in 14 to 30% of patients. Significant functional impairment will occur in up to 28% of patients with ectopic bone. The high risk group includes those with preexisting heterotopic bone in either hip, those suffering from hypertrophic osteoarthritis or ankylosing spondylitis and patients who have had multiple procedures on the hip. Fifty-eight patients (67 hips) were irradiated after surgical removal of ectopic bone (53 hips) or received radiation prophylaxis of heterotopic ossification (14 hips). Ninety-five percent of patients had either no bone visible or insignificant amounts of ectopic bone visible on postoperative hip X-rays. Only 5% of patients showed significant persistence of ectopic bone. Postoperative hip function was dramatically improved compared to preoperative function in all patients treated. The importance of early commencement of irradiation is emphasized

Thrombocytopenia in Moderate- to High-Risk Sutureless Aortic Valve Replacement

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Puwadon Thitivaraporn

2018-06-01

Full Text Available Background : This study aimed to compare preliminary data on the outcomes of sutureless aortic valve replacement (SU-AVR with those of aortic valve replacement (AVR. Methods : We conducted a retrospective study of SU-AVR in moderate- to high-risk patients from 2013 to 2016. Matching was performed at a 1:1 ratio using the Society of Thoracic Surgeons predicted risk of mortality score with sex and age. The primary outcome was 30-day mortality. The secondary outcomes were operative outcomes and complications. Results : A total of 277 patients were studied. Ten patients (50% males; median age, 81.5 years underwent SU-AVR. Postoperative echocardiography showed impressive outcomes in the SU-AVR group. The 30-day mortality was 10% in both groups. In our study, the patients in the SU-AVR group developed postoperative thrombocytopenia. Platelet counts decreased from 225X103 /μL preoperatively to 94.5, 54.5, and 50.1X10 3/μL on postoperative days 1, 2, and 3, respectively, showing significant differences compared with the AVR group (p=0.04, p=0.16, and p=0.20, respectively. The median amount of platelet transfusion was higher in the AVR group (12.5 vs. 0 units, p=0.052. Conclusion : There was no difference in the 30-day mortality of moderate- to high-risk patients depending on whether they underwent SU-AVR or AVR. Although SU-AVR is associated with favorable cardiopulmonary bypass and cross-clamp times, it may be associated with postoperative thrombocytopenia.

Adjuvant Sunitinib in High-Risk Renal-Cell Carcinoma after Nephrectomy.

Science.gov (United States)

Ravaud, Alain; Motzer, Robert J; Pandha, Hardev S; George, Daniel J; Pantuck, Allan J; Patel, Anup; Chang, Yen-Hwa; Escudier, Bernard; Donskov, Frede; Magheli, Ahmed; Carteni, Giacomo; Laguerre, Brigitte; Tomczak, Piotr; Breza, Jan; Gerletti, Paola; Lechuga, Mariajose; Lin, Xun; Martini, Jean-Francois; Ramaswamy, Krishnan; Casey, Michelle; Staehler, Michael; Patard, Jean-Jacques

2016-12-08

Sunitinib, a vascular endothelial growth factor pathway inhibitor, is an effective treatment for metastatic renal-cell carcinoma. We sought to determine the efficacy and safety of sunitinib in patients with locoregional renal-cell carcinoma at high risk for tumor recurrence after nephrectomy. In this randomized, double-blind, phase 3 trial, we assigned 615 patients with locoregional, high-risk clear-cell renal-cell carcinoma to receive either sunitinib (50 mg per day) or placebo on a 4-weeks-on, 2-weeks-off schedule for 1 year or until disease recurrence, unacceptable toxicity, or consent withdrawal. The primary end point was disease-free survival, according to blinded independent central review. Secondary end points included investigator-assessed disease-free survival, overall survival, and safety. The median duration of disease-free survival was 6.8 years (95% confidence interval [CI], 5.8 to not reached) in the sunitinib group and 5.6 years (95% CI, 3.8 to 6.6) in the placebo group (hazard ratio, 0.76; 95% CI, 0.59 to 0.98; P=0.03). Overall survival data were not mature at the time of data cutoff. Dose reductions because of adverse events were more frequent in the sunitinib group than in the placebo group (34.3% vs. 2%), as were dose interruptions (46.4% vs. 13.2%) and discontinuations (28.1% vs. 5.6%). Grade 3 or 4 adverse events were more frequent in the sunitinib group (48.4% for grade 3 events and 12.1% for grade 4 events) than in the placebo group (15.8% and 3.6%, respectively). There was a similar incidence of serious adverse events in the two groups (21.9% for sunitinib vs. 17.1% for placebo); no deaths were attributed to toxic effects. Among patients with locoregional clear-cell renal-cell carcinoma at high risk for tumor recurrence after nephrectomy, the median duration of disease-free survival was significantly longer in the sunitinib group than in the placebo group, at a cost of a higher rate of toxic events. (Funded by Pfizer; S-TRAC Clinical

A Proactive Approach to High Risk Delirium Patients Undergoing Total Joint Arthroplasty.

Science.gov (United States)

Duque, Andres F; Post, Zachary D; Orozco, Fabio R; Lutz, Rex W; Ong, Alvin C

2018-04-01

Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid Services consider delirium following TJA a "never-event." The purpose of this study is to evaluate a simple perioperative protocol used to identify delirium risk patients and prevent its incidence following TJA. Our group developed a protocol to identify and prevent delirium in patients undergoing TJA. All patients were screened and scored in the preoperative assessment, on criteria such as age, history of forgetfulness, history of agitation or visual hallucinations, history of falls, history of postoperative confusion, and inability to perform higher brain functions. Patients were scored on performance in a simple mental examination. The patients were classified as low, medium, or high risk. Patients who were identified as high risk were enrolled in a delirium avoidance protocol that minimized narcotics and emphasized nursing involvement and fluids administration. Five of 7659 (0.065%) consecutive TJA patients from 2010 to 2015 developed delirium. A total of 422 patients were identified as high risk. All 5 patients who suffered delirium were within the high risk group. No low or medium risk patients suffered a delirium complication. Three (0.039%) patients suffered drug-induced delirium, 1 (0.013%) had delirium related to alcohol withdrawal, and 1 (0.013%) had delirium after a systemic infection. This protocol is effective in identifying patients at high delirium risk and diminishing the incidence of this complication by utilizing a simple screening tool and perioperative protocol. Copyright © 2017 Elsevier Inc. All rights reserved.

A mathematical model for stratification of LADA risk groups

Directory of Open Access Journals (Sweden)

Tatiana Mikhailovna Tikhonova

2014-03-01

Full Text Available Aim. To stratify risk groups via discriminant analysis based on the most clinically relevant indications of LADA onset derived from medical history. Materials and Methods. Present study included 141 patients with diabetes mellitus (DM of whom 65 had preliminary diagnosis of LADA, 40 patients were diagnosed with type 1 diabetes mellitus (T1DM and 36 ? with type 2 diabetes mellitus (T2DM. Discriminant analysis was performed to evaluate the differences between the clinical onsets in study groups. Results. Aside from torpid onset with early evidence for insulin resistance, clinical characteristics of LADA included diagnosis during random examination, progressive loss of body mass, hyperglycemia greater than 14 mmol/L at the diagnosis and, possibly, ketonuria without history of acute ketoacidosis. Conclusion. Discriminant analysis is beneficial in stratifying risk groups for the development of LADA.

Peer group self-identification as a predictor of relational and physical aggression among high school students.

Science.gov (United States)

Pokhrel, Pallav; Sussman, Steven; Black, David; Sun, Ping

2010-05-01

Adolescent peer group self-identification refers to adolescents' affiliation with reputation-based peer groups such as "Goths" or "Jocks." These groups tend to vary on normative characteristics, including the group members' attitudes and behaviors. This article examined whether adolescents' baseline peer group self-identification predicted their self-reported relational and physical aggression 1 year later. Self-report data were collected from 1614 students from 9 regular and 9 continuation (alternative) high schools in Southern California, at baseline and 1-year follow-up. Subjects' mean baseline age was 15.21 years (SD = 1.18) and 51.6% of the subjects were female. Findings indicated that compared with self-identified "Regular" or "Normal" students, adolescents who identified with high-risk peer groups (eg, "Druggies,"Goths") tended to report higher relational and physical aggression 1 year later, controlling for baseline aggression and demographic variables. In addition, adolescents' self-identification with high-status peer groups (eg, "Jocks,"Populars") was predictive of higher relational aggression 1 year later. Gender and school type (ie, regular vs continuation) were not found to moderate these effects. It appears that peer group self-identification is a salient predictor of physical and relational aggression across gender and school type. Adolescents who identify with high-risk peer groups tend to report higher levels of physical as well as relational aggression in the future. In addition, adolescents who affiliate with elite groups tend to become more relationally aggressive over time. School-based prevention programs targeting aggression may benefit from addressing the impacts of peer group self-identification on adolescents' aggressive behavior.

High-risk populations identified in Childhood Cancer Survivor Study investigations: implications for risk-based surveillance.

Science.gov (United States)

Hudson, Melissa M; Mulrooney, Daniel A; Bowers, Daniel C; Sklar, Charles A; Green, Daniel M; Donaldson, Sarah S; Oeffinger, Kevin C; Neglia, Joseph P; Meadows, Anna T; Robison, Leslie L

2009-05-10

Childhood cancer survivors often experience complications related to cancer and its treatment that may adversely affect quality of life and increase the risk of premature death. The purpose of this manuscript is to review how data derived from Childhood Cancer Survivor Study (CCSS) investigations have facilitated identification of childhood cancer survivor populations at high risk for specific organ toxicity and secondary carcinogenesis and how this has informed clinical screening practices. Articles previously published that used the resource of the CCSS to identify risk factors for specific organ toxicity and subsequent cancers were reviewed and results summarized. CCSS investigations have characterized specific groups to be at highest risk of morbidity related to endocrine and reproductive dysfunction, pulmonary toxicity, cerebrovascular injury, neurologic and neurosensory sequelae, and subsequent neoplasms. Factors influencing risk for specific outcomes related to the individual survivor (eg, sex, race/ethnicity, age at diagnosis, attained age), sociodemographic status (eg, education, household income, health insurance) and cancer history (eg, diagnosis, treatment, time from diagnosis) have been consistently identified. These CCSS investigations that clarify risk for treatment complications related to specific treatment modalities, cumulative dose exposures, and sociodemographic factors identify profiles of survivors at high risk for cancer-related morbidity who deserve heightened surveillance to optimize outcomes after treatment for childhood cancer.

The third spatial dimension risk approach for individual risk and group risk in multiple use of space

International Nuclear Information System (INIS)

Suddle, Shahid; Ale, Ben

2005-01-01

Buildings above roads and railways are examples of multiple use of space. Safety is one of the critical issues for such projects. Risk analyses can be undertaken to investigate what safety measures that are required to realise these projects. The results of these analyses can also be compared to risk acceptance criteria, if they are applicable. In The Netherlands, there are explicit criteria for acceptability of individual risk and societal risk. Traditionally calculations of individual risk result in contours of equal risk on a map and thus are considered in two-dimensional space only. However, when different functions are layered the third spatial dimension, height, becomes an important parameter. The various activities and structures above and below each other impose mutual risks. There are no explicit norms or policies about how to deal with the individual or group risk approach in the third dimension. This paper proposes an approach for these problems and gives some examples. Finally, the third dimension risk approach is applied in a case study of Bos en Lommer, Amsterdam

Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients.

Science.gov (United States)

Jamerson, Kenneth; Weber, Michael A; Bakris, George L; Dahlöf, Björn; Pitt, Bertram; Shi, Victor; Hester, Allen; Gupte, Jitendra; Gatlin, Marjorie; Velazquez, Eric J

2008-12-04

The optimal combination drug therapy for hypertension is not established, although current U.S. guidelines recommend inclusion of a diuretic. We hypothesized that treatment with the combination of an angiotensin-converting-enzyme (ACE) inhibitor and a dihydropyridine calcium-channel blocker would be more effective in reducing the rate of cardiovascular events than treatment with an ACE inhibitor plus a thiazide diuretic. In a randomized, double-blind trial, we assigned 11,506 patients with hypertension who were at high risk for cardiovascular events to receive treatment with either benazepril plus amlodipine or benazepril plus hydrochlorothiazide. The primary end point was the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac arrest, and coronary revascularization. The baseline characteristics of the two groups were similar. The trial was terminated early after a mean follow-up of 36 months, when the boundary of the prespecified stopping rule was exceeded. Mean blood pressures after dose adjustment were 131.6/73.3 mm Hg in the benazepril-amlodipine group and 132.5/74.4 mm Hg in the benazepril-hydrochlorothiazide group. There were 552 primary-outcome events in the benazepril-amlodipine group (9.6%) and 679 in the benazepril-hydrochlorothiazide group (11.8%), representing an absolute risk reduction with benazepril-amlodipine therapy of 2.2% and a relative risk reduction of 19.6% (hazard ratio, 0.80, 95% confidence interval [CI], 0.72 to 0.90; Pbenazepril-amlodipine combination was superior to the benazepril-hydrochlorothiazide combination in reducing cardiovascular events in patients with hypertension who were at high risk for such events. (ClinicalTrials.gov number, NCT00170950.) 2008 Massachusetts Medical Society

Maternal health, antenatal and at 8 weeks after delivery, in home versus in-hospital fetal monitoring in high-risk pregnancies

NARCIS (Netherlands)

Monincx, W. M.; Birnie, E.; Zondervan, H. A.; Bleker, O. P.; Bonsel, G. J.

2001-01-01

To assess maternal health outcome, comparing high-risk pregnant women to either domiciliary monitoring or in-hospital monitoring, and a low risk pregnant group. Paper and pencil questionnaire, distributed antenatal and 8 weeks after the delivery. A university hospital. Three groups: 130 high-risk

Development of innovative methods for risk assessment in high-rise construction based on clustering of risk factors

Science.gov (United States)

Okolelova, Ella; Shibaeva, Marina; Shalnev, Oleg

2018-03-01

The article analyses risks in high-rise construction in terms of investment value with account of the maximum probable loss in case of risk event. The authors scrutinized the risks of high-rise construction in regions with various geographic, climatic and socio-economic conditions that may influence the project environment. Risk classification is presented in general terms, that includes aggregated characteristics of risks being common for many regions. Cluster analysis tools, that allow considering generalized groups of risk depending on their qualitative and quantitative features, were used in order to model the influence of the risk factors on the implementation of investment project. For convenience of further calculations, each type of risk is assigned a separate code with the number of the cluster and the subtype of risk. This approach and the coding of risk factors makes it possible to build a risk matrix, which greatly facilitates the task of determining the degree of impact of risks. The authors clarified and expanded the concept of the price risk, which is defined as the expected value of the event, 105 which extends the capabilities of the model, allows estimating an interval of the probability of occurrence and also using other probabilistic methods of calculation.

High School Football and Risk of Neurodegeneration: A Community-Based Study

Science.gov (United States)

Savica, Rodolfo; Parisi, Joseph E.; Wold, Lester E.; Josephs, Keith A.; Ahlskog, J. Eric

2012-01-01

Objective To assess whether high school football played between 1946 and 1956, when headgear was less protective than today, was associated with development of neurodegenerative diseases later in life. Methods All male students who played football from 1946 to 1956 in the high schools of Rochester, Minnesota, plus a non–football-playing referent group of male students in the band, glee club, or choir were identified. Using the records-linkage system of the Rochester Epidemiology Project, we reviewed (from October 31, 2010, to March 30, 2011) all available medical records to assess later development of dementia, Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS). We also compared the frequency of dementia, PD, or ALS with incidence data from the general population of Olmsted County, Minnesota. Results We found no increased risk of dementia, PD, or ALS among the 438 football players compared with the 140 non–football-playing male classmates. Parkinson disease and ALS were slightly less frequent in the football group, whereas dementia was slightly more frequent, but not significantly so. When we compared these results with the expected incidence rates in the general population, only PD was significantly increased; however, this was true for both groups, with a larger risk ratio in the non–football group. Conclusion Our findings suggest that high school students who played American football from 1946 to 1956 did not have an increased risk of later developing dementia, PD, or ALS compared with non–football-playing high school males, despite poorer equipment and less regard for concussions compared with today and no rules prohibiting head-first tackling (spearing). PMID:22469346

[Making up tuberculosis risk groups from decreed contingents].

Science.gov (United States)

Kucherov, A L; Il'icheva, E Iu

2001-01-01

The paper provides materials to make up risk groups from decreed contingents by using the database developed and introduced in the Novomoskovsk district, as well as a programme for rapid determination of the risk of tuberculosis. This procedure reduces a scope of fluorographic surveys among the decreed contingents, as well as their expenditures by 60%. Moreover, it may be useful for professional choice in the employment of the decreed persons, which may promote a decrease in the incidence of tuberculosis among them.

Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement.

Science.gov (United States)

van Hest, N A; Aldridge, R W; de Vries, G; Sandgren, A; Hauer, B; Hayward, A; Arrazola de Oñate, W; Haas, W; Codecasa, L R; Caylà, J A; Story, A; Antoine, D; Gori, A; Quabeck, L; Jonsson, J; Wanlin, M; Orcau, Å; Rodes, A; Dedicoat, M; Antoun, F; van Deutekom, H; Keizer, St; Abubakar, I

2014-03-06

In low-incidence countries in the European Union (EU), tuberculosis (TB) is concentrated in big cities, especially among certain urban high-risk groups including immigrants from TB high-incidence countries, homeless people, and those with a history of drug and alcohol misuse. Elimination of TB in European big cities requires control measures focused on multiple layers of the urban population. The particular complexities of major EU metropolises, for example high population density and social structure, create specific opportunities for transmission, but also enable targeted TB control interventions, not efficient in the general population, to be effective or cost effective. Lessons can be learnt from across the EU and this consensus statement on TB control in big cities and urban risk groups was prepared by a working group representing various EU big cities, brought together on the initiative of the European Centre for Disease Prevention and Control. The consensus statement describes general and specific social, educational, operational, organisational, legal and monitoring TB control interventions in EU big cities, as well as providing recommendations for big city TB control, based upon a conceptual TB transmission and control model.

High Genomic Instability Predicts Survival in Metastatic High-Risk Neuroblastoma

Directory of Open Access Journals (Sweden)

Sara Stigliani

2012-09-01

Full Text Available We aimed to identify novel molecular prognostic markers to better predict relapse risk estimate for children with high-risk (HR metastatic neuroblastoma (NB. We performed genome- and/or transcriptome-wide analyses of 129 stage 4 HR NBs. Children older than 1 year of age were categorized as “short survivors” (dead of disease within 5 years from diagnosis and “long survivors” (alive with an overall survival time ≥ 5 years. We reported that patients with less than three segmental copy number aberrations in their tumor represent a molecularly defined subgroup with a high survival probability within the current HR group of patients. The complex genomic pattern is a prognostic marker independent of NB-associated chromosomal aberrations, i.e., MYCN amplification, 1p and 11q losses, and 17q gain. Integrative analysis of genomic and expression signatures demonstrated that fatal outcome is mainly associated with loss of cell cycle control and deregulation of Rho guanosine triphosphates (GTPases functioning in neuritogenesis. Tumors with MYCN amplification show a lower chromosome instability compared to MYCN single-copy NBs (P = .0008, dominated by 17q gain and 1p loss. Moreover, our results suggest that the MYCN amplification mainly drives disruption of neuronal differentiation and reduction of cell adhesion process involved in tumor invasion and metastasis. Further validation studies are warranted to establish this as a risk stratification for patients.

High Center Volume Does Not Mitigate Risk Associated with Using High Donor Risk Organs in Liver Transplantation.

Science.gov (United States)

Beal, Eliza W; Black, Sylvester M; Mumtaz, Khalid; Hayes, Don; El-Hinnawi, Ashraf; Washburn, Kenneth; Tumin, Dmitry

2017-09-01

High-risk donor allografts increase access to liver transplant, but potentially reduce patient and graft survival. It is unclear whether the risk associated with using marginal donor livers is mitigated by increasing center experience. The United Network for Organ Sharing registry was queried for adult first-time liver transplant recipients between 2/2002 and 12/2015. High donor risk was defined as donor risk index >1.9, and 1-year patient and graft survival were compared according to donor risk index in small and large centers. Multivariable Cox regression estimated the hazard ratio (HR) associated with using high-risk donor organs, according to a continuous measure of annual center volume. The analysis included 51,770 patients. In 67 small and 67 large centers, high donor risk index predicted increased mortality (p = 0.001). In multivariable analysis, high-donor risk index allografts predicted greater mortality hazard at centers performing 20 liver transplants per year (HR 1.35; 95% CI 1.22, 1.49; p donor risk index and center volume was not statistically significant (p = 0.747), confirming that the risk associated with using marginal donor livers was comparable between smaller and larger centers. Results were consistent when examining graft loss. At both small and large centers, high-risk donor allografts were associated with reduced patient and graft survival after liver transplant. Specific strategies to mitigate the risk of liver transplant involving high-risk donors are needed, in addition to accumulation of center expertise.

Cardiovascular disease and ABO blood-groups in Africans. Are blood-group A individuals at higher risk of ischemic disease?: A pilot study.

Science.gov (United States)

Ba, Djibril Marie; Sow, Mamadou Saidou; Diack, Aminata; Dia, Khadidiatou; Mboup, Mouhamed Cherif; Fall, Pape Diadie; Fall, Moussa Daouda

2017-12-01

, there was no statistical difference between blood group A and non-A in myocardial infarction (MI) incidence ( p  = 0.09, 95% CI = 0.99-2.83) but a statistically significant difference between blood group A and non-A in stroke and coronary artery disease (CAD) incidence (p blood group A (95% CI = 2.26-4.57, p  group, while there was no statistically significant difference in women ( p  = 0.35). However, an overall effect was detected to be statistically significant regardless of gender ( p  blood group A and ID in sub-Sahara Africans.In African countries, where most of health facilities are understaffed, more rigorous studies with a larger population are needed to give a high level of evidence to confirm this association in order to establish the need to be more aggressive in risk factor control in these individuals.

Phase 2 Study of Temozolomide-Based Chemoradiation Therapy for High-Risk Low-Grade Gliomas: Preliminary Results of Radiation Therapy Oncology Group 0424

Energy Technology Data Exchange (ETDEWEB)

Fisher, Barbara J., E-mail: barbara.fisher@lhsc.on.ca [London Regional Cancer Program, London, Ontario (Canada); Hu, Chen [Radiation Therapy Oncology Group-Statistical Center, Philadelphia, Pennsylvania (United States); Macdonald, David R. [London Regional Cancer Program, London, Ontario (Canada); Lesser, Glenn J. [Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina (United States); Coons, Stephen W. [Barrow Neurological Institute, Phoenix, Arizona (United States); Brachman, David G. [Arizona Oncology Services Foundation, Phoenix, Arizona (United States); Ryu, Samuel [Henry Ford Hospital, Detroit, Michigan (United States); Werner-Wasik, Maria [Thomas Jefferson University Hospital Center, Philadelphia, Pennsylvania (United States); Bahary, Jean-Paul [Centre Hospitalier de l' Université de Montréal-Notre Dame, Montreal, Quebec (Canada); Liu, Junfeng [GCE Solutions, Inc., Bloomington, Illinois (United States); Chakravarti, Arnab [The Ohio State University, The James, Columbus, Ohio (United States); Mehta, Minesh [University of Maryland Medical Systems, Baltimore, Maryland (United States)

2015-03-01

Purpose: Radiation Therapy Oncology Group (RTOG) 0424 was a phase 2 study of a high-risk low-grade glioma (LGG) population who were treated with temozolomide (TMZ) and radiation therapy (RT), and outcomes were compared to those of historical controls. This study was designed to detect a 43% increase in median survival time (MST) from 40.5 to 57.9 months and a 20% improvement in 3-year overall survival (OS) rate from 54% to 65% at a 10% significance level (1-sided) and 96% power. Methods and Materials: Patients with LGGs with 3 or more risk factors for recurrence (age ≥40 years, astrocytoma histology, bihemispherical tumor, preoperative tumor diameter of ≥6 cm, or a preoperative neurological function status of >1) were treated with RT (54 Gy in 30 fractions) and concurrent and adjuvant TMZ. Results: From 2005 to 2009, 129 evaluable patients (75 males and 54 females) were accrued. Median age was 49 years; 91% had a Zubrod score of 0 or 1; and 69%, 25%, and 6% of patients had 3, 4, and 5 risk factors, respectively. Patients had median and minimum follow-up examinations of 4.1 years and 3 years, respectively. The 3-year OS rate was 73.1% (95% confidence interval: 65.3%-80.8%), which was significantly improved compared to that of prespecified historical control values (P<.001). Median survival time has not yet been reached. Three-year progression-free survival was 59.2%. Grades 3 and 4 adverse events occurred in 43% and 10% of patients, respectively. One patient died of herpes encephalitis. Conclusions: The 3-year OS rate of 73.1% for RTOG 0424 high-risk LGG patients is higher than that reported for historical controls (P<.001) and the study-hypothesized rate of 65%.

Group identity and positive deviance in work groups.

Science.gov (United States)

Kim, Moon Joung; Choi, Jin Nam

2017-12-05

This study examines why and how identity cognitions, including group identification and individual differentiation, influence the positive deviance of employees. We identify the risk-taking intention of employees as a critical psychological mechanism to overcome stigma-induced identity threat of positive deviance. The analysis of data collected from 293 members comprising 66 work teams reveals that the relationship between individual differentiation and positive deviance is partially mediated by risk-taking intention. The indirect effect of group identification on positive deviance through risk-taking intention is also significant and positive in groups with low conformity pressure, whereas the same indirect effect is neutralized in groups with high conformity pressure. The current analysis offers new insights into the way the group context and the identity cognition of members explain the development of positive deviance and workplace creativity.

Growth recovery lines are more common in infants at high vs. low risk for abuse

International Nuclear Information System (INIS)

Zapala, Matthew A.; Tsai, Andy; Kleinman, Paul K.

