Cadmium body burden and increased blood pressure in middle-aged American Indians: the Strong Heart Study.

Science.gov (United States)

Franceschini, N; Fry, R C; Balakrishnan, P; Navas-Acien, A; Oliver-Williams, C; Howard, A G; Cole, S A; Haack, K; Lange, E M; Howard, B V; Best, L G; Francesconi, K A; Goessler, W; Umans, J G; Tellez-Plaza, M

2017-03-01

Cadmium (Cd) is an environmental pollutant that has been associated with cardiovascular disease in populations, but the relationship of Cd with hypertension has been inconsistent. We studied the association between urinary Cd concentrations, a measure of total body burden, and blood pressure in American Indians, a US population with above national average Cd burden. Urinary Cd was measured using inductively coupled plasma mass spectrometry, and adjusted for urinary creatinine concentration. Among 3714 middle-aged American Indian participants of the Strong Heart Study (mean age 56 years, 41% male, 67% ever-smokers, 23% taking antihypertensive medications), urinary Cd ranged from 0.01 to 78.48 μg g -1 creatinine (geometric mean=0.94 μg g -1 ) and it was correlated with smoking pack-year among ever-smokers (r 2 =0.16, Pyears), and urinary Cd was similarly elevated in light- and never-smokers (geometric means of 0.88 μg g -1 creatinine for both categories). Log-transformed urinary Cd was significantly associated with higher systolic blood pressure in models adjusted for age, sex, geographic area, body mass index, smoking (ever vs never, and cumulative pack-years) and kidney function (mean blood pressure difference by lnCd concentration (β)=1.64, P=0.002). These associations were present among light- and never-smokers (β=2.03, P=0.002, n=2627), although not significant among never-smokers (β=1.22, P=0.18, n=1260). Cd was also associated with diastolic blood pressure among light- and never-smokers (β=0.94, P=0.004). These findings suggest that there is a relationship between Cd body burden and increased blood pressure in American Indians, a population with increased cardiovascular disease risk.

The use of comparative 137Cs body burden estimates from environmental data/models and whole body counting to evaluate diet models for the ingestion pathway

International Nuclear Information System (INIS)

Robison, W.L.; Sun, C.

1997-01-01

Rongelap and Utirik Atolls were contaminated on 1 March 1954, by a U.S. nuclear test at Bikini Atoll code named BRAVO. The people at both atolls were removed from their atolls in the first few days after the detonation and were returned to their atolls at different times. Detailed studies have been carried out over the years by Lawrence Livermore National Laboratory (LLNL) to determine the radiological conditions at the atolls and estimate the doses to the populations. The contribution of each exposure pathway and radionuclide have been evaluated. All dose assessments show that the major potential contribution to the estimated dose is 137 Cs uptake via the terrestrial food chain. Brookhaven National Laboratory (BNL) has carried out an extensive whole body counting program at both atolls over several years to directly measure the 137 Cs body burden. Here we compare the estimates of the body burdens from the LLNL environmental method with body burdens measured by the BNL whole body counting method. The combination of the results from both methods is used to evaluate proposed diet models to establish more realistic dose assessments. Very good agreement is achieved between the two methods with a diet model that includes both local and imported foods. Other diet models greatly overestimate the body burdens (i.e., dose) observed by whole body counting. The upper 95% confidence limit of interindividual variability around the population mean value based on the environmental method is similar to that calculated from direct measurement by whole body counting. Moreover, the uncertainty in the population mean value based on the environmental method is in very good agreement with the whole body counting data. This provides additional confidence in extrapolating the estimated doses calculated by the environmental method to other islands and atolls. 46 refs., 8 figs., 5 tabs

The Severity of Autism Is Associated with Toxic Metal Body Burden and Red Blood Cell Glutathione Levels

Energy Technology Data Exchange (ETDEWEB)

Adams, J B; Mitchell, I J [Division of Basic Medical Sciences, Southwest College of Naturopathic Medicine, Tempe, AZ 85282 (United States); Baral, M; Bradstreet, J [Department of Pediatric Medicine, Southwest College of Naturopathic Medicine, Tempe, AZ 85282 (United States); Geis, E; Ingram, J; Hensley, A; Zappia, I; Gehn, E; Mitchell, K [Autism Research Institute, San Diego, CA 92116-2599 (United States); Newmark, S [Center for Integrative Pediatric Medicine, Tucson, AZ 85711 (United States); Rubin, R A [Department of Mathematics, Whittier College, Whittier, CA 90601-4413 (United States); Bradstreet, J [International Child Development Resource Center, Phoenix, AZ (United States); El-Dahrn, J M [Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112 (United States)

2009-07-01

This study investigated the relationship of children's autism symptoms with their toxic metal body burden and red blood cell (RBC) glutathione levels. In children ages 38 years, the severity of autism was assessed using four tools: ADOS, PDD-BI, ATEC, and SAS. Toxic metal body burden was assessed by measuring urinary excretion of toxic metals, both before and after oral dimercaptosuccinic acid (DMSA). Multiple positive correlations were found between the severity of autism and the urinary excretion of toxic metals. Variations in the severity of autism measurements could be explained, in part, by regression analyses of urinary excretion of toxic metals before and after DMSA and the level of RBC glutathione (adjusted R2 of 0.220.45, P<.005 in all cases). This study demonstrates a significant positive association between the severity of autism and the relative body burden of toxic metals.

The Severity of Autism Is Associated with Toxic Metal Body Burden and Red Blood Cell Glutathione Levels

International Nuclear Information System (INIS)

Adams, J.B.; Mitchell, I.J.; Baral, M.; Bradstreet, J.; Geis, E.; Ingram, J.; Hensley, A.; Zappia, I.; Gehn, E.; Mitchell, K.; Newmark, S.; Rubin, R.A.; Bradstreet, J.; El-Dahrn, J.M.

2009-01-01

This study investigated the relationship of children's autism symptoms with their toxic metal body burden and red blood cell (RBC) glutathione levels. In children ages 38 years, the severity of autism was assessed using four tools: ADOS, PDD-BI, ATEC, and SAS. Toxic metal body burden was assessed by measuring urinary excretion of toxic metals, both before and after oral dimercaptosuccinic acid (DMSA). Multiple positive correlations were found between the severity of autism and the urinary excretion of toxic metals. Variations in the severity of autism measurements could be explained, in part, by regression analyses of urinary excretion of toxic metals before and after DMSA and the level of RBC glutathione (adjusted R2 of 0.220.45, P<.005 in all cases). This study demonstrates a significant positive association between the severity of autism and the relative body burden of toxic metals.

Pediatric scalds: do cooking-related burns have a higher injury burden?

Science.gov (United States)

Bachier, Marielena; Hammond, Sarah E; Williams, Regan; Jancelewicz, Timothy; Feliz, Alexander

2015-11-01

Pediatric scald burns result in frequent emergency room visits and hospitalizations. We investigated whether cooking-related burns produce greater morbidity requiring more extensive care than noncooking burns. We performed a 6-y review at our free-standing children's hospital. Children aged cooking versus noncooking burns. The Mann-Whitney U test, a chi-square test, and the negative binomial were used to compare continuous, categorical, and count data between groups. Bivariate analysis was performed to identify risk factors among patients with adverse outcomes. We identified 308 patients; 262 (85%) cooking and 46 (15%) noncooking burns. Most patients were African-American males, with public insurance, and a median age of 2 y. Cooking burns preferentially occurred over the head, neck, and upper body; noncooking burns were distributed over the lower body (P  0.11). In subgroup analysis, semisolid and grease burns resulted in increased rates of wound contractures and/or limited mobility when compared with noncooking burns (P = 0.05 and P = 0.008, respectively). Patients with complications were more likely to have third degree burns and required more consults, longer hospitalization, and more surgical debridements and clinic visits. Most accidental scald burns occurred in young children during food preparation. Greater long-term morbidity was found in patients with semisolid and grease burns. This subset of children has a higher injury burden and requires extensive care in the acute and long-term setting. Copyright © 2015 Elsevier Inc. All rights reserved.

Radium-226 body burden in U miners by measurement of Rn in exhaled breath.

Science.gov (United States)

Srivastava, G K; Raghavayya, M; Kotrappa, P; Somasundaram, S

1986-02-01

Uranium miners were made to inhale Rn-free medical O2 and exhale through a 5.2-1 A1 chamber before reporting to work. The chamber was sealed and isolated from the sampling circuit. An electrostatic plate collected the freshly formed Rn-decay products. The subsequent programmed alpha counting of the plate yielded a Rn concentration in the exhaled breath. Assuming that the exhaled breath represents a certain fraction of the Rn produced inside the body, the body burden of 226Ra was calculated. Standardisation of this procedure and the data collected on 310 miners are discussed. The procedure is simple and applicable for routine measurements. The miner needs to be in the laboratory for only 10 min. The system is also portable for field application. For routine use, the minimum detectable concentration is 3.87 Bq X m-3 which corresponds to a body burden of 0.26 kBq in a typical miner, if one assumes the Rn release fraction from the body as 84%. The system offers a more convenient and sensitive alternative to whole-body counting of workers for 226Ra.

Sampling and Analysis for Assessment of Body Burdens

International Nuclear Information System (INIS)

Harley, J.H.

1964-01-01

A review of sampling criteria and techniques and of sample processing methods for indirect assessment of body burdens is presented. The text is limited to the more recent developments in the field of bioassay and to the nuclides which cannot be readily determined in the body directly. A selected bibliography is included. The planning of a bioassay programme should emphasize the detection of high or unusual exposures and the concentrated study of these cases when detected. This procedure gives the maximum amount of data for the dosimetry of individuals at risk and also adds to our scientific background for an understanding of internal emitters. Only a minimum of effort should be spent on sampling individuals having had negligible exposure. The chemical separation procedures required for bioassay also fall into two categories. The first is the rapid method, possibly of low accuracy, used for detection. The second is the more accurate method required for study of the individual after detection of the exposure. Excretion, whether exponential or a power function, drops off rapidly. It is necessary to locate the exposure in time before any evaluation can be made, even before deciding if the exposure is significant. One approach is frequent sampling and analysis by a quick screening technique. More commonly, samples are collected at longer intervals and an arbitrary level of re-sampling is set to assist in the detection of real exposures. It is probable that too much bioassay effort has gone into measurements on individuals at low risk and not enough on those at higher risk. The development of bioassay procedures for overcoming this problem has begun, and this paper emphasizes this facet of sampling and sample processing. (author) [fr

An approach to calculating childhood body burdens of dibenzodioxins and dibenzofurans which accounts for age-dependent biological half lives

Energy Technology Data Exchange (ETDEWEB)

Paustenbach, D. [ChemRisk, San Francisco, CA (United States); Leung, H.W. [Leung, H.W. Private Consultant, Danbury, CT (United States); Scott, P. [ChemRisk, Pittsburgh, PA (United States); Kerger, B. [HSRI, Tallahassee, FL (United States)

2004-09-15

The purpose of this study is to apply an age-dependent half life model to examine the range of child (ages 0-7) body burdens that correspond to selected exposure scenarios involving background dietary and environmental doses of dioxins. The scenarios examined include breast-fed and nonbreast- fed infants feeding for 6 months, other dioxin uptake from foods through age 7, and exposures to urban residential soils at 1 ppb TCDD toxic equivalents (TEQ). These body burden estimates in children are then compared to the adult body burden estimates corresponding to the range of tolerable daily intakes (1 to 4 pg TEQ/kg-day) proposed by some U.S. and international regulatory/advisory groups.

An investigation into the potassium body burden in humans with the help of a whole-body counter

International Nuclear Information System (INIS)

Selzer, A.

1981-01-01

The purpose of this study was to examine the available information concerning the potassium body burden of a large number of adults and to find a correlation with other easily measurable body parameters such as mass, height and age so that a normal expected body potassium may be predicted for patients with potassium abnormalities who are also referred to the whole-body counter. The calibration of the whole-body counter to make provision for the differences in geometry and absorption in various body sizes was carried out by injecting a number of people with a small dose of potassium-42 and calculating a correction factor for the potassium standard which is in use daily. All measurements of body potassium were corrected with the calculated correction factor. Fatty tissue in the body contains very little potassium in comparison with muscle tissue and a better correction should therefore be obtained between body potassium and lean body mass. Although it is not possible to predict the smaller potassium abnormalities even when lean body mass is used, the derived regression equation in which lean body mass and age are used, may be viewed as a good first approach in the advance estimation of body potassium

Body burdens of heavy metals in Lake Michigan wetland turtles.

Science.gov (United States)

Smith, Dayna L; Cooper, Matthew J; Kosiara, Jessica M; Lamberti, Gary A

2016-02-01

Tissue heavy metal concentrations in painted (Chrysemys picta) and snapping (Chelydra serpentina) turtles from Lake Michigan coastal wetlands were analyzed to determine (1) whether turtles accumulated heavy metals, (2) if tissue metal concentrations were related to environmental metal concentrations, and (3) the potential for non-lethal sampling techniques to be used for monitoring heavy metal body burdens in freshwater turtles. Muscle, liver, shell, and claw samples were collected from painted and snapping turtles and analyzed for cadmium, chromium, copper, iron, lead, magnesium, manganese, and zinc. Turtle tissues had measurable quantities of all eight metals analyzed. Statistically significant correlations between tissue metal concentrations and sediment metal concentrations were found for a subset of metals. Metals were generally found in higher concentrations in the larger snapping turtles than in painted turtles. In addition, non-lethal samples of shell and claw were found to be possible alternatives to lethal liver and muscle samples for some metals. Human consumption of snapping turtles presents potential health risks if turtles are harvested from contaminated areas. Overall, our results suggest that turtles could be a valuable component of contaminant monitoring programs for wetland ecosystems.