2016-01-01

Growth recovery lines, also known as growth arrest lines, are transverse radiodense metaphyseal bands that develop due to a temporary arrest of endochondral ossification caused by local or systemic insults. To determine if growth recovery lines are more common in infants at high risk versus low risk for abuse. Reports of American College of Radiology compliant skeletal surveys (1999-2013) were reviewed with clinical records. Infants at low risk for abuse had a skull fracture without significant intracranial injury, history of a fall and clinical determination of low risk (child protection team/social work assessment). Infants at high risk had significant intracranial injury, retinal hemorrhages, other skeletal injuries and clinical determination of high risk. There were 52 low-risk infants (mean: 4.7 months, range: 0.4-12 months) and 21 high-risk infants (mean: 4.2 months, range: 0.8-9.1 months). Two blinded radiologists independently evaluated the skeletal survey radiographs of the knees/lower legs for the presence of at least one growth recovery line. When growth recovery lines are scored as probably present or definitely present, their prevalence in the low-risk group was 38% (standard deviation [SD] = 8%; reader 1 = 17/52, reader 2 = 23/52) vs. 71% (SD = 7%; reader 1 = 16/21, reader 2 = 14/21) in the high-risk group (P < 0.001; odds ratio 4.0, 95% CI: 1.7-9.5). Growth recovery lines are encountered at a significantly higher rate in infants at high risk vs. low risk for abuse. This suggests that abused infants are prone to a temporary disturbance in endochondral ossification as a result of episodic physiological stresses. (orig.)

Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

Science.gov (United States)

Konda, Kelika A.; Roberts, Chelsea P.; Maguiña, Jorge L.; Leon, Segundo R.; Clark, Jesse L.; Coates, Thomas J.; Caceres, Carlos F.; Klausner, Jeffrey D.

2016-01-01

Background Syphilis is concentrated among high-risk groups, but the epidemiology of syphilis reinfection is poorly understood. We characterized factors associated with syphilis incidence, including reinfection, in a high-risk cohort in Peru. Methods Participants in the NIMH CPOL trial were assessed at baseline and 2 annual visits with HIV/STI testing and behavioral surveys. Participants diagnosed with syphilis also attended 4- and 9-month visits. All participants underwent syphilis testing with RPR screening and TPPA confirmation. Antibiotic treatment was provided according to CDC guidelines. Reinfection was defined as a 4-fold titer increase or recurrence of seroreactivity after successful treatment with subsequent negative RPR titers. The longitudinal analysis used a Possion generalized estimating equations model with backward selection of variables in the final model (criteria P <0.02). Results Of 2,709 participants, 191 (7.05%) were RPR-reactive (median 1:8, range 1:1–1:1024) with TPPA confirmation. There were 119 total cases of incident syphilis, which included both reinfection and first-time incident cases. In the bivariate analysis, the oldest 2 quartiles of age (incidence ratio (IR) 3.84; P <0.001 and IR 8.15; P <0.001) and being MSM/TW (IR 6.48; P <0.001) were associated with higher risk of incident syphilis infection. Of the sexual risk behaviors, older age of sexual debut (IR 12.53; P <0.001), not being in a stable partnership (IR 1.56, P = 0.035), higher number of sex partners (IR 3.01; P <0.001), unprotected sex in the past 3 months (IR 0.56; P = 0.003), HIV infection at baseline (IR 3.98; P <0.001) and incident HIV infection during the study period (IR 6.26; P = 0.003) were all associated with incident syphilis. In the multivariable analysis, older age group (adjusted incidence ratio (aIR) 6.18; P <0.001), men reporting having sex with a man (aIR 4.63; P <0.001), and incident HIV infection (aIR 4.48; P = 0.008) were significantly associated

Rapid COJEC versus standard induction therapies for high-risk neuroblastoma

NARCIS (Netherlands)

Peinemann, Frank; Tushabe, Doreen A.; van Dalen, Elvira C.; Berthold, Frank

2015-01-01

Neuroblastoma is a rare malignant disease and mainly affects infants and very young children. The tumors mainly develop in the adrenal medullary tissue and an abdominal mass is the most common presentation. The high-risk group is characterized by metastasis and other characteristics that increase

Clinical characteristics of high plasma adiponectin and high plasma leptin as risk factors for arterial stiffness and related end-organ damage.

Science.gov (United States)

Kohara, Katsuhiko; Ochi, Masayuki; Okada, Yoko; Yamashita, Taiji; Ohara, Maya; Kato, Takeaki; Nagai, Tokihisa; Tabara, Yasuharu; Igase, Michiya; Miki, Tetsuro

2014-08-01

The relationship between plasma levels of adiponectin and cardiovascular events is inconclusive. We evaluated the clinical characteristics of people with high plasma adiponectin and high plasma leptin levels. Thousand seven hundred participants recruited from visitors to the Anti-Aging Doc were divided into four groups by combining the bipartiles of plasma adiponectin and leptin levels in men and women separately: AL, high adiponectin and high leptin; Al, high adiponectin and low leptin; al, low adiponectin and low leptin; aL, low adiponectin and high leptin. Body composition, including visceral fat area and thigh muscle cross-sectional area (CSA), brachial-ankle pulse wave velocity (baPWV), periventricular hyperintensity, and urinary albumin excretion, were determined. Twenty percent of the studied population fell within the AL group. This group had a significantly higher visceral fat area than the Al group. Thigh muscle CSA was lowest in the AL group among groups. baPWV, brain white matter lesions, and albuminuria findings in the AL group were significantly higher than those of the Al group. Multiple and logistic regression analyses with confounding parameters further confirmed that plasma adiponectin was not an independent determinant for brain and renal small vessel-related disease. These findings suggest that the plasma level of adiponectin alone is not enough for the risk stratification of cardiovascular disease. Leptin resistance associated with skeletal muscle loss in addition to obesity may need to be addressed to identify high risk people with high plasma adiponectin levels. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Finding Risk Groups by Optimizing Artificial Neural Networks on the Area under the Survival Curve Using Genetic Algorithms.

Science.gov (United States)

Kalderstam, Jonas; Edén, Patrik; Ohlsson, Mattias

2015-01-01

We investigate a new method to place patients into risk groups in censored survival data. Properties such as median survival time, and end survival rate, are implicitly improved by optimizing the area under the survival curve. Artificial neural networks (ANN) are trained to either maximize or minimize this area using a genetic algorithm, and combined into an ensemble to predict one of low, intermediate, or high risk groups. Estimated patient risk can influence treatment choices, and is important for study stratification. A common approach is to sort the patients according to a prognostic index and then group them along the quartile limits. The Cox proportional hazards model (Cox) is one example of this approach. Another method of doing risk grouping is recursive partitioning (Rpart), which constructs a decision tree where each branch point maximizes the statistical separation between the groups. ANN, Cox, and Rpart are compared on five publicly available data sets with varying properties. Cross-validation, as well as separate test sets, are used to validate the models. Results on the test sets show comparable performance, except for the smallest data set where Rpart's predicted risk groups turn out to be inverted, an example of crossing survival curves. Cross-validation shows that all three models exhibit crossing of some survival curves on this small data set but that the ANN model manages the best separation of groups in terms of median survival time before such crossings. The conclusion is that optimizing the area under the survival curve is a viable approach to identify risk groups. Training ANNs to optimize this area combines two key strengths from both prognostic indices and Rpart. First, a desired minimum group size can be specified, as for a prognostic index. Second, the ability to utilize non-linear effects among the covariates, which Rpart is also able to do.

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

Science.gov (United States)

Lee, Suzanne; Ayers, Susan; Holden, Des

2014-04-01

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

[Detecting high risk pregnancy].

Science.gov (United States)

Doret, Muriel; Gaucherand, Pascal

2009-12-20

Antenatal care is aiming to reduce maternal land foetal mortality and morbidity. Maternal and foetal mortality can be due to different causes. Their knowledge allows identifying pregnancy (high risk pregnancy) with factors associated with an increased risk for maternal and/or foetal mortality and serious morbidity. Identification of high risk pregnancies and initiation of appropriate treatment and/or surveillance should improve maternal and/or foetal outcome. New risk factors are continuously described thanks to improvement in antenatal care and development in biology and cytopathology, increasing complexity in identifying high risk pregnancies. Level of risk can change all over the pregnancy. Ideally, it should be evaluated prior to the pregnancy and at each antenatal visit. Clinical examination is able to screen for intra-uterin growth restriction, pre-eclampsia, threatened for preterm labour; ultrasounds help in the diagnosis of foetal morphological anomalies, foetal chromosomal anomalies, placenta praevia and abnormal foetal growth; biological exams are used to screen for pre-eclampsia, gestational diabetes, trisomy 21 (for which screening method just changed), rhesus immunisation, seroconversion for toxoplasmosis or rubeola, unknown infectious disease (syphilis, hepatitis B, VIH). During pregnancy, most of the preventive strategies have to be initiated during the first trimester or even before conception. Prevention for neural-tube defects, neonatal hypocalcemia and listeriosis should be performed for all women. On the opposite, some measures are concerning only women with risk factors such as prevention for toxoplasmosis, rhesus immunization (which recently changed), tobacco complications and pre-eclampsia and intra-uterine growth factor restriction.

Evaluation of risk management and financial performance of BMW Group

OpenAIRE

Mysina, Amira

2017-01-01

Effective risk and financial management possess a great challenge for the multinational companies operating globally. Despite the increasing development of diverse hedging strategies against foreign exchange risk, global firms cannot fully foresee and measure the degree of the impact of foreign currency fluctuations. This paper aims to evaluate the exchange risk management and financial performance of the BMW Group from the year 2005 to 2016. Moreover, this paper is devoted to provide explana...

Using cross-game behavioral markers for early identification of high-risk internet gamblers.

Science.gov (United States)

Braverman, Julia; LaPlante, Debi A; Nelson, Sarah E; Shaffer, Howard J

2013-09-01

Using actual gambling behavior provides the opportunity to develop behavioral markers that operators can use to predict the development of gambling-related problems among their subscribers. Participants were 4,056 Internet gamblers who subscribed to the Internet betting service provider bwin.party. Half of this sample included multiple platform gamblers who were identified by bwin.party's Responsible Gambling (RG) program; the other half were controls randomly selected from those who had the same first deposit date. Using the daily aggregated Internet betting transactions for gamblers' first 31 calendar days of online betting activities at bwin.party, we employed a 2-step analytic strategy: (a) applying an exploratory chi-squared automatic interaction detection (CHAID) decision tree method to identify characteristics that distinguished a subgroup of high-risk Internet gamblers from the rest of the sample, and (b) conducting a confirmatory analysis of those characteristics among an independent validation sample. This analysis identified two high-risk groups (i.e., groups in which 90% of the members were identified by bwin.party's RG program): Group 1 engaged in three or more gambling activities and evidenced high wager variability on casino-type games; Group 2 engaged in two different gambling activities and evidenced high variability for live action wagers. This analysis advances an ongoing research program to identify potentially problematic Internet gamblers during the earliest stages of their Internet gambling. Gambling providers and public policymakers can use these results to inform early intervention programs that target high-risk Internet gamblers. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Using risk-tracing snowball approach to increase HIV case detection among high-risk populations in Cambodia: an intervention study.

Science.gov (United States)

Chhim, Srean; Macom, John; Pav, Chettana; Nim, Nirada; Yun, Phearun; Seng, Sopheap; Chhim, Kolab; Tuot, Sovannary; Yi, Siyan

2017-10-18

Early HIV diagnosis and initiation onto antiretroviral therapy may prevent ongoing spread of HIV. Risk Tracing Snowball Approach (RTSA) has been shown to be effective in detecting new HIV cases in other settings. The main objective of this study is to evaluate the effectiveness of RTSA in increasing the rate of newly identified HIV cases among high-risk populations. Our second objective was to evaluate the effectiveness of RTSA, as compared to the walk-in group, in increasing the number of HIV tests and early case detection. This study was conducted from April 1 to September 30, 2016 at two NGO clinics in Phnom Penh, Cambodia. Respondent driven sampling method was adapted to develop RTSA to reach high-risk populations, including key populations and the general population who have social connections with key populations. Bivariate and multivariate logistic regression analyses were conducted. During the implementation period, 721 clients walked in for HIV testing (walk-in group), and all were invited to be seeds. Of the invited clients, 36.6% agreed to serve as seeds. Throughout the implementation, 6195 coupons were distributed to seeds or recruiters, and resulted in 1572 clients visiting the two clinics with coupons (RTSA group), for a coupon return rate of 25.3%. The rate of newly identified HIV cases among the RTSA group was significantly lower compared to that in walk-in group. However, the highest number of newly identified HIV cases was found during the implementation period, compared to both pre- and post-implementation period. Although statistically not significant, the mean CD4 count of newly identified HIV cases detected through RTSA was almost 200 cells/mm3 higher than that in the walk-in group. Although the rate of newly identified HIV cases among the RTSA group was lower than that in the walk-in group, the inclusion of RTSA in addition to the traditional walk-in method boosted new HIV case detection in the two participating clinics. A higher mean CD4

The New York High-Risk Project: social and general intelligence in children at risk for schizophrenia.

Science.gov (United States)

Ott, S L; Spinelli, S; Rock, D; Roberts, S; Amminger, G P; Erlenmeyer-Kimling, L

1998-05-04

Social deficits, as well as low performance on intelligence tests, are known early symptoms of schizophrenia. We studied whether impairment of social intelligence can be detected before the outbreak of the disorder. In the New York High-Risk Project, children at risk for schizophrenia (HRSz) or affective disorder (HRAff) and a normal control group (NC) were studied over the past 26 years. The children are now in mid-adulthood, with known psychiatric outcomes. Developmental and clinical data from childhood can now be related to adulthood diagnoses. We compared mean WISC (or WISC-R) and WAIS (or WAIS-R) scores from childhood and adolescence, and change of IQ, between the risk groups, as well as between the adulthood outcomes. We were specifically interested in the development of social intelligence (the Picture Arrangement and Comprehension subtests). We used logistic regression analyses to generate a model predicting adulthood schizophrenia. IQ at age 9,7 was lower in children with HRSz than with HRAff. Adulthood schizophrenia, compared with major depressive disorder and no psychiatric diagnosis could not be related conclusively to low IQ. This may be a result of the study design, since children with IQ below 70 or behavioral problems were not eligible as study subjects. There was no evidence of lower scores or more decline in social intelligence related to age or group membership (risk or outcome). Subtest-Scatter, a nondirectional measure of the differences between all subtests and Vocabulary, reflecting a lesser difference between crystallized and fluid intelligence, was identified as a significant predictor of adulthood schizophrenia, in the whole group as well as in the HRSz group alone.

Lipid profiles and ischemic stroke risk: variations by sex within racial/ethnic groups

Directory of Open Access Journals (Sweden)

Gezmu T

2014-05-01

Full Text Available Tefera Gezmu,1 Dona Schneider,1 Kitaw Demissie,2 Yong Lin,2 Christine Giordano,3 Martin S Gizzi4 1Edward J. Bloustein School of Planning and Public Policy, Rutgers, the State University of New Jersey, New Brunswick, NJ, 2Rutgers School of Public Health, Department of Epidemiology, Piscataway, NJ, 3Rutgers New Jersey Medical School, Newark, NJ, 4New Jersey Neuroscience Institute at JFK Medical Center and Seton Hall University, Edison, NJ, USA Abstract: Evidence implicates lipid abnormalities as important but modifiable risk factors for stroke. This study assesses whether hypercholesterolemia can be used to predict the risk for etiologic subtypes of ischemic stroke between sexes within racial/ethnic groups. Data elements related to stroke risk, diagnosis, and outcomes were abstracted from the medical records of 3,290 acute stroke admissions between 2006 and 2010 at a regional stroke center. Sex comparison within racial/ethnic groups revealed that South Asian and Hispanic men had a higher proportion of ischemic stroke than women, while the inverse was true for Whites and African Americans (P=0.0014. All women, except South Asian women, had higher mean plasma total cholesterol and higher blood circulating low-density lipoprotein levels (≥100 mg/dL than men at the time of their admissions. The incidence of large-artery atherosclerosis (LAA was more common among women than men, except among Hispanics, where men tended to have higher incidences. A regression analysis that considered patients diagnosed with either LAA or small-artery occlusion etiologic subtype as the outcomes and high-density lipoproteins and triglycerides as predictors showed inconsistent associations between lipid profiles and the incidence of these subtypes between the sexes within racial/ethnic groups. In conclusion, our investigation suggests that women stroke patients may be at increased risk for stroke etiologic subtype LAA than men. Although the higher prevalence of stroke

Soluble Urokinase Plasminogen Activator Receptor Levels in Tuberculosis Patients at High Risk for Multidrug Resistance

Directory of Open Access Journals (Sweden)

Tri Yudani Mardining Raras

2012-01-01

Full Text Available The soluble urokinase plasminogen activator receptor (suPAR has been shown to be a strong prognostic biomarker for tuberculosis (TB. In the present study, the profiles of plasma suPAR levels in pulmonary TB patients at high risk for multidrug resistance were analyzed and compared with those in multidrug resistant (MDR-TB patients. Forty patients were prospectively included, consisting of 10 MDR-TB patients and 30 TB patients at high risk for MDR, underwent clinical assesment. Plasma suPAR levels were measured using ELISA (SUPARnostic, Denmark and bacterial cultures were performed in addition to drug susceptibility tests. All patients of suspected MDR-TB group demonstrated significantly higher suPAR levels compared with the healthy TB-negative group (1.79 ng/mL. Among the three groups at high risk for MDR-TB, only the relapse group (7.87 ng/mL demonstrated suPAR levels comparable with those of MDR-TB patients (7.67 ng/mL. suPAR levels in the two-month negative acid-fast bacilli conversion group (9.29 ng/mL were higher than positive control, whereas levels in the group consisting of therapy failure patients (5.32 ng/mL were lower. Our results strongly suggest that suPAR levels enable rapid screening of suspected MDR-TB patients, but cannot differentiate between groups.

Use of focus groups to develop methods to communicate cardiovascular disease risk and potential for risk reduction to people with type 2 diabetes.

Science.gov (United States)

Price, Hermione C; Dudley, Christina; Barrow, Beryl; Kennedy, Ian; Griffin, Simon J; Holman, Rury R

2009-10-01

People need to perceive a risk in order to build an intention-to-change behaviour yet our ability to interpret information about risk is highly variable. We aimed to use a user-centred design process to develop an animated interface for the UK Prospective Diabetes Study (UKPDS) Risk Engine to illustrate cardiovascular disease (CVD) risk and the potential to reduce this risk. In addition, we sought to use the same approach to develop a brief lifestyle advice intervention. Three focus groups were held. Participants were provided with examples of materials used to communicate CVD risk and a leaflet containing a draft brief lifestyle advice intervention and considered their potential to increase motivation-to-change behaviours including diet, physical activity, and smoking in order to reduce CVD risk. Discussions were tape-recorded, transcribed and coded and recurring themes sought. Sixty-two percent of participants were male, mean age was 66 years (range = 47-76 years) and median age at leaving full-time education was 18 years (range = 15-40 years). Sixteen had type 2 diabetes and none had a prior history of CVD. Recurring themes from focus group discussions included the following: being less numerate is common, CVD risk reduction is important and a clear visual representation aids comprehension. A simple animated interface of the UKPDS Risk Engine to illustrate CVD risk and the potential for reducing this risk has been developed for use as a motivational tool, along with a brief lifestyle advice intervention. Future work will investigate whether use of this interactive version of the UKPDS Risk Engine and brief lifestyle advice is associated with increased behavioural intentions and changes in health behaviours designed to reduce CVD risk.

Adverse pregnancy outcomes in deliveries prior to, at and beyond 39 weeks; low- and high-risk women.

Science.gov (United States)

Moussa, Hind N; Hosseini Nasab, Susan; Amro, Farah H; Hoayek, Jennifer; Haidar, Ziad A; Blackwell, Sean C; Sibai, Baha M

2017-07-18

Hypertensive disorders are associated with maternal and neonatal complications. Though they are more common in women with history of prior preeclampsia, they can occur in uncomplicated pregnancies. To determine the proportion of adverse pregnancy outcomes in deliveries prior to or at ≥39 weeks, in uncomplicated singleton nulliparous women (low-risk), as well as women with history of preeclampsia in a prior gestation (high-risk). This was a secondary analysis from the multicenter trials of low dose aspirin for preeclampsia prevention in low and high-risk pregnancies. The proportion of adverse pregnancy outcomes including hypertensive disorders in pregnancy, small for gestational age, placental abruption, neonatal intensive critical unit admission, and respiratory distress syndrome were evaluated in the two groups. Adverse pregnancy outcomes were stratified by gestational age at delivery (39 weeks and ≥39 weeks). Descriptive statistics were performed, and results reported as percentages. Three thousand twenty-one pregnancies were included in the low risk group, and 600 in the high risk one. In the low risk group 362 (12%) had hypertensive disorders, with 58% occurring at ≥39 weeks. In the low risk group, the rate of small for gestational age was of 5.9%, placental abruption 0.4%, neonatal intensive care unit admission 9%, and respiratory distress syndrome 3.5%. Sixty percent of all small for gestational age, 31% of all placenta abruptions, 44% of all neonatal intensive care unit admissions and 33% of respiratory distress syndrome cases, occurred at ≥39 weeks in the low risk group. In contrast in the high risk group, 197 (33%) patients developed a hypertensive disorder, with 35.5% occurring at ≥39 weeks. The overall rate of small for gestational age was 9.2%, abruption 2%, neonatal intensive care unit admission 15.5%, and respiratory distress syndrome 5%. In this group, 24% of all small for gestational age, 8.3% of all placental abruptions, 16% of all

[Risk groups in travel to tropical countries within the frame of mass tourism].

Science.gov (United States)

van der Linde, F; Steffen, R; Schwarzenbach, F H

1977-01-01

More than 10,000 tourists returning from tropical countries have been asked about health problems during their stay abroad. Preliminary results from the first 5,550 questionnaires indicate that 74,8% had complaints of any kind concerning their health and 13,6% can be considered as having been ill. The frequency of complaints and illness in relation to different variables is shown and the possibility of definition of high risk groups is being discussed.

Adding an alcohol-related risk score to an existing categorical risk classification for older adults: sensitivity to group differences.

Science.gov (United States)

Wilson, Sandra R; Fink, Arlene; Verghese, Shinu; Beck, John C; Nguyen, Khue; Lavori, Philip

2007-03-01

To evaluate a new alcohol-related risk score for research use. Using data from a previously reported trial of a screening and education system for older adults (Computerized Alcohol-Related Problems Survey), secondary analyses were conducted comparing the ability of two different measures of risk to detect post-intervention group differences: the original categorical outcome measure and a new, finely grained quantitative risk score based on the same research-based risk factors. Three primary care group practices in southern California. Six hundred sixty-five patients aged 65 and older. A previously calculated, three-level categorical classification of alcohol-related risk and a newly developed quantitative risk score. Mean post-intervention risk scores differed between the three experimental conditions: usual care, patient report, and combined report (Ptrinary risk classification. The additional clinical value of the risk score relative to the categorical measure needs to be determined.

Identifying functional network changing patterns in individuals at clinical high-risk for psychosis and patients with early illness schizophrenia: A group ICA study

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Yuhui Du

2018-01-01

Full Text Available Although individuals at clinical high risk (CHR for psychosis exhibit a psychosis-risk syndrome involving attenuated forms of the positive symptoms typical of schizophrenia (SZ, it remains unclear whether their resting-state brain intrinsic functional networks (INs show attenuated or qualitatively distinct patterns of functional dysconnectivity relative to SZ patients. Based on resting-state functional magnetic imaging data from 70 healthy controls (HCs, 53 CHR individuals (among which 41 subjects were antipsychotic medication-naive, and 58 early illness SZ (ESZ patients (among which 53 patients took antipsychotic medication within five years of illness onset, we estimated subject-specific INs using a novel group information guided independent component analysis (GIG-ICA and investigated group differences in INs. We found that when compared to HCs, both CHR and ESZ groups showed significant differences, primarily in default mode, salience, auditory-related, visuospatial, sensory-motor, and parietal INs. Our findings suggest that widespread INs were diversely impacted. More than 25% of voxels in the identified significant discriminative regions (obtained using all 19 possible changing patterns excepting the no-difference pattern from six of the 15 interrogated INs exhibited monotonically decreasing Z-scores (in INs from the HC to CHR to ESZ, and the related regions included the left lingual gyrus of two vision-related networks, the right postcentral cortex of the visuospatial network, the left thalamus region of the salience network, the left calcarine region of the fronto-occipital network and fronto-parieto-occipital network. Compared to HCs and CHR individuals, ESZ patients showed both increasing and decreasing connectivity, mainly hypo-connectivity involving 15% of the altered voxels from four INs. The left supplementary motor area from the sensory-motor network and the right inferior occipital gyrus in the vision-related network showed a

Risk perception in women with high-risk pregnancies

OpenAIRE

Lee, S.

2014-01-01

Risk perception in women with high risk pregnancies affects the decisions they make about antenatal care and so may therefore influence the wellbeing of mother and baby. This article addresses the factors which influence women when making risk assessments and how these assessments may differ from those of healthcare professionals.\\ud \\ud Women use multiple sources of information to determine their risk status including advice from professionals, from other trusted sources, and their own intui...

Occupational stress and cardiovascular risk factors in high-ranking government officials and office workers.

Science.gov (United States)

Mirmohammadi, Seyyed Jalil; Taheri, Mahmoud; Mehrparvar, Amir Houshang; Heydari, Mohammad; Saadati Kanafi, Ali; Mostaghaci, Mehrdad

2014-08-01

Cardiovascular diseases are among the most important sources of mortality and morbidity, and have a high disease burden. There are some major well-known risk factors, which contribute to the development of these diseases. Occupational stress is caused due to imbalance between job demands and individual's ability, and it has been implicated as an etiology for cardiovascular diseases. This study was conducted to evaluate the cardiovascular risk factors and different dimensions of occupational stress in high-ranking government officials, comparing an age and sex-matched group of office workers with them. We invited 90 high-ranking officials who managed the main governmental offices in a city, and 90 age and sex-matched office workers. The subjects were required to fill the occupational role questionnaire (Osipow) which evaluated their personal and medical history as well as occupational stress. Then, we performed physical examination and laboratory tests to check for cardiovascular risk factors. Finally, the frequency of cardiovascular risk factors and occupational stress of two groups were compared. High-ranking officials in our study had less work experience in their current jobs and smoked fewer pack-years of cigarette, but they had higher waist and hip circumference, higher triglyceride level, more stress from role overload and responsibility, and higher total stress score. Our group of office workers had more occupational stress because of role ambiguity and insufficiency, but their overall job stress was less than officials. The officials have higher scores in some dimensions of occupational stress and higher overall stress score. Some cardiovascular risk factors were also more frequent in managers.

Grouping and Read-Across Approaches for Risk Assessment of Nanomaterials.

Science.gov (United States)

Oomen, Agnes G; Bleeker, Eric A J; Bos, Peter M J; van Broekhuizen, Fleur; Gottardo, Stefania; Groenewold, Monique; Hristozov, Danail; Hund-Rinke, Kerstin; Irfan, Muhammad-Adeel; Marcomini, Antonio; Peijnenburg, Willie J G M; Rasmussen, Kirsten; Jiménez, Araceli Sánchez; Scott-Fordsmand, Janeck J; van Tongeren, Martie; Wiench, Karin; Wohlleben, Wendel; Landsiedel, Robert

2015-10-26

Physicochemical properties of chemicals affect their exposure, toxicokinetics/fate and hazard, and for nanomaterials, the variation of these properties results in a wide variety of materials with potentially different risks. To limit the amount of testing for risk assessment, the information gathering process for nanomaterials needs to be efficient. At the same time, sufficient information to assess the safety of human health and the environment should be available for each nanomaterial. Grouping and read-across approaches can be utilised to meet these goals. This article presents different possible applications of grouping and read-across for nanomaterials within the broader perspective of the MARINA Risk Assessment Strategy (RAS), as developed in the EU FP7 project MARINA. Firstly, nanomaterials can be grouped based on limited variation in physicochemical properties to subsequently design an efficient testing strategy that covers the entire group. Secondly, knowledge about exposure, toxicokinetics/fate or hazard, for example via properties such as dissolution rate, aspect ratio, chemical (non-)activity, can be used to organise similar materials in generic groups to frame issues that need further attention, or potentially to read-across. Thirdly, when data related to specific endpoints is required, read-across can be considered, using data from a source material for the target nanomaterial. Read-across could be based on a scientifically sound justification that exposure, distribution to the target (fate/toxicokinetics) and hazard of the target material are similar to, or less than, the source material. These grouping and read-across approaches pave the way for better use of available information on nanomaterials and are flexible enough to allow future adaptations related to scientific developments.

Grouping and Read-Across Approaches for Risk Assessment of Nanomaterials

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Agnes G. Oomen

2015-10-01

Full Text Available Physicochemical properties of chemicals affect their exposure, toxicokinetics/fate and hazard, and for nanomaterials, the variation of these properties results in a wide variety of materials with potentially different risks. To limit the amount of testing for risk assessment, the information gathering process for nanomaterials needs to be efficient. At the same time, sufficient information to assess the safety of human health and the environment should be available for each nanomaterial. Grouping and read-across approaches can be utilised to meet these goals. This article presents different possible applications of grouping and read-across for nanomaterials within the broader perspective of the MARINA Risk Assessment Strategy (RAS, as developed in the EU FP7 project MARINA. Firstly, nanomaterials can be grouped based on limited variation in physicochemical properties to subsequently design an efficient testing strategy that covers the entire group. Secondly, knowledge about exposure, toxicokinetics/fate or hazard, for example via properties such as dissolution rate, aspect ratio, chemical (non-activity, can be used to organise similar materials in generic groups to frame issues that need further attention, or potentially to read-across. Thirdly, when data related to specific endpoints is required, read-across can be considered, using data from a source material for the target nanomaterial. Read-across could be based on a scientifically sound justification that exposure, distribution to the target (fate/toxicokinetics and hazard of the target material are similar to, or less than, the source material. These grouping and read-across approaches pave the way for better use of available information on nanomaterials and are flexible enough to allow future adaptations related to scientific developments.

Neoadjuvant/adjuvant treatment of high-risk retinoblastoma: a report from the German Retinoblastoma Referral Centre.

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Künkele, Annette; Wilm, Josephine; Holdt, Markus; Lohmann, Dietmar; Bornfeld, Norbert; Eggert, Angelika; Temming, Petra; Schulte, Johannes H

2015-07-01

Retinoblastoma can extend beyond the structures of the eye, where cells can enter the bloodstream and cause metastases. Various types of protocols for adjuvant treatment risk-adapted according to histopathological risk factors are used worldwide. Between 1997 and 2009, 420 children were diagnosed with retinoblastoma at the German Retinoblastoma Referral Centre and risk factors were assessed. Patients with post-laminar optic nerve infiltration or choroid or minor scleral invasion received six courses of adjuvant chemotherapy using vincristine, etoposide, carboplatin and cyclophosphamide (group 1). Patients with microscopic extension beyond the sclera to the resection margin of the optic nerve or potential spread due to vitrectomy received chemotherapy plus orbital radiotherapy (group 2). Neoadjuvant chemotherapy was performed in patients with local extraocular invasion detected on MRI. Following this protocol, 42 of the 420 patients and 21 referred from other centres showed high-risk histopathological factors qualifying for adjuvant therapy (57 in group 1 and 6 in group 2). Seven of the 63 patients received neoadjuvant and adjuvant treatment. During a mean follow-up of 5.8 (range 0.4-15.4) years, one of six patients in group 2 developed metastases and died. No patients died from toxicity. The 5-year overall survival was 100% for group 1 and 80% for group 2. This retrospective single-site study reveals a 10% incidence of high-risk features in children with retinoblastoma diagnosed at the German Retinoblastoma Referral Centre. Overall survival rates of 98.3% underline the safety of this adjuvant chemotherapy protocol and its efficiency in preventing metastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Liberal or restrictive transfusion in high-risk patients after hip surgery.

Science.gov (United States)

Carson, Jeffrey L; Terrin, Michael L; Noveck, Helaine; Sanders, David W; Chaitman, Bernard R; Rhoads, George G; Nemo, George; Dragert, Karen; Beaupre, Lauren; Hildebrand, Kevin; Macaulay, William; Lewis, Courtland; Cook, Donald Richard; Dobbin, Gwendolyn; Zakriya, Khwaja J; Apple, Fred S; Horney, Rebecca A; Magaziner, Jay

2011-12-29

The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture. We enrolled 2016 patients who were 50 years of age or older, who had either a history of or risk factors for cardiovascular disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. We randomly assigned patients to a liberal transfusion strategy (a hemoglobin threshold of 10 g per deciliter) or a restrictive transfusion strategy (symptoms of anemia or at physician discretion for a hemoglobin level of strategy group and none in the restrictive-strategy group. The rates of the primary outcome were 35.2% in the liberal-strategy group and 34.7% in the restrictive-strategy group (odds ratio in the liberal-strategy group, 1.01; 95% confidence interval [CI], 0.84 to 1.22), for an absolute risk difference of 0.5 percentage points (95% CI, -3.7 to 4.7). The rates of in-hospital acute coronary syndrome or death were 4.3% and 5.2%, respectively (absolute risk difference, -0.9%; 99% CI, -3.3 to 1.6), and rates of death on 60-day follow-up were 7.6% and 6.6%, respectively (absolute risk difference, 1.0%; 99% CI, -1.9 to 4.0). The rates of other complications were similar in the two groups. A liberal transfusion strategy, as compared with a restrictive strategy, did not reduce rates of death or inability to walk independently on 60-day follow-up or reduce in-hospital morbidity in elderly patients at high cardiovascular risk. (Funded by the National Heart, Lung, and Blood Institute; FOCUS ClinicalTrials.gov number, NCT00071032.).

INTERFERON IN THE TREATMENT OF WOMEN INFECTED WITH HIGH-RISK HUMAN PAPILLOMAVIRUS

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Кристина Владимировна Марочко

2017-02-01

Full Text Available Human papillomavirus (HPV is the most common sexually transmitted infection worldwide. About 99 % of cervical cancer is caused by persistent infection with high-risk types of HPV. It can take over 10 years from the time of an initial human papillomavirus infection until a cervical cancer. In most cases, HPV infections are transient and go away within 1 year. There is evidence that cell mediated immune responses of the host, both systemic and local, are important determinants of the course of infection, thus, it is reasonable to use immunocorrective therapy. Many studies have demonstrated the effectiveness of interferon alpha in complex therapy of HPV infection. The aim – to determine the efficacy of interferon alpha-2b in reducing the viral load of high-risk HPV among infected women of reproductive age. Materials and methods. 60 high-risk HPV positive women were included in the study. Qualitative and quantitative determination of high-risk HPV (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 was carried out by PCR in real time. Patients were randomized into two groups: group 1 (n = 30 received alfa-interferon in the form of rectal suppositories; group 2 (n = 30 did not receive the drug. Control study was conducted 1 month later. The average age in group 1 was 31,7 ± 1,6 years, in group 2 – 35,0 ± 1,6 years (p = 0,08. In group 1 monoinfection diagnosed in 72,4 % of cases, mixed infection in 27,6 % of cases in group 2 – at 64,3 % and 35,7 %, respectively. Results. The average viral load was 3,5 ± 0,2 Lg (HPV on 105 cells in group 1 and 3,4 ± 0,3 in group 2 (p = 0,473. Сlinically significant viral load dominated in group 1 (41,4 %, insignificant viral load was dominated in group 2 (42,9 %. After 1 month the average viral load was 1,9 ± 0,3 Lg (HPV on 105 cells in group 1 and 2,8 ± 0,4 Lg in group 2 (р = 0,04. There were statistically significant difference in both groups before and after 1 month (p < 0

Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies.

Science.gov (United States)

Schwingshackl, Lukas; Hoffmann, Georg; Lampousi, Anna-Maria; Knüppel, Sven; Iqbal, Khalid; Schwedhelm, Carolina; Bechthold, Angela; Schlesinger, Sabrina; Boeing, Heiner

2017-05-01

The aim of this systematic review and meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups and risk of type 2 diabetes (T2D). We conducted a systematic search in PubMed, Embase, Medline (Ovid), Cochrane Central, and Google Scholar for prospective studies investigating the association between whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages (SSB) on risk of T2D. Summary relative risks were estimated using a random effects model by contrasting categories, and for linear and non-linear dose-response relationships. Six out of the 12 food-groups showed a significant relation with risk of T2D, three of them a decrease of risk with increasing consumption (whole grains, fruits, and dairy), and three an increase of risk with increasing consumption (red meat, processed meat, and SSB) in the linear dose-response meta-analysis. There was evidence of a non-linear relationship between fruits, vegetables, processed meat, whole grains, and SSB and T2D risk. Optimal consumption of risk-decreasing foods resulted in a 42% reduction, and consumption of risk-increasing foods was associated with a threefold T2D risk, compared to non-consumption. The meta-evidence was graded "low" for legumes and nuts; "moderate" for refined grains, vegetables, fruit, eggs, dairy, and fish; and "high" for processed meat, red meat, whole grains, and SSB. Among the investigated food groups, selecting specific optimal intakes can lead to a considerable change in risk of T2D.

Citizen involvement in flood risk governance: flood groups and networks

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Twigger-Ross Clare

2016-01-01

Full Text Available Over the past decade has been a policy shift withinUK flood risk management towards localism with an emphasis on communities taking ownership of flood risk. There is also an increased focus on resilience and, more specifically, on community resilience to flooding. This paper draws on research carried out for UK Department for Environment Food and Rural Affairs to evaluate the Flood Resilience Community Pathfinder (FRCP scheme in England. Resilience is conceptualised as multidimensional and linked to exisiting capacities within a community. Creating resilience to flooding is an ongoing process of adaptation, learning from past events and preparing for future risks. This paper focusses on the development of formal and informal institutions to support improved flood risk management: institutional resilience capacity. It includes new institutions: e.g. flood groups, as well as activities that help to build inter- and intra- institutional resilience capacity e.g. community flood planning. The pathfinder scheme consisted of 13 projects across England led by local authorities aimed at developing community resilience to flood risk between 2013 – 2015. This paper discusses the nature and structure of flood groups, the process of their development, and the extent of their linkages with formal institutions, drawing out the barriers and facilitators to developing institutional resilience at the local level.

Identification and management of cardiometabolic risk in Canada: a position paper by the cardiometabolic risk working group (executive summary).

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Leiter, Lawrence A; Fitchett, David H; Gilbert, Richard E; Gupta, Milan; Mancini, G B John; McFarlane, Philip A; Ross, Robert; Teoh, Hwee; Verma, Subodh; Anand, Sonia; Camelon, Kathryn; Chow, Chi-Ming; Cox, Jafna L; Després, Jean-Pierre; Genest, Jacques; Harris, Stewart B; Lau, David C W; Lewanczuk, Richard; Liu, Peter P; Lonn, Eva M; McPherson, Ruth; Poirier, Paul; Qaadri, Shafiq; Rabasa-Lhoret, Rémi; Rabkin, Simon W; Sharma, Arya M; Steele, Andrew W; Stone, James A; Tardif, Jean-Claude; Tobe, Sheldon; Ur, Ehud

2011-01-01

With the objectives of clarifying the concepts related to "cardiometabolic risk," "metabolic syndrome" and "risk stratification" and presenting practical strategies to identify and reduce cardiovascular risk in multiethnic patient populations, the Cardiometabolic Working Group presents an executive summary of a detailed analysis and position paper that offers a comprehensive and consolidated approach to the identification and management of cardiometabolic risk. The above concepts overlap and relate to the atherogenic process and development of type 2 diabetes. However, there is confusion about what these terms mean and how they can best be used to improve our understanding of cardiovascular disease treatment and prevention. The concepts related to cardiometabolic risk, pathophysiology, and strategies for identification and management (including health behaviours, pharmacotherapy, and surgery) in the multiethnic Canadian population are presented. "Global cardiometabolic risk" is proposed as an umbrella term for a comprehensive list of existing and emerging factors that predict cardiovascular disease and/or type 2 diabetes. Health behaviour interventions (weight loss, physical activity, diet, smoking cessation) in people identified at high cardiometabolic risk are of critical importance given the emerging crisis of obesity and the consequent epidemic of type 2 diabetes. Vascular protective measures (health behaviours for all patients and pharmacotherapy in appropriate patients) are essential to reduce cardiometabolic risk, and there is growing consensus that a multidisciplinary approach is needed to adequately address cardiometabolic risk factors. Health care professionals must also consider ethnicity-related risk factors in order to appropriately evaluate all individuals in their diverse patient populations. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Coronary heart disease risk assessment and characterization of coronary artery disease using coronary CT angiography: comparison of asymptomatic and symptomatic groups

International Nuclear Information System (INIS)

Hwang, Y.; Kim, Y.; Chung, I.-M.; Ryu, J.; Park, H.

2010-01-01

Aim: To evaluate the prevalence of coronary artery disease (CAD) in relation to risk of coronary heart disease (CHD) and assess plaque characteristics from coronary computed tomography (CT) angiography in asymptomatic and symptomatic patients. Materials and methods: Three hundred and ninety consecutive patients [asymptomatic group, n = 138; symptomatic group (atypical or non-anginal chest pain), n = 252] were retrospectively enrolled. They were subsequently classified into three CHD risk categories, based on the National Cholesterol Education Program guidelines, and 10 year risks of coronary events were calculated using Framingham risk score. CT was evaluated for stenosis, plaque composition, and coronary calcium scores. Results: CAD was observed in 42% of the asymptomatic group and 62% of the symptomatic group. In the former, the prevalence of CAD in low-, moderate- and high-risk subgroups was 21.4, 47.4 and 65%, respectively, and was 33.3, 74.4, and 72.4% in the symptomatic group. Framingham 10-year risks of coronary events were significantly higher in patients with CAD than in normal participants, and receiver operating characteristics curves showed that discriminatory power was poor in the asymptomatic group and symptomatic men, and good in symptomatic women. Of the participants in the asymptomatic group, 12% exhibited only non-calcified plaques and of the symptomatic group, 7% exhibited only non-calcified plaques. The coronary calcium score was significantly higher for significant stenosis than for non-significant stenosis in both groups. Conclusions: The prevalence of CAD was not negligible even in subgroups with low-to-moderate CHD risk. Additionally, the Framingham risk score was effective for predicting CAD only in symptomatic women. Coronary calcium scores correlated with significant stenosis; however, a sizeable percentage of both groups had only non-calcified plaques.

Prescription of the High Risk Narcotics and Trading or Illicit Purchasing of High Risk Narcotics

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Nicoleta-Elena Buzatu

2012-05-01

Full Text Available The present essay will analyze the offence of prescribing high risk narcotics and trading or illicit purchasing of high risk narcotics, as it was regulated - together with other offences - by Law no 143 of July 26, 2000 on preventing and fighting against the traffic and illicit consumption of narcotics. The same law defines the meaning of such a phrase “substances which are under national control” by mentioning the fact that they are the narcotics and their precursors listed in Annexes I-IV of the law. The analysis of the offence of prescribing the high risk narcotics and trading or illicit purchasing of high risk narcotics is following the already known structure mentioned in the doctrine and which consists of: object and subjects of the offence, its constituent content: the objective side with its material element, the immediate consequence and causality connections; the subjective side of the offence, as well as forms and modalities of these offences, and the applicable sanctions, of course.

Male sex workers: Are we ignoring a risk group in Mumbai, India?

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Shinde Santosh

2009-01-01

Full Text Available Background: Male sex workers (MSWs have recently been recognized as an important risk group for sexually transmitted infections (STIs including human immunodeficiency virus (HIV infection. Although there are global studies on MSWs, few such studies describe the behavioral patterns and STIs among this population in India. Methods: MSWs were evaluated at the Humsafar trust, a community based organization situated in suburban Mumbai, India. We report on the demographics, sexual behaviors, and STIs including HIV of these sex workers. Results: Of the 75 MSWs, 24 were men and 51 were transgenders. The mean age of the group was 23.3 (+ 4.9 years. About 15% were married or lived with a permanent partner. Of these individuals, 85% reported sex work as a main source of income and 15% as an additional source. All the individuals reported anal sex (87% anal receptive sex and 13% anal insertive sex. About 13% of MSWs had never used a condom. The HIV prevalence was 33% (17% in men vs 41% in transgenders, P = 0.04. The STI prevalence was 60% (58% in men vs 61% in transgenders, P = 0.8. Syphilis was the most common STI (28% in these MSWs. HIV was associated with being a transgender (41 vs 17%, P = 0.04, age > 26 years (57 vs 28%, P = 0.04, more than one year of sex work (38 vs 8%, P = 0.05, and income < Rs. 2000 per month (62 vs 27%, P = 0.02. Conclusions: The MSWs have high-risk behaviors, low consistent condom use, and high STI/HIV infections. These groups should be the focus of intensive public health interventions aimed at reduction of risky sexual practices, and STI/HIV prevention and care.

Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile.

Science.gov (United States)

Mangen, M-J J; Stibbe, H; Urbanus, A; Siedenburg, E C; Waldhober, Q; de Wit, G A; van Steenbergen, J E

2017-05-31

The aim of this study was to evaluate the cost-effectiveness of the on-going decentralised targeted hepatitis B vaccination program for behavioural high-risk groups operated by regional public health services in the Netherlands since 1-November-2002. Target groups for free vaccination are men having sex with men (MSM), commercial sex workers (CSW) and hard drug users (HDU). Heterosexuals with a high partner change rate (HRP) were included until 1-November-2007. Based on participant, vaccination and serology data collected up to 31-December-2012, the number of participants and program costs were estimated. Observed anti-HBc prevalence was used to estimate the probability of susceptible individuals per risk-group to become infected with hepatitis B virus (HBV) in their remaining life. We distinguished two time-periods: 2002-2006 and 2007-2012, representing different recruitment strategies and target groups. Correcting for observed vaccination compliance, the number of future HBV-infections avoided was estimated per risk-group. By combining these numbers with estimates of life-years lost, quality-of-life losses and healthcare costs of HBV-infections - as obtained from a Markov model-, the benefit of the program was estimated for each risk-group separately. The overall incremental cost-effectiveness ratio of the program was €30,400/QALY gained, with effects and costs discounted at 1.5% and 4%, respectively. The program was more cost-effective in the first period (€24,200/QALY) than in the second period (€42,400/QALY). In particular, the cost-effectiveness for MSM decreased from €20,700/QALY to €47,700/QALY. This decentralised targeted HBV-vaccination program is a cost-effective intervention in certain unvaccinated high-risk adults. Saturation within the risk-groups, participation of individuals with less risky behaviour, and increased recruitment investments in the second period made the program less cost-effective over time. The project should therefore

The experience of fear in high-risk sport | Miesel | South African ...

African Journals Online (AJOL)

An additional quantitative measure, Zuckerman's Sensation Seeking Scale, was used to complement the interview findings. The results were presented in the delineation of 26 meaning cluster groups and seven themes. High-risk sport participants indicated frequent experiences with "peak" and "ultimate" athletic moments ...

Prognostic Value of Stress Echocardiography in Patients With Low-Intermediate or High Short-Term (10 Years) Versus Low (Risk of Cardiovascular Disease According to the American College of Cardiology/American Heart Association 2013 Cardiovascular Risk Calculator.

Science.gov (United States)

Yao, Siu-Sun; Supariwala, Azhar; Yao, Amanda; Dukkipati, Sai Sreenija; Wyne, Jamshad; Chaudhry, Farooq A

2015-09-01

This study evaluates the prognostic value of stress echocardiography (Secho) in short-term (10 years) and lifetime atherosclerotic cardiovascular disease risk-defined groups according to the American College of Cardiology/American Heart Association 2013 cardiovascular risk calculator. The ideal risk assessment and management of patients with low-to-intermediate or high short-term versus low (risk is unclear. The purpose of this study was to evaluate the prognostic value of Secho in short-term and lifetime CV risk-defined groups. We evaluated 4,566 patients (60 ± 13 years; 46% men) who underwent Secho (41% treadmill and 59% dobutamine) with low-intermediate short-term (risk divided into low (risk and third group with high short-term risk (≥20%, n = 3,537). Follow-up (3.2 ± 1.5 years) for nonfatal myocardial infarction (n = 102) and cardiac death (n = 140) were obtained. By univariate analysis, age (p risk and also in those with high short-term CV risk group (3.5% vs 1.0% per year, p risk assessment in patients with low-intermediate or high short-term versus low or high lifetime cardiovascular risk. Event rate with normal Secho is low (≤1% per year) but higher in patients with high short-term CV risk by the American College of Cardiology/American Heart Association 2013 cardiovascular risk calculator. Copyright © 2015 Elsevier Inc. All rights reserved.

Rapid COJEC versus standard induction therapies for high-risk neuroblastoma.

Science.gov (United States)

Peinemann, Frank; Tushabe, Doreen A; van Dalen, Elvira C; Berthold, Frank

2015-05-19

Neuroblastoma is a rare malignant disease and mainly affects infants and very young children. The tumors mainly develop in the adrenal medullary tissue and an abdominal mass is the most common presentation. The high-risk group is characterized by metastasis and other characteristics that increase the risk for an adverse outcome. In the rapid COJEC induction schedule, higher single doses of selected drugs than standard induction schedules are administered over a substantially shorter treatment period, with shorter intervals between cycles. Shorter intervals and higher doses increase the dose intensity of chemotherapy and might improve survival. The aim of this study was to evaluate the efficacy and adverse events of the rapid COJEC induction schedule as compared to standard induction schedules in patients with high-risk neuroblastoma (as defined by the International Neuroblastoma Risk Group (INRG) classification system). Outcomes of interest were complete response, early toxicity and treatment-related mortality as primary endpoints and overall survival, progression- and event-free survival, late non-hematological toxicity, and health-related quality of life as secondary endpoints. We searched the electronic databases CENTRAL (2014, Issue 11), MEDLINE (PubMed), and EMBASE (Ovid) for articles from inception to 11 November 2014. Further searches included trial registries, conference proceedings, and reference lists of recent reviews and relevant articles. We did not apply limits on publication year or languages. Randomized controlled trials evaluating the rapid COJEC induction schedule for high-risk neuroblastoma patients compared to standard induction schedules. Two review authors performed study selection, abstracted data on study and patient characteristics, and assessed risk of bias independently. We resolved differences by discussion or by appeal to a third review author. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic

Radical prostatectomy for high-risk prostate cancer.

Science.gov (United States)

Yossepowitch, Ofer; Eastham, James A

2008-06-01

Consensus recommendations for the identification and treatment of men whose apparent organ confined prostate cancer has high risk features are lacking. Despite ongoing refinements in surgical technique and improvements in morbidity and functional outcomes, the tradition of steering high-risk patients away from radical prostatectomy (RP) remains steadfast. We performed a medical literature search in English using MEDLINE/PubMed that addressed high risk prostate cancer. We analyzed the literature with respect to the historical evolution of this concept, current risk stratification schemes and treatment guidelines and related short and long term outcomes following RP. Contemporary evidence suggest that patients classified with high-risk prostate cancer by commonly used definitions do not have a uniformly poor prognosis after RP. Many cancers categorized clinically as high risk are actually pathologically confined to the prostate, and most men with such cancers who undergo RP are alive and free of additional therapy long after surgery. RP in the high-risk setting appears to be associated with a similar morbidity as in lower-risk patients. Men with clinically localized high-risk prostate cancer should not be categorically disqualified from local definitive therapy with RP. With careful attention to surgical technique, cancer control rates should improve further, and adverse effects on quality of life after RP should continue to decrease.

Combining social and genetic networks to study HIV transmission in mixing risk groups

NARCIS (Netherlands)

Zarrabi, N.; Prosperi, M.C.F.; Belleman, R.G.; Di Giambenedetto, S.; Fabbiani, M.; De Luca, A.; Sloot, P.M.A.

2013-01-01

Reconstruction of HIV transmission networks is important for understanding and preventing the spread of the virus and drug resistant variants. Mixing risk groups is important in network analysis of HIV in order to assess the role of transmission between risk groups in the HIV epidemic. Most of the

The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

Science.gov (United States)

Antioch, Kathryn M; Walsh, Michael K

2004-06-01

Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

fMRI study of language activation in schizophrenia, schizoaffective disorder and in individuals genetically at high risk.

Science.gov (United States)

Li, Xiaobo; Branch, Craig A; Ardekani, Babak A; Bertisch, Hilary; Hicks, Chindo; DeLisi, Lynn E

2007-11-01

Structural and functional abnormalities have been found in language-related brain regions in patients with schizophrenia. We previously reported findings pointing to differences in word processing between people with schizophrenia and individuals who are at high-risk for schizophrenia using a voxel-based (whole brain) fMRI approach. We now extend this finding to specifically examine functional activity in three language related cortical regions using a larger cohort of individuals. A visual lexical discrimination task was performed by 36 controls, 21 subjects at high genetic-risk for schizophrenia, and 20 patients with schizophrenia during blood oxygenation level dependent (BOLD) fMRI scanning. Activation in bilateral inferior frontal gyri (Brodmann's area 44-45), bilateral inferior parietal lobe (Brodmann's area 39-40), and bilateral superior temporal gyri (Brodmann's area 22) was investigated. For all subjects, two-tailed Pearson correlations were calculated between the computed laterality index and a series of cognitive test scores determining language functioning. Regional activation in Brodmann's area 44-45 was left lateralized in normal controls, while high-risk subjects and patients with schizophrenia or schizoaffective disorder showed more bilateral activation. No significant differences among the three diagnostic groups in the other two regions of interest (Brodmann's area 22 or areas 39-40) were found. Furthermore, the apparent reasons for loss of leftward language lateralization differed between groups. In high-risk subjects, the loss of lateralization was based on reduced left hemisphere activation, while in the patient group, it was due to increased right side activation. Language ability related cognitive scores were positively correlations with the laterality indices obtained from Brodmann's areas 44-45 in the high-risk group, and with the laterality indices from Brodmann's areas 22 and 44-45 in the patient group. This study reinforces previous

Reduction of Risk Factors in Patients with Behavioral Dysphonia After Vocal Group Therapy.