Cesium-137 body burden in Japanese from 1967 to 1975

Energy Technology Data Exchange (ETDEWEB)

Anzai, I; Ueda, K; Togo, M [Tokyo Univ. (Japan). Faculty of Medicine

1976-11-01

Cesium-137 concentrations in Japanese male adults were measured monthly during 1967 to 1975 by whole body counting. The /sup 137/Cs content decreased rapidly until 1968, then the reduction rate was considerably decelerated, being probably affected by the French and Chinese nuclear testing. A small rise was observed at the end of 1970, and its causes have been multilaterally studied from the radioecological viewpoints, which has not resulted in a clearcut conclusion. Daily intake estimated from body burden varies in a wide range but, on the average, agrees well with the reported values based on the radiochemical analyses of foods. The integrated absorbed dose from January 1967 to April 1975 is calculated to be 2.5 mrads. The authors re-emphasize the importance of the periodic measurement of human population.

Body burden of cadmium and its related factors: A large-scale survey in China

Energy Technology Data Exchange (ETDEWEB)

Ke, Shen; Cheng, Xi-Yu; Li, Hao; Jia, Wen-Jing; Zhang, Jie-Ying; Luo, Hui-Fang; Wang, Zi-Ling; Chen, Zhi-Nan, E-mail: chen_zhinan56@163.com

2015-04-01

A survey of more than 6000 participants from four distinct non-polluted and polluted regions in China was conducted to evaluate the body burden of cadmium (Cd) on the Chinese populations using urinary Cd (UCd) as a biomarker. The findings revealed that the UCd level was 1.24 μg/g creatinine (μg/g cr) for the sample population from non-polluted Shanghai, and the UCd levels exceeded 5 μg/g cr, which is the health-based exposure limit set by the World Health Organization (WHO), in 1.1% of people. The mean UCd levels in moderately polluted (Hubei and Liaoning) and highly polluted areas (Guizhou) were 4.69 μg/g cr, 3.62 μg/g cr and 6.08 μg/g cr, respectively, and these levels were 2.9 to 4.9 times the levels observed in Shanghai. Notably, the UCd levels exceeded the recently updated human biomonitoring II values (i.e., intervention or “action level”) in 44.8%–87.9% of people from these areas compared to only 5.1%–21.4% of people in Shanghai. The corresponding prevalence of elevated UCd levels (> WHO threshold, 5 μg/g cr) was also significantly higher (30.7% to 63.8% vs. 1.1%), which indicates that elevated Cd-induced health risks to residents in these areas. Age and region were significant determinants for UCd levels in a population, whereas gender did not significantly influence UCd. - Highlights: • We performed a Cd exposure survey that involved more than 6000 Chinese subjects. • The body burden of Cd in most of subjects of non-polluted Shanghai is relatively safe. • The UCd levels were much higher in the subjects from polluted areas than from Shanghai. • The UCd levels in the population from Guizhou substantially exceeded the safety limit. • Age and region were significant determinants of UCd.

National Status and Trends: Contaminant body burdens and histopathology of fish and shellfish from Alaska

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — In response to the growing concerns among Chugach communities, contaminant body burden and histopathological condition of chum and sockeye salmon (Oncorhynchus keta...

History of PUQFUA: plutonium body burden (Q) from urine assays

International Nuclear Information System (INIS)

Lawrence, J.N.P.

1978-10-01

PUQFUA is a FORTRAN computer program that calculates plutonium body burdens (Q) from urine assay data. This report describes the historical development of the program at the Los Alamos Scientific Laboratory (LASL) since 1959. After a review of the basic techniques used in the original PUQFUA, its deficiencies are listed. The procedures used to improve the program and correct the deficiencies are described. Appendixes provide a detailed discussion of the evaluation made of the analytical errors in the plutonium urine assay program at LASL from 1944 to 1978

Body burden of aluminum in relation to central nervous system function among metal inert-gas welders.

Science.gov (United States)

Riihimäki, V; Hänninen, H; Akila, R; Kovala, T; Kuosma, E; Paakkulainen, H; Valkonen, S; Engström, B

2000-04-01

The relationship between elevated internal aluminum loads and central nervous system function was studied among aluminum welders, and the threshold level for adverse effect was defined. For 65 aluminum welders and 25 current mild steel welders body burden was estimated, and the aluminum concentrations in serum (S-Al) and urine (U-Al) were analyzed with graphite furnace atomic absorption spectrometry with Zeeman background correction. Referents and low-exposure and high-exposure groups were defined according to an aggregated measure of aluminum body burden, the group median S-Al levels being 0.08, 0.14, and 0.46 micromol/l, respectively, and the corresponding values for U-Al being 0.4, 1.8, and 7.1 micromol/l. Central nervous system functions were assessed with a neuropsychological test battery, symptom and mood questionnaires, a visual and quantitative analysis of electroencephalography (EEG), and P3 event-related potentials with pitch and duration paradigms. Subjective symptoms showed exposure-related increases in fatigue, mild depression, and memory and concentration problems. Neuropsychological testing revealed a circumscribed effect of aluminum, mainly in tasks demanding complex attention and the processing of information in the working memory system and in the analysis and recall of abstract visual patterns. The visual EEG analysis revealed pathological findings only for aluminum welders. Mild, diffuse abnormalities were found in 17% of the low-exposure group and 27% of the high-exposure group, and mild to moderate epileptiform abnormalities at a frequency of 7% and 17%, respectively. Both objective neurophysiological and neuropsychological measures and subjective symptomatology indicated mild but unequivocal findings dose-dependently associated with increased aluminum body burden. The study indicates that the body burden threshold for adverse effect approximates an U-Al value of 4-6 micromol/l and an S-Al value of 0.25-0.35 micromol/l among aluminum welders.

Does higher education reduce body weight?

DEFF Research Database (Denmark)

Greve, Jane; Weatherall, Cecilie Dohlmann

The prevalence of obesity and overweight has increased in almost all Western countries in the past twenty to thirty years, with social disparities in many of these countries. This paper contributes to the literature on the relation between education and body weight by studying the effect of higher...... education on body weight according to subgroups of parental income background. To uncover the causal relationship between higher education and body weight, we use a reform of the Danish student grant scheme, which involved a grant increase of approximately 60% in 1988. When using this reform as instrumental...

Understanding differences in the body burden-age relationships of bioaccumulating contaminants based on population cross sections versus individuals.

Science.gov (United States)

Quinn, Cristina L; Wania, Frank

2012-04-01

Body burdens of persistent bioaccumulative contaminants estimated from the cross-sectional biomonitoring of human populations are often plotted against age. Such relationships have previously been assumed to reflect the role of age in bioaccumulation. We used a mechanistic modeling approach to reproduce concentration-versus-age relationships and investigate factors that influence them. CoZMoMAN is an environmental fate and human food chain bioaccumulation model that estimates time trends in human body burdens in response to time-variant environmental emissions. Trends of polychlorinated biphenyl (PCB) congener 153 concentrations versus age for population cross sections were estimated using simulated longitudinal data for individual women born at different times. The model was also used to probe the influence of partitioning and degradation properties, length of emissions, and model assumptions regarding lipid content and liver metabolism on concentration-age trends of bioaccumulative and persistent contaminants. Body burden-age relationships for population cross sections and individuals over time are not equivalent. The time lapse between the peak in emissions and sample collection for biomonitoring is the most influential factor controlling the shape of concentration-age trends for chemicals with human metabolic half-lives longer than 1 year. Differences in observed concentration-age trends for PCBs and polybrominated diphenyl ethers are consistent with differences in emission time trends and human metabolic half-lives. Bioaccumulation does not monotonically increase with age. Our model suggests that the main predictors of cross-sectional body burden trends with age are the amount of time elapsed after peak emissions and the human metabolic and environmental degradation rates.

Association of Higher Cortical Amyloid Burden With Loneliness in Cognitively Normal Older Adults.

Science.gov (United States)

Donovan, Nancy J; Okereke, Olivia I; Vannini, Patrizia; Amariglio, Rebecca E; Rentz, Dorene M; Marshall, Gad A; Johnson, Keith A; Sperling, Reisa A

2016-12-01

Emotional and behavioral symptoms in cognitively normal older people may be direct manifestations of Alzheimer disease (AD) pathophysiology at the preclinical stage, prior to the onset of mild cognitive impairment. Loneliness is a perceived state of social and emotional isolation that has been associated with cognitive and functional decline and an increased risk of incident AD dementia. We hypothesized that loneliness might occur in association with elevated cortical amyloid burden, an in vivo research biomarker of AD. To determine whether cortical amyloid burden is associated with greater loneliness in cognitively normal older adults. Cross-sectional analyses using data from the Harvard Aging Brain Study of 79 cognitively normal, community-dwelling participants. A continuous, aggregate measure of cortical amyloid burden, determined by Pittsburgh Compound B-positron emission tomography (PiB-PET), was examined in association with loneliness in linear regression models adjusting for age, sex, apolipoprotein E ε4 (APOEε4), socioeconomic status, depression, anxiety, and social network (without and with the interaction of amyloid and APOEε4). We also quantified the association of high amyloid burden (amyloid-positive group) to loneliness (lonely group) using logistic regression, controlling for the same covariates, with the amyloid-positive group and the lonely group, each composing 32% of the sample (n = 25). Loneliness, as determined by the 3-item UCLA Loneliness Scale (possible range, 3-12, with higher score indicating greater loneliness). The 79 participants included 43 women and 36 men with a mean (SD) age of 76.4 (6.2) years. Mean (SD) cortical amyloid burden via PiB-PET was 1.230 (0.209), and the mean (SD) UCLA-3 loneliness score was 5.3 (1.8). Twenty-two (28%) had positive APOEε4 carrier status, and 25 (32%) were in the amyloid-positive group with cortical PiB distribution volume ratio greater than 1.2. Controlling for age, sex, APOEε4, socioeconomic

Mobilized plasma lead as an index of lead body burden and its relation to the heme-related indices.

Science.gov (United States)

Sakai, T; Ushio, K; Ikeya, Y

1998-07-01

Plasma lead (Pb-P) from workers were distributed in two main fractions: a protein bound fraction and low molecular weight fractions. Lead mobilized into plasma by CaEDTA was mainly observed in the low molecular weight fraction corresponding to lead disodium ethylenediamine tetraacetic acid (PbEDTA). The peak levels of Pb-P was attained around 1.5 and 2.5 hours after the start of CaEDTA injection. Pb-P and blood lead levels (Pb-B) at 2 h after the injection were 4.26 (+/- 2.84) and 0.96 (+/- 0.27) fold of the initial levels just before the injection. Pb-P concentrations at 2 hours after the start of CaEDTA injection (MPb-P) were well correlated (r = 0.740) with amounts of lead excreted in urine for 24 h thereafter (MPb-U). log MPb-P as well as log MPb-U were correlated with Pb-B (r = 0.765 and 0.817, respectively). Correlation coefficients of lead body burden (MPb-P or MPb-U) vs the logarithms of the effect indices (delta-aminolevulinic acid (ALA) dehydratase, ALA in urine, coproporphyrin in urine, and erythrocyte zinc protoporphyrin) were higher than the correlation coefficients of exposure indices (Pb-B or Pb-U) vs the logarithms of the effect indices. Thus the biological effect monitoring is significant and reliable for evaluating the functional components of lead body burden (MPb-P or MPb-U).

Identification of threshold body burdens of metals for the protection of the aquatic ecological status using two benthic invertebrates

International Nuclear Information System (INIS)

Bervoets, Lieven; De Jonge, Maarten; Blust, Ronny

2016-01-01

In this study accumulated concentrations of As, Cd, Cr, Cu, Ni, Pb and Zn in two benthic invertebrate taxa, Chironomus sp. and Tubificidae are related to ecological responses expressed as changes in macro invertebrate communities. In addition critical body burdens were estimated above which ecological quality was always lower than a certain threshold. Data from existing studies on bioaccumulation of the metals in both taxa were combined with different biological water quality indices. For all metal-endpoint combinations threshold values could be calculated above which ecological quality was always low. Safe threshold body burdens could be estimated for both species for all metals although the data set was more extended for Chrionomus sp. with estimated threshold values being 65, 3.2, 10, 57, 6.5, 73 and 490 μg/g dw for As, Cd, Cr, Cu, Ni, Pb and Zn. This study demonstrated that metal accumulation in resistant species such as chironomids and tubificid worms have the potential to be used as predictors of ecological effects in aquatic ecosystems. However, the estimated threshold values have to be validated and supported by more lines of evidence before they can be used by regulators. - Highlights: • Chironomid larvae and Tubificid worms can be used to relate accumulated metals to ecological endpoints. • Ecological water quality, calculated with biotic indices, is always low at high accumulated metal concentrations. • Critical body burdens in chironomids and tubificds could be estimated for As, Cd, Cr, Cu, Ni, Pb and Zn. - Maximal body burdens of metals in two invertebrate species could be estimated above which ecological quality was always low.