Science.gov (United States)

Silva, Wégina Jordâna Nascimento da; Lopes, Leonardo Wanderley; Macedo, Anny Elizabety Ramalho de; Costa, Denise Batista da; Almeida, Anna Alice Figueiredo de

2017-01-01

The origin and development of dysphonia, particularly behavioral dysphonia, is associated with several risk factors. Here, we verified the effectiveness of group therapy in reducing the risk factors, and established the association between risk factors and sex, age, profession, and diagnosis of laryngeal disorders in patients with behavioral dysphonia. This is a descriptive, quantitative, field intervention study. Participants (n = 26, adult patients of both sexes), with a diagnosis of behavioral dysphonia, received group therapy intervention. Data for risk factors were collected pre- and posttherapy using the Vocal Screening Protocol. The data were analyzed using descriptive and inferential statistics (Student t test, chi-squared test or Spearman correlation test). The majority (80.8%, n = 21) of patients were female, 65.4% (n = 17) were not in a vocal profession, and 42.3% (n = 11) presented with a lesion in the membranous portion of the vocal fold. The number of personal risk factors decreased after group therapy (P = 0.04). In addition, age was correlated with total (P = 0.001), environmental (P = 0.002), and personal (P = 0.003) vocal risk factors posttherapy. This study revealed an association between the reduction of personal risk factors and vocal group therapy, and a correlation between age and total, environmental, and personal vocal risk factors posttherapy. Thus, maintenance and origins of the behaviors that modify the behavioral aspects of the participants directly influence the production of individual vocal habits. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Sudden Cardiac arrest Risk profile in a group of amateur level ...

African Journals Online (AJOL)

... males and females in this group of university basketball players showed varying signs of SCA risk, with the overall risk being reasonably low, albeit abnormalities were highlighted in some and Marfanoid characteristics were clearly evident in others. Key words: Sudden cardiac arrest; Basketball players, Marfan syndrome; ...

Prophylactic ketoconazole shampoo for tinea capitis in a high-risk pediatric population.

Science.gov (United States)

Bookstaver, P Brandon; Watson, Holly J; Winters, Shauna D; Carlson, Adrian L; Schulz, Richard M

2011-07-01

Although topical agents for the treatment of tinea capitis decrease viable fungal elements and reduce shedding, their use as a prophylactic agent has not been investigated. This study evaluated the effectiveness of a prophylactic ketoconazole shampoo (Nizoral 2%) protocol to reduce the number of clinically evident tinea capitis infections in a high-risk African American, urban population. We conducted a retrospective analysis of a ketoconazole prophylaxis protocol that was implemented at an urban pediatric clinic for medically fragile children. Patients at high risk for tinea capitis received twice-weekly ketoconazole shampoo. The primary outcome of the study was a reduction in the number of documented tinea capitis infections between the 12-month preprotocol and 12-month postprotocol periods. A secondary outcome included the evaluation of predisposing risk factors for acquiring tinea infections. Ninety-seven patients, with a mean age of 8.06 years, were included. Most patients (78%) were African American. There were a total of 13 tinea capitis infections during the 12-month preprotocol period. During the 12-month postprotocol period, 41 infections were documented: 37 (90.2%) in the prophylaxis group and 4 (9.8%) in the nonprophylaxis group. The average numbers of per-patient infections in the postprotocol period were 0.79 and 0.08 in the prophylaxis and nonprophylaxis groups, respectively. Initiation of prophylaxis did not reduce tinea capitis infections (p=NS). Previous history of infection and a high level of care were significant predictors of infections (pshampoo) prophylaxis protocol.

A Patient Risk Model of Chemotherapy-Induced Febrile Neutropenia: Lessons Learned From the ANC Study Group.

Science.gov (United States)

Lyman, Gary H; Poniewierski, Marek S

2017-12-01

Neutropenia and its complications, including febrile neutropenia (FN), represent major toxicities associated with cancer chemotherapy, resulting in considerable morbidity, mortality, and costs. The myeloid growth factors such as granulocyte colony-stimulating factor (G-CSF) have been shown to reduce the risk of neutropenia complications while enabling safe and effective chemotherapy dose intensity. Concerns about the high costs of these agents along with limited physician adherence to clinical practice guidelines, resulting in both overuse and underuse, has stimulated interest in models for individual patient risk assessment to guide appropriate use of G-CSF. In a model developed and validated by the ANC Study Group, half of patients were classified as high risk and half as low risk based on patient-, disease-, and treatment-related factors. This model has been further validated in an independent patient population. Physician-assessed risk of FN, as well as the decision to use prophylactic CSF, has been shown to correlate poorly with the FN risk estimated by the model. Additional modeling efforts in both adults and children receiving cancer treatment have been reported. Identification of patients at a high individual risk for FN and its consequences may offer the potential for optimal chemotherapy delivery and patient outcomes. Likewise, identification of patients at low risk for neutropenic events may reduce costs when such supportive care is not warranted. This article reviews and summarizes FN modeling studies and the opportunities for personalizing supportive care in patients receiving chemotherapy. Copyright © 2017 by the National Comprehensive Cancer Network.

Percutaneous nephrolithotripsy under assisted local anaesthesia for high risk patients: Is it effective?

Directory of Open Access Journals (Sweden)

T.KH. Fathelbab

2013-12-01

Conclusion: Our results demonstrated that PNL under local anesthesia with narcotics and sedatives seems to be a satisfying solution for the treatment of a selected group of patients with renal pelvic stones and who have high anesthetic risk. However, additional studies with different groups of patients are required to validate our results.

[Preventive efficacy of ondansetron and granisetron for postoperative nausea and vomiting in high risk patients].

Science.gov (United States)

Quan, Xiang; Zhu, Bo; Ye, Tie-hu

2011-08-01

To compare the efficacy of ondansetron and granisetron in the prevention of postoperative nausea and vomiting (PONV) in high-risk patients. Totally 200 patients with three key risk factors for PONV (female, non-smoking and postoperative opioid use) were equally randomized into ondansetron group and granisetron group. Ondansetron (4 mg) or granisetron (3 mg) was intravenously administered upon the completion of surgery. The episodes of nausea and vomiting were observed for 24 hours after surgery. A significantly greater proportion of patients in granisetron group achieved a complete response (i.e., no PONV or rescue medication) during the first 24 hours postoperatively versus those in ondansetron group (62.6% vs. 46.9%, respectively; P=0.048). There were no significant differences in terms of postoperative nausea incidences (42.9% vs. 34.3%, respectively), postoperative vomiting incidences (25.5% vs. 20.2%, respectively) and postoperative rescue anti-emetics incidences (19.4% vs. 15.2%, respectively) (P>0.05). Granisetron is more effective than ondansetron in preventing PONV in high-risk patients during the first 24 hours postoperatively.

Identifying Critical Nutrient Intake in Groups at Risk of Poverty in Europe: The CHANCE Project Approach

Science.gov (United States)

Nikolić, Marina; Glibetić, Maria; Gurinović, Mirjana; Milešević, Jelena; Khokhar, Santosh; Chillo, Stefania; Abaravicius, Jonas Algis; Bordoni, Alessandra; Capozzi, Francesco

2014-01-01

The aim of the CHANCE project is to develop novel and affordable nutritious foods to optimize the diet and reduce the risk of diet-related diseases among groups at risk of poverty (ROP). This paper describes the methodology used in the two initial steps to accomplish the project’s objective as follows: 1. a literature review of existing data and 2. an identification of ROP groups with which to design and perform the CHANCE nutritional survey, which will supply new data that is useful for formulating the new CHANCE food. Based on the literature review, a low intake of fruit and vegetables, whole grain products, fish, energy, fiber, vitamins B1, B2, B3, B6, B12 and C, folate, calcium, magnesium, iron, potassium and zinc and a high intake of starchy foods, processed meat and sodium were apparent. However, the available data appeared fragmented because of the different methodologies used in the studies. A more global vision of the main nutritional problems that are present among low-income people in Europe is needed, and the first step to achieve this goal is the use of common criteria to define the risk of poverty. The scoring system described here represents novel criteria for defining at-risk-of-poverty groups not only in the CHANCE-participating countries but also all over Europe. PMID:24699195

Identifying Critical Nutrient Intake in Groups at Risk of Poverty in Europe: The CHANCE Project Approach

Directory of Open Access Journals (Sweden)

Marina Nikolić

2014-04-01

Full Text Available The aim of the CHANCE project is to develop novel and affordable nutritious foods to optimize the diet and reduce the risk of diet-related diseases among groups at risk of poverty (ROP. This paper describes the methodology used in the two initial steps to accomplish the project’s objective as follows: 1. a literature review of existing data and 2. an identification of ROP groups with which to design and perform the CHANCE nutritional survey, which will supply new data that is useful for formulating the new CHANCE food. Based on the literature review, a low intake of fruit and vegetables, whole grain products, fish, energy, fiber, vitamins B1, B2, B3, B6, B12 and C, folate, calcium, magnesium, iron, potassium and zinc and a high intake of starchy foods, processed meat and sodium were apparent. However, the available data appeared fragmented because of the different methodologies used in the studies. A more global vision of the main nutritional problems that are present among low-income people in Europe is needed, and the first step to achieve this goal is the use of common criteria to define the risk of poverty. The scoring system described here represents novel criteria for defining at-risk-of-poverty groups not only in the CHANCE-participating countries but also all over Europe.

Identifying critical nutrient intake in groups at risk of poverty in Europe: the CHANCE project approach.

Science.gov (United States)

Nikolić, Marina; Glibetić, Maria; Gurinović, Mirjana; Milešević, Jelena; Khokhar, Santosh; Chillo, Stefania; Abaravicius, Jonas Algis; Bordoni, Alessandra; Capozzi, Francesco

2014-04-02

The aim of the CHANCE project is to develop novel and affordable nutritious foods to optimize the diet and reduce the risk of diet-related diseases among groups at risk of poverty (ROP). This paper describes the methodology used in the two initial steps to accomplish the project's objective as follows: 1. a literature review of existing data and 2. an identification of ROP groups with which to design and perform the CHANCE nutritional survey, which will supply new data that is useful for formulating the new CHANCE food. Based on the literature review, a low intake of fruit and vegetables, whole grain products, fish, energy, fiber, vitamins B1, B2, B3, B6, B12 and C, folate, calcium, magnesium, iron, potassium and zinc and a high intake of starchy foods, processed meat and sodium were apparent. However, the available data appeared fragmented because of the different methodologies used in the studies. A more global vision of the main nutritional problems that are present among low-income people in Europe is needed, and the first step to achieve this goal is the use of common criteria to define the risk of poverty. The scoring system described here represents novel criteria for defining at-risk-of-poverty groups not only in the CHANCE-participating countries but also all over Europe.

Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy

Directory of Open Access Journals (Sweden)

Célia Regina Farias de Araújo Lucena

2013-02-01

Full Text Available PURPOSE: To compare pain related to intravitreal injection and panretinal photocoagulation in the management of patients with high-risk proliferative diabetic retinopathy. METHODS: Prospective study including patients with high-risk proliferative diabetic retinopathy and no prior laser treatment randomly assigned to receive panretinal photocoagulation (PRP group or panretinal photocoagulation plus intravitreal ranibizumab (PRPplus group. In all patients, panretinal photocoagulation was administered in two sessions (weeks 0 and 2, and intravitreal ranibizumab was administered at the end of the first laser session in the PRPplus group. Retreatment was performed at weeks 16 and 32 if active new vessels were detected at fluorescein angiography. Patients in the PRPplus group received intravitreal ranibizumab and patients in the PRP group received 500-µm additional spots per quadrant of active new vessels. After the end of retreatment, a 100-degree Visual Analog Scale was used for pain score estimation. The patient was asked about the intensity of pain during the whole procedure (retinal photocoagulation session or intravitreal ranibizumab injection. Statistics for pain score comparison were performed using a non-parametric test (Wilcoxon rank sums. RESULTS: Seventeen patients from PRPplus and 14 from PRP group were evaluated for pain scores. There were no significant differences between both groups regarding gender, glycosylated hemoglobin and disease duration. Mean intravitreal injection pain (±SEM was 4.7 ± 2.1 and was significantly lower (p<0.0001 than mean panretinal photocoagulation pain (60.8 ± 7.8. Twelve out of 17 patients from the PRPplus group referred intensity pain score of zero, while the minimal score found in PRP group was found in one patient with 10.5. CONCLUSION: In patients with high-risk proliferative diabetic retinopathy who needed retreatment for persistent new vessels, there was more comfort for the patient when retreatment

Intake of predatory fish in Amazonia is a driver of toxicological risk for susceptible exposure groups

Directory of Open Access Journals (Sweden)

Hacon S.S.

2014-07-01

Full Text Available High fish intake has marked the scenario of riparian communities in Amazon basin during the last three decades. Although efforts have been done by some national and international scientific groups to control mercury exposure in Brazilian Amazon, the problem persists. The return of artisan gold mining, the new hydroelectric power plants (with its reservoirs and the expansion of the agribusiness are some of the economic activities that may contribute to the increment of mercury load in the Amazon ecosystem with direct influence in the food chain. These changes in Amazon scenario increase complexity of environmental issue and mercury may become a threat for susceptible exposure groups. This study evaluated mercury exposure scenarios for susceptible groups around the hydroelectric plant to calculate toxicological risk before damming. During the period of 2009 to 2011, about 771 children under 16 years age and 276 female in reproductive age (from 16 to 40 years old were assessed. Besides, regular fish samples (n=1580 were collected for total mercury determination. The mercury concentration in fish ranged from 0.01 to 6.06 mg/kg. For the current scenario the toxicological risk ranged from 3.5 to 24 for mercury for the susceptible groups. Regarding the critical scenario after 3 years flooding, the area is expected to double the risk for the same group, especially for the communities downstream, which may represent a critical situation.

Prevalence and risk factors of intestinal parasitism among two indigenous sub-ethnic groups in Peninsular Malaysia.

Science.gov (United States)

Chin, Yuee Teng; Lim, Yvonne Ai Lian; Chong, Chun Wie; Teh, Cindy Shuan Ju; Yap, Ivan Kok Seng; Lee, Soo Ching; Tee, Mian Zi; Siow, Vinnie Wei Yin; Chua, Kek Heng

2016-07-18

Intestinal parasitic infections (IPIs) among indigenous people have been widely documented in Malaysia, however, the prevalence of these infections remains high. In the past, most studies have focused on specific species of parasites but polyparasitism has received limited attention. In addition, epidemiology studies on indigenous people tend to consider them as a homogenous group, whereas in reality different sub-ethnic groups have different cultural and living practices. Variations in living habits such as personal hygiene practices may predispose different groups to different parasitic infections. To better understand prevalence and risk factors of intestinal parasitism among different sub-ethnic groups, the present study was conducted among two sub-ethnic groups of indigenous people (Temuan and Mah Meri) residing in Selangor state, Malaysia. A cross-sectional study that focused on two distinct sub-ethnic groups was carried out from February to September 2014. Faecal samples were collected from 186 participants and examined using the formalin-ether sedimentation technique. A molecular approach was adopted to conduct a genetic characterisation of the parasites. Additionally, questionnaires were administered to obtain information on the demographics, socio-economic backgrounds and behavioural risks relating to the participants, as well as information about their environments. Statistical analyses (i.e. binary and multivariate logistic regression analyses) were performed to measure risk factors. For Temuan communities, trichuriasis (64.2 %) was the most common infection found, preceding hookworm infection (34 %), ascariasis (7.5 %), giardiasis (14.2 %) and amoebiasis (7.5 %). As for the Mah Meri communities, trichuriasis (77.5 %) prevailed over ascariasis (21.3 %), hookworm (15 %), giardiasis (7.5 %) and amoebiasis (3.8 %). Significant differences in proportions of trichuriasis, ascariasis and hookworm infections were observed between the Temuan and Mah

Neoadjuvant chemotherapy in locally advanced nasopharyngeal carcinoma: Defining high-risk patients who may benefit before concurrent chemotherapy combined with intensity-modulated radiotherapy.

Science.gov (United States)

Du, Xiao-Jing; Tang, Ling-Long; Chen, Lei; Mao, Yan-Ping; Guo, Rui; Liu, Xu; Sun, Ying; Zeng, Mu-Sheng; Kang, Tie-Bang; Shao, Jian-Yong; Lin, Ai-Hua; Ma, Jun

2015-11-13

The purpose of this study was to create a prognostic model for distant metastasis in patients with locally advanced NPC who accept concurrent chemotherapy combined with intensity-modulated radiotherapy (CCRT) to identify high-risk patients who may benefit from neoadjuvant chemotherapy (NACT). A total of 881 patients with newly-diagnosed, non-disseminated, biopsy-proven locoregionally advanced NPC were retrospectively reviewed; 411 (46.7%) accepted CCRT and 470 (53.3%) accepted NACT followed by CCRT. Multivariate analysis demonstrated N2-3 disease, plasma Epstein-Barr virus (EBV) DNA > 4000 copies/mL, serum albumin ≤ 46 g/L and platelet count >300 k/cc were independent prognostic factors for distant metastasis in the CCRT group. Using these four factors, a prognostic model was developed, as follows: 1) low-risk group: 0-1 risk factors; and 2) high-risk group: 2-4 risk factors. In the high-risk group, patients who accepted NACT + CCRT had significantly higher distant metastasis-free survival and progression-free survival rates than the CCRT group (P = 0.001; P = 0.011). This simple prognostic model for distant metastasis in locoregionally advanced NPC may facilitate with the selection of high-risk patients who may benefit from NACT prior to CCRT.

"Where are all the lonely people?" A population-based study of high-risk groups across the life span

DEFF Research Database (Denmark)

Lasgaard, Mathias; Friis, Karina; Shevlin, Mark

2016-01-01

and socio-demographic and health-related factors across multiple age groups. Methods. This was a combined population-based questionnaire survey and register data study based on a representative sample, including 33,285 Danish individuals aged 16–102 years. Loneliness was measured using the Three......Item Loneliness Scale. Results. The relation between loneliness and age took a shallow U-shaped distribution. Ethnic minority status, receiving disability pensions or being unemployed, living alone, prolonged mental disorder, and psychiatric treatment were strongly associated with severe loneliness. Socio......-demographic and health-related factors were associated with an increased risk of severe loneliness in specific age groups. Being female, having a low educational level and living in a deprived area were only associated with loneliness in adolescence/emerging adulthood. Receiving disability pensions and living alone (i...

Retinol and α-Tocopherol in the Breast Milk of Women after a High-Risk Pregnancy.

Science.gov (United States)

Sámano, Reyna; Martínez-Rojano, Hugo; Hernández, Rosa M; Ramírez, Cristina; Flores Quijano, María E; Espíndola-Polis, José M; Veruete, Daniela

2017-01-01

There is scant information about whether, after a high-risk pregnancy, breast milk provides enough vitamins for assuring satisfactory bodily reserves in newborns. To comparatively evaluate, in women with high-risk and normal pregnancy, the concentration of retinol and α-tocopherol in breast milk. This cross-sectional, analytical study was evaluated with reverse-phase high-performance liquid chromatography (HPLC). Informed consent was signed by 95 mothers with a high-risk pregnancy and 32 mothers with a normal pregnancy. From the mothers with a high-risk pregnancy were obtained: 23 samples of colostrum, 24 of transitional milk, and 48 of mature milk. From the normal pregnancy group, 32 mature milk samples were collected. Pregestational Body Mass Index (BMI) and the gestational weight gain were noted. Models of logistic regression were constructed to identify the variables related to a low concentration of either retinol or α-tocopherol in breast milk. The concentration of retinol and α-tocopherol in mature milk was 60 (interquartile range (IQR), 41-90) and 276 (103-450) μg/dL, respectively, for the high-risk pregnancy group, and 76 (65-91) and 673 (454-866) µg/dL, respectively, for the normal pregnancy group ( p = 0.001). The concentration of retinol and α-tocopherol was similar in the subgroups of mothers with different disorders during gestation. A clear correlation was found between a greater pregestational weight and a lower concentration of retinol ( Rho = -0.280, p = 0.006), and between α-tocopherol and retinol in all cases ( Rho = 0.463, p = 0.001). Among women having a high-risk pregnancy, those delivering prematurely rather than carrying their pregnancy to term had a reduced concentration of retinol (54 (37-78) vs. 70 (49-106) µg/dL; p = 0.002) and a tendency to a lower concentration of α-tocopherol in breast milk (185 (75-410) vs. 339 (160-500) µg/dL; p = 0.053). Compared to mothers with a normal pregnancy, those with a high-risk pregnancy

Defining risk groups to yellow fever vaccine-associated viscerotropic disease in the absence of denominator data.

Science.gov (United States)

Seligman, Stephen J; Cohen, Joel E; Itan, Yuval; Casanova, Jean-Laurent; Pezzullo, John C

2014-02-01

Several risk groups are known for the rare but serious, frequently fatal, viscerotropic reactions following live yellow fever virus vaccine (YEL-AVD). Establishing additional risk groups is hampered by ignorance of the numbers of vaccinees in factor-specific risk groups thus preventing their use as denominators in odds ratios (ORs). Here, we use an equation to calculate ORs using the prevalence of the factor-specific risk group in the population who remain well. The 95% confidence limits and P values can also be calculated. Moreover, if the estimate of the prevalence is imprecise, discrimination analysis can indicate the prevalence at which the confidence interval results in an OR of ∼1 revealing if the prevalence might be higher without yielding a non-significant result. These methods confirm some potential risk groups for YEL-AVD and cast doubt on another. They should prove useful in situations in which factor-specific risk group denominator data are not available.

Lessons Learned From Implementation of Westinghouse Owners Group Risk-Informed Inservice Inspection Methodology for Piping

International Nuclear Information System (INIS)

Stevenson, Paul R.; Haessler, Richard L.; McNeill, Alex; Pyne, Mark A.; West, Raymond A.

2006-01-01

Risk-informed inservice inspection (ISI) programs have been in use for over seven years as an alternative to current regulatory requirements in the development and implementation of ISI programs for nuclear plant piping systems. Programs using the Westinghouse Owners Group (WOG) (now known as the Pressurized Water Reactor Owners Group - PWROG) risk-informed ISI methodology have been developed and implemented within the U.S. and several other countries. Additionally, many plants have conducted or are in the process of conducting updates to their risk-informed ISI programs. In the development and implementation of these risk-informed ISI programs and the associated updates to those programs, the following important lessons learned have been identified and are addressed. Concepts such as 'loss of inventory', which are typically not modeled in a plant's probabilistic risk assessment (PRA) model for all systems. The importance of considering operator actions in the identification of consequences associated with a piping failure and the categorization of segments as high safety significant (HSS) or low safety significant (LSS). The impact that the above considerations have had on the large early release frequency (LERF) and categorization of segments as HSS or LSS. The importance of automation. Making the update process more efficient to reduce costs associated with maintaining the risk-informed ISI program. The insights gained are associated with many of the steps in the risk-informed ISI process including: development of the consequences associated with piping failures, categorization of segments, structural element selection and program updates. Many of these lessons learned have impacted the results of the risk-informed ISI programs and have impacted the updates to those programs. This paper summarizes the lessons learned and insights gained from the application of the WOG risk-informed ISI methodology in the U.S., Europe and Asia. (authors)

Financial risk relationships and adoption of management strategies in physician groups for self-administered injectable drugs.

Science.gov (United States)

Agnew, Jonathan D; Stebbins, Marilyn R; Hickman, David E; Lipton, Helene Levins

2003-01-01

To consider the extent, nature, and range of risk arrangements between physician groups and health maintenance organizations (HMOs) for self-administered injectable (SAI) drugs; to examine types and frequencies of SAI drug-use management strategies adopted by physician groups; and to explore the relationship between locus and level of financial risk for SAIs and physician group strategy adoption. We used a multiple case-study design to select physician groups and their health maintenance organization (HMO) contractual partners in 4 markets in the United States (Northwest, Northeast, Midwest, Southwest). Physician groups in these markets were chosen based on size (e50 physicians) and experience with drug risk (e1 year). Physician groups were asked to identify their 3 major HMO contractual partners in each market. Telephone interviews were conducted from January 2000 to June 2001, with the resulting purposive sample of 37 individuals representing 20 physician groups. We found that the level and locus of SAI financial risk were related to the adoption of management strategies. Physician groups with higher financial risk for SAIs adopted more strategies than lower-risk groups. Groups with SAI financial risk in the medical services capitation (MSC) adopted 9.2 strategies per group. In contrast, groups with SAI financial risk in the pharmacy-risk budget (PRB) averaged 1.5 strategies per group. Groups with SAI financial risk in both the MSC and PRB fell in-between, averaging 4.5 strategies per group. The most frequently adopted strategy was designing evidenced-based therapeutic guidelines, i.e., protocols based on evidence from the peer-reviewed literature used to guide physicians in the treatment of typically chronic conditions (9 groups, 45% of sample). The second most common strategy involved adapting the existing utilization management system to process SAIs (7 groups, 35%) and the establishment of office procedures for internal authorization (5 groups, 25%). The

Utilization of 3-Month Yoga Program for Adults at High Risk for Type 2 Diabetes: A Pilot Study

Directory of Open Access Journals (Sweden)

Kyeongra Yang

2011-01-01

Full Text Available Various modes of physical activity, combined with dieting, have been widely recommended to prevent or delay type 2 diabetes. Among these, yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss, improving glucose levels and reducing blood pressure and lipid levels. This pilot study aimed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes. Twenty-three adults (19 Whites and 4 non-Whites were randomly assigned to the yoga intervention group or the educational group. The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational materials every 2 weeks. All participants completed questionnaires and had blood tests at baseline and at the end of 3 months. Effect sizes were reported to summarize the efficacy of the intervention. All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program (99.2%. Their yoga session attendance ranged from 58.3 to 100%. Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides and exercise self-efficacy indicated by small to large effect sizes. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group.

Can we avoid high levels of dose escalation for high-risk prostate cancer in the setting of androgen deprivation?

Directory of Open Access Journals (Sweden)

Shakespeare TP

2016-05-01

Full Text Available Thomas P Shakespeare,1,2 Shea W Wilcox,1 Noel J Aherne1,2 1Department of Radiation Oncology, North Coast Cancer Institute, 2Rural Clinical School, Faculty of Medicine, University of New South Wales, Coffs Harbour, NSW, Australia Aim: Both dose-escalated external beam radiotherapy (DE-EBRT and androgen deprivation therapy (ADT improve outcomes in patients with high-risk prostate cancer. However, there is little evidence specifically evaluating DE-EBRT for patients with high-risk prostate cancer receiving ADT, particularly for EBRT doses >74 Gy. We aimed to determine whether DE-EBRT >74 Gy improves outcomes for patients with high-risk prostate cancer receiving long-term ADT. Patients and methods: Patients with high-risk prostate cancer were treated on an institutional protocol prescribing 3–6 months neoadjuvant ADT and DE-EBRT, followed by 2 years of adjuvant ADT. Between 2006 and 2012, EBRT doses were escalated from 74 Gy to 76 Gy and then to 78 Gy. We interrogated our electronic medical record to identify these patients and analyzed our results by comparing dose levels. Results: In all, 479 patients were treated with a 68-month median follow-up. The 5-year biochemical disease-free survivals for the 74 Gy, 76 Gy, and 78 Gy groups were 87.8%, 86.9%, and 91.6%, respectively. The metastasis-free survivals were 95.5%, 94.5%, and 93.9%, respectively, and the prostate cancer-specific survivals were 100%, 94.4%, and 98.1%, respectively. Dose escalation had no impact on any outcome in either univariate or multivariate analysis. Conclusion: There was no benefit of DE-EBRT >74 Gy in our cohort of high-risk prostate patients treated with long-term ADT. As dose escalation has higher risks of radiotherapy-induced toxicity, it may be feasible to omit dose escalation beyond 74 Gy in this group of patients. Randomized studies evaluating dose escalation for high-risk patients receiving ADT should be considered. Keywords: radiotherapy, IMRT, dose

[A model list of high risk drugs].

Science.gov (United States)

Cotrina Luque, J; Guerrero Aznar, M D; Alvarez del Vayo Benito, C; Jimenez Mesa, E; Guzman Laura, K P; Fernández Fernández, L

2013-12-01

«High-risk drugs» are those that have a very high «risk» of causing death or serious injury if an error occurs during its use. The Institute for Safe Medication Practices (ISMP) has prepared a high-risk drugs list applicable to the general population (with no differences between the pediatric and adult population). Thus, there is a lack of information for the pediatric population. The main objective of this work is to develop a high-risk drug list adapted to the neonatal or pediatric population as a reference model for the pediatric hospital health workforce. We made a literature search in May 2012 to identify any published lists or references in relation to pediatric and/or neonatal high-risk drugs. A total of 15 studies were found, from which 9 were selected. A model list was developed mainly based on the ISMP one, adding strongly perceived pediatric risk drugs and removing those where the pediatric use was anecdotal. There is no published list that suits pediatric risk management. The list of pediatric and neonatal high-risk drugs presented here could be a «reference list of high-risk drugs » for pediatric hospitals. Using this list and training will help to prevent medication errors in each drug supply chain (prescribing, transcribing, dispensing and administration). Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

A metasynthesis of risk perception in women with high risk pregnancies

OpenAIRE

Lee, S.; Ayers, S.; Holden, D.

2014-01-01

Introduction: Risk perception in women with high risk pregnancies affects their decisions about perinatal care and is of interest to anyone involved in the care of pregnant women. This paper provides a metasynthesis of qualitative studies of risk perception in women with high risk pregnancies.\\ud \\ud Methods: A systematic search of eight electronic databases was conducted. Additional papers were obtained through searching references of identified articles. Six studies were identified that rep...

Improving STD testing behavior among high-risk young adults by offering STD testing at a vocational school

Directory of Open Access Journals (Sweden)

Hoebe Christian JPA

2011-09-01

Full Text Available Abstract Background Chlamydia trachomatis infection (CT is the most prevalent bacterial STD. Sexually active adolescents and young adults are the main risk group for CT. However, STD testing rates in this group are low since exposed individuals may not feel at risk, owing-at least in part-to the infection's largely asymptomatic nature. Designing new testing environments that are more appealing to young people who are most at risk of acquiring chlamydia can be an important strategy to improve overall testing rates. Here we evaluate the effect of a school-based sexual health program conducted among vocational school students, aiming to obtain better access for counseling and enhance students' STD testing behavior. Methods Adolescents (median age 19 years attending a large vocational school were provided with sexual health education. Students filled in a questionnaire measuring CT risk and were offered STD testing. Using univariate and multivariate analysis, we assessed differences between men and women in STD-related risk behavior, sexual problems, CT testing behavior and determinants of CT testing behavior. Results Of 345 participants, 70% were female. Of the 287 sexually active students, 75% were at high risk for CT; one third of women reported sexual problems. Of sexually active participants, 61% provided a self-administered specimen for STD testing. Independent determinants for testing included STD related symptoms and no condom use. All CT diagnoses were in the high-CT-risk group. In the high-risk group, STD testing showed an increased uptake, from 27% (previous self-reported test to 65% (current test. CT prevalence was 5.7%. Conclusions Vocational school students are a target population for versatile sexual health prevention. When provided with CT testing facilities and education, self selection mechanisms seemed to increase CT testing rate dramatically in this high-CT-risk population expressing sexual problems. Considering the relative ease

Preventing the link between SES and high-risk behaviors: "value-added" education, drug use and delinquency in high-risk, urban schools.

Science.gov (United States)

Tobler, Amy L; Komro, Kelli A; Dabroski, Alexis; Aveyard, Paul; Markham, Wolfgang A

2011-06-01

We examined whether schools achieving better than expected educational outcomes for their students influence the risk of drug use and delinquency among urban, racial/ethnic minority youth. Adolescents (n = 2,621), who were primarily African American and Hispanic and enrolled in Chicago public schools (n = 61), completed surveys in 6th (aged 12) and 8th (aged 14) grades. Value-added education was derived from standardized residuals of regression equations predicting school-level academic achievement and attendance from students' sociodemographic profiles and defined as having higher academic achievement and attendance than that expected given the sociodemographic profile of the schools' student composition. Multilevel logistic regression estimated the effects of value-added education on students' drug use and delinquency. After considering initial risk behavior, value-added education was associated with lower incidence of alcohol, cigarette and marijuana use; stealing; and participating in a group-against-group fight. Significant beneficial effects of value-added education remained for cigarette and marijuana use, stealing and participating in a group-against-group fight after adjustment for individual- and school-level covariates. Alcohol use (past month and heavy episodic) showed marginally significant trends in the hypothesized direction after these adjustments. Inner-city schools may break the links between social disadvantage, drug use and delinquency. Identifying the processes related to value-added education in order to improve school environments is warranted given the high costs associated with individual-level interventions.

Comparing the Central Eight Risk Factors: Do They Differ Across Age Groups of Sex Offenders?

Science.gov (United States)

Wilpert, Julia; van Horn, Joan E; Boonmann, Cyril

2018-02-01

Following the risk-need-responsivity (RNR) model, cognitive-behavioral therapy is considered most effective in reducing recidivism when based on dynamic risk factors. As studies have found differences of these factors across age, exploring this seems beneficial. The current study investigates the Central Eight (C8) risk factors across six age groups of outpatient sex offenders ( N = 650). Results showed that recidivism rates and age were inversely related from 19 years and up. Half of the C8 did not predict general recidivism at all, substance abuse, antisocial cognition, antisocial associates, and history of antisocial behavior in only one or several age groups. However, factors differed between age groups, with the youngest group demonstrating the most dysfunction in several areas and the oldest group the least. It is concluded that the C8 risk factors seem to lose significance in the older age groups. Results may benefit targeting treatment goals.

High intensity interior aircraft noise increases the risk of high diastolic blood pressure in Indonesian Air Force pilots

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Minarma Siagian

2009-12-01

Full Text Available Aim: To analyze the effects of aircraft noise, resting pulse rate, and other factors on the risk of high diastolic blood pressure (DBP in Indonesian Air Force pilots.Methods: A nested case-control study was conducted using data extracted from annual medical check-ups indoctrination aerophysiologic training records at the Saryanto Aviation and Aerospace Health Institute (LAKESPRA in Jakarta from January 2003 – September 2008. For analysis of DBP: the case group with DBP ≥ 90 mmHg were compared with contral group with DBP < 79 mmHG. One case matched to 12 controls.Results: Out of 567 pilots, 544 (95.9% had complete medical records. For this analysis there were 40 cases of high DBP and 480 controls for DBP. Pilots exposed to aircraft noise 90-95 dB rather than 70-80 dB had a 2.7-fold increase for high DBP [adjusted odds ratio (ORa = 2.70; 95% confi dence interval (CI = 1.05-6.97]. Pilots with resting pulse rates of ≥ 81/minute rather than ≤ 80/minute had a 2.7-fold increase for high DBP (ORa = 2.66; 95% CI = 1.26-5.61. In terms of total fl ight hours, pilots who had 1401-11125 hours rather than 147-1400 hours had a 3.2-fold increase for high DBP (ORa = 3.18; 95% CI = 1.01-10.03.Conclusion: High interior aircraft noise, high total flight hours,  and high resting pulse rate, increased risk for high DBP. Self assessment of resting pulse rate can be used to control the risk of high DBP. (Med J Indones 2009; 276: 276-82Keywords: diastolic blood pressure, aircraft noise, resting pulse rate, military pilots

Early amplitude‐integrated electroencephalography for monitoring neonates at high risk for brain injury

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Gabriel Fernando Todeschi Variane

2017-09-01

Conclusion: This study supports previous results and demonstrates the utility of amplitude‐integrated electroencephalography for monitoring brain function and predicting early outcome in the studied groups of infants at high risk for brain injury.

Does functional capacity, fall risk awareness and physical activity level predict falls in older adults in different age groups?

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Moreira, Natália Boneti; Rodacki, Andre Luiz Felix; Pereira, Gléber; Bento, Paulo Cesar Barauce

2018-04-11

The aims of this study were to examine whether: i) functional capacity and physical activity level differ between fallers and non-fallers older adults, by controlling for fall risk awareness; ii) functional capacity, fall risk awareness and physical activity differ between fallers and non-fallers older adults, by controlling for age; iii) variables and which may predict falls in different age groups. 1826 older adults performed a series of functional tests and reported their fall episodes, fall risk awareness and physical activity level. The overall incidence of falls was high (40.2%), and falls risk awareness scores reduced with age. The older adults with greater falls risk awareness and non-fallers presented better scores in all functional tests and physical activity level (P age groups and differed between fallers and non-fallers, irrespective of age group (P age groups (odds ranging: 1.05-1.09). Handgrip strength and balance scores predicted falls until 79 years (OR = 1.04, 95%CI = 1.01-1.06). The physical activity level predicted falls up to 70 years (OR = 1.09, 95%CI = 1.06-1.12). Functional mobility was able to predict falls up to 80 years (OR = 1.06, 95%CI = 1.01-1.08). Therefore, according to age, functional capacity, physical activity level and falls risk awareness can be a predictor of falls in older adults. Copyright © 2018 Elsevier B.V. All rights reserved.

Cost-effectiveness of surveillance programs for families at high and moderate risk of hereditary non-polyposis colorectal cancer

DEFF Research Database (Denmark)

Olsen, Kim R.; Bojesen, Stig E.; Gerdes, Anne-Marie M.

2007-01-01

for the group at high risk. The aim of the present study is to determine cost-effectiveness of surveillance programs where families at both high and moderate risk of HNPCC participate. METHODS: A decision analytic model (Markov model) is developed to assess surveillance programs where families at high......OBJECTIVES: Surveillance programs are recommended to both families at high risk (Amsterdam-positive families with known- and unknown mutation) and moderate risk (families not fulfilling all Amsterdam criteria) of colorectal cancer (CRC). Cost-effectiveness has so far only been estimated...

High-risk factors of parotid lymph node metastasis in nasopharyngeal carcinoma: a case-control study

International Nuclear Information System (INIS)

Wang, Hong-zhi; Cao, Cai-neng; Luo, Jing-wei; Yi, Jun-lin; Huang, Xiao-dong; Zhang, Shi-ping; Wang, Kai; Qu, Yuan; Xiao, Jian-ping; Li, Su-yan; Gao, Li; Xu, Guo-zhen

2016-01-01

Although parotid-sparing IMRT decreased the dose distribution of parotid, parotid region recurrence has been reported. Prophylactic irradiation in parotid area would be necessary in patients with high risk of parotid lymph node metastasis (PLNM). This study was to detect the high-risk factors of PLNM in nasopharyngeal carcinoma. This was a 1:2 case-control study. All patients in this study were newly diagnosed NPC with N2-3 classification from January 2005 to December 2012. Cases were 22 sides with ipsilateral PLNM. Controls were 44 patients who were randomly selected from N2-3 disease in database. 20/1096 (1.82 %) NPC patients were found PLNM. Sum of the longest diameter for multiple lymph nodes (SLD) in level II was larger in case group than that in control group (6.0 cm vs. 3.6 cm, p = 0.003). Level II lymph node necrosis, level Va/b involvement, and rare neck areas involvement were more common in case group (p = 0.016, p = 0.034, and p < 0.001, respectively). RPN, level III, and level IV metastases showed no significant difference between the two groups. Multivariate analysis in logistic regression showed that only SLD ≥5 cm in II area (OR = 4.11, p = 0.030) and rare neck areas involvement (OR = 3.95, p = 0.045) were associated with PLNM in NPC patients. PLNM was an uncommon event in NPC patients. SLD ≥5 cm in level II and involvement in rare-neck areas may be potentially high-risk factors for PLNM. Sparing parotid in IMRT was not recommended for NPC patients with high risks of PLNM

[Prevalence trends of high risk of mental disorders in the Spanish adult population: 2006-2012].

Science.gov (United States)

Basterra, Virginia

To evaluate the prevalence of high risk of psychiatric morbidity in the Spanish adult population and its changes between 2006 and 2012. Data from 47,905 participants obtained from the National Health Surveys in 2006 and 2012 were used. Mental health status was assessed with the General Health Questionnaire score. Adjusted logistic regression models were fitted. The prevalence of high risk of psychiatric morbidity was 20.5% in 2012 and 21.3% in 2006. Using 2006 as the reference, the odds ratio (OR) for these problems in 2012 was 0.84 (0.79-0.89) in women and 1.10 (1.02-1.18) in men. In women, it decreased for all ages. In men, these ORs were 1.15 (1.04-1.27) in the aged 16-44 group, 1.23 (1.08-1.40) in the aged 45-64 group and 0.81 (0.68-0.96) in the aged ≥ 65 group. The prevalence of high risk of psychiatric morbidity decreased except in males <65 years of age, who are more sensitive to the economic crisis. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Investigation of zoonotic infections in risk groups in Ordu University ...

African Journals Online (AJOL)

2016-02-15

Feb 15, 2016 ... 2017 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer - Medknow. Abstract. Aims:Zoonotic ... Investigation of zoonotic infections in risk groups in ..... of Cystic Echinococcosis in Veterinary Surgeons. Turkish ...

PROPHYLACTIС DIET OF ALLERGIC DISEASES IN CHILDREN WITH HIGH RISK OF ATOPY

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V.A. Revyakina

2007-01-01

Full Text Available The preventive efficiency of various kinds of feedings in children of the first year of life with high risk of an allergic pathology is studied. Under observation there were 87 children from group of high risk of an allergic pathology (from birth up to 18 months. The results of this study have confirmed the importance of breast feeding for prophylaxis of an allergic pathology in children with high risk of atopy. If it is impossible, the transclation of the child on artificial feeding by an dairy admixture based on a partial hydrolysate of serumal protein, which procvides physiological needs of a growing organism, assists physiological dynamics of parameters of weight and height, allows to increase frequency of early manifestation of atopy and prevents a sensibilization to proteins of the cow milk.Key words: allergic diseases, prevention, feeding, hydrolysate of protein of the cow milk, infants.

Personalized treatment of women with early breast cancer: a risk-group specific cost-effectiveness analysis of adjuvant chemotherapy accounting for companion prognostic tests OncotypeDX and Adjuvant!Online.

Science.gov (United States)

Jahn, Beate; Rochau, Ursula; Kurzthaler, Christina; Hubalek, Michael; Miksad, Rebecca; Sroczynski, Gaby; Paulden, Mike; Bundo, Marvin; Stenehjem, David; Brixner, Diana; Krahn, Murray; Siebert, Uwe

2017-10-16

Due to high survival rates and the relatively small benefit of adjuvant therapy, the application of personalized medicine (PM) through risk stratification is particularly beneficial in early breast cancer (BC) to avoid unnecessary harms from treatment. The new 21-gene assay (OncotypeDX, ODX) is a promising prognostic score for risk stratification that can be applied in conjunction with Adjuvant!Online (AO) to guide personalized chemotherapy decisions for early BC patients. Our goal was to evaluate risk-group specific cost effectiveness of adjuvant chemotherapy for women with early stage BC in Austria based on AO and ODX risk stratification. A previously validated discrete event simulation model was applied to a hypothetical cohort of 50-year-old women over a lifetime horizon. We simulated twelve risk groups derived from the joint application of ODX and AO and included respective additional costs. The primary outcomes of interest were life-years gained, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness (ICER). The robustness of results and decisions derived were tested in sensitivity analyses. A cross-country comparison of results was performed. Chemotherapy is dominated (i.e., less effective and more costly) for patients with 1) low ODX risk independent of AO classification; and 2) low AO risk and intermediate ODX risk. For patients with an intermediate or high AO risk and an intermediate or high ODX risk, the ICER is below 15,000 EUR/QALY (potentially cost effective depending on the willingness-to-pay). Applying the AO risk classification alone would miss risk groups where chemotherapy is dominated and thus should not be considered. These results are sensitive to changes in the probabilities of distant recurrence but not to changes in the costs of chemotherapy or the ODX test. Based on our modeling study, chemotherapy is effective and cost effective for Austrian patients with an intermediate or high AO risk and an intermediate or high

Attenuating the mortality risk of high serum uric acid: the role of physical activity underused.

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Chen, Jiunn-Horng; Wen, Chi Pang; Wu, Shiuan Bei; Lan, Joung-Liang; Tsai, Min Kuang; Tai, Ya-Ping; Lee, June Han; Hsu, Chih Cheng; Tsao, Chwen Keng; Wai, Jackson Pui Man; Chiang, Po Huang; Pan, Wen Han; Hsiung, Chao Agnes

2015-11-01

High serum uric acid (sUA) has been associated with increased mortality risks, but its clinical treatment varied with potential side effects. The role of physical activity has received limited attention. A cohort, consisting of 467 976 adults, who went through a standard health screening programme, with questionnaire and fasting blood samples, was successively recruited between 1996 and 2008. High sUA is defined as uric acid above 7.0 mg/dL. Leisure time physical activity level was self-reported, with fully active defined as those with 30 min per day for at least 5 days a week. National death file identified 12 228 deaths with a median follow-up of 8.5 years. Cox proportional model was used to analyse HRs, and 12 variables were controlled, including medical history, life style and risk factors. High sUA constituted one quarter of the cohort (25.6%). Their all-cause mortality was significantly increased [HR: 1.22 (1.15-1.29)], with much of the increase contributed to by the inactive (HR: 1.27 (1.17-1.37)), relative to the reference group with sUA level of 5-6 mg/dL. When they were fully active, mortality risks did not increase, but decreased by 11% (HR: 0.89 (0.82-0.97)), reflecting the benefits of being active was able to overcome the adverse effects of high sUA. Given the same high sUA, a 4-6 years difference in life expectancy was found between the active and the inactive. Physical activity is a valuable alternative to pharmacotherapy in its ability to reduce the increases in mortality risks from high sUA. By being fully active, exercise can extend life span by 4-6 years, a level greater than the 1-4 years of life-shortening effect from high sUA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Resuscitation of newborn in high risk deliveries

International Nuclear Information System (INIS)

Yousaf, U.F.; Hayat, S.

2015-01-01

High risk deliveries are usually associated with increased neonatal mortality and morbidity. Neonatal resuscitation can appreciably affect the outcome in these types of deliveries. Presence of personnel trained in basic neonatal resuscitation at the time of delivery can play an important role in reducing perinatal complications in neonates at risk. The study was carried out to evaluate the effects of newborn resuscitation on neonatal outcome in high risk deliveries. Methods: This descriptive case series was carried out at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore. Ninety consecutive high risk deliveries were included and attended by paediatricians trained in newborn resuscitation. Babies delivered by elective Caesarean section, normal spontaneous vaginal deliveries and still births were excluded. Neonatal resuscitation was performed in babies who failed to initiate breathing in the first minute after birth. Data was analyzed using SPSS-16.0. Results: A total of 90 high risk deliveries were included in the study. Emergency caesarean section was the mode of delivery in 94.4% (n=85) cases and spontaneous vaginal delivery in 5.6% (n=5). Preterm pregnancy was the major high risk factor. Newborn resuscitation was required in 37.8% (n=34) of all high risk deliveries (p=0.013). All the new-borns who required resuscitation survived. Conclusion: New-born resuscitation is required in high risk pregnancies and personnel trained in newborn resuscitation should be available at the time of delivery. (author)

Brain structure in people at ultra-high risk of psychosis, patients with first-episode schizophrenia, and healthy controls: a VBM study.

Science.gov (United States)

Nenadic, Igor; Dietzek, Maren; Schönfeld, Nils; Lorenz, Carsten; Gussew, Alexander; Reichenbach, Jürgen R; Sauer, Heinrich; Gaser, Christian; Smesny, Stefan

2015-02-01

Early intervention research in schizophrenia has suggested that brain structural alterations might be present in subjects at high risk of developing psychosis. The heterogeneity of regional effects of these changes, which is established in schizophrenia, however, has not been explored in prodromal or high-risk populations. We used high-resolution MRI and voxel-based morphometry (VBM8) to analyze grey matter differences in 43 ultra high-risk subjects for psychosis (meeting ARMS criteria, identified through CAARMS interviews), 24 antipsychotic-naïve first-episode schizophrenia patients and 49 healthy controls (groups matched for age and gender). Compared to healthy controls, resp., first-episode schizophrenia patients had reduced regional grey matter in left prefrontal, insula, right parietal and left temporal cortices, while the high-risk group showed reductions in right middle temporal and left anterior frontal cortices. When dividing the ultra-high-risk group in those with a genetic risk vs. those with attenuated psychotic symptoms, the former showed left anterior frontal, right caudate, as well as a smaller right hippocampus, and amygdala reduction, while the latter subgroup showed right middle temporal cortical reductions (each compared to healthy controls). Our findings in a clinical psychosis high-risk cohort demonstrate variability of brain structural changes according to subgroup and background of elevated risk, suggesting frontal and possibly also hippocampal/amygdala changes in individuals with genetic susceptibility. Heterogeneity of structural brain changes (as seen in schizophrenia) appears evident even at high-risk stage, prior to potential onset of psychosis. Copyright © 2014 Elsevier B.V. All rights reserved.

Need assessment for HIV/AIDS Education: The level of knowledge about transmission in some risk groups in Turkey

International Nuclear Information System (INIS)

Ozcebe, H.

2002-01-01

Every year, the number of HIV/AIDS cases increases twice as much as the year before in Turkey. The authors anticipate that the actual numbers of HIV/AIDS cases in Turkey are higher than the number of cases diagnosed and reported. This review summarizes the results of some previous studies that were conducted among various risk groups, such as high school and university students, barbers, hair dressers, nurses, pharmacists and doctors, men and women engaged in sex trade and security workers in different regions of country. The responses of participants to similar questions of studies on the transmission of HIV/AIDS were evaluated in this review. The studies that have been conducted among different risk groups in different regions have shown that in spite of low prevalence of HIV/AIDS in Turkey, many risk groups still do not have adequate or correct information on the prevalence and transmission of disease. Effective and extensive health education on HIV/AIDS and the practice of healthy lifestyle would change the epidemiology of the disease in Turkey. (author)

Relationship of child abuse with personality features and high risk behaviors in adolescents

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Mehdi Ghezelseflo

2015-05-01

Full Text Available Background: Children are one of the most vulnerable groups of the society and are constantly threatened by different people in their family or society. The aim of this study was investigating the correlation of child abuse with personality features and high risk behavior in high school students of Islamshahr, Iran. Methods: This study cross-sectional analytical was conducted on the high school girls and boys of Islamshahr in spring 2014.528 students were selected by cluster random sampling among 4 high schools (two female and two male high schools. Childhood trauma questionnaire, NEO-Five Factor Inventory and Youth Risk-Taking Scale were used for data collection. Data were analyzed by independence t-test, Pearson's correlation coefficient and multiple linear regression. Results: The results of independence t-test indicated significant differences between girls and boys in terms of child abuse and high risk experience (t=-2.16,p=0.03 and t=-5.03, P=0.001, respectively. Also, the results demonstrated a significant relationship between child abuse and personality characteristics, high risk behavior and all its subscales (P<0.05. The findings of multiple linear regressionindicated that child abuse could explain 14% total risk-taking, 25% neurotic personality feature , 14% extroversion, 10% agreeableness, 1% flexibility and 13% conscientiousness (P<0.05. Conclusion: According to the research findings, appropriate behavior with children is of great importance. Therefore, child abuse would form inappropriate personality features and increase risk behaviors among children.

Risk selection and risk adjustment: improving insurance in the individual and small group markets.

Science.gov (United States)

Baicker, Katherine; Dow, William H

2009-01-01

Insurance market reforms face the key challenge of addressing the threat that risk selection poses to the availability, of stable, high-value insurance policies that provide long-term risk protection. Many of the strategies in use today fail to address this breakdown in risk pooling, and some even exacerbate it. Flexible risk adjustment schemes are a promising avenue for promoting market stability and limiting insurer cream-skimming, potentially providing greater benefits at lower cost. Reforms intended to increase insurance coverage and the value of care delivered will be much more effective if implemented in conjunction with policies that address these fundamental selection issues.

High consumption of vegetable and fruit colour groups is inversely associated with the risk of colorectal cancer: a case-control study.