Survival, reproduction, and arsenic body burdens in Chironomus riparius exposed to arsenate and phosphate

Energy Technology Data Exchange (ETDEWEB)

Mogren, Christina L., E-mail: christina.mogren@email.ucr.edu [Department of Entomology, University of California, Riverside, 900 University Ave, Riverside, CA 92521 (United States); Kiparski, Guntram R. von; Parker, David R. [Department of Environmental Science, University of California, Riverside, 900 University Ave, Riverside, CA 92521 (United States); Trumble, John T. [Department of Entomology, University of California, Riverside, 900 University Ave, Riverside, CA 92521 (United States)

2012-05-15

Despite the increasing awareness of arsenic (As) contamination in surface waters worldwide, little is known about how As alone and in the presence of other chemicals affects aquatic insects. Larvae of Chironomus riparius were exposed in a laboratory investigation to factorial combinations of 0, 0.13, 2.0, 5.3, and 13 {mu}mol As l{sup -1} and 0, 0.15, and 15 {mu}mol PO{sub 4} l{sup -1} throughout development from first instar to pupal emergence. The time between male and female emergence increased from 1.8 {+-} 0.17 days to 2.9 {+-} 0.34 days with exposure at higher As levels. The highest As exposure also decreased the number of eggs per egg mass, which may affect population maintenance. For these parameters, there was no effect from PO{sub 4}, and no interaction between As and PO{sub 4}. Total As determination of larval and adult tissues was conducted using Hydride Generated Atomic Absorption Spectroscopy (HGAAS) and revealed concentrations ranging from 2.48 {+-} 0.363 to 30.5 {+-} 0.473 {mu}g/g and 1.03 {+-} 0.286 to 8.97 {+-} 0.662 {mu}g/g, respectively, indicating elimination of approximately 72% of total As body burdens between the fourth instar and adult stages. There was no effect of PO{sub 4}, indicating PO{sub 4} does not alter uptake of As in C. riparius. The potential for movement of As to terrestrial systems exists, though trophic transfer may be more likely during the aquatic larval stage. - Highlights: Black-Right-Pointing-Pointer We evaluate how sublethal concentrations of As and P affect C. riparius. Black-Right-Pointing-Pointer High As exposure significantly increased the time between male and female emergence. Black-Right-Pointing-Pointer High As exposure significantly decreased the number of eggs per egg mass. Black-Right-Pointing-Pointer Fourth instar larvae eliminate 72% of As body burdens before the adult stage.

The economic consequences of elevated body-lead burdens in urban children

International Nuclear Information System (INIS)

Agree, M.D.

1991-01-01

The following analysis develops the theory and implementation of the observed behavior technique in an altruistic setting, to assess the health benefits of reducing environmental lead exposure in urban children. Three models are presented which allow for endogenous body lead burden, risk of irreversible neurological damages, and Bayesian information. Conditions are derived under which the observed behavior technique can be modified to value the health consequences of exposure to a general class of persistent micropollutants (PMP's): the heavy metals. Benefit expressions reflect the tradeoff between parental wealth and child health when children are exposed to low level doses of lead. The purpose is to derive exact measures of marginal welfare change associated with variations in child body lead burden, and to determine the conditions under which these measures will be functions of observable parameters. The analysis presents an entirely ex ante approach to the recovery of benefit estimates when PMP exposure involves risk of irreversible health damages. In doing so, an empirical estimate is also obtained for the parental value of child health information that is used in the revision of prior risk beliefs. Risk of chronic irreversible health effects in younger generations from environmental lead exposure may be experienced by a large share of metropolitan population in the US. Given the large numbers of possible victims, the aggregate social value of avoiding this risk is an important policy issues. Moreover, the value of health risk information is potentially important to the use of an information program as a policy instrument in reducing health risk because it would enable the comparison of societal benefits from an information program to the cost of it's implementation

The burden of cesium 137 in forest clerks

International Nuclear Information System (INIS)

Piechotowski, I.; Jaroni, J.; Link, B.; Groezinger, O.

2000-01-01

In 47 forest clerks from the regions Ortenau and Oberschwaben in south-west Germany the incorporation of cesium 137 and potassium 40 was measured in autumn 1994. Soil burden as well as burden of nutrition with cesium 137 are different in these regions for geological reasons and as a result of the nuclear accident of Chernobyl. Caused by low content of clay in Oberschwaben, the transfer of cesium to plants is assisted. Heavy rainfall after the nuclear accident led to an additional increase of burden. The median of the concentration of cesium 137 was 1.4 Bq/kg body weight. The median for potassium 40 was 58 Bq/kg body weight. For cesium 137 regional differences were observed. For persons from Oberschwaben the median for cesium 137 was with 2.8 Bq/kg body weight clearly higher than for persons from Ortenau with 0,6 Bq/kg body weight. Concerning nutrition habits, the clearest difference was found comparing persons who had ate a minimum of four portions of deer from the surroundings within the last four weeks with persons who had ate less than four portions of deer from the surroundings within the last four weeks. The difference was greater in Oberschwaben than in Ortenau. The effective dose of cesium 137 calculated on the basis of the incorporation is very low compared to natural radiation. This is also valid for persons from Oberschwaben. (orig.) [de

Evaluation of 137Cs body burden in inhabitants of Bryansk Oblast, Russian Federation, where a high incidence of thyroid cancer was observed after the accident at the Chernobyl nuclear power plant

International Nuclear Information System (INIS)

Sekitani, Y.; Hayashida, N.; Karevskaya, I. V.; Vasilitsova, O. A.; Kozlovsky, A.; Omiya, M.; Yamashita, S.; Takamura, N.

2010-01-01

To determine the current risk of internal radiation exposure after the Chernobyl accident, the 137 Cs body burden of the inhabitants of Bryansk Oblast (Russian Federation) was evaluated, from 1998 to 2008. The study population is composed of 84 666 people who visited Bryansk No. 2 Hospital. A whole-body counter was used for measurement of 137 Cs body burden. 137 Cs concentration was significantly higher in the late period during the study and showed seasonal variation, suggesting that inhabitants may have consumed contaminated forest products. However, people with high annual exposure doses were quite rare during all years of the study. In conclusion, although internal radiation exposure from 137 Cs continues to this day in Bryansk Oblast, the annual exposure dose is low in almost all inhabitants. Because of the long half-life of 137 Cs, the long term follow-up is necessary to monitor the health status and relieve the anxiety of the inhabitants around Chernobyl. (authors)

In-vivo assessment of whole-body radioisotope burdens at the Los Alamos National Laboratory

International Nuclear Information System (INIS)

Vasilik, D.G.; Aikin, I.C.

1983-08-01

The Los Alamos National Laboratory program for in-vivo measurements includes the capability for the whole-body assessment of body burdens for x-ray or gamma-ray emitting radioisotopes. This capability is an important part of the health and safety program at Los Alamos where a wide variety of radioisotopes are utilized. This report addresses the whole body portion of our in-vivo measurement capabilities. Whole-body measurements at Los Alamos make use of a hyperpure germanium (HpGe) detector and a lithium-drifted germanium [Ge(Li)] detector for identification and quantification of radioisotopes. Analysis results are interpreted in terms of two basic statistical measures of detection limits. One measure is called the minimum significant measured activity (MSMA), which is interpreted as meaning that there is some activity in the body. The second measure is called the minimum detectable true activity (MDTA), which is defined as the smallest amount of activity required to be in the body in order that a measurement of an individual can be expected to imply correctly the presence of activity with a predetermined degree of confidence. 7 references, 8 figures

Screening for 137Cs body burden due to the Chernobyl accident in Korosten city, Zhitomir, Ukraine. 1996-2008

International Nuclear Information System (INIS)

Hayashida, Naomi; Sekitani, Yui; Yamashita, Shunichi; Takamura, Noboru; Kozlovsky, A.; Rafalsky, R.; Gutevich, A; Daniliuk, V.

2011-01-01

During the Chernobyl Nuclear Power Plant (CNPP) accident on 26 April 1986, large amounts of radionuclides were released and spread to vast areas. Inhabitants residing around CNPP have been exposed to external and internal irradiation due to the long half-life of 137 Cs (30 years). In this study, we screened for internal whole-body 137 Cs concentration using a whole-body counter in the Zhitomir state of Ukraine. The total number of participants was 144,972 (96,149 females and 48,823 males). The median body burden of 137 Cs per body weight decreased from 1996 to 2008. In particular, after 2003, more than half of subjects had internal exposure doses below the detectable level. A weak seasonal effect was found in measurement data from 1997 to 1999, but no such effects were observed in later years. We also calculated annual dose for each year and confirmed that doses have been decreasing gradually. In particular, after 2003, the annual effective dose decreased to 0.1 mSv y -1 for 95% of the participants. Only two persons were found to have received more than 5 mSv y -1 since 2007. Although the health effects of 137 Cs body burden due to the Chernobyl accident remain uncertain, further screening is needed to monitor the health status and to allay the anxiety of inhabitants in the contaminated areas around CNPP. (author)

Association of PCB, PBDE and PCDD/F body burdens with hormone levels for children in an e-waste dismantling area of Zhejiang Province, China

Energy Technology Data Exchange (ETDEWEB)

Xu, Peiwei, E-mail: pwxu@cdc.zj.cn; Lou, Xiaoming; Ding, Gangqiang; Shen, Haitao; Wu, Lizhi; Chen, Zhijian; Han, Jianlong; Han, Guangen; Wang, Xiaofeng, E-mail: zjcdcwxf@gmail.com

2014-11-15

Increased electronic waste (e-waste) has raised public concerns regarding exposure to numerous toxic contaminants, particularly polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). In China, the body burdens of PCBs, PBDEs and PCDD/Fs are associated with thyroid hormones in populations from e-waste dismantling sites; however, it is unclear whether this association occurs in children. In this study, we determined the serum levels of PCBs, PBDEs and PCDD/Fs and the endocrine hormones including free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), total thyroxine (TT4), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), cortisol and growth hormone (GH) in 21 children from an e-waste dismantling area and 24 children from a control area. The results showed that the mean levels of ∑ PCBs and ∑ PBDEs in the exposure group were significantly higher than in the control group (40.56 and 32.09 ng g{sup −1} lipid vs. 20.69 and 8.43 ng g{sup −1} lipid, respectively, p < 0.01 for each), and the mean level of ∑ PCDD/Fs in the exposure group was higher than in the control group, but the difference was not significant (206.17 vs. 160.27 pg g{sup −1} lipid, p > 0.05). For the endocrine hormones, we did not find significant differences between the exposed and control groups, although the mean levels of FT3, TT3, TT4, ACTH, cortisol and GH were higher, whereas the mean levels of FT4 and TSH were lower in the exposed group. The mean level of ∑ PBDEs was positively correlated with the mean levels of ∑ PCBs (r = 0.60, p < 0.05) and ∑ PCDD/Fs (r = 0.61, p < 0.05). Furthermore, the mean level of ∑ PBDEs was positively correlated with ACTH (r = 0.61, p < 0.05). In conclusion, our data suggested that exposure to e-waste dismantling environment increased the body burdens of PCBs and PBDEs in local children and that these contaminants

Association of PCB, PBDE and PCDD/F body burdens with hormone levels for children in an e-waste dismantling area of Zhejiang Province, China

International Nuclear Information System (INIS)

Xu, Peiwei; Lou, Xiaoming; Ding, Gangqiang; Shen, Haitao; Wu, Lizhi; Chen, Zhijian; Han, Jianlong; Han, Guangen; Wang, Xiaofeng

2014-01-01

Increased electronic waste (e-waste) has raised public concerns regarding exposure to numerous toxic contaminants, particularly polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). In China, the body burdens of PCBs, PBDEs and PCDD/Fs are associated with thyroid hormones in populations from e-waste dismantling sites; however, it is unclear whether this association occurs in children. In this study, we determined the serum levels of PCBs, PBDEs and PCDD/Fs and the endocrine hormones including free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), total thyroxine (TT4), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), cortisol and growth hormone (GH) in 21 children from an e-waste dismantling area and 24 children from a control area. The results showed that the mean levels of ∑ PCBs and ∑ PBDEs in the exposure group were significantly higher than in the control group (40.56 and 32.09 ng g −1 lipid vs. 20.69 and 8.43 ng g −1 lipid, respectively, p < 0.01 for each), and the mean level of ∑ PCDD/Fs in the exposure group was higher than in the control group, but the difference was not significant (206.17 vs. 160.27 pg g −1 lipid, p > 0.05). For the endocrine hormones, we did not find significant differences between the exposed and control groups, although the mean levels of FT3, TT3, TT4, ACTH, cortisol and GH were higher, whereas the mean levels of FT4 and TSH were lower in the exposed group. The mean level of ∑ PBDEs was positively correlated with the mean levels of ∑ PCBs (r = 0.60, p < 0.05) and ∑ PCDD/Fs (r = 0.61, p < 0.05). Furthermore, the mean level of ∑ PBDEs was positively correlated with ACTH (r = 0.61, p < 0.05). In conclusion, our data suggested that exposure to e-waste dismantling environment increased the body burdens of PCBs and PBDEs in local children and that these contaminants released from the e

Diet, Lifestyle and Chronic disease burden

NARCIS (Netherlands)

Struijk, E.A.

2014-01-01

Background Diet, Body Mass Index (BMI), physical activity and smoking are among the most important lifestyle factors that influence global disease burden. In this thesis we investigate the relations of these factors with total disease burden in a large Dutch population, the EPIC-NL cohort. In this

The double burden of undernutrition and excess body weight in Ecuador.