Science.gov (United States)

Luo, Wei-Ping; Fang, Yu-Jing; Lu, Min-Shan; Zhong, Xiao; Chen, Yu-Ming; Zhang, Cai-Xia

2015-04-14

The colour of the edible portion of vegetables and fruit reflects the presence of specific micronutrients and phytochemicals. No existing studies have examined the relationship between the intake of vegetable and fruit colour groups and the risk of colorectal cancer. The present study, therefore, aimed to investigate these associations in a Chinese population. A case-control study was conducted between July 2010 and July 2014 in Guangzhou, China, in which 1057 consecutively recruited cases of colorectal cancer were frequency-matched to 1057 controls by age (5-year interval), sex and residence (rural/urban). A validated FFQ was used to collect dietary information during face-to-face interviews. Vegetables and fruit were classified into four groups according to the colour of their primarily edible parts: green; orange/yellow; red/purple; white. Unconditional logistic regression models were used to estimate the OR and 95 % CI. A higher consumption of orange/yellow, red/purple and white vegetables and fruit was inversely associated with the risk of colorectal cancer, with adjusted OR of 0·16 (95 % CI 0·12, 0·22) for orange/yellow, 0·23 (95 % CI 0·17, 0·31) for red/purple and 0·53 (95 % CI 0·40, 0·70) for white vegetables and fruit when the highest and lowest quartiles were compared. Total vegetable intake and total fruit intake have also been found to be inversely associated with colorectal cancer risk. However, the intake of green vegetable and fruit was not associated with colorectal cancer risk. The results of the present study, therefore, suggest that a greater intake of orange/yellow, red/purple and white vegetables and fruit is inversely associated with the risk of colorectal cancer.

The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.

Science.gov (United States)

Anderson, D R; Whitmer, R W; Goetzel, R Z; Ozminkowski, R J; Dunn, R L; Wasserman, J; Serxner, S

2000-01-01

To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.

Blood group AB and factor V Leiden as risk factors for pre-eclampsia: a population-based nested case-control study.

Science.gov (United States)

Hiltunen, Leena M; Laivuori, Hannele; Rautanen, Anna; Kaaja, Risto; Kere, Juha; Krusius, Tom; Paunio, Mikko; Rasi, Vesa

2009-06-01

Pre-eclampsia is an important cause of maternal morbidity and mortality. Its etiology is still unknown. Clinical symptoms correlate with activation of coagulation and inherited thrombophilia has been associated with pre-eclampsia. ABO blood group has been associated with thrombotic disorders and pre-eclampsia. We assessed ABO blood group, seven thrombophilia associated polymorphisms, and anti-beta2-glycoprotein I antibodies as risk factors for pre-eclampsia. We performed a population-based nested case-control study of 100,000 consecutive pregnancies in Finland. Cases and controls were identified by combining national registers and medical records were reviewed. We studied 248 cases fulfilling strict criteria for pre-eclampsia and 679 controls. Severe pre-eclampsia, early pre-eclampsia, and pre-eclampsia with intra-uterine growth restriction (IUGR) were analyzed separately. Blood group AB increased the risk for pre-eclampsia as a whole (OR 2.1, 95% CI 1.3-3.5), and in the three subgroups (OR 2.3, 3.8, 3.4; 95% CI 1.3-3.9, 2.0-7.1, 1.6-7.1). FV Leiden increased the risk as a whole (OR 1.7, 95% CI 0.8-3.9), and in the three subgroups, although not statistically significantly. Anti-beta2-glycoprotein I antibodies were not associated with pre-eclampsia. High body mass index, diabetes, first pregnancy, and twin pregnancy increased the risk from 1.5-fold to 8.2-fold. Our results confirm and extend the prior observation of blood group AB being a risk factor for pre-eclampsia. ABO blood group is known from all pregnant women. The value of blood group as risk factor for pre-eclampsia should be further assessed in prospective studies. In this study, FV Leiden was not statistically significant risk factor.

Is the Population Detected by Screening in China Truly at High Risk of Stroke?

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Wang, Yuan; Wang, Jing; Cheng, Juan; Liang, Xuan; Li, Xin; Lu, Wenli

2018-04-09

The Chinese Stroke Screening and Prevention Project (CSSPP) considers patients with 3 or more risk factors to be at high risk of stroke, and does not quantitatively assess the risk for stroke. However, to detect high-risk groups more efficiently, a health risk appraisal (HRA) model should be used to assess individual risk of stroke. The odds ratios for the 8 risk factors for stroke were pooled and the data were used to develop an HRA model to predict individuals' risks of developing stroke in the next 5 years. The Chinese screening project and HRA screening strategies were then compared. We assessed 4196 Chinese individuals who received checkups in 2015. The average 5-year risk of stroke was 5.81‰, with men being at higher risk of stroke than women over that period. The average 5-year risk of stroke also increased with the number of risk factors. 932 individuals (22.2%) were identified as being at high risk of stroke according to CSSPP, whereas 318 individuals with fewer than 3 risk factors were considered being at low risk despite having a 5-year risk of stroke greater than 4.0% by our assessment. Notably, among patients with hypertension and diabetes who were classified as being at low risk of stroke by the CSSPP, the HRA recognized 15.9% and 14.3% as being at high risk of stroke, respectively. All 8 major risk factors affect stroke risk differently, and the efficiency of clustering these risk factors might be improved by considering the relative risk of each factor with an HRA model. Copyright © 2018. Published by Elsevier Inc.

High-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil

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Sandra L. Ulinski

2016-01-01

Full Text Available Objective: To explore high-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil. Method: Data from 398 drivers on sociodemographic parameters, high-risk behaviors, experiences with traffic law, and traffic law violations were collected through interviews conducted at sobriety checkpoints. Exploratory-descriptive and analytical statistics were used. Results: The mean age of the participants was 32.6±11.2 years (range, 18 to 75 years. Half of the drivers reported having driven after drinking in the last year, predominantly single men aged 18 to 29 years who drive cars and drink alcohol frequently. Only 55% of the drivers who had driven after drinking in the last year self-reported some concern about being detected in a police operation. Conclusions: A significant association was found between sociodemographic variables and behavior, which can help tailor public interventions to a specific group of drivers: young men who exhibit high-risk behaviors in traffic, such as driving after drinking alcohol, some of whom report heavy alcohol consumption. This group represents a challenge for educational and enforcement interventions, particularly because they admit to violating current laws and have a low perception of punishment due to the low risk of being detected by the police.

High-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil.

Science.gov (United States)

Ulinski, Sandra L; Moysés, Simone T; Werneck, Renata I; Moysés, Samuel J

2016-01-08

To explore high-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil. Data from 398 drivers on sociodemographic parameters, high-risk behaviors, experiences with traffic law, and traffic law violations were collected through interviews conducted at sobriety checkpoints. Exploratory-descriptive and analytical statistics were used. The mean age of the participants was 32.6±11.2 years (range, 18 to 75 years). Half of the drivers reported having driven after drinking in the last year, predominantly single men aged 18 to 29 years who drive cars and drink alcohol frequently. Only 55% of the drivers who had driven after drinking in the last year self-reported some concern about being detected in a police operation. A significant association was found between sociodemographic variables and behavior, which can help tailor public interventions to a specific group of drivers: young men who exhibit high-risk behaviors in traffic, such as driving after drinking alcohol, some of whom report heavy alcohol consumption. This group represents a challenge for educational and enforcement interventions, particularly because they admit to violating current laws and have a low perception of punishment due to the low risk of being detected by the police.

Double trouble: modelling the impact of low risk perception and high-risk sexual behaviour on chlamydia transmission.

Science.gov (United States)

van Wees, Daphne A; den Daas, Chantal; Kretzschmar, Mirjam E E; Heijne, Janneke C M

2018-04-01

Risk perception plays an important role in testing behaviour for sexually transmitted infections, but is rarely included in mathematical models exploring the impact of testing. We explored the impact of incorporating sexual behaviour (SB), risk perception (RP) and differential testing uptake in SB-RP groups on prevalence, using chlamydia as an example. We developed a pair model with a susceptible-infected-susceptible structure representing heterosexuals aged 16-26 years. The effect of testing on chlamydia prevalence was compared between a model with only SB (SB model) and a model with SB and RP (SB-RP model). In the SB-RP model, a scenario without differential testing uptake in SB-RP groups was compared to scenarios with differential testing uptake in SB-RP groups. Introducing testing into the SB-RP model resulted in a slightly smaller reduction in chlamydia prevalence (-38.0%) as compared to the SB model (-40.4%). In the SB-RP model, the scenario without differential testing uptake in SB-RP groups overestimated the reduction in chlamydia prevalence (with 4.8%), especially in the group with high SB and low RP (19.8%). We conclude that mathematical models incorporating RP and differential testing uptake in SB-RP groups improve the impact assessment of testing and treatment on chlamydia prevalence. © 2018 The Author(s).

Disrupted resting brain graph measures in individuals at high risk for alcoholism.

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Holla, Bharath; Panda, Rajanikant; Venkatasubramanian, Ganesan; Biswal, Bharat; Bharath, Rose Dawn; Benegal, Vivek

2017-07-30

Familial susceptibility to alcoholism is likely to be linked to the externalizing diathesis seen in high-risk offspring from high-density alcohol use disorder (AUD) families. The present study aimed at comparing resting brain functional connectivity and their association with externalizing symptoms and alcoholism familial density in 40 substance-naive high-risk (HR) male offspring from high-density AUD families and 30 matched healthy low-risk (LR) males without a family history of substance dependence using graph theory-based network analysis. The HR subjects from high-density AUD families compared with LR, showed significantly reduced clustering, small-worldness, and local network efficiency. The frontoparietal, cingulo-opercular, sensorimotor and cerebellar networks exhibited significantly reduced functional segregation. These disruptions exhibited independent incremental value in predicting the externalizing symptoms over and above the demographic variables. The reduction of functional segregation in HR subjects was significant across both the younger and older age groups and was proportional to the family loading of AUDs. Detection and estimation of these developmentally relevant disruptions in small-world architecture at critical brain regions sub-serving cognitive, affective, and sensorimotor processes are vital for understanding the familial risk for early onset alcoholism as well as for understanding the pathophysiological mechanism of externalizing behaviors. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Retinol and α-Tocopherol in the Breast Milk of Women after a High-Risk Pregnancy

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Reyna Sámano

2017-01-01

Full Text Available Background: There is scant information about whether, after a high-risk pregnancy, breast milk provides enough vitamins for assuring satisfactory bodily reserves in newborns. Objective: To comparatively evaluate, in women with high-risk and normal pregnancy, the concentration of retinol and α-tocopherol in breast milk. Methods: This cross-sectional, analytical study was evaluated with reverse-phase high-performance liquid chromatography (HPLC. Informed consent was signed by 95 mothers with a high-risk pregnancy and 32 mothers with a normal pregnancy. From the mothers with a high-risk pregnancy were obtained: 23 samples of colostrum, 24 of transitional milk, and 48 of mature milk. From the normal pregnancy group, 32 mature milk samples were collected. Pregestational Body Mass Index (BMI and the gestational weight gain were noted. Models of logistic regression were constructed to identify the variables related to a low concentration of either retinol or α-tocopherol in breast milk. Results: The concentration of retinol and α-tocopherol in mature milk was 60 (interquartile range (IQR, 41–90 and 276 (103–450 μg/dL, respectively, for the high-risk pregnancy group, and 76 (65–91 and 673 (454–866 µg/dL, respectively, for the normal pregnancy group (p = 0.001. The concentration of retinol and α-tocopherol was similar in the subgroups of mothers with different disorders during gestation. A clear correlation was found between a greater pregestational weight and a lower concentration of retinol (Rho = –0.280, p = 0.006, and between α-tocopherol and retinol in all cases (Rho = 0.463, p = 0.001. Among women having a high-risk pregnancy, those delivering prematurely rather than carrying their pregnancy to term had a reduced concentration of retinol (54 (37–78 vs. 70 (49–106 µg/dL; p = 0.002 and a tendency to a lower concentration of α-tocopherol in breast milk (185 (75–410 vs. 339 (160–500 µg/dL; p = 0.053. Compared to mothers with

[German Language Version and Validation of the Risk-Taking Behaviour Scale (RBS-K) for High-Risk Sports].

Science.gov (United States)

Frühauf, Anika; Niedermeier, Martin; Ruedl, Gerhard; Barlow, Matthew; Woodman, Tim; Kopp, Martin

2017-11-23

Background  High-risk sports, particularly climbing, kayaking and extreme skiing, have become increasingly popular. The most widely used psychological survey instrument with regard to risk behaviour in sports is the Sensation Seeking Model, mostly assessed by the Sensation Seeking Scale (SSS-V). Until recently, the literature discussed risk behaviour solely through this model. However, this scale does not measure risk-taking behaviours. In contrast, the Risk-Taking Behaviour Scale (RBS-K) is a three-item scale that measures risk behaviour in high-risk sports. This study aimed to validate a German language version of the RBS-K. Methods  The RBS-K was translated and back-translated between English and German. High-risk sports participants (n = 2399) completed the German version of the RBS-K. Of those participants, 820 completed the RBS-K in person as part of a field survey and 1579 participated in an online survey. To validate the questionnaire, the SSS-V, accident involvement, age and sex were evaluated. The RBS-K divides the sample into deliberate risk takers (mean + standard deviation) and risk-averse persons (mean - standard deviation). We tested for internal consistency and correlations with SSS-V, age, sex and accident involvement. Group differences were calculated between deliberate risk takers and risk-averse persons. Results  For internal consistency, we obtained a Cronbach's alpha of 0.56 and a McDonald's omega of 0.63. Significant correlations were shown between RBS-K and SSS-V as well as age and sex. Compared to risk-averse persons (n = 643, 26.8 %), deliberate risk takers (n = 319, 13.3 %) scored significantly higher in sensation seeking, were significantly younger and primarily male and had a significantly higher accident involvement. Conclusion  The RBS-K discriminates well for age, sex and accident involvement. Also, correlations between the RBS-K and the well-established SSS-V are acceptable. With regard to the results and its

Chemoradiation With Paclitaxel and Carboplatin in High-Risk Cervical Cancer Patients After Radical Hysterectomy: A Korean Gynecologic Oncology Group Study

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Lee, Taek Sang [Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); Kang, Soon Beom, E-mail: tslee70@gmail.com [Department of Obstetrics and Gynecology, Konkuk University Medical Center, Seoul (Korea, Republic of); Kim, Young Tak [Department of Obstetrics and Gynecology, Asan Medical Center, Seoul (Korea, Republic of); Park, Byung Joo [Department of Preventive Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Man [Department of Obstetrics and Gynecology, Asan Medical Center, Seoul (Korea, Republic of); Lee, Jong Min [Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of); Kim, Seok Mo [Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju (Korea, Republic of); Kim, Young Tae [Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Jae Hoon [Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Seoul (Korea, Republic of); Kim, Kyung Tai [Department of Obstetrics and Gynecology, Hanyang University Medical Center, Seoul (Korea, Republic of)

2013-06-01

Purpose: To evaluate the efficacy and toxicity of concurrent chemoradiation with paclitaxel and carboplatin in patients with high-risk cervical cancer. Methods and Materials: Patients after radical hysterectomy for cervical cancer, with at least 1 high-risk characteristic, were administered paclitaxel 135 mg/m{sup 2}, carboplatin area under the curve = 5 every 3 weeks for 3 cycles concomitant with radiation therapy as adjuvant treatment. Results: This prospective study enrolled 71 consecutive patients. Sixty-six patients (93%) completed the planned treatment. The majority of grade 3/4 neutropenia or nonhematologic toxicities were usually self-limited. Diarrhea grades 3/4 were observed in 4 patients (5.6%). One patient developed anaphylactic shock after infusion of paclitaxel. With a median follow-up of 57 months, recurrences occurred in 16 patients. Multivariable analysis indicated that common iliac lymph node involvement is an independent risk factor for disease recurrence (odds ratio 13.48; 95% confidence interval 2.93-62.03). In the intent-to-treat population (n=71), the estimated 5-year disease-free survival and overall survival rates were 77.3% and 80.3% respectively. In the per-protocol population (n=62), disease-free survival was 78.9% and overall survival was 83.9%. Conclusions: Concurrent chemoradiation with paclitaxel/carboplatin is well tolerated and seems to be effective for patients who undergo radical hysterectomy. Therefore, a prospective, randomized controlled study should be designed to evaluate efficacy of this approach for patients with high-risk cervical cancer.

Identifying potential risk situations for humans when removing horses from groups

DEFF Research Database (Denmark)

Hartmann, Elke; Søndergaard, Eva; Keeling, Linda J.

2012-01-01

Removing a horse from its social group may be considered risky, both for the handler and the horse, because other horses can interfere in the catching process. The main aim of this study was to identify where and when these risk situations occur while removing a horse from its group. A potential...

7 CFR 407.13 - Group risk plan for forage.

Science.gov (United States)

2010-01-01

... acres of hay in the county, as specified in the actuarial documents. The actuarial documents will... a period for forage regrowth. 2. Crop Insured The insured crop will be the forage types shown on the... the Group Risk Plan Common Policy, acreage seeded to forage after July 1 of the previous crop year...

MMSC-LIKE LIMBAL CELLS COTRANSPLANTATION PROMOTES LOCAL IMMUNOCORRECTION AND CORNEAL GRAFT TRANSPARENT RETENTION IN HIGH RISK KERATOPLASTY

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S. A. Borzenok

2014-01-01

Full Text Available Aim was to evaluate clinical results of donor corneal graft survival in high-risk recipients in co-transplantation of preserved allogenic limbal grafts. Materials and methods. Two types of penetrative keratoplasties were carried out in patients with corneal graft opacities and high risk of rejection (n = 69. Co-transplantation of donor cornea and allogenic MMSC-like limbal cells in the form of limbal transplants was carried out in the 1st group (n = 36; in the 2nd group (n = 33 only the cornea was transplanted. Results. Observation of the patients during one year after surgery showed that the rate of transparent cornea engraftment increased in the 1st group (86,1 against 69,7% in the 2nd group. The density of endothelial cells was also higher in the 1st group (85,9 against 76,2% in the 2nd group. At the same time, progressive decreasing of pro-inflammatory cytokines (IL-6, IFNγ, TNFα and increasing of anti-inflammatory cytokines (IL-10, IL-1RA, TGFβ along with higher level of HLA-G5 were revealed in the recipients’ tear fluid in the 1st group in comparison to the 2nd group. Conclusion. Simultaneous transplantation of preserved limbal grafts with corneal graft in high-risk keratoplasty favors the transparent cornea engraftment, obviously, this is due to immunoregulatory activity of the MMSC-like limbal cells. 

Rapid COJEC Induction Therapy for High-risk Neuroblastoma Patients - Cochrane Review.

Science.gov (United States)

Peinemann, F; van Dalen, E C; Berthold, F

2016-04-01

Neuroblastoma is a rare malignant disease and patients with high-risk neuroblastoma have a poor prognosis. Rapid COJEC induction chemotherapy means (almost) the same total doses given within a shorter time period. In theory, rapid COJEC could reduce the risk of drug resistance and it has been considered as a potential candidate for improving the outcome. The objective was to evaluate effects of rapid COJEC compared to standard induction chemotherapy in patients with high-risk neuroblastoma. We searched the databases CENTRAL, MEDLINE, and EMBASE from inception to 11 November 2014 and included randomized controlled trials. We identified one relevant randomized controlled trial with 130 participants receiving rapid COJEC and 132 participants receiving standard OPEC/COJEC induction chemotherapy. There was no statistically significant difference between the treatment groups in complete response (risk ratio 0.99, 95% confidence interval 0.71 to 1.38, P=0.94) and treatment-related mortality (risk ratio 1.21, 95% confidence interval 0.33 to 4.39, P=0.77). A statistically significant difference in favor of the standard treatment arm was identified for the following early toxicities: febrile neutropenia, septicemia, and renal toxicity. The differences in complete response and treatment-related mortality between treatment alternatives were not statistically significantly different. Based on the currently available evidence, we are uncertain about the effects of rapid COJEC induction chemotherapy in patients with high-risk neuroblastoma. © Georg Thieme Verlag KG Stuttgart · New York.

ORDEM 3.0 and the Risk of High-Density Debris

Science.gov (United States)

Matney, Mark; Anz-Meador, Philip

2014-01-01

NASA’s Orbital Debris Engineering Model was designed to calculate orbital debris fluxes on spacecraft in order to assess collision risk. The newest of these models, ORDEM 3.0, has a number of features not present in previous models. One of the most important is that the populations and fluxes are now broken out into material density groups. Previous models concentrated on debris size alone, but a particle’s mass and density also determine the amount of damage it can cause. ORDEM 3.0 includes a high-density component, primarily consisting of iron/steel particles that drive much of the risk to spacecraft. This paper will outline the methods that were used to separate and identify the different densities of debris, and how these new densities affect the overall debris flux and risk.

High-density genotyping of immune loci in Koreans and Europeans identifies eight new rheumatoid arthritis risk loci.

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Kim, Kwangwoo; Bang, So-Young; Lee, Hye-Soon; Cho, Soo-Kyung; Choi, Chan-Bum; Sung, Yoon-Kyoung; Kim, Tae-Hwan; Jun, Jae-Bum; Yoo, Dae Hyun; Kang, Young Mo; Kim, Seong-Kyu; Suh, Chang-Hee; Shim, Seung-Cheol; Lee, Shin-Seok; Lee, Jisoo; Chung, Won Tae; Choe, Jung-Yoon; Shin, Hyoung Doo; Lee, Jong-Young; Han, Bok-Ghee; Nath, Swapan K; Eyre, Steve; Bowes, John; Pappas, Dimitrios A; Kremer, Joel M; Gonzalez-Gay, Miguel A; Rodriguez-Rodriguez, Luis; Ärlestig, Lisbeth; Okada, Yukinori; Diogo, Dorothée; Liao, Katherine P; Karlson, Elizabeth W; Raychaudhuri, Soumya; Rantapää-Dahlqvist, Solbritt; Martin, Javier; Klareskog, Lars; Padyukov, Leonid; Gregersen, Peter K; Worthington, Jane; Greenberg, Jeffrey D; Plenge, Robert M; Bae, Sang-Cheol

2015-03-01

A highly polygenic aetiology and high degree of allele-sharing between ancestries have been well elucidated in genetic studies of rheumatoid arthritis. Recently, the high-density genotyping array Immunochip for immune disease loci identified 14 new rheumatoid arthritis risk loci among individuals of European ancestry. Here, we aimed to identify new rheumatoid arthritis risk loci using Korean-specific Immunochip data. We analysed Korean rheumatoid arthritis case-control samples using the Immunochip and genome-wide association studies (GWAS) array to search for new risk alleles of rheumatoid arthritis with anticitrullinated peptide antibodies. To increase power, we performed a meta-analysis of Korean data with previously published European Immunochip and GWAS data for a total sample size of 9299 Korean and 45,790 European case-control samples. We identified eight new rheumatoid arthritis susceptibility loci (TNFSF4, LBH, EOMES, ETS1-FLI1, COG6, RAD51B, UBASH3A and SYNGR1) that passed a genome-wide significance threshold (p<5×10(-8)), with evidence for three independent risk alleles at 1q25/TNFSF4. The risk alleles from the seven new loci except for the TNFSF4 locus (monomorphic in Koreans), together with risk alleles from previously established RA risk loci, exhibited a high correlation of effect sizes between ancestries. Further, we refined the number of single nucleotide polymorphisms (SNPs) that represent potentially causal variants through a trans-ethnic comparison of densely genotyped SNPs. This study demonstrates the advantage of dense-mapping and trans-ancestral analysis for identification of potentially causal SNPs. In addition, our findings support the importance of T cells in the pathogenesis and the fact of frequent overlap of risk loci among diverse autoimmune diseases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Volume of hospital is important for the prognosis of high-risk patients with nonvariceal upper gastrointestinal bleeding (NVUGIB).

Science.gov (United States)

Choi, Jin Woo; Jeon, Seong Woo; Kwon, Jung Gu; Lee, Dong Wook; Ha, Chang Yoon; Cho, Kwang Bum; Jang, Byung Ik; Park, Jung Bae; Park, Youn Sun

2017-08-01

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a potentially life-threatening hospital emergency requiring hemodynamic stabilization and resuscitation. This study is carried out to determine whether hospital volume can influence outcome in patients with NVUGIB. This is a retrospective study with a prospective cohort database (KCT 0000514. cris.nih.go.kr). Eight teaching hospitals were divided into two different groups: high-volume centers (HVC, ≥60 NVUGIB patients/year, four clinics) and low-volume centers (LVC, bleeding after treatment, re-bleeding, necessity for surgical/other retreatments, and death within 30 days. Similar baseline characters for patients were observed in both groups. There was a significant difference in the incidence of poor outcome between the HVC and LVC groups (9.06 vs. 13.69%, P = 0.014). The incidence rate of poor outcome in high-risk patients (Rockall score ≥8) in HVC was lower than that in high-risk patients in LVC (16.07 vs. 26.92%, P = 0.048); however, there was no significant difference in poor outcome in the lower-risk patients in either group (8.72 vs. 10.42%, P = 0.370). Significant correlation between hospital volume and outcome in NVUGIB patients was observed. Referral to HVC for the management of high-risk NVUGIB patients should be considered in clinical practice.

Dating Violence among High-Risk Young Women: A Systematic Review Using Quantitative and Qualitative Methods

Science.gov (United States)

Joly, Lauren E.; Connolly, Jennifer

2016-01-01

Our systematic review identified 21 quantitative articles and eight qualitative articles addressing dating violence among high risk young women. The groups of high-risk young women in this review include street-involved, justice-involved, pregnant or parenting, involved with Child Protective Services, and youth diagnosed with a mental health issue. Our meta-analysis of the quantitative articles indicated that 34% (CI = 0.24–0.45) of high-risk young women report that they have been victims of physical dating violence and 45% (CI = 0.31–0.61) of these young women report perpetrating physical dating violence. Significant moderator variables included questionnaire and timeframe. Meta-synthesis of the qualitative studies revealed that high-risk young women report perpetrating dating violence to gain power and respect, whereas women report becoming victims of dating violence due to increased vulnerability. PMID:26840336

Dating Violence among High-Risk Young Women: A Systematic Review Using Quantitative and Qualitative Methods

Directory of Open Access Journals (Sweden)

Lauren E. Joly

2016-01-01

Full Text Available Our systematic review identified 21 quantitative articles and eight qualitative articles addressing dating violence among high risk young women. The groups of high-risk young women in this review include street-involved, justice-involved, pregnant or parenting, involved with Child Protective Services, and youth diagnosed with a mental health issue. Our meta-analysis of the quantitative articles indicated that 34% (CI = 0.24–0.45 of high-risk young women report that they have been victims of physical dating violence and 45% (CI = 0.31–0.61 of these young women report perpetrating physical dating violence. Significant moderator variables included questionnaire and timeframe. Meta-synthesis of the qualitative studies revealed that high-risk young women report perpetrating dating violence to gain power and respect, whereas women report becoming victims of dating violence due to increased vulnerability.

Chromosomal imbalance in the progression of high-risk non-muscle invasive bladder cancer

International Nuclear Information System (INIS)

Zieger, Karsten; Wiuf, Carsten; Jensen, Klaus Møller-Ernst; Ørntoft, Torben Falck; Dyrskjøt, Lars

2009-01-01

(stage T1 or high-grade), but did not predict subsequent progression. Recurrences after 'high-risk' tumors had fewer chromosomal alterations, but there was no association with the risk of progression in this group either. Thus, the prediction of progression of 'high risk' non-muscle invasive bladder tumors using chromosomal changes is difficult. Loss of chromosome 8p11 may play a role in the progression process. About 25% of the 'high risk' tumors were chromosomal stable

An Intra-Group Perspective on Leader Preferences

DEFF Research Database (Denmark)

Bøggild, Troels; Laustsen, Lasse

2016-01-01

This article argues that followers’ preferences for dominant leadership vary according to two types of exploitation risks from other individuals within the group. Previous work demonstrates that contexts of inter-group war and peace make followers prefer dominant- and non-dominant-looking leaders......, respectively. We add an intra-group perspective to this literature. Four original studies demonstrate that contexts with high risks of free-riding and criminal behavior from other group members (i.e., horizontal exploitation) increase preferences for dominant-looking leaders, whereas contexts with high risks...... of unresponsive, self-interested behavior from leaders themselves (i.e., vertical exploitation) decrease preferences for dominant-looking leaders. Moreover, within this framework of intra-group exploitation risks we show that followers prefer leaders from another vis-à-vis their own ethnic coalition to look less...

Impact of sickle cell trait on the thrombotic risk associated with non-O blood groups in northern Nigeria.

Science.gov (United States)

Ahmed, Sagir G; Kagu, Modu B; Ibrahim, Umma A; Bukar, Audu A

2015-10-01

The non-O blood group is an established risk factor for deep vein thrombosis (DVT), while controversy surrounds the role of sickle cell trait (SCT) as a risk factor for DVT. We hypothesised that if SCT is a risk factor for DVT, individuals with non-O blood groups and SCT (Hb AS) would have a higher risk of DVT than their counterparts with non-O blood groups and normal haemoglobin phenotype (Hb AA). We retrospectively analysed the prevalence of SCT and non-O blood groups among 148 DVT patients with control subjects in order to determine the role of SCT as a risk factor for DVT and its impact on the risk of DVT among patients with non-O blood groups. In comparison with control subjects, DVT patients had significantly higher prevalences of SCT (35.1% vs 27.7%, p=0.04) and non-O blood groups (68.9% vs 45.9%, p=0.02). The odds ratios for DVT due to SCT, non-O blood groups with normal Hb phenotype (Hb AA) and non-O blood groups with SCT (Hb AS) were 1.3, 2.4 and 3.5, respectively. These results suggest that SCT by itself is a weak risk factor for DVT but it has the potential of escalating the DVT risk among patients with non-O blood groups. The combined effects of elevated clotting factors (non-O group effect) and increased clotting factor activation (SCT effect) were responsible for the escalated DVT risk among patients with co-inheritance of non-O blood groups and SCT. Co-inheritance of SCT and non-O blood group is, therefore, an important mixed risk factor for DVT. This should be taken into account when assessing DVT risk profiles of patients in Africa and other parts of the world where the SCT is prevalent.

Modifiable risk factors for Alzheimer disease and subjective memory impairment across age groups.

Science.gov (United States)

Chen, Stephen T; Siddarth, Prabha; Ercoli, Linda M; Merrill, David A; Torres-Gil, Fernando; Small, Gary W

2014-01-01

Previous research has identified modifiable risk factors for Alzheimer's disease (AD) in older adults. Research is limited on the potential link between these risk factors and subjective memory impairment (SMI), which may precede AD and other dementias. Examination of these potential relationships may help identify those at risk for AD at a stage when interventions may delay or prevent further memory problems. The objective of this study was to determine whether risk factors for AD are associated with SMI among different age groups. Trained interviewers conducted daily telephone surveys (Gallup-Healthways) of a representative community sample of 18,614 U.S. respondents, including 4,425 younger (age 18 to 39 years), 6,365 middle-aged (40 to 59 years), and 7,824 older (60 to 99 years) adults. The surveyors collected data on demographics, lifestyles, and medical information. Less education, smoking, hypertension, diabetes, less exercise, obesity and depression, and interactions among them, were examined for associations with SMI. Weighted logistic regressions and chi-square tests were used to calculate odds ratios and confidence intervals for SMI with each risk factor and pairwise interactions across age groups. Depression, less education, less exercise, and hypertension were significantly associated with SMI in all three age groups. Several interactions between risk factors were significant in younger and middle-aged adults and influenced their associations with SMI. Frequency of SMI increased with age and number of risk factors. Odds of having SMI increased significantly with just having one risk factor. These results indicate that modifiable risk factors for AD are also associated with SMI, suggesting that these relationships occur in a broad range of ages and may be targeted to mitigate further memory problems. Whether modifying these risk factors reduces SMI and the eventual incidence of AD and other dementias later in life remains to be determined.

Modifiable risk factors for Alzheimer disease and subjective memory impairment across age groups.

Directory of Open Access Journals (Sweden)

Stephen T Chen

Full Text Available INTRODUCTION: Previous research has identified modifiable risk factors for Alzheimer's disease (AD in older adults. Research is limited on the potential link between these risk factors and subjective memory impairment (SMI, which may precede AD and other dementias. Examination of these potential relationships may help identify those at risk for AD at a stage when interventions may delay or prevent further memory problems. The objective of this study was to determine whether risk factors for AD are associated with SMI among different age groups. METHOD: Trained interviewers conducted daily telephone surveys (Gallup-Healthways of a representative community sample of 18,614 U.S. respondents, including 4,425 younger (age 18 to 39 years, 6,365 middle-aged (40 to 59 years, and 7,824 older (60 to 99 years adults. The surveyors collected data on demographics, lifestyles, and medical information. Less education, smoking, hypertension, diabetes, less exercise, obesity and depression, and interactions among them, were examined for associations with SMI. Weighted logistic regressions and chi-square tests were used to calculate odds ratios and confidence intervals for SMI with each risk factor and pairwise interactions across age groups. RESULTS: Depression, less education, less exercise, and hypertension were significantly associated with SMI in all three age groups. Several interactions between risk factors were significant in younger and middle-aged adults and influenced their associations with SMI. Frequency of SMI increased with age and number of risk factors. Odds of having SMI increased significantly with just having one risk factor. CONCLUSIONS: These results indicate that modifiable risk factors for AD are also associated with SMI, suggesting that these relationships occur in a broad range of ages and may be targeted to mitigate further memory problems. Whether modifying these risk factors reduces SMI and the eventual incidence of AD and other

High-Risk Driving Behaviors among Adolescent Binge-Drinkers

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Marcotte, Thomas D.; Bekman, Nicole M.; Meyer, Rachel A.; Brown, Sandra A.

2013-01-01

Background Binge drinking is common among adolescents. Alcohol use, and binge-drinking in particular, has been associated with neurocognitive deficits as well as risk-taking behaviors, which may contribute to negative driving outcomes among adolescents even while sober. Objectives To examine differences in self-reported driving behaviors between adolescent binge-drinkers and a matched sample of controls, including (a) compliance with graduated licensing laws, (b) high risk driving behaviors, and (c) driving outcomes (crashes, traffic tickets). Methods The present study examined driving behaviors and outcomes in adolescent recent binge drinkers (n=21) and demographically and driving history matched controls (n=17), ages 16-18. Results Binge drinkers more frequently violated graduated licensing laws (e.g., driving late at night), and engaged in more “high risk” driving behaviors, such as speeding and using a cell-phone while driving. Binge drinkers had more traffic tickets, crashes and “near crashes” than the control group. In a multivariate analysis, binge drinker status and speeding were the most robust predictors of a crash. Conclusion Binge drinking teens consistently engage in more dangerous driving behaviors and experience more frequent crashes and traffic tickets. They are also less compliant with preventative restrictions placed on youth while they are learning critical safe driving skills. Scientific Significance These findings highlight a need to examine the contribution of underlying traits (such as sensation seeking) and binge-related cognitive changes to these high-risk driving behaviors, which may assist researchers in establishing alternative prevention and policy efforts targeting this population. PMID:22324748

Drinking and driving among high-risk young Mexican-American men.

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Fiorentino, Dary D; Berger, Dale E; Ramirez, Juan R

2007-01-01

Determinants of driving under the influence of alcohol (DUI) were explored among a sample of relatively young Mexican-American males with limited income and education, high levels of alcohol consumption, and regular vehicle use. Data were collected using questionnaires (N=104) and focus groups (N=27), including a focus group with wives and girlfriends (N=4). Four mechanisms that may contribute to the high rate of DUI behavior in this population were identified: (1) a subculture of permissiveness toward drinking and driving for men, (2) heavy drinking, promoted by machismo and a propensity to measure masculinity with alcohol intake, (3) inadequate knowledge of DUI statutes and inadequate understanding of the relationships between BAC, impairment, and crash risk, and (4) for undocumented drivers, lack of accountability in case of an alcohol-related incident.

Deficits in implicit attention to social signals in schizophrenia and high risk groups: behavioural evidence from a new illusion.

Directory of Open Access Journals (Sweden)

Mascha van 't Wout

Full Text Available BACKGROUND: An increasing body of evidence suggests that the apparent social impairments observed in schizophrenia may arise from deficits in social cognitive processing capacities. The ability to process basic social cues, such as gaze direction and biological motion, effortlessly and implicitly is thought to be a prerequisite for establishing successful social interactions and for construing a sense of "social intuition." However, studies that address the ability to effortlessly process basic social cues in schizophrenia are lacking. Because social cognitive processing deficits may be part of the genetic vulnerability for schizophrenia, we also investigated two groups that have been shown to be at increased risk of developing schizophrenia-spectrum pathology: first-degree relatives of schizophrenia patients and men with Klinefelter syndrome (47,XXY. RESULTS: We compared 28 patients with schizophrenia, 29 siblings of patients with schizophrenia, and 29 individuals with Klinefelter syndrome with 46 matched healthy control subjects on a new paradigm. This paradigm measures one's susceptibility for a bias in distance estimation between two agents that is induced by the implicit processing of gaze direction and biological motion conveyed by these agents. Compared to control subjects, patients with schizophrenia, as well as siblings of patients and Klinefelter men, showed a lack of influence of social cues on their distance judgments. CONCLUSIONS: We suggest that the insensitivity for social cues is a cognitive aspect of schizophrenia that may be seen as an endophenotype as it appears to be present both in relatives who are at increased genetic risk and in a genetic disorder at risk for schizophrenia-spectrum psychopathology. These social cue-processing deficits could contribute, in part, to the difficulties in higher order social cognitive tasks and, hence, to decreased social competence that has been observed in these groups.

Deficits in implicit attention to social signals in schizophrenia and high risk groups: behavioural evidence from a new illusion.

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van 't Wout, Mascha; van Rijn, Sophie; Jellema, Tjeerd; Kahn, René S; Aleman, André

2009-01-01

An increasing body of evidence suggests that the apparent social impairments observed in schizophrenia may arise from deficits in social cognitive processing capacities. The ability to process basic social cues, such as gaze direction and biological motion, effortlessly and implicitly is thought to be a prerequisite for establishing successful social interactions and for construing a sense of "social intuition." However, studies that address the ability to effortlessly process basic social cues in schizophrenia are lacking. Because social cognitive processing deficits may be part of the genetic vulnerability for schizophrenia, we also investigated two groups that have been shown to be at increased risk of developing schizophrenia-spectrum pathology: first-degree relatives of schizophrenia patients and men with Klinefelter syndrome (47,XXY). We compared 28 patients with schizophrenia, 29 siblings of patients with schizophrenia, and 29 individuals with Klinefelter syndrome with 46 matched healthy control subjects on a new paradigm. This paradigm measures one's susceptibility for a bias in distance estimation between two agents that is induced by the implicit processing of gaze direction and biological motion conveyed by these agents. Compared to control subjects, patients with schizophrenia, as well as siblings of patients and Klinefelter men, showed a lack of influence of social cues on their distance judgments. We suggest that the insensitivity for social cues is a cognitive aspect of schizophrenia that may be seen as an endophenotype as it appears to be present both in relatives who are at increased genetic risk and in a genetic disorder at risk for schizophrenia-spectrum psychopathology. These social cue-processing deficits could contribute, in part, to the difficulties in higher order social cognitive tasks and, hence, to decreased social competence that has been observed in these groups.

Lifestyle behaviors and ethnic identity among diverse women at high risk for type 2 diabetes.

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Brown, Susan D; Ehrlich, Samantha F; Kubo, Ai; Tsai, Ai-Lin; Hedderson, Monique M; Quesenberry, Charles P; Ferrara, Assiamira

2016-07-01

Diet and physical activity lifestyle behaviors are modifiable risk factors for type 2 diabetes and are shaped by culture, potentially influencing diabetes health disparities. We examined whether ethnic identity-the strength of attachment to one's ethnic group, and a long-standing focus of psychological research-could help account for variations in lifestyle behaviors within a diverse population at high risk for chronic disease. Using data from the Gestational Diabetes' Effects on Moms trial, this US-based cross-sectional study included 1463 pregnant women (74% from minority ethnic/racial groups; 46% born outside the US) with gestational diabetes (GDM), a common pregnancy complication conferring high risk for type 2 diabetes after delivery. Mixed linear regression models examined whether ethnic identity is associated with lifestyle behaviors after adjusting for demographic, clinical, and acculturative characteristics (e.g., nativity and length of residence in the US). In the overall sample, a one-unit increase in ethnic identity score was significantly associated with 3% greater fiber intake, 4% greater fruit/vegetable intake, 11% greater total activity, and 11% greater walking (p values ethnic/racial groups, a one-unit increase in ethnic identity score was significantly associated with 17% greater fiber intake among Filipina women; 5% lower total caloric intake among non-Hispanic White women; and 40% greater total activity, 35% greater walking, and 8% greater total caloric intake among Latina women (p values ≤ 0.03). Results from this large study suggest that ethnic group attachment is associated with some lifestyle behaviors, independent of acculturation indicators, among young women with GDM who are at high risk for type 2 diabetes. Stronger ethnic identity may promote certain choices known to be associated with reduced risk of type 2 diabetes. Prospective research is needed to clarify the temporal nature of associations between ethnic identity and

Pathologic Findings at Risk-Reducing Salpingo-Oophorectomy: Primary Results From Gynecologic Oncology Group Trial GOG-0199

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Sherman, Mark E.; Piedmonte, Marion; Mai, Phuong L.; Ioffe, Olga B.; Ronnett, Brigitte M.; Van Le, Linda; Ivanov, Iouri; Bell, Maria C.; Blank, Stephanie V.; DiSilvestro, Paul; Hamilton, Chad A.; Tewari, Krishnansu S.; Wakeley, Katie; Kauff, Noah D.; Yamada, S. Diane; Rodriguez, Gustavo; Skates, Steven J.; Alberts, David S.; Walker, Joan L.; Minasian, Lori; Lu, Karen; Greene, Mark H.

2014-01-01

Purpose Risk-reducing salpingo-oophorectomy (RRSO) lowers mortality from ovarian/tubal and breast cancers among BRCA1/2 mutation carriers. Uncertainties persist regarding potential benefits of RRSO among high-risk noncarriers, optimal surgical age, and anatomic origin of clinically occult cancers detected at surgery. To address these topics, we analyzed surgical treatment arm results from Gynecologic Oncology Group Protocol-0199 (GOG-0199), the National Ovarian Cancer Prevention and Early Detection Study. Participants and Methods This analysis included asymptomatic high-risk women age ≥ 30 years who elected RRSO at enrollment. Women provided risk factor data and underwent preoperative cancer antigen 125 (CA-125) serum testing and transvaginal ultrasound (TVU). RRSO specimens were processed according to a standardized tissue processing protocol and underwent central pathology panel review. Research-based BRCA1/2 mutation testing was performed when a participant's mutation status was unknown at enrollment. Relationships between participant characteristics and diagnostic findings were assessed using univariable statistics and multivariable logistic regression. Results Invasive or intraepithelial ovarian/tubal/peritoneal neoplasms were detected in 25 (2.6%) of 966 RRSOs (BRCA1 mutation carriers, 4.6%; BRCA2 carriers, 3.5%; and noncarriers, 0.5%; P < .001). In multivariable models, positive BRCA1/2 mutation status (P = .0056), postmenopausal status (P = .0023), and abnormal CA-125 levels and/or TVU examinations (P < .001) were associated with detection of clinically occult neoplasms at RRSO. For 387 women with negative BRCA1/2 mutation testing and normal CA-125 levels, findings at RRSO were benign. Conclusion Clinically occult cancer was detected among 2.6% of high-risk women undergoing RRSO. BRCA1/2 mutation, postmenopausal status, and abnormal preoperative CA-125 and/or TVU were associated with cancer detection at RRSO. These data can inform management decisions

Risk-avoidance or utmost commitment. : Dutch focus group research on views on cohabitation and marriage.

Directory of Open Access Journals (Sweden)

Renske Keizer

2015-02-01

Full Text Available Background: Dutch adults grew up in a highly individualized country, characterized by high divorce rates, which may have influenced their views on cohabitation and marriage. Objective: We examine Dutch adults' perceptions of how similar or different cohabitation and marriage are, whether they believe that cohabitation would be a strategy to avoid the risk of divorce, as well as their views on why people marry in individualized societies. Methods: We analyze seven focus group interviews with 40 Dutch participants, collected in 2012 in Rotterdam, the Netherlands. Results: Many participants discussed differences and similarities between cohabitation and marriage in a context of high divorce rates, and frequently viewed cohabitation as a risk-reduction strategy. At the same time, marriage was often seen as ―the real deal‖, in terms of legal arrangements, but also as a symbol of utmost commitment. Less educated participants viewed more financial advantages in cohabitation compared to marriage, and felt more strongly about the symbolic value of marriage than their highly educated counterparts. There was strong consensus that there is not, and should not be, a social norm to marry. Conclusions: In a context of high relationship instability, cohabitation has become a risk-reduction strategy. When norms to marry are weak, people may marry in order to emphasize the uniqueness of their relationship. However, the individualistic nature of Dutch society is mirrored in respondents' reluctance to set standards or proscribe norms on why and when to marry and their emphasis that cohabitation can also imply high levels of commitment.

A low socio-economic status is an additional risk factor for glucose intolerance in high risk Hong Kong Chinese

International Nuclear Information System (INIS)

Ko, Gary T.C.; Chan, Juliana C.N.; Yeung, Vincent T.F.; Chow, Chun-Chung; Tsang, Lynn W.W.; Cockram, Clive S.

2001-01-01

To examine whether a low socio-economic status (SES) is an additional risk factor for glucose intolerance in Hong Kong Chinese with known risk factors for glucose intolerance, a total of 2847 Chinese subjects (473 men and 2374 women) were recruited from the community for assessment. They had known risk factors for glucose intolerance including a previous history of gestational diabetes, positive family history of diabetes in first degree relatives and equivocal fasting plasma glucose concentrations between 7 and 8 mmol/l or random plasma glucose concentrations between 8 and 11 mmol/l. The 2847 subjects were classified according to their education levels and occupations: education group 1 = high school or university, group 2 = middle school, group 3 = illiterate or up to elementary school; occupational group 1 = professional or managerial, group 2 = non-manual, group 3 = manual, group 4 = unskilled, group 5 = housewife or unemployed. Different socio-economic groups were well represented in this selected population. The distribution of educational groups in this study was similar to that recorded in the 1991 Hong Kong Census. When analysed according to education levels and after adjustment for age, women in the lowest social class had the highest prevalence of diabetes, body mass index, blood pressure and plasma glucose concentrations. Men with the lowest education level had the highest prevalence of diabetes after age adjustment. The age-adjusted odds ratio (95% confidence intervals) of having diabetes was 2.3 (1.3, 4.3) in female subjects and 2.5 (1.2, 5.4) in male subjects with the lowest SES compared to subjects with the highest SES. When categorised according to occupation and after adjustment for age, women in the lowest social class had the highest prevalence of diabetes and glycaemic indexes. The age-adjusted odds ratio of having diabetes was 4.5 (1.9, 10.9) in female subjects with the lowest SES compared to those with the highest SES. The corresponding age

Tumor mutational load and immune parameters across metastatic Renal Cell Carcinoma (mRCC) risk groups

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de Velasco, Guillermo; Miao, Diana; Voss, Martin H.; Hakimi, A. Ari; Hsieh, James J.; Tannir, Nizar M.; Tamboli, Pheroze; Appleman, Leonard J.; Rathmell, W. Kimryn; Van Allen, Eliezer M.; Choueiri, Toni K.

2016-01-01

Patients with metastatic renal cell carcinoma (mRCC) have better overall survival when treated with nivolumab, a cancer immunotherapy that targets the immune checkpoint inhibitor programmed cell death 1 (PD-1), rather than everolimus (a chemical inhibitor of mTOR and immunosuppressant). Poor-risk mRCC patients treated with nivolumab seemed to experience the greatest overall survival benefit, compared to patients with favorable or intermediate-risk, in an analysis of the CheckMate-025 trial subgroup of the Memorial Sloan Kettering Cancer Center (MSKCC) prognostic risk groups. Here we explore whether tumor mutational load and RNA expression of specific immune parameters could be segregated by prognostic MSKCC risk strata and explain the survival seen in the poor-risk group. We queried whole exome transcriptome data in RCC patients (n = 54) included in The Cancer Genome Atlas that ultimately developed metastatic disease or were diagnosed with metastatic disease at presentation and did not receive immune checkpoint inhibitors. Nonsynonymous mutational load did not differ significantly by MSKCC risk group, nor was the expression of cytolytic genes –granzyme A and perforin – or selected immune checkpoint molecules different across MSKCC risk groups. In conclusion, this analysis found that mutational load and expression of markers of an active tumor microenvironment did not correlate with MSKCC risk prognostic classification in mRCC. PMID:27538576

Risk perception in an interest group context: an examination of the TMI restart issue

International Nuclear Information System (INIS)

Soderstrom, E.J.; Sorensen, J.H.; Copenhaver, E.D.; Carnes, S.A.

1984-01-01

Human response to environmental hazards and risks has been the subject of considerable research by social scientists. Work has traditionally focused on either individual response to the risks of an ongoing or future threat (hazards research), or group and organizational response to a specific disaster event (disaster research). As part of a larger investigation of the restart of the Unit 1 reactor at Three Mile Island (TMI), the response of interest groups active in the restart issue to the continued threat of TMI and to future risks due to restart was examined. After reviewing the restart issue in general, the local dimensions of the restart issue from interest group perspectives are discussed. A method for defining appropriate issues at the community level is reviewed. Differences in the perceived local impacts of alternative decisions, and systems of beliefs associated with differing perceptions are discussed. Finally, the implications of interest group versus individual perceptions of local issues for decision making about TMI, in particular, and about technological hazards management, in general, are discussed. Associated implications for determining socially acceptable risk levels are identified

Identifying drug risk perceptions in Danish youths: Ranking exercises in focus groups

DEFF Research Database (Denmark)

Demant, Jakob; Ravn, Signe

2010-01-01

Abstract: Background: This paper develops an analytical approach for understanding the perceptions of risks associated with drugs among youths in general. These perceptions are central in order to understand how certain drugs become popular, leading to increasing prevalence of use, while others do...... not. As such, this approach can become an efficient policy tool. Methods: Focus groups are used to investigate risk perceptions. We develop a specific methodology that combines a ranking exercise with discourse theory as an analytical approach. This methodology produces detailed information...... and provides a relatively efficient way of investigating normative risk perceptions at a national or subcultural level. The paper develops this methodology in relation to a Danish case with 12 focus group interviews with youths aged from 17 to 22. Results: The analysis identifies five discourses articulated...

Identifying drug risk perceptions in Danish youths: Ranking exercises in focus groups

DEFF Research Database (Denmark)

Demant, Jakob Johan; Ravn, Signe

2010-01-01

not. As such, this approach can become an efficient policy tool. Methods: Focus groups are used to investigate risk perceptions. We develop a specific methodology that combines a ranking exercise with discourse theory as an analytical approach. This methodology produces detailed information......Abstract: Background: This paper develops an analytical approach for understanding the perceptions of risks associated with drugs among youths in general. These perceptions are central in order to understand how certain drugs become popular, leading to increasing prevalence of use, while others do...... and provides a relatively efficient way of investigating normative risk perceptions at a national or subcultural level. The paper develops this methodology in relation to a Danish case with 12 focus group interviews with youths aged from 17 to 22. Results: The analysis identifies five discourses articulated...

ABO blood group and esophageal carcinoma risk: from a case-control study in Chinese population to meta-analysis.

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Wang, Wei; Liu, Lei; Wang, Zhiwei; Lu, Xiaopeng; Wei, Min; Lin, Tianlong; Zhang, Yixin; Jiang, Songqi; Wang, Qiang; Cao, Ziang; Shi, Minxin

2014-10-01

The association between ABO blood group and the risk of esophageal carcinoma (EC) in previously published studies is uncertain and conflicting. The aim of the current study was to determine the correlation of ABO blood group with EC risk via a case-control study and meta-analysis. We performed a population-based case-control study of 3,595 cases and 41,788 controls in Chinese population to evaluate the association between ABO blood group and EC risk. Then, a comprehensive meta-analysis combining our original data and previously published data was conducted to clearly discern the real relationship. The strength of association was measured by odds ratios (ORs) with 95% confidence intervals (CI). In our case-control study, the risk of EC in blood group B was significantly higher than that in non-B groups (A, O, and AB) (OR = 1.15, 95% CI 1.09-1.21). Compared with non-O groups (A, B, and AB), individuals with blood group O demonstrated a reduced risk of EC (OR = 0.90, 95% CI 0.85-0.94). The meta-analysis also indicated that blood group B was associated with significantly higher EC risk (OR = 1.20, 95% CI 1.10-1.31), and people with blood group O had a decreased EC risk (OR = 0.94, 95% CI 0.90-0.99). Neither the case-control study nor the meta-analysis produced any significant association of blood group A or AB with EC risk. Results from our case-control study and the followed meta-analysis confirmed that there was an increased risk of EC in blood group B individuals, whereas a decreased risk of EC was observed in blood group O individuals.