Science.gov (United States)

Freire, Wilma B; Silva-Jaramillo, Katherine M; Ramírez-Luzuriaga, María J; Belmont, Philippe; Waters, William F

2014-12-01

Ecuador's current nutrition policies have not taken adequate notice of the double burden of malnutrition and continue to focus on stunting and to a lesser extent on overweight, without addressing the simultaneous presence of undernutrition, micronutrient deficiencies, and overweight or obesity (OW/OB). The aim of this article was to describe the prevalence and distribution of undernutrition (stunting, anemia, and zinc deficiency), overweight, and obesity in Ecuador to explore the evolving double burden of malnutrition at the national, household, and individual levels and to discuss whether current public health policies are addressing the double burden. Data from the 2012 Ecuadorian National Health and Nutrition Survey (ENSANUT-ECU) was used to estimate the dual burden of malnutrition at the national, household, and individual levels in children Ecuador. Although integrated approaches to address the emerging double burden are required, public health policies to date have not responded adequately. © 2014 American Society for Nutrition.

The significance of hair mineral analysis as a means for assessing internal body burdens of environmental pollutants

International Nuclear Information System (INIS)

1993-01-01

In recent years there has been a considerable growth of interest in problems of environmental pollution from industrial and agricultural substances and the harmful impact of such pollution on human health. There has been an increasing interest in using hair mineral analysis for biological monitoring of human population exposure to environmental mineral pollutants. This is because hair has some ideal attributes for such purposes. It can be collected by simple, non-invasive methods, and is easily sampled and stored. Concentrations of most of the toxic trace elements, i.e. mercury and lead, in scalp hair are at least an order of magnitude higher than those in body fluids or other easily accessible tissues. In addition, mineral elements in hair can easily be determined with good precision and sensitivity by nuclear as well as conventional methods of chemical analysis. Despite these apparent advantages of using hair as a biomonitor, serious uncertainty existed, and to some extent still exist, as to the meaningful interpretation of human hair mineral data in environmental health studies. The Co-ordinated Research Programme (CRP), which is the subject of this report, has attempted to tackle this problem by promoting a variety of studies (as distinct from routine monitoring) to investigate the quantitative relationships between internal body burdens of a number of elements of environmental health significance and their respective concentrations in hair. Refs, figs and tabs

Body Burden of Hg in Different Bio-Samples of Mothers in Shenyang City, China

Science.gov (United States)

Xu, Jian; Du, Juan; Yan, Chong-huai

2014-01-01

Hg is an accumulative and neuro-toxic heavy metal which has a wide range of adverse effects in human health. However, few studies are available on body burden of Hg level in different bio-samples of pregnant women in Chinese population. Therefore, this study evaluated Hg levels in different maternal bio-samples in Shenyang city, China and investigated the correlation of Hg levels in different bio-samples. From October to December 2008, 200 pregnant women about to deliver their babies at ShengJing Hospital (Shenyang city, northeast of China) participated in this study. The geometric mean (GM) of Hg levels in cord blood, maternal venous blood, breast milk, and maternal urine were 2.18 µg/L, 1.17 µg/L, 1.14 µg/L, and 0.73 µg/L, respectively, and the GM of maternal hair Hg level was 404.45 µg/kg. There was a strong correlation between cord blood and maternal blood total Hg level (r = 0.713, PHg exposure (unadjusted OR 3.5, adjusted OR 2.94, PHg burden of mothers and the risk factors of prenatal Hg exposure in Shenyang city, China. PMID:24858815

The Relationship between Sleep Quality and Brain Amyloid Burden.

Science.gov (United States)

Brown, Belinda M; Rainey-Smith, Stephanie R; Villemagne, Victor L; Weinborn, Michael; Bucks, Romola S; Sohrabi, Hamid R; Laws, Simon M; Taddei, Kevin; Macaulay, S Lance; Ames, David; Fowler, Christopher; Maruff, Paul; Masters, Colin L; Rowe, Christopher C; Martins, Ralph N

2016-05-01

To evaluate the association between self-reported sleep quality and levels of brain β-amyloid (Aβ) burden, and to determine the effect of the apolipoprotein E (APOE) ε4 allele on any associations found. This study is a cross-sectional analysis of 184 cognitively healthy men and women aged over 60 y. We measured sleep quality factors: specifically, sleep duration, latency (time taken to fall asleep), disturbances, efficiency, daytime dysfunction, and overall sleep quality, using the Pittsburgh Sleep Quality Index. All participants underwent Aβ positron emission tomography imaging for the quantification of brain Aβ burden and were APOE genotyped. Linear regression analyses were used to evaluate the relationship between sleep quality factors and brain Aβ burden, adjusting for age, body mass index, cardiovascular disease, and symptoms of depression, with APOE ε4 carriage entered as a moderator. Of the sleep factors, longer sleep latency was associated with higher levels of brain Aβ (B = 0.003 [standard error = 0.001], P = 0.02). APOE ε4 allele (carrier/noncarrier) did not moderate the relationship between sleep latency and brain Aβ burden. Our findings suggest a relationship between brain Aβ burden and sleep latency, independent of APOE ε4 genotype. © 2016 Associated Professional Sleep Societies, LLC.

Comorbidity burden is not associated with higher mortality after out-of-hospital cardiac arrest

DEFF Research Database (Denmark)

Winther-Jensen, Matilde; Kjaergaard, Jesper; Nielsen, Niklas

2016-01-01

at either 33 or 36 °C with no difference regarding mortality and neurological outcome. This post-hoc study of the TTM-trial formed a modified comorbidity index (mCI), based on available comorbidities from the Charlson comorbidity index (CCI). RESULTS: Bystander cardiopulmonary resuscitation (CPR) decreased...... was associated with higher mortality following OHCA, but when adjusting for confounders, the influence was no longer significant. The association between mCI and mortality was not modified by TTM. Comorbidity burden is associated with lower rates of bystander cardiopulmonary resuscitation after OHCA....

Imposex and butyltin body burden in Nassarius nitidus (Jeffreys, 1867), in coastal waters within the Basque Country (northern Spain)

Energy Technology Data Exchange (ETDEWEB)

Rodriguez, J. German, E-mail: grodriguez@pas.azti.es [AZTI-Tecnalia, Herrera Kaia Portualdea z/g, 20110-Pasaia (Spain); Borja, Angel; Franco, Javier [AZTI-Tecnalia, Herrera Kaia Portualdea z/g, 20110-Pasaia (Spain); Garcia Alonso, J. Ignacio [Department of Physical and Analytical Chemistry, Faculty of Chemistry, University of Oviedo, Julian Claveria 8, 33006 Oviedo (Spain); Garmendia, Joxe Mikel; Muxika, Inigo [AZTI-Tecnalia, Herrera Kaia Portualdea z/g, 20110-Pasaia (Spain); Sariego, Cristina [Servicio de Espectrometria de Masas, SCT' s, University of Oviedo, Julian Claveria s/n, 33006, Oviedo (Spain); Valencia, Victoriano [AZTI-Tecnalia, Herrera Kaia Portualdea z/g, 20110-Pasaia (Spain)

2009-07-01

Levels of imposex (superimposition of male characters, upon females) and the presence of sterile females are assessed in the gastropod Nassarius nitidus (Jeffreys, 1867), at 22 locations in the Basque Country (northern Spain). At 18 of these localities, butyltin bioaccumulation (tributyltin (TBT); dibutyltin; monobutyltin) was analysed using isotope dilution and GC-ICP-MS. Higher imposex levels and TBT body burden were found in confined harbours, with a large vessel traffic or the presence of a fishing fleet or a shipyard. For the first time, four apparently sequential types of aborted capsules are described in this species. Another novelty is the interspecific comparison between imposex intensities in sympatrically living populations of N. nitidus and N. reticulatus. This showed that sensitivity to TBT pollution of both species is relatively similar (in terms of Relative Penis Length Index). Since N. nitidus has a restricted habitat distribution due to its low presence in wave-exposed habitats, its complementary use with other species is recommended for its use in TBT monitoring programmes.

Imposex and butyltin body burden in Nassarius nitidus (Jeffreys, 1867), in coastal waters within the Basque Country (northern Spain)

International Nuclear Information System (INIS)

Rodriguez, J. German; Borja, Angel; Franco, Javier; Garcia Alonso, J. Ignacio; Garmendia, Joxe Mikel; Muxika, Inigo; Sariego, Cristina; Valencia, Victoriano

2009-01-01

Levels of imposex (superimposition of male characters, upon females) and the presence of sterile females are assessed in the gastropod Nassarius nitidus (Jeffreys, 1867), at 22 locations in the Basque Country (northern Spain). At 18 of these localities, butyltin bioaccumulation (tributyltin (TBT); dibutyltin; monobutyltin) was analysed using isotope dilution and GC-ICP-MS. Higher imposex levels and TBT body burden were found in confined harbours, with a large vessel traffic or the presence of a fishing fleet or a shipyard. For the first time, four apparently sequential types of aborted capsules are described in this species. Another novelty is the interspecific comparison between imposex intensities in sympatrically living populations of N. nitidus and N. reticulatus. This showed that sensitivity to TBT pollution of both species is relatively similar (in terms of Relative Penis Length Index). Since N. nitidus has a restricted habitat distribution due to its low presence in wave-exposed habitats, its complementary use with other species is recommended for its use in TBT monitoring programmes.

The significance of mineral pollutants in hair for the assessment of the body burden and the concentration in the critical organs in laboratory animals

International Nuclear Information System (INIS)

Kollmer, W.E.

1993-01-01

If the content of an element in hair of an individual is used for the assessment of health risk of that person it is of special importance to know if the hair analytical data reflect the body burden or the content of the organ or tissues at risk. Ideally the content in hair should rise and fall in parallel to an increase or decrease of the body burden or the content in the critical organs. It was the aim of this project to study the transfer of Hg, methyl-mercury and Zn to hair and to compare it with the levels simultaneously observed in the total body and the relevant organs under controlled experimental conditions in an animal model. In addition, a similar study on As and the analyses of two experiments of a long term study on Cd exposure were also included. 11 refs, 3 figs, 4 tabs

Studies on the current Cs-137 body burden of children in Belarus - can the dose be further reduced?

International Nuclear Information System (INIS)

Hill, P.; Schlaeger, M.; Vogel, V.; Hille, R.; Nesterenko, A.V.; Nesterenko, V.B.

2005-01-01

Full text: After the Chernobyl reactor accident wide areas of Belarus have been contaminated with radioactive fallout. The verification and documentation of the long-term development of radiation doses is still going on. A population group of special concern are the children living in contaminated regions. The annual dose limit of 1 mSv/a is still exceeded in some cases, essentially due to high body burdens of Cs-137 as indicated by screening measurements with portable incorporation monitors. In this situation the evaluation of possible dose reduction measures in addition to the control of food contamination is being investigated. Special attention is given to the cure-like application of a pectin-preparation (Vitapekt), for which a dose-lowering effect is presumed by Belarusian scientists. In a placebo-controlled double-blind study, several groups of contaminated children were treated with Vitapekt for a two-week period during their stay in a sanatorium. For comparison the same number of control groups were given a placebo preparation. The Cs-137 body burden of the children was measured at the beginning and the end. First results indicate a mean relative reduction of the specific activity within the Vitapekt groups of about 35 %, whereas the specific activity of the children who received a placebo decreased only by about 15 %. It is proposed that pectins chemically bind cesium in the gastrointestinal tract and thereby increase fecal excretion. Theoretical calculations based on this assumption are qualitatively consistent with the experimentally found retention of radiocesium in the human body after a pectin treatment. (author)

In vivo monitoring of skeletal aluminium burden in patients with renal failure

International Nuclear Information System (INIS)

Ellis, K.J.; Kelleher, S.; Raciti, A.; Savory, J.; Wills, M.

1988-01-01

In vivo neutron activation analysis was used to examine the total body and partial body (hand) aluminium levels in patients with end-stage renal failure. Patients maintained on chronic hemodialysis had higher mean body burdens of aluminium than did those clinically managed without dialysis. Approximately 70% of the patients examined indicated elevated levels of body or skeletal aluminium. A significant correlation was observed between the in vivo aluminium/calcium ratio obtained for the hand measurement and the increase in serum aluminium levels following a disferroxamine infusion test. The direct in vivo monitoring of hand Al/Ca values in patients may provide an alternate choice to bone biopsy for the detection of aluminium intoxication. (author) 15 refs.; 5 figs.; 2 tabs

Adjustment of a direct method for the determination of man body burden in Pu-239 on by X-ray detection of U-235

International Nuclear Information System (INIS)

Boulay, P.

1968-04-01

The use of Pu-239 on a larger scale sets a problem about the contamination measurement by aerosol at lung level. A method of direct measurement of Pu-239 lung burden is possible, thanks to the use of a large area window proportional counter. A counter of such pattern, has been especially carried out for this purpose. The adjustment of the apparatus allows an adequate sensibility to detect a contamination at the maximum permissible body burden level. Besides, a method for individual 'internal calibration', with a plutonium mock: the protactinium-233, is reported. (author) [fr

Body burden of Hg in different bio-samples of mothers in Shenyang city, China.

Directory of Open Access Journals (Sweden)

Min-Ming Li

Full Text Available Hg is an accumulative and neuro-toxic heavy metal which has a wide range of adverse effects in human health. However, few studies are available on body burden of Hg level in different bio-samples of pregnant women in Chinese population. Therefore, this study evaluated Hg levels in different maternal bio-samples in Shenyang city, China and investigated the correlation of Hg levels in different bio-samples. From October to December 2008, 200 pregnant women about to deliver their babies at ShengJing Hospital (Shenyang city, northeast of China participated in this study. The geometric mean (GM of Hg levels in cord blood, maternal venous blood, breast milk, and maternal urine were 2.18 µg/L, 1.17 µg/L, 1.14 µg/L, and 0.73 µg/L, respectively, and the GM of maternal hair Hg level was 404.45 µg/kg. There was a strong correlation between cord blood and maternal blood total Hg level (r = 0.713, P<0.001. Frequency of fish consumption more than or equal to 3 times per week during pregnancy was suggested as a significant risk factor of prenatal Hg exposure (unadjusted OR 3.5, adjusted OR 2.94, P<0.05. This study provides evidence about Hg burden of mothers and the risk factors of prenatal Hg exposure in Shenyang city, China.

Effects of variations in cadmium and lead levels in river sediments on local foods and body burden of local residents in non-polluted areas in Japan.

Science.gov (United States)

Ikeda, Masayuki; Watanabe, Takao; Ohashi, Fumiko; Shimbo, Shinichiro

2010-03-01

This study was initiated to examine if variations in the concentrations of cadmium (Cd) and lead (Pb) in water environment may affect metal levels in local foods and body burden of local residents in non-polluted areas in Japan. Two nationwide databases have been made available on concentrations of Cd in locally harvested brown rice and of Cd and Pb in sediments in local river beds. These data were combined with published data on metal concentrations in polished rice, food duplicates, and blood and urine from the residents. Cd in river sediments correlated significantly with those in brown rice, food duplicates, blood, and urine. Cd in food duplicates correlated with Cd in rice. In contrast, Pb concentrations in the river sediments either did not correlate or correlated only weakly with Pb in biological materials or food duplicates. Possible implication of the different behavior between Cd and Pb regarding the intensity of correlation was discussed with reference to the different routes of exposure to the elements. In conclusions, the Cd body burden on local residents in Japan is significantly influenced by Cd levels in water in the general environment, whereas water-borne Pb did not show clear correlation with the Pb body burden.

Patients' self-perceived burden, caregivers' burden and quality of life for amyotrophic lateral sclerosis patients: a cross-sectional study.

Science.gov (United States)

Geng, Dan; Ou, RuWei; Miao, XiaoHui; Zhao, LiHong; Wei, QianQian; Chen, XuePing; Liang, Yan; Shang, HuiFang; Yang, Rong

2017-10-01

This study surveys the quality of life of amyotrophic lateral sclerosis patients and the factors associated with amyotrophic lateral sclerosis patients' self-perceived burden and their caregivers' burden. Burdens of patients with amyotrophic lateral sclerosis and their caregivers in Chinese population are largely unknown. A cross-sectional study was conducted among 81 pairs of amyotrophic lateral sclerosis patients and their caregivers. Amyotrophic lateral sclerosis patients' self-perceived burden and caregivers' burden were assessed by the Self-Perceived Burden Scale and Zarit-Burden Interview, respectively. Quality of life of amyotrophic lateral sclerosis patients was measured using the World Health Organization Quality of Life-Bref. The amyotrophic lateral sclerosis Functional Rating Scale-Revised questionnaire was used to estimate patients' physical function. Both patients and caregivers reported a mild to moderate burden. The World Health Organization quality of life-Bref scores were decreased in respondents with lower amyotrophic lateral sclerosis Functional Rating Scale-Revised, higher Self-Perceived Burden Scale and higher Zarit-Burden Interview scores. Self-Perceived Burden Scale scores were associated with patients' knowledge of amyotrophic lateral sclerosis, respiratory function and female sex. Zarit-Burden Interview scores were associated with caregivers' age, patients' motor function and out-of-pocket payment. With increase in amyotrophic lateral sclerosis patients' self-perceived burden and caregivers' burden, quality of life of amyotrophic lateral sclerosis patients decreased. Female patients, who had known more about the disease, and those with severe respiratory dysfunction were subject to higher self-perceived burden. Older caregivers and caregivers of patients with severe motor dysfunction and more out-of-pocket payment experienced more care burdens. Our study suggests that paying more attention to female amyotrophic lateral sclerosis patients

Studies on the current 137Cs body burden of children in Belarus - Can the dose be further reduced?

International Nuclear Information System (INIS)

Hill, P.; Schlaeger, M.; Vogel, V.; Hille, R.; Nesterenko, A. V.; Nesterenko, V. B.

2007-01-01

After the Chernobyl reactor accident wide areas of Belarus were contaminated with radioactive fallout. The verification and documentation of the long-term development of radiation doses is still going on. A population group of special concern are the children living in contaminated regions. The annual dose limit of 1 mSv is still exceeded in some cases, essentially due to high body burdens of 137 Cs as indicated by screening measurements with portable incorporation monitors. In this situation the evaluation of possible dose reduction measures in addition to the control of food contamination is being investigated. Special attention is given to the therapeutic application of a pectin preparation (Vitapect), for which a dose-lowering effect is presumed by Belarusian scientists. In a placebo-controlled double-blind study, several groups of contaminated children received a pectin compound named Vitapect for a two-week period during their stay in a sanatorium. For comparison the same number of control groups were given a placebo preparation. The 137 Cs body burden of the children was measured at the beginning and the end. The mean relative reduction of the specific activity within the Vitapect groups was found to be ∼33%, whereas the specific activity of the children who received a placebo decreased only by ∼14%, due to clean food supply. It is known that pectins chemically bind cations like caesium in the gastrointestinal tract and thereby increase faecal excretion. Theoretical calculations based on this assumption and considering metabolism processes are qualitatively consistent with the experimentally found retention of radiocaesium in the human body after pectin treatment. (authors)

Burden of Sexual Dysfunction.

Science.gov (United States)

Balon, Richard

2017-01-02

Similar to the burden of other diseases, the burden of sexual dysfunction has not been systematically studied. However, there is growing evidence of various burdens (e.g., economic, symptomatic, humanistic) among patients suffering from sexual dysfunctions. The burden of sexual dysfunction has been studied a bit more often in men, namely the burden of erectile dysfunction (ED), premature ejaculation (PE) and testosterone deficiency syndrome (TDS). Erectile dysfunction is frequently associated with chronic conditions such as cardiovascular disease, diabetes, and depression. These conditions could go undiagnosed, and ED could be a marker of those diseases. The only available report from the United Kingdom estimated the total economic burden of ED at £53 million annually in terms of direct costs and lost productivity. The burden of PE includes significant psychological distress: anxiety, depression, lack of sexual confidence, poor self-esteem, impaired quality of life, and interpersonal difficulties. Some suggest that increase in female sexual dysfunction is associated with partner's PE, in addition to significant interpersonal difficulties. The burden of TDS includes depression, sexual dysfunction, mild cognitive impairment, and osteoporosis. One UK estimate of the economic burden of female sexual dysfunctions demonstrated that the average cost per patient was higher than the per annum cost of ED. There are no data on burden of paraphilic disorders. The burden of sexual dysfunctions is underappreciated and not well studied, yet it is significant for both the patients and the society.

Cesium-137 body burdens in Norwegian Lapps, 1965-1983

International Nuclear Information System (INIS)

Westerlund, E.A.; Berthelsen, T.; Berteig, L.

1987-01-01

Results of measurements of the whole-body contents of 137 Cs during the period 1965-1983 in Lapps from the Kautokeino area in Norway are reported with measurements of 137 Cs in reindeer meat during the period 1966-1983. By using available data on 137 Cs in precipitation for the period 1950-1980, transfer coefficients from 137 Cs in precipitation to reindeer meat have been assessed. A correlation between the 137 Cs content in reindeer meat and the 137 Cs content in Lapp reindeer breeders has been established. The average whole-body committed dose equivalent, H50, to the reindeer breeders from internally deposited 137 Cs from intakes up to year 2000 was assessed to 13 mSv with a peak value of 30 mSv. In comparison, the corresponding committed dose equivalent to the Norwegian population from internally deposited 137 Cs has been estimated to be about 1 mSv. The higher intake of 137 Cs by reindeer breeders is due to the lichen-reindeer-man exposure pathway

Organ burdens and excretion rates of inhaled uranium - computations using ICRP model

International Nuclear Information System (INIS)

Abani, M.C.; Murthy, K.B.S.; Sunta, C.M.

1988-01-01

Uranium being a highly toxic material, proper estimation of the body burden is very important. During manufacture of uranium fuel, it is likely to enter the body by inhalation. By the body burden and excretion measurements, one should be able to assess whether the intake is within the safe limits or not. This is possible if one performs theoretical calculations and estimates the amount of uranium which builds up in the body as a function of time. Similarly theoretical estimates in case of excretion have to be made. For this purpose, a computer programme has been developed to find out organ burdens and excretion rates resulting from exposure to a radioactive nuclide. ICRP-30 lung model has been used and cases of single instantaneous inhalation of 1 ALI as well as inhalation at a steady rate of ALI/365 per day have been considered. Using this programme, results for uranium aerosols of classes D, W and Y and sizes 0.2, 1 and 5 microns are generated by ND computers in tabular as well as graphical forms. These will be useful in conjunction with body burden measurements by direct counting or excretion analysis. (author). 7 tabs., 56 figs

A review of environmental fate, body burdens, and human health risk assessment of PCDD/Fs at two typical electronic waste recycling sites in China

International Nuclear Information System (INIS)

Chan, Janet Kit Yan; Wong, Ming H.

2013-01-01

This paper reviews the levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in different environmental media, human body burdens and health risk assessment results at e-waste recycling sites in China. To provide an indication of the seriousness of the pollution levels in the e-waste recycling sites in China, the data are compared with guidelines and available existing data for other areas. The comparison clearly shows that PCDD/Fs derived from the recycling processes lead to serious pollution in different environmental compartments (such as air, soil, sediment, dust and biota) and heavy body burdens. Of all kinds of e-waste recycling operations, open burning of e-waste and acid leaching activities are identified as the major sources of PCDD/Fs. Deriving from the published data, the estimated total exposure doses via dietary intake, inhalation, soil/dust ingestion and dermal contact are calculated for adults, children and breast-fed infants living in two major e-waste processing locations in China. The values ranged from 5.59 to 105.16 pg WHO-TEQ/kg bw/day, exceeding the tolerable daily intakes recommended by the WHO (1–4 pg WHO-TEQ/kg bw/day). Dietary intake is the most important exposure route for infants, children and adults living in these sites, contributing 60–99% of the total intakes. Inhalation is the second major exposure route, accounted for 12–30% of the total exposure doses of children and adults. In order to protect the environment and human health, there is an urgent need to control and monitor the informal e-waste recycling operations. Knowledge gaps, such as comprehensive dietary exposure data, epidemiological and clinical studies, body burdens of infants and children, and kinetics about PCDD/Fs partitions among different human tissues should be addressed. - Highlights: ► PCDD/F levels at e-waste recycling sites in China were reviewed. ► Data on environment and body burden and health risk assessment results were reviewed

A review of environmental fate, body burdens, and human health risk assessment of PCDD/Fs at two typical electronic waste recycling sites in China

Energy Technology Data Exchange (ETDEWEB)

Chan, Janet Kit Yan, E-mail: chanjky@hku.hk [School of Biological Sciences, The University of Hong Kong, Pokfulam, Hong Kong (China); Wong, Ming H., E-mail: mhwong@hkbu.edu.hk [Croucher Institute for Environmental Sciences, and Department of Biology, Hong Kong Baptist University, Hong Kong (China)

2013-10-01

This paper reviews the levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in different environmental media, human body burdens and health risk assessment results at e-waste recycling sites in China. To provide an indication of the seriousness of the pollution levels in the e-waste recycling sites in China, the data are compared with guidelines and available existing data for other areas. The comparison clearly shows that PCDD/Fs derived from the recycling processes lead to serious pollution in different environmental compartments (such as air, soil, sediment, dust and biota) and heavy body burdens. Of all kinds of e-waste recycling operations, open burning of e-waste and acid leaching activities are identified as the major sources of PCDD/Fs. Deriving from the published data, the estimated total exposure doses via dietary intake, inhalation, soil/dust ingestion and dermal contact are calculated for adults, children and breast-fed infants living in two major e-waste processing locations in China. The values ranged from 5.59 to 105.16 pg WHO-TEQ/kg bw/day, exceeding the tolerable daily intakes recommended by the WHO (1–4 pg WHO-TEQ/kg bw/day). Dietary intake is the most important exposure route for infants, children and adults living in these sites, contributing 60–99% of the total intakes. Inhalation is the second major exposure route, accounted for 12–30% of the total exposure doses of children and adults. In order to protect the environment and human health, there is an urgent need to control and monitor the informal e-waste recycling operations. Knowledge gaps, such as comprehensive dietary exposure data, epidemiological and clinical studies, body burdens of infants and children, and kinetics about PCDD/Fs partitions among different human tissues should be addressed. - Highlights: ► PCDD/F levels at e-waste recycling sites in China were reviewed. ► Data on environment and body burden and health risk assessment results were reviewed

Financial Burden Borne by Laparoscopic Living Kidney Donors.

Science.gov (United States)

Wiseman, Jennifer F; Jacobs, Cheryl L; Larson, Dawn B; Berglund, Danielle M; Garvey, Catherine A; Ibrahim, Hassan N; Matas, Arthur J

2017-09-01

Living kidney donors have donation-related out-of-pocket costs (direct costs) and/or ongoing daily expenses while losing income (indirect costs). Yet there is little information about how much of a subjective burden these constitute for the donors. From December 2003 through December 2014, we surveyed donors 6 months postdonation to determine their financial burden related to donation (on a scale of 1 to 10) and what resources were used to cover expenses. Of 1136 surveyed, 796 (70%) responded. Among respondents, mean age at donation was 43.6 ± 10.6 years, 64% were women, 96% were white, and 53% were related by blood to their recipient. Overall, 26% scored their financial burden as 5 or higher; 8% scored it as 8 or higher. Increased expenses were associated with a higher reported burden; however, significant burden was reported by some with no out-of-pocket expenses (presumably due to lost wages and continuing expenses). The burden was scored as 5 or higher by 27% of those employed outside the home (n = 660), 15% homemakers, 13% retirees, 40% students; 28% unemployed; and 26% whose occupation was unknown. Over half (51%) of those receiving a local or (means-tested) national grant still reported moderate to severe burden. Besides grants, donors used a variety of sources to help offset expenses: dipped into savings, borrowed from friends or family, took out a loan, and/or had a fundraiser. Those with the highest burden reported using the most additional sources. Donors should not have to incur costs or a financial burden to donate; the transplant community should strive to make donation financially neutral.

Assessment of Radioactivity in Man. Vol. II. Proceedings of the Symposium on the Assessment of Radioactive Body Burdens

International Nuclear Information System (INIS)

1964-01-01

This Symposium on the Assessment of Radioactive Body Burdens in Man was organized jointly by the International Atomic Energy Agency, the International Labour Organisation and the World Health Organization and was held in Heidelberg from 11-15 May 1964. It was attended by 181 participants from 28 countries and 6 international organizations. It was the objective of the Symposium to bring together experts from the various scientific disciplines of physics, chemistry, biology, medicine and mathematics, and to survey their experience in the assessment of radioactive body burdens in man and the resultant radiation doses. In most investigations of internal contamination the errors in the physical measurements are smaller than the errors associated with the interpretation of measurements. For this reason special emphasis was laid in this meeting on the interpretation of measured data. The 67 papers and the discussions which they stimulated are published in these Proceedings produced in two volumes. Volume I includes all papers which deal with problems generally common to many isotopes: in- vivo counting, bioassay techniques, sample counting and analysis of data. Volume II includes those papers concerned with radioisotopes of specific elements: caesium, radium, radon, strontium, tritium, thorium, uranium, plutonium and rare earth elements. These Proceedings should prove invaluable to all radiation protection services entrusted with the physical surveillance of internal radiation exposure of man. They should complement the studies of the International Commission on Radiological Protection (ICRP) and assist the work of the Organizations that jointly organized the meeting

Role of Airborne Lead in Increased Body Burden of Lead in Hartford Children*

Science.gov (United States)

Lepow, Martha L.; Bruckman, Leonard; Rubino, Robert A.; Markowitz, Steven; Gillette, Marybeth; Kapish, Janet

1974-01-01

The ingestion of airborne lead fallout is the mechanism responsible for increased lead body burdens found in 10 urban Connecticut children. The mean indoor lead levels found in housedust was 11,000 μg/g; highest concentrations occurred on windowsills and in floor dust. The mean lead content of Hartford street dirt was 1,200 μg/g; levels were highest near the street and next to the buildings. The mean lead concentration of hand samples taken from the subject children was 2,400 μg/g; the mean weight of hand samples was 11 mg. The concentration of lead in dirt and househould dust was high enough to theoretically result in excessive lead accumulation in young children who are putting their dusty, dirty hands in their mouths during play. While we believe that lead emitted from automobiles contributes significantly to air, dirt and dust lead levels the environmental impact of reducing or eliminating lead from gasoline is not yet completely understood. PMID:4133903

Body burdens of brominated flame retardants and other persistent organo-halogenated compounds and their descriptors in US girls

Energy Technology Data Exchange (ETDEWEB)

Windham, Gayle C., E-mail: gayle.windham@cdph.ca.gov [CA Department of Public Health, DEODC, 850 Marina Bay Pkwy, Bldg. P, Richmond, CA 94804 (United States); Pinney, Susan M. [University of Cincinnati College of Medicine, Cincinnati, OH 45267 (United States); Sjodin, Andreas [Centers for Disease Control and Prevention, Atlanta, GA 30341 (United States); Lum, Raymond [Impact Assessment Inc., San Diego, CA (United States); Jones, Richard S.; Needham, Larry L. [Centers for Disease Control and Prevention, Atlanta, GA 30341 (United States); Biro, Frank M. [University of Cincinnati College of Medicine, Cincinnati, OH 45267 (United States); Hiatt, Robert A. [University of California Medical School, San Francisco, CA (United States); Kushi, Lawrence H. [Kaiser Permanente Northern California, Oakland, CA 94612 (United States)

2010-04-15

Background: Levels of brominated flame retardants are increasing in US populations, yet little data are available on body burdens of these and other persistent hormonally active agents (HAAs) in school-aged children. Exposures to such chemicals may affect a number of health outcomes related to development and reproductive function. Objective: Determine the distribution of biomarkers of polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), and organo-chlorinated pesticides (OCPs), such as DDT/DDE, in children, and their variation by key descriptor variables. Methods: Ethnically diverse cohorts of girls 6-8 y old at baseline are being followed for growth and pubertal development in a multi-site, longitudinal study. Nearly 600 serum samples from the California and Ohio sites were analyzed for lipids, 35 PCB congeners, 11 PBDE congeners, and 9 OCPs. The biomarker distributions were examined and geometric means compared for selected analytes across categories of age, race, site, body mass index (BMI), parental education, maternal age at delivery, and breast feeding in adjusted models. Results: Six PBDE congeners were detected among greater than 70% of samples, with BDE-47 having the highest concentration (median 42.2, range 4.9-855 ng/g lipid). Girls in California had adjusted geometric mean (GM) PBDE levels significantly higher than girls in Ohio. Furthermore, Blacks had significantly higher adjusted GMs of all six PBDE congeners than Whites, and Hispanics had intermediate values. GMs tended to be lower among more obese girls, while other variables were not strongly associated. In contrast, GMs of the six PCB congeners most frequently detected were significantly lower among Blacks and Hispanics than Whites. PCBs and the three pesticides most frequently detected were also consistently lower among girls with high BMI, who were not breast-fed, whose mothers were younger, or whose care-givers (usually parents) were less educated. Girls in California had

Body burdens of brominated flame retardants and other persistent organo-halogenated compounds and their descriptors in US girls

International Nuclear Information System (INIS)

Windham, Gayle C.; Pinney, Susan M.; Sjodin, Andreas; Lum, Raymond; Jones, Richard S.; Needham, Larry L.; Biro, Frank M.; Hiatt, Robert A.; Kushi, Lawrence H.

2010-01-01

Background: Levels of brominated flame retardants are increasing in US populations, yet little data are available on body burdens of these and other persistent hormonally active agents (HAAs) in school-aged children. Exposures to such chemicals may affect a number of health outcomes related to development and reproductive function. Objective: Determine the distribution of biomarkers of polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), and organo-chlorinated pesticides (OCPs), such as DDT/DDE, in children, and their variation by key descriptor variables. Methods: Ethnically diverse cohorts of girls 6-8 y old at baseline are being followed for growth and pubertal development in a multi-site, longitudinal study. Nearly 600 serum samples from the California and Ohio sites were analyzed for lipids, 35 PCB congeners, 11 PBDE congeners, and 9 OCPs. The biomarker distributions were examined and geometric means compared for selected analytes across categories of age, race, site, body mass index (BMI), parental education, maternal age at delivery, and breast feeding in adjusted models. Results: Six PBDE congeners were detected among greater than 70% of samples, with BDE-47 having the highest concentration (median 42.2, range 4.9-855 ng/g lipid). Girls in California had adjusted geometric mean (GM) PBDE levels significantly higher than girls in Ohio. Furthermore, Blacks had significantly higher adjusted GMs of all six PBDE congeners than Whites, and Hispanics had intermediate values. GMs tended to be lower among more obese girls, while other variables were not strongly associated. In contrast, GMs of the six PCB congeners most frequently detected were significantly lower among Blacks and Hispanics than Whites. PCBs and the three pesticides most frequently detected were also consistently lower among girls with high BMI, who were not breast-fed, whose mothers were younger, or whose care-givers (usually parents) were less educated. Girls in California had

Comparison of organochlorine chemical body burdens of female breast cancer cases with cancer free women in Rio Grande do Sul, Brazil--Pilot Study

Energy Technology Data Exchange (ETDEWEB)

Erdmann, C.A.; Petreas, M.X.; Caleffi, M.; Barbosa, F.S.; Goth-Goldstein, R.

1999-12-01

This pilot study collected preliminary data to examine known and suspected breast cancer risk factors among women living in rural and urban areas in the state of Rio Grande do Sul, Brazil by questionnaire. In addition, the body burden levels of a panel of organochlorines was measured in a small clinic-based prospective sample.

Case report: heavy metal burden presenting as Bartter syndrome.

Science.gov (United States)

Crinnion, Walter J; Tran, Jessica Q

2010-12-01

Maternal transfer of heavy metals during fetal development or lactation possibly contributed to the clinical manifestations of Bartter syndrome and developmental delay in the offspring. An 11-month-old child diagnosed with Bartter syndrome and failure to thrive was treated concurrently for elevated metal burden while he was undergoing standard medical interventions. Treatment with body-weight doses of meso-2,3-dimercaptosuccinic acid (DMSA) reduced the body burden of lead, beryllium, copper, mercury, and cadmium at the three- and sixth-month follow-up tests. During the course of the six-month treatment, the patient gained 2.4 kg (5.2 lb) and grew approximately 9.5 cm (3.75 in). His weight shifted from significantly below the 5th percentile in weight to within the 5th percentile, and from below the 5th to within the 10th percentile for length. The child's acquisition of lead, beryllium, and copper correspond to his mother's history of stained glass assembly and occurred during fetal development or lactation, since there were no other identifiable sources that could have contributed to the heavy metal burden. Tests for known genetic mutations leading to Bartter syndrome were all negative. This case report highlights the potential benefit of DMSA for treatment of heavy metal body burden in infants who present with Bartter syndrome.

Burden of higher lead exposure in African-Americans starts in utero and persists into childhood.

Science.gov (United States)

Cassidy-Bushrow, Andrea E; Sitarik, Alexandra R; Havstad, Suzanne; Park, Sung Kyun; Bielak, Lawrence F; Austin, Christine; Johnson, Christine Cole; Arora, Manish

2017-11-01

Recent public health lead crises in urban areas emphasize the need to better understand exposure to environmental toxicants, particularly in higher risk groups. Although African-American children have the highest prevalence of elevated blood lead levels in the United States, little is known about when this trajectory of disproportionate burden of lead exposure first emerges. Using tooth-matrix biomarkers that directly measure fetal and early childhood metal levels, the primary goal of this study was to determine if there were racial disparities in lead levels during fetal development and early childhood. Manganese, an essential nutrient that modifies the neurotoxic effects of lead, was also measured. Pregnant women served by the Henry Ford Health System and living in a predefined geographic area in and around Detroit, Michigan, were recruited during the second trimester or later into the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS), a population-based birth cohort. Offspring born between September 2003 and December 2007 were studied in childhood. Child race was parent-reported. Lead and manganese during the second and third trimesters, early postnatal life (birth through age 1year) and early childhood (age 1 through time of tooth shedding, which ranges from 6 to 12years) were measured via high-resolution microspatial mapping of dentin growth rings, a validated biomarker for prenatal and childhood metal exposure. African-American children (N=71) had 2.2 times higher lead levels in the second and third trimesters (both pAfrican-American children were also higher during childhood, but this effect was only marginally significant (p=0.066) and was attenuated after covariate adjustment. Additionally, we observed that African-American children had lower tooth‑manganese levels during the third trimester (p=0.063) and postnatally (p=0.043), however these differences were attenuated after covariate adjustment. The disproportionate burden

Factors Associated With Higher Caregiver Burden Among Family Caregivers of Elderly Cancer Patients: A Systematic Review.

Science.gov (United States)

Ge, Lixia; Mordiffi, Siti Zubaidah

Caring for elderly cancer patients may cause multidimensional burden on family caregivers. Recognition of factors associated with caregiver burden is important for providing proactive support to caregivers at risk. The aim of this study was to identify factors associated with high caregiver burden among family caregivers of elderly cancer patients. A systematic search of 7 electronic databases was conducted from database inception to October 2014. The identified studies were screened, and full text was further assessed. The quality of included studies was assessed using a checklist, and relevant data were extracted using a predeveloped data extraction form. Best-evidence synthesis model was used for data synthesis. The search yielded a total of 3339 studies, and 7 studies involving 1233 family caregivers were included after screening and full assessment of 116 studies. Moderate evidence supported that younger caregivers, solid tumors, and assistance with patient's activities of daily living were significantly associated with high caregiver burden. Eighteen factors were supported by limited evidence, and 1 was a conflicting factor. The scientific literature to date proved that caregiver burden was commonly experienced by family caregivers of elderly cancer patients. The evidence indicated that family caregivers who were at younger age, caring for solid tumor patients, and providing assistance with patient's activities of daily living reported high caregiver burden. The data provide evidence in identifying family caregivers at high risk of high caregiver burden. More high-quality studies are needed to clarify and determine the estimates of the effects of individual factors.

The burden of mental disorders in the Eastern Mediterranean region, 1990-2015: findings from the global burden of disease 2015 study.

Science.gov (United States)

2017-08-03

Mental disorders are among the leading causes of nonfatal burden of disease globally. We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7-5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.

Whole body cardiovascular magnetic resonance imaging to stratify symptomatic and asymptomatic atherosclerotic burden in patients with isolated cardiovascular disease

International Nuclear Information System (INIS)

Weir-McCall, Jonathan R.; Duce, Suzanne L.; Gandy, Stephen J.; Matthew, Shona Z.; Martin, Patricia; Cassidy, Deirdre B.; McCormick, Lynne; Belch, Jill J. F.; Struthers, Allan D.; Colhoun, Helen M.; Houston, J. Graeme

2016-01-01

The aim of this study was to use whole body cardiovascular magnetic resonance imaging (WB CVMR) to assess the heart and arterial network in a single examination, so as to describe the burden of atherosclerosis and subclinical disease in participants with symptomatic single site vascular disease. 64 patients with a history of symptomatic single site vascular disease (38 coronary artery disease (CAD), 9 cerebrovascular disease, 17 peripheral arterial disease (PAD)) underwent whole body angiogram and cardiac MR in a 3 T scanner. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cine and late gadolinium enhancement images of the left ventricle were obtained. Asymptomatic atherosclerotic disease with greater than 50 % stenosis in arteries other than that responsible for their presenting complain was detected in 37 % of CAD, 33 % of cerebrovascular and 47 % of PAD patients. Unrecognised myocardial infarcts were observed in 29 % of PAD patients. SAS was significantly higher in PAD patients 24 (17.5-30.5) compared to CAD 4 (2–11.25) or cerebrovascular disease patients 6 (2-10) (ANCOVA p < 0.001). Standardised atheroma score positively correlated with age (β 0.36 p = 0.002), smoking status (β 0.34 p = 0.002), and LV mass (β -0.61 p = 0.001) on multiple linear regression. WB CVMR is an effective method for the stratification of cardiovascular disease. The high prevalence of asymptomatic arterial disease, and silent myocardial infarctions, particularly in the peripheral arterial disease group, demonstrates the importance of a systematic approach to the assessment of cardiovascular disease

The double burden of undernutrition and excess body weight in Mexico.

Science.gov (United States)

Kroker-Lobos, Maria F; Pedroza-Tobías, Andrea; Pedraza, Lilia S; Rivera, Juan A

2014-12-01

In Mexico, stunting and anemia have declined but are still high in some regions and subpopulations, whereas overweight and obesity have increased at alarming rates in all age and socioeconomic groups. The objective was to describe the coexistence of stunting, anemia, and overweight and obesity at the national, household, and individual levels. We estimated national prevalences of and trends for stunting, anemia, and overweight and obesity in children aged obesity in women aged 20-49 y by using the National Health and Nutrition Surveys conducted in 1988, 1999, 2006, and 2012. With the use of the most recent data (2012), the double burden of malnutrition at the household level was estimated and defined as the coexistence of stunting in children aged obesity in the mother. At the individual level, double burden was defined as concurrent stunting and overweight and obesity in children aged 5-11 y and concurrent anemia and overweight or obesity in children aged 5-11 y and in women. We also tested if the coexistence of the conditions corresponded to expected values, under the assumption of independent distributions of each condition. At the household level, the prevalence of concurrent stunting in children aged obesity in mothers was 8.4%; at the individual level, prevalences were 1% for stunting and overweight or obesity and 2.9% for anemia and overweight or obesity in children aged 5-11 y and 7.6% for anemia and overweight or obesity in women. At the household and individual levels in children aged 5-11 y, prevalences of double burden were significantly lower than expected, whereas anemia and the prevalence of overweight or obesity in women were not different from that expected. Although some prevalences of double burden were lower than expected, assuming independent distributions of the 2 conditions, the coexistence of stunting, overweight or obesity, and anemia at the national, household, and intraindividual levels in Mexico calls for policies and programs to prevent

Caregiving burden and its determinants in Polish caregivers of stroke survivors.

Science.gov (United States)

Jaracz, Krystyna; Grabowska-Fudala, Barbara; Górna, Krystyna; Kozubski, Wojciech

2014-10-27

Despite the growing body of literature on the consequences of providing non-professional care to stroke survivors, the determinants of caregiving burden are still not fully recognized. Identification of significant determinants can facilitate caregiver intervention programs. The aim of this study was to evaluate the level of burden borne by caregivers of stroke patients and to identify the most important determinants of burden at 6 months after hospitalization. Data were collected from 150 pairs of stroke patients/caregivers. Caregiver burden was assessed on the Caregiver Burden scale (CB). Several characteristics were measured as potential predictors of the burden. Special attention was paid to the caregiver's sense of coherence (SOC) and anxiety. Regression analysis was employed to test the hypothesized relationships between these variables and the burden. Forty-seven percentage of the caregivers reported a substantial burden (severe or moderate). Caregiver SOC (p emotional state and the level of patients' dependency, as these are the vital and modifiable factors affecting caregiver burden following stroke.

Health and economic burden of obesity in Brazil.

Directory of Open Access Journals (Sweden)

Ketevan Rtveladze

Full Text Available INTRODUCTION: Higher and lower-middle income countries are increasingly affected by obesity. Obesity-related diseases are placing a substantial health and economic burden on Brazil. Our aim is to measure the future consequences of these trends on the associated disease burden and health care costs. METHOD: A previously developed micro-simulation model is used to project the extent of obesity, obesity-related diseases and associated healthcare costs to 2050. In total, thirteen diseases were considered: coronary heart disease, stroke, hypertension, diabetes, osteoarthritis, and eight cancers. We simulated three hypothetical intervention scenarios: no intervention, 1% and 5% reduction in body mass index (BMI. RESULTS: In 2010, nearly 57% of the Brazilian male population was overweight or obese (BMI ≥25 kg/m(2, but the model projects rates as high as 95% by 2050. A slightly less pessimistic picture is predicted for females, increasing from 43% in 2010 to 52% in 2050. Coronary heart disease, stroke, hypertension, cancers, osteoarthritis and diabetes prevalence cases are projected to at least double by 2050, reaching nearly 34,000 cases of hypertension by 2050 (per 100,000. 1% and 5% reduction in mean BMI will save over 800 prevalence cases and nearly 3,000 cases of hypertension by 2050 respectively (per 100,000. The health care costs will double from 2010 ($5.8 billion in 2050 alone ($10.1 billion. Over 40 years costs will reach $330 billion. However, with effective interventions the costs can be reduced to $302 billion by 1% and to $273 billion by 5% reduction in mean BMI across the population. CONCLUSION: Obesity rates are rapidly increasing creating a high burden of disease and associated costs. However, an effective intervention to decrease obesity by just 1% will substantially reduce obesity burden and will have a significant effect on health care expenditure.

Body composition, symptoms, and survival in advanced cancer patients referred to a phase I service.

Directory of Open Access Journals (Sweden)

Henrique A Parsons

Full Text Available Body weight and body composition are relevant to the outcomes of cancer and antineoplastic therapy. However, their role in Phase I clinical trial patients is unknown.We reviewed symptom burden, body composition, and survival in 104 patients with advanced cancer referred to a Phase I oncology service. Symptom burden was analyzed using the MD Anderson Symptom Assessment Inventory(MDASI; body composition was evaluated utilizing computerized tomography(CT images. A body mass index (BMI≥25 kg/m² was considered overweight. Sarcopenia, severe muscle depletion, was assessed using CT-based criteria.Most patients were overweight (n = 65, 63%; 53 patients were sarcopenic (51%, including 79% of patients with a BMI<25 kg/m² and 34% of those with BMI≥25 kg/m². Sarcopenic patients were older and less frequently African-American. Symptom burden did not differ among patients classified according to BMI and presence of sarcopenia. Median (95% confidence interval survival (days varied according to body composition: 215 (71-358 (BMI<25 kg/m²; sarcopenic, 271 (99-443 (BMI<25 kg/m²; non-sarcopenic, 484 (286-681 (BMI≥25 kg/m²; sarcopenic; 501 d (309-693 (BMI≥25 kg/m²; non-sarcopenic. Higher muscle index and gastrointestinal cancer diagnosis predicted longer survival in multivariate analysis after controlling for age, gender, performance status, and fat index.Patients referred to a Phase I clinic had a high frequency of sarcopenia and a BMI≥25 kg/m², independent of symptom burden. Body composition variables were predictive of clinically relevant survival differences, which is potentially important in developing Phase I studies.

Investing in improved performance of national tuberculosis programs reduces the tuberculosis burden: analysis of 22 high-burden countries, 2002-2009.

Science.gov (United States)

Akachi, Yoko; Zumla, Alimuddin; Atun, Rifat

2012-05-15

To assess the impact of investment in national tuberculosis programs (NTPs) on NTP performance and tuberculosis burden in 22 high-burden countries, as determined by the World Health Organization (WHO). Estimates of annual tuberculosis burden and NTP performance indicators and control variables during 2002-2009 were obtained from the Organization for Economic Cooperation and Development, the WHO, the World Bank, and the Penn World Table for the 22 high-burden countries. Panel data analysis was performed using the outcome variables tuberculosis incidence, prevalence, and mortality and the key explanatory variables Partnership case detection rate and treatment success rate, controlling for gross domestic product per capita, population structure, and human immunodeficiency virus (HIV) prevalence. A $1 per capita (general population) higher NTP budget (including domestic and external sources) was associated with a 1.9% (95% confidence interval, .12%-3.6%) higher estimated case detection rate the following year for the 22 high-burden countries between 2002 and 2009. In the final models, which corrected for autocorrelation and heteroskedasticity, achieving the STOP TB Partnership case detection rate target of >70% was associated with significantly (P < .01) lower tuberculosis incidence, prevalence, and mortality the following year, even when controlling for general economic development and HIV prevalence as potential confounding variables. Increased investment in NTPs was significantly associated with improved performance and with a downward trend in the tuberculosis burden in the 22 high-burden countries during 2002-2009.

Factors associated with perceived donation-related financial burden among living kidney donors.

Science.gov (United States)

Ruck, Jessica M; Holscher, Courtenay M; Purnell, Tanjala S; Massie, Allan B; Henderson, Macey L; Segev, Dorry L

2018-03-01

The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. We sought to identify characteristics that predicted higher risk of perceived financial burden. We surveyed 51 living kidney donors (LKDs) who donated from 01/2015 to 3/2016 about socioeconomic characteristics, predonation cost concerns, and perceived financial burden. We tested associations between both self-reported and ZIP code-level characteristics and perceived burden using Fisher's exact test and bivariate modified Poisson regression. Donors who perceived donation-related financial burden were less likely to have an income above their ZIP code median (14% vs. 72%, P = .006); however, they were more likely than donors who did not perceive burden to rent their home (57% vs. 16%, P = .03), have an income donation-related cost concerns prior to donation might allow transplant centers to target financial support interventions toward potential donors at higher risk of perceiving donation-related financial burden. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

68Ga-PSMA-11 PET/CT-derived metabolic parameters for determination of whole-body tumor burden and treatment response in prostate cancer.

Science.gov (United States)

Schmidkonz, Christian; Cordes, Michael; Schmidt, Daniela; Bäuerle, Tobias; Goetz, Theresa Ida; Beck, Michael; Prante, Olaf; Cavallaro, Alexander; Uder, Michael; Wullich, Bernd; Goebell, Peter; Kuwert, Torsten; Ritt, Philipp

2018-05-03

We aimed at evaluating the role of 68 Ga-PSMA-11 PET/CT-derived metabolic parameters for assessment of whole-body tumor burden and its capability to determine therapeutic response in patients with prostate cancer. A total of 142 patients with biochemical recurrence of prostate cancer underwent PET/CT with [ 68 Ga]Ga-PSMA-HBED-CC ( 68 Ga-PSMA-11). Quantitative assessment of all 641 68 Ga-PSMA-11-positive lesions in the field of view was performed to calculate PSMA-derived parameters, including whole-body PSMA tumor volume (PSMA-TV) and whole-body total lesion PSMA (TL-PSMA), as well as the established SUVmax and SUVmean values. All PET-derived parameters were tested for correlation with serum PSA levels and for association with Gleason scores. In 23 patients who underwent 68 Ga-PSMA-11 PET/CT before and after therapy with either external beam radiation, androgen deprivation, or docetaxel chemotherapy, SUVmax and TL-PSMA were compared to radiographic response assessment of CT images based on RECIST 1.1 criteria and to biochemical response determined by changes of serum PSA levels. PSMA-TV and TL-PSMA demonstrated a significant correlation with serum PSA levels (P PET and biochemical response was 87% (95% confidence interval, 0.66-0.97; Cohen's κ = 0.78; P PET and CT were most likely due to limitations of CT and RECIST in rating small lymph nodes as metastases, as well as bone involvement, which was sometimes not detectable in CT. 68 Ga-PSMA-11 PET/CT-derived metabolic tumor parameters showed promising results for evaluation of treatment response. Especially, TL-PSMA demonstrated higher agreement rates with biochemical response compared to SUVmax. Larger, ideally prospective trials are needed to help to reveal the full potential of metabolic parameters derived from PET imaging with 68 Ga-PSMA-11.

Lead Burden as a Factor for Higher Complication Rate in Patients With Implantable Cardiac Devices

Directory of Open Access Journals (Sweden)

Christopher Kolibash

2015-01-01

Full Text Available Purpose: Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads. Methods: We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 [n=168]; Group C: ≥5 [n=16]. Prespecified inhospital and long-term follow-up events were compared. Mortality rates were obtained from Social Security Death Index. Median follow-up was 2 years. Results: Baseline age, gender and race demographics were similar among the three groups. Increasing lead burden was associated with more adverse periprocedural events (A: 3.4%, B: 10.1%, C: 25.0%; P=0.031 and long-term device-related events (A: 1.7%, B: 13.0%, C: 18.8%; P=0.031. Device-related readmissions increased in frequency as lead burden increased (A: 3.5%, B: 18.5%, C: 37.5%; P=0.002. Combined periprocedural and late events also increased with more redundant leads (A: 5.2%, B: 23.2%, C: 44.0%; P=0.001. Total major events were infrequent (3.3%. There was no procedure-related mortality. Long-term all-cause mortality was not significantly different (A: 17.2%, B: 23.8%, C: 25.0%; P=0.567. Conclusions: Greater lead burden was associated with increased number of periprocedural and long-term minor events. It did not significantly impact major events or mortality.

Inhaled /sup 147/Pm and/or total-body gamma radiation: Early mortality and morbidity in rats

Energy Technology Data Exchange (ETDEWEB)

Filipy, R.E.; Lauhala, K.E.; McGee, D.R.; Cannon, W.C.; Buschbom, R.L.; Decker, J.R.; Kuffel, E.G.; Park, J.F.; Ragan, H.A.; Yaniv, S.S.; Scott, B.R.

1989-05-01

Rats were given doses of /sup 60/Co gamma radiation and/or lung burdens of /sup 147/Pm (in fused aluminosilicate particles) within lethal ranges in an experiment to determine and compare morbidity and mortality responses for the radiation insults within 1 year after exposure. Radiation-induced morbidity was assessed by measuring changes in body weights, hematologic parameters, and pulmonary-function parameters. Acute mortality and morbidity from inhaled promethium were caused primarily by radiation pneumonitis and pulmonary fibrosis that occurred more than 53 days after exposure. Acute mortality and morbidity from total-body gamma irradiation occurred within 30 days of exposure and resulted from the bone-marrow radiation syndrome. Gamma radiation caused transient morbidity, reflected by immediately depressed blood cell levels and by reduced body weight gain in animals that survived the acute gamma radiation syndrome. Inhaled promethium caused a loss of body weight and diminished pulmonary function, but its only effect on blood cell levels was lymphocytopenia. Combined gamma irradiation and promethium lung burdens were synergistic, in that animals receiving both radiation insults had higher morbidity and mortality rates than would be predicted based on the effect of either kind of radiation alone. Promethium lung burdens enhanced the effect of gamma radiation in rats within the first 30 days of exposure, and gamma radiation enhanced the later effect of promethium lung burdens. 70 refs., 68 figs., 21 tabs.

Caregiver burden in Danish family members of patients with severe brain injury

DEFF Research Database (Denmark)

Doser, Karoline; Norup, Anne

2016-01-01

OBJECTIVE: To investigate caregiver burden and factors associated with caregiver burden among family members of patients with severe brain injury in the chronic phase. Additionally, the study aimed at investigating differences in burden between parents and spouses. METHODS: Forty-four Danish...... caregivers of patients with severe brain injury were contacted 3-6 years post-injury and asked to complete a measure of caregiver burden. RESULTS: Medium, high and low levels of burden were observed in 45%, 16% and 39% of family members, respectively. Higher burden was seen in caregivers of patients...... with more severe injuries, who spent more time on caregiving and reported more unmet needs. Overall, spouses spent significantly more time taking care of their family member than parents and reported higher levels of burden. CONCLUSIONS: The findings emphasized the continuing consequences of brain injury...

Inhaled 239PuO2 and/or total-body gamma radiation: Early mortality and morbidity in rats and dogs

International Nuclear Information System (INIS)

Filipy, R.E.; Decker, J.R.; Lai, Y.L.

1988-08-01

Rats and beagle dogs were given doses of 60 Co gamma radiation and/or body burdens of 239 PuO 2 within lethal ranges in an experiment to determine and compare morbidity and mortality responses of both species within 1 year after exposure. Radiation-induced morbidity was assessed by measuring changes in body weights, hematologic parameters, and pulmonary-function parameters. Gamma radiation caused transient morbidity, reflected by immediately depressed blood cell concentrations and by long-term loss of body weight and diminished pulmonary function in animals of both species that survived the acute gamma radiation syndrome. Inhaled plutonium caused a loss of body weight and diminished pulmonary function in both species, but its only effect on blood cell concentrations was lymphocytopenia in dogs. Combined gamma irradiation and plutonium lung burdens were synergistic, in that animals receiving both radiation insults had higher morbidity and mortality rates than would be predicted based on the effect of either kind of radiation alone. Plutonium lung burdens enhanced the effect of gamma radiation in rats within the first 30 days of exposure, and gamma radiation enhanced the long-term effect of plutonium lung burdens in both species. Rats were less sensitive to both kinds of radiation, whether administered alone or in combination. 71 refs., 105 figs., 48 tabs

Effective dose and time-integrated effective dose to humans from internal contamination of 134Cs and 137Cs: Results from a compilation of a Swedish national database of internal body burden of radiocaesium in various populations between 1964 and 2002

International Nuclear Information System (INIS)

Raeaef, L.C.; Zakaria, M.; Hubbard, L.; Falk, R.; Aagren, G.; Vesanen, R.

2003-01-01

A compilation of data on the whole-body burden of 134 Cs, 137 Cs and 40 K in various Swedish populations between 1964 and 2002 has been made. The compilation was carried out in co-operation with the Department of Radiation Physics in Malmoe, the Swedish Radiation Protection Authority (SSI), the Swedish Defence Research Agency Department (FOI) and the Department of Radiation Physics, Goeteborg University. Individual body burden values have been inserted into a calculation spread sheet, with data on body weight, gender, age, occupation (if available) and place of residence. The database enables a study of the time-pattern and geographical dependence of radiocaesium transfer from ground deposition to man, and the associated absorbed dose. The Swedish government has assigned SSI the responsibility for obtaining and assuring one of Sweden's national environmental quality objectives, A Safe Radiation Environment. A natural consequence of this responsibility is that a means for quantifying progress towards the objective is necessary. The data compilation discussed here is one important component in the national environmental monitoring programme that is currently (2002) being developed at SSI. The new program for monitoring environmental radiation has the goal of following geographical and ecological differences in the radiological effects to both mankind and the environment, and assessing relevant doses and risks. During the period between 1964 and 2002, fallout of radiocaesium from nuclear weapons tests (only 137 Cs) and from the Chernobyl accident in 1986 (both 134 Cs and 137 Cs) have occurred in Sweden. The ground deposition of the radiocaesium has gradually been transferred through different ecological pathways to man. From the database it can be deduced that large regional variations in the body burden of radiocaesium in man have occurred through this period. Three populations exhibit considerably higher body content levels than others; (i) reindeer herders in

Physical Activity and Sedentary Behaviors of Urban Chinese Children: Grade Level Prevalence and Academic Burden Associations

Directory of Open Access Journals (Sweden)

Xihe Zhu

2017-01-01

Full Text Available The objectives of this study were (a to report grade level prevalence in physical activity and sedentary behaviors and (b to examine academic burden associations with these behaviors. School-aged children (n = 48,118 reported their physical activity, perception of physical activity sufficiency, factors for activity insufficiency, homework hours, and screen time in a typical week. Data were analyzed using general linear models and logistic regression models of Complex Samples. Prevalence results showed that children had lower physical activity and lower screen viewing time, but higher homework time during transition grades (6th, 9th, and 12th and high school years. Academic burden was cited as the primary reason for not having sufficient physical activity (76.6%. Compared to those citing academic burden, students who did not report academic burden were significantly more likely to meet physical activity guidelines (Odds Ratio (OR = 5.38, 95% CI = 4.74–6.11, but less likely to meet screen time guidelines (OR = 0.78, 95% CI = 0.72–0.84, controlling for body mass index, gender, and grade level. Additionally, children who reported academic burdens had significantly longer average daily homework time than those who did not (p<0.01. Policy makers should promote physical activity and help children find a balance between homework and physical activity time particularly among the educational transition grades.

Modeling response of species to microcontaminants: comparative ecotoxicology by (sub)lethal body burdens as a function of species size and partition ratio of chemicals.

Science.gov (United States)

Hendriks, A J

1995-11-01

A model was designed and calibrated with accumulation data to calculate the internal concentrations of microcontaminants in organisms as a function of a few constants and variables. The main factors are the exposure time, the external exposure concentration, the partition ratio of the compound, and the size of the taxon concerned. The model was applied to calculate the lethal and sublethal body burdens of several priority compounds and some major taxa. Estimations were generally confirmed at the order of magnitude level by measured residues and applied doses if available. According to the estimations, most priority compounds chosen were critical for most taxa above internal concentrations of 0.1 mmol.kg-1 wet wt. Trichloromethane, 1,2,4-trichlorobenzene, and hexachlorobenzene were lethal above this level only, whereas other organic microcontaminants affected at least some taxa at lower body burdens. The log(Kow) of the organic compounds ranged from 2.0 to 7.0. Keeping in mind that bioconcentration and -magnification ratios for metals may be quite variable, the lowest critical residues estimated were just below the value of 0.1 mmol.kg-1 wet wt. Here, external concentrations encountered in natural habitats seem to be a promising tool for predictive comparative ecotoxicology. The critical body burdens for plants and invertebrates may have been overestimated due to uncertainty about the parameters. Among the different taxa, however, the fish families chosen (Salmonidae and Cyprinidae) seem to be most sensitive to most compounds. Internal response concentrations of the herbicide atrazine were the lowest in micro- and macrophytes, whereas parathion affected invertebrates at low levels. The database that provided the external response concentrations was also consulted to estimate so-called extrapolation or safety factors. On average, long-term no effect concentrations in water are estimated to be about 10-30 times below short-term median lethal levels. In general, short

Incidental Findings in Imaging Research: Evaluating Incidence, Benefit and Burden

Science.gov (United States)

Orme, Nicholas M.; Fletcher, Joel G.; Siddiki, Hassan A.; Harmsen, W. Scott; O’Byrne, Megan M.; Port, John D.; Tremaine, William J.; Pitot, Henry C.; McFarland, Beth; Robinson, Marguerite E.; Koenig, Barabara A.; King, Bernard F.; Wolf, Susan M.

2013-01-01

Context Little information exists concerning the frequency of clinically significant incidental findings (IFs) identified in the course of imaging research across a broad spectrum of imaging modalities and body regions. Objective To estimate the frequency with which research imaging IFs generate further clinical action, and the medical benefit/burden of identifying these IFs. Design, Setting, and Participants Retrospective review of subjects undergoing a research imaging exam that was interpreted by a radiologist for IFs in the first quarter of 2004, with 3-year clinical follow-up. An expert panel reviewed IFs generating clinical action to determine medical benefit/burden based on predefined criteria. Main Outcome Measures Frequency of (1) IFs that generated further clinical action by modality, body part, age, gender, and (2) IFs resulting in clear medical benefit or burden. Results 1376 patients underwent 1426 research imaging studies. 40% (567/1426) of exams had at least one IF (1055 total). Risk of an IF increased significantly by age (OR=1.5; [1.4–1.7=95% C.I.] per decade increase). Abdominopelvic CT generated more IFs than other exams (OR=18.9 compared with ultrasound; 9.2% with subsequent clinical action), with CT Thorax and MR brain next (OR=11.9 and 5.9; 2.8% and 2.2% with action, respectively). Overall 6.2% of exams (35/567) with an IF generated clinical action, resulting in clear medical benefit in 1.1% (6/567) and clear medical burden in 0.5% (3/567). In most instances, medical benefit/burden was unclear (4.6%; 26/567). Conclusions The frequency of IFs in imaging research exams varies significantly by imaging modality, body region and age. Research imaging studies at high risk for generating IFs can be identified. Routine evaluation of research images by radiologists may result in identification of IFs in a substantial number of cases and subsequent clinical action to address them in much smaller number. Such clinical action can result in medical

The psychosocial burden of psoriatic arthritis.

Science.gov (United States)

Husni, M Elaine; Merola, Joseph F; Davin, Sara

2017-12-01

To assess the psychosocial impact of psoriatic arthritis (PsA), describe how health-related quality of life (QoL) is affected in patients with PsA, discuss measures used to evaluate the psychosocial impact of PsA, and review studies examining the effect of therapy on QoL. A targeted review on the impact of PsA on QoL and the role of tailored psychosocial management in reducing the psychosocial burden of the disease was performed. PubMed literature searches were conducted using the terms PsA, psychosocial burden, QoL, and mood/behavioral changes. Articles were deemed relevant if they presented information regarding the psychosocial impact of PsA, methods used to evaluate these impacts, or ways to manage/improve management of PsA and its resulting comorbidities. The findings of this literature search are descriptively reviewed and the authors׳ expert opinion on their interpretation is provided. The psychosocial burden of PsA negatively affects QoL. Patients suffer from sleep disorders, fatigue, low-level stress, depression and mood/behavioral changes, poor body image, and reduced work productivity. Additionally, each patient responds to pain differently, depending on a variety of psychological factors including personality structure, cognition, and attention to pain. Strategies for evaluating the burdens associated with PsA and the results of properly managing patients with PsA are described. PsA is associated with a considerable psychosocial burden and new assessment tools, specific to PsA, have been developed to help quantify