Variation in the risk for liver and gallbladder cancers in socioeconomic and occupational groups in Sweden with etiological implications.

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Ji, Jianguang; Hemminki, Kari

2005-09-01

To examine the associations between socioeconomic/occupational factors and liver cancer at various anatomic sites (including primary liver, gallbladder and other cancers). We carried out a follow-up study on the economically active Swedish population, based on the Swedish Family-Cancer Database. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated in different social classes and occupations. For primary liver cancer, farmers were at a decreased risk; increased risks were observed for male sales agents, journalists, seamen, waiters, cooks and female beverage manufacture workers. Similar patterns were observed for gallbladder cancer; workers employed as journalists, sales agents, cooks and stewards, and public safety workers showed increased risk. Only male transport workers showed increased risk of cancers in other parts. Occupations with high consumption of alcohol and/or high prevalence of smoking associated with a risk of liver and gallbladder cancers. The present study suggests that the effects of socioeconomic factors on liver cancer of different subsites are similar; alcohol drinking is a risk factor of gallbladder cancer because of the covariation of primary liver and gallbladder cancers in occupational groups.

International consensus for neuroblastoma molecular diagnostics: report from the International Neuroblastoma Risk Group (INRG) Biology Committee

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Ambros, P F; Ambros, I M; Brodeur, G M; Haber, M; Khan, J; Nakagawara, A; Schleiermacher, G; Speleman, F; Spitz, R; London, W B; Cohn, S L; Pearson, A D J; Maris, J M

2009-01-01

Neuroblastoma serves as a paradigm for utilising tumour genomic data for determining patient prognosis and treatment allocation. However, before the establishment of the International Neuroblastoma Risk Group (INRG) Task Force in 2004, international consensus on markers, methodology, and data interpretation did not exist, compromising the reliability of decisive genetic markers and inhibiting translational research efforts. The objectives of the INRG Biology Committee were to identify highly prognostic genetic aberrations to be included in the new INRG risk classification schema and to develop precise definitions, decisive biomarkers, and technique standardisation. The review of the INRG database (n=8800 patients) by the INRG Task Force finally enabled the identification of the most significant neuroblastoma biomarkers. In addition, the Biology Committee compared the standard operating procedures of different cooperative groups to arrive at international consensus for methodology, nomenclature, and future directions. Consensus was reached to include MYCN status, 11q23 allelic status, and ploidy in the INRG classification system on the basis of an evidence-based review of the INRG database. Standardised operating procedures for analysing these genetic factors were adopted, and criteria for proper nomenclature were developed. Neuroblastoma treatment planning is highly dependant on tumour cell genomic features, and it is likely that a comprehensive panel of DNA-based biomarkers will be used in future risk assignment algorithms applying genome-wide techniques. Consensus on methodology and interpretation is essential for uniform INRG classification and will greatly facilitate international and cooperative clinical and translational research studies. PMID:19401703

Patients at High-Risk for Surgical Site Infection.

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Mueck, Krislynn M; Kao, Lillian S

Surgical site infections (SSIs) are a significant healthcare quality issue, resulting in increased morbidity, disability, length of stay, resource utilization, and costs. Identification of high-risk patients may improve pre-operative counseling, inform resource utilization, and allow modifications in peri-operative management to optimize outcomes. Review of the pertinent English-language literature. High-risk surgical patients may be identified on the basis of individual risk factors or combinations of factors. In particular, statistical models and risk calculators may be useful in predicting infectious risks, both in general and for SSIs. These models differ in the number of variables; inclusion of pre-operative, intra-operative, or post-operative variables; ease of calculation; and specificity for particular procedures. Furthermore, the models differ in their accuracy in stratifying risk. Biomarkers may be a promising way to identify patients at high risk of infectious complications. Although multiple strategies exist for identifying surgical patients at high risk for SSIs, no one strategy is superior for all patients. Further efforts are necessary to determine if risk stratification in combination with risk modification can reduce SSIs in these patient populations.

Supplementary arteriel embolization an option in high-risk ulcer bleeding--a randomized study.

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Laursen, Stig Borbjerg; Hansen, Jane Møller; Andersen, Poul Erik; Schaffalitzky de Muckadell, Ove B

2014-01-01

One of the major challenges in peptic ulcer bleeding (PUB) is rebleeding which is associated with up to a fivefold increase in mortality. We examined if supplementary transcatheter arterial embolization (STAE) performed after achieved endoscopic hemostasis improves outcome in patients with high-risk ulcers. The study was designed as a non-blinded, parallel group, randomized-controlled trial and performed in a university hospital setting. Patients admitted with PUB from Forrest Ia - IIb ulcers controlled by endoscopic therapy were randomized (1:1 ratio) to STAE of the bleeding artery within 24 h or continued standard treatment. Randomization was stratified according to stigmata of hemorrhage. Patients were followed for 30 days. Primary outcome was a composite endpoint where patients were classified into five groups based on transfusion requirement, development of rebleeding, need of hemostatic intervention and mortality. Secondary outcomes were rebleeding, number of blood transfusions received, duration of admission and mortality. Totally 105 patients were included. Of the 49 patients allocated to STAE 31 underwent successful STAE. There was no difference in composite endpoint. Two versus eight patients re-bled in the STAE and control group, respectively (Intention-to-treat analysis; p = .10). After adjustment for possible imbalances a strong trend was noted between STAE and rate of rebleeding (p = .079). STAE is potentially useful for preventing rebleeding in high-risk PUB. STAE can safely be performed in selected cases with high risk of rebleeding. Further studies are needed in order to confirm these findings; ClincialTrials.gov number, NCT01125852.

Genetic Alterations and Their Clinical Implications in High-Recurrence Risk Papillary Thyroid Cancer.

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Lee, Min-Young; Ku, Bo Mi; Kim, Hae Su; Lee, Ji Yun; Lim, Sung Hee; Sun, Jong-Mu; Lee, Se-Hoon; Park, Keunchil; Oh, Young Lyun; Hong, Mineui; Jeong, Han-Sin; Son, Young-Ik; Baek, Chung-Hwan; Ahn, Myung-Ju

2017-10-01

Papillary thyroid carcinomas (PTCs) frequently involve genetic alterations. The objective of this study was to investigate genetic alterations and further explore the relationships between these genetic alterations and clinicopathological characteristics in a high-recurrence risk (node positive, N1) PTC group. Tumor tissue blocks were obtained from 240 surgically resected patients with histologically confirmed stage III/IV (pT3/4 or N1) PTCs. We screened gene fusions using NanoString's nCounter technology and mutational analysis was performed by direct DNA sequencing. Data describing the clinicopathological characteristics and clinical courses were retrospectively collected. Of the 240 PTC patients, 207 (86.3%) had at least one genetic alteration, including BRAF mutation in 190 patients (79.2%), PIK3CA mutation in 25 patients (10.4%), NTRK1/3 fusion in six patients (2.5%), and RET fusion in 24 patients (10.0%). Concomitant presence of more than two genetic alterations was seen in 36 patients (15%). PTCs harboring BRAF mutation were associated with RET wild-type expression (p=0.001). RET fusion genes have been found to occur with significantly higher frequency in N1b stage patients (p=0.003) or groups of patients aged 45 years or older (p=0.031); however, no significant correlation was found between other genetic alterations. There was no trend toward favorable recurrence-free survival or overall survival among patients lacking genetic alterations. In the selected high-recurrence risk PTC group, most patients had more than one genetic alteration. However, these known alterations could not entirely account for clinicopathological features of high-recurrence risk PTC.

Work and diet-related risk factors of cardiovascular diseases: comparison of two occupational groups.

Science.gov (United States)

Hartung, Danielle; Stadeler, Martina; Grieshaber, Romano; Keller, Sylvia; Jahreis, Gerhard

2010-03-22

Although work related risk factors associated with Cardiovascular Diseases (CD) have been well researched, there is no detailed knowledge regarding disparate occupational groups each with a different risk exposition. Therefore, two occupational groups (chefs and office workers) were compared with a focus on nutritional and psychosocial factors. Two groups of subjects were tested for work and diet-related risks of CD (45 chefs and 48 office workers). The groups matched both for gender (male) and age (30 to 45 years). The study included a medical check-up, bioelectrical impedance analysis as well as an evaluation of questionnaires on health, nutritional behaviour and coping capacity. In addition, volunteers were required to compile a 7-day-dietary-record and collect their urine 24 h prior to their check-up. Blood samples drawn were analysed for glucose and lipid metabolism, homocysteine, vitamin B12, folic acid; C-reactive protein, uric acid, red blood cell fatty acids, plant sterols, antioxidative capacity and oxidative stress. On average, the chefs showed one risk factor more compared to the office workers. The most frequent risk factors in both groups included overweight/obesity (chef group [CG]: 62.2%; office group [OG]: 58.3%) and elevated TC (CG: 62.2%; OG: 43.8%]. Moreover, although the chefs often had higher CRP-concentrations (40.0%), more office workers suffered from hypertension (37.5%).Chefs showed significant higher concentrations of saturated fatty acids and oleic acid, whereas docosahexaenoic acid, Omega-6- and trans fatty acids were found more frequently in the red blood cell membranes of office workers. While there were no significant differences in analysed plant sterols between the two occupational groups, 7,8-dihydro-8-oxo-2'-deoxyguanosine was significantly increased in office workers.Concerning the work-related psychosocial factors, the chefs were characterised by a stronger subjective importance of work, a greater degree of professional

Is High Sexual Desire a Risk for Women's Relationship and Sexual Well-Being?

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Štulhofer, Aleksandar; Bergeron, Sophie; Jurin, Tanja

2016-09-01

Historically, women's sexual desire has been deemed socially problematic. The growing popularity of the concept of hypersexuality-which lists high sexual desire among its core components-poses a risk of re-pathologizing female sexual desire. Data from a 2014 online survey of 2,599 Croatian women aged 18-60 years was used to examine whether high sexual desire is detrimental to women's relationship and sexual well-being. Based on the highest scores on an indicator of sexual desire, 178 women were classified in the high sexual desire (HSD) group; women who scored higher than one standard deviation above the Hypersexual Disorder Screening Inventory mean were categorized in the hypersexuality (HYP) group (n = 239). Fifty-seven women met the classification criteria for both groups (HYP&HSD). Compared to other groups, the HSD was the most sexually active group. Compared to controls, the HYP and HYP&HSD groups-but not the HSD group-reported significantly more negative consequences associated with their sexuality. Compared to the HYP group, women with HSD reported better sexual function, higher sexual satisfaction, and lower odds of negative behavioral consequences. The findings suggest that, at least among women, hypersexuality should not be conflated with high sexual desire and frequent sexual activity.

Hepatitis B/C in the countries of the EU/EEA: a systematic review of the prevalence among at-risk groups.

Science.gov (United States)

Falla, Abby May; Hofstraat, Sanne Henrietta Ina; Duffell, Erika; Hahné, Susan Josien Maria; Tavoschi, Lara; Veldhuijzen, Irene Karen

2018-02-12

In 2016, the World Health Organisation set a goal to eliminate viral hepatitis by 2030. Robust epidemiological information underpins all efforts to achieve elimination and this systematic review provides estimates of HBsAg and anti-HCV prevalence in the European Union/European Economic Area (EU/EEA) among three at-risk populations: people in prison, men who have sex with men (MSM), and people who inject drugs (PWID). Estimates of the prevalence among the three risk groups included in our study were derived from multiple sources. A systematic search of literature published during 2005-2015 was conducted without linguistic restrictions to identify studies among people in prison and HIV negative/HIV sero-status unknown MSM. National surveillance focal points were contacted to validate the search results. Studies were assessed for risk of bias and high quality estimates were pooled at country level. PWID data were extracted from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) repository. Despite gaps, we report 68 single study/pooled HBsAg/anti-HCV prevalence estimates covering 23/31 EU/EEA countries, 42 of which were of intermediate/high prevalence using the WHO endemicity threshold (of ≥2%). This includes 20 of the 23 estimates among PWID, 20 of the 28 high quality estimates among people in prison, and four of the 17 estimates among MSM. In general terms, the highest HBsAg prevalence was found among people in prison (range of 0.3% - 25.2%) followed by PWID (0.5% - 6.1%) and MSM (0.0% - 1.4%). The highest prevalence of anti-HCV was also found among people in prison (4.3% - 86.3%) and PWID (13.8% - 84.3%) followed by MSM (0.0% - 4.7%). Our results suggest prioritisation of PWID and the prison population as the key populations for HBV/HCV screening and treatment given their dynamic interaction and high prevalence. The findings of this study do not seem to strongly support the continued classification of MSM as a high risk group for chronic

Causes of death from the randomized CoreValve US Pivotal High-Risk Trial.

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Gaudiani, Vincent; Deeb, G Michael; Popma, Jeffrey J; Adams, David H; Gleason, Thomas G; Conte, John V; Zorn, George L; Hermiller, James B; Chetcuti, Stan; Mumtaz, Mubashir; Yakubov, Steven J; Kleiman, Neal S; Huang, Jian; Reardon, Michael J

2017-06-01

Explore causes and timing of death from the CoreValve US Pivotal High-Risk Trial. An independent clinical events committee adjudicated causes of death, followed by post hoc hierarchical classification. Baseline characteristics, early outcomes, and causes of death were evaluated for 3 time periods (selected based on threshold of surgical 30-day mortality and on the differences in the continuous hazard between the 2 groups): early (0-30 days), recovery (31-120 days), and late (121-365 days). Differences in the rate of death were evident only during the recovery period (31-120 days), whereas 15 patients undergoing transcatheter aortic valve replacement (TAVR) (4.0%) and 27 surgical aortic valve replacement (SAVR) patients (7.9%) died (P = .025). This mortality difference was largely driven by higher rates of technical failure, surgical complications, and lack of recovery following surgery. From 0 to 30 days, the causes of death were more technical failures in the TAVR group and lack of recovery in the SAVR group. Mortality in the late period (121-365 days) in both arms was most commonly ascribed to other circumstances, comprising death from medical complications from comorbid disease. Mortality at 1 year in the CoreValve US Pivotal High-Risk Trial favored TAVR over SAVR. The major contributor was that more SAVR patients died during the recovery period (31-121 days), likely affected by the overall influence of physical stress associated with surgery. Similar rates of technical failure and complications were observed between the 2 groups. This suggests that early TAVR results can improve with technical refinements and that high-risk surgical patients will benefit from reducing complications. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Consistent association of type 2 diabetes risk variants found in europeans in diverse racial and ethnic groups.

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Kevin M Waters

2010-08-01

Full Text Available It has been recently hypothesized that many of the signals detected in genome-wide association studies (GWAS to T2D and other diseases, despite being observed to common variants, might in fact result from causal mutations that are rare. One prediction of this hypothesis is that the allelic associations should be population-specific, as the causal mutations arose after the migrations that established different populations around the world. We selected 19 common variants found to be reproducibly associated to T2D risk in European populations and studied them in a large multiethnic case-control study (6,142 cases and 7,403 controls among men and women from 5 racial/ethnic groups (European Americans, African Americans, Latinos, Japanese Americans, and Native Hawaiians. In analysis pooled across ethnic groups, the allelic associations were in the same direction as the original report for all 19 variants, and 14 of the 19 were significantly associated with risk. In summing the number of risk alleles for each individual, the per-allele associations were highly statistically significant (P<10(-4 and similar in all populations (odds ratios 1.09-1.12 except in Japanese Americans the estimated effect per allele was larger than in the other populations (1.20; P(het = 3.8×10(-4. We did not observe ethnic differences in the distribution of risk that would explain the increased prevalence of type 2 diabetes in these groups as compared to European Americans. The consistency of allelic associations in diverse racial/ethnic groups is not predicted under the hypothesis of Goldstein regarding "synthetic associations" of rare mutations in T2D.

Risk assessment of occupational groups working in open pit mining: Analytic Hierarchy Process

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Yaşar Kasap

2017-01-01

Full Text Available In open pit mining it is possible to prevent industrial accidents and the results of industrial accidents such as deaths, physical disabilities and financial loss by implementing risk analyses in advance. If the probabilities of different occupational groups encountering various hazards are determined, workers’ risk of having industrial accidents and catching occupational illnesses can be controlled. In this sense, the aim of this study was to assess the industrial accidents which occurred during open pit coal production in the Turkish Coal Enterprises (TCE Garp Lignite unit between 2005 and 2010 and to analyze the risks using the Analytic Hierarchy Process (AHP. The analyses conducted with AHP revealed that the greatest risk in open pit mining is landslides, the most risky occupational group is unskilled labourers and the most common hazards are caused by landslides and transportation/hand tools/falling.

Different psychological effects of cannabis use in adolescents at genetic high risk for schizophrenia and with attention deficit/hyperactivity disorder (ADHD).

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Hollis, Chris; Groom, Madeleine J; Das, Debasis; Calton, Tim; Bates, Alan T; Andrews, Hayley K; Jackson, Georgina M; Liddle, Peter F

2008-10-01

Controversy exists regarding whether young people at risk for schizophrenia are at increased risk of adverse mental effects of cannabis use. We examined cannabis use and mental health functioning in three groups of young people aged 14-21; 36 non-psychotic siblings of adolescents with schizophrenia (genetic high risk group), 25 adolescents with attention deficit hyperactivity disorder (ADHD) and 72 healthy controls. The groups were sub-divided into 'users' and 'non-users' of cannabis based on how often they had used cannabis previously. Mental health functioning was quantified by creating a composite index derived from scores on the Schizotypal Personality Questionnaire (SPQ), Strengths and Difficulties Questionnaire (SDQ) and Global Assessment of Function (GAF). A significant positive association between cannabis use and mental health disturbance was confined to young people at genetic high risk for schizophrenia. To determine whether the relationship was specific to particular dimensions of mental health function, a second composite index was created based on scores from the SPQ Disorganisation and SDQ hyperactivity-inattention sub-scales. Again, there was a significant positive association between cannabis use and factor scores which was specific to the genetic high risk group. There was a trend for this association to be negative in the ADHD group (p=0.07). The findings support the view that young people at genetic high risk for schizophrenia are particularly vulnerable to mental health problems associated with cannabis use. Further research is needed to investigate the basis of relationships between cannabis and mental health in genetically vulnerable individuals.

PSYCHO-PHYSIOLOGICAL CHARACTERISTICS OF ADOLESCENTS WITH HIGH RISK OF DEVELOPMENT OF BEER DEPENDENCE

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A.G. Solov’ev

2009-01-01

Full Text Available The aim of present trial is study of psycho physiological peculiarities of adolescents with high risk of development of beer dependence. 143 schoolchildren from 5-11 form of Archangelsk schools of general education took part in trial. 3 groups of adolescents were formed, depending of summarized indices of beer alcoholization: group of high grade of alcoholization (35.5%, medium grade (45.2% and low grade (19.3%. Adolescents with high risk of development of beer dependence are characterized with lowering of simple visual-motor and audio-motor response rate, complex visual-motor response rate, complex sensomotor response rate on moving object, decrease of stability of sensomotor processes and attention stability, stability of mental work and mental efficiency depending on time, efficiency in deficit of time and information. These disorders may be used in early diagnostics of beer dependence in structure of primary and secondary psycho prophylactic measures.Key words: adolescents, beer dependence, psycho physiological peculiarities, prophylaxis.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(1:25-29

Warfarin improves the outcome of infrainguinal vein bypass grafting at high risk for failure.

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Sarac, T P; Huber, T S; Back, M R; Ozaki, C K; Carlton, L M; Flynn, T C; Seeger, J M

1998-09-01

Patients with marginal venous conduit, poor arterial runoff, and prior failed bypass grafts are at high risk for infrainguinal graft occlusion and limb loss. We sought to evaluate the effects of anticoagulation therapy after autogenous vein infrainguinal revascularization on duration of patency, limb salvage rates, and complication rates in this subset of patients. This randomized prospective trial was performed in a university tertiary care hospital and in a Veterans Affairs Hospital. Fifty-six patients who were at high risk for graft failure were randomized to receive aspirin (24 patients, 27 bypass grafts) or aspirin and warfarin (WAR; 32 patients, 37 bypass grafts). All patients received 325 mg of aspirin each day, and the patients who were randomized to warfarin underwent anticoagulation therapy with heparin immediately after surgery and then were started on warfarin therapy to maintain an international normalized ratio between 2 and 3. Perioperative blood transfusions and complications were compared with the Student t test or with the chi2 test. Graft patency rates, limb salvage rates, and survival rates were compared with the Kaplan-Meier method and the log-rank test. Sixty-one of the 64 bypass grafts were performed for rest pain or tissue loss, and 3 were performed for short-distance claudication. There were no differences between the groups in ages, indications, bypass graft types, risk classifications (ie, conduit, runoff, or graft failure), or comorbid conditions (except diabetes mellitus). The cumulative 5-year survival rate was similar between the groups. The incidence rate of postoperative hematoma (32% vs 3.7%; P = .004) was greater in the WAR group, but no differences were seen between the WAR group and the aspirin group in the number of packed red blood cells transfused, in the incidence rate of overall nonhemorrhagic wound complications, or in the overall complication rate (62% vs 52%). The immediate postoperative primary graft patency rates (97

40 CFR 280.97 - Insurance and risk retention group coverage.

Science.gov (United States)

2010-07-01

... UNDERGROUND STORAGE TANKS (UST) Financial Responsibility § 280.97 Insurance and risk retention group coverage... information and the brackets deleted: (1) Endorsement Name: [name of each covered location] Address: [address... liability, and exclusions of the policy.] I hereby certify that the wording of this instrument is identical...

Low risk of pulmonary tuberculosis of residents in high background radiation area, Yangjiang, China

International Nuclear Information System (INIS)

Li Xiaojuan; Sun Quanfu

2006-01-01

Objective: To examine the pulmonary tuberculosis mortality risk of the residents in high background radiation area (HBRA), Yangjiang, China. Methods: A cohort including 89 694 persons in HBRA and 35 385 persons in control area (CA) has been established since 1979. Person-year tables based on classified variables including sex, attained age, follow-up calendar year, and dose-rate group (high, intermediate, and low in HBRA, and control group) were tabulated using DATAB in EPICURE. Poisson regression analysis was used to estimate the relative risks (RR) of infectious and parasitic disease especially for pulmonary tuberculosis. Cumulative dose for each cohort member was obtained. Results: Two million person-years were accumulated by follow-up and 612 cases of pulmonary tuberculosis ascertained. Compared with risk in the control area, statistically significant lower risk of pulmonary tuberculosis was observed in HBRA among those who aged 60 years and over; markedly decreased risk occurred among males; no significant difference was found among the 6 follow-up stages, two subregions in the HBRA, or different diagnostic facilities. A statistically significantly negative dose-response was observed (P<0.001), the higher accumulative dose, the lower dose the pulmonary tuberculosis mortality risk. Its excess relative risk (ERR/Sv) was estimated to be -1.09 (95% CI: -1.34, -0.85). No established risk factors could explain this lower risk. Conclusions: The mortality of puhnonary tuberculosis among residents in HBRA who were chronically exposed to low-dose radiation was statistically significantly lower than that in the control area, and a significant dose-response relationship was observed, which probably resulted from the immunoenhancement of low dose radiation. (authors)

Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy.

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Nagle, Ramzy T; Leiby, Benjamin E; Lavu, Harish; Rosato, Ernest L; Yeo, Charles J; Winter, Jordan M

2017-04-01

Pancreatectomy is associated with a high complication rate that varies between 40-60%. Although many specific complications have been extensively studied, postoperative pneumonia has received little attention. Patients undergoing pancreaticoduodenectomy (n = 1,090) and distal pancreatectomy (n = 436) from 2002 to 2014 at Thomas Jefferson University Hospital were retrospectively assessed for postoperative pneumonia. Incidence, predictive factors, and outcomes were determined. Pneumonia was diagnosed in 4.3% of patients after pancreaticoduodenectomy and 2.5% after distal pancreatectomy. The majority of the pneumonias were attributed to aspiration (87.2% and 81.8%, respectively). Pneumonias were more frequently severe (Clavien-Dindo grades 4 or 5) in the pancreaticoduodenectomy group compared to the distal pancreatectomy group (55.3% vs 9.1%, P = .006). Post-pancreaticoduodenectomy pneumonia predictors included delayed gastric emptying (odds ratio 8.2, P < .001), oxygen requirement on postoperative day 3 (odds ratio 3.2, P = .005), and chronic obstructive pulmonary disease (odds ratio 3.1, P = .049). In the post-pancreaticoduodenectomy group, pneumonia was associated with a very high 90-day mortality compared with those who did not have pneumonia (29.8% vs 2.1%, P < .001) and had the largest effect on mortality after pancreaticoduodenectomy (odds ratio 9.6, P < .001). A preoperative risk score model for pneumonia post-pancreaticoduodenectomy was developed. Pneumonia after pancreaticoduodenectomy is an uncommon but highly morbid event and is associated with a substantially increased risk of perioperative death. Copyright © 2016 Elsevier Inc. All rights reserved.

[FRAX® thresholds to identify people with high or low risk of osteoporotic fracture in Spanish female population].

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Azagra, Rafael; Roca, Genís; Martín-Sánchez, Juan Carlos; Casado, Enrique; Encabo, Gloria; Zwart, Marta; Aguyé, Amada; Díez-Pérez, Adolf

2015-01-06

To detect FRAX(®) threshold levels that identify groups of the population that are at high/low risk of osteoporotic fracture in the Spanish female population using a cost-effective assessment. This is a cohort study. Eight hundred and sixteen women 40-90 years old selected from the FRIDEX cohort with densitometry and risk factors for fracture at baseline who received no treatment for osteoporosis during the 10 year follow-up period and were stratified into 3 groups/levels of fracture risk (low20%) according to the real fracture incidence. The thresholds of FRAX(®) baseline for major osteoporotic fracture were: low riskX-ray absorptiometry (DXA-scan) for FRAX(®)≥ 5 (Intermediate and high risk) to reclassify by FRAX(®) with DXA-scan at high/low risk. These thresholds select 17.5% of women for DXA-scan and 10% for treatment. With these thresholds of FRAX(®), compared with the strategy of opportunistic case finding isolated risk factors, would improve the predictive parameters and reduce 82.5% the DXA-scan, 35.4% osteoporosis prescriptions and 28.7% cost to detect the same number of women who suffer fractures. The use of FRAX ® thresholds identified as high/low risk of osteoporotic fracture in this calibration (FRIDEX model) improve predictive parameters in Spanish women and in a more cost-effective than the traditional model based on the T-score ≤ -2.5 of DXA scan. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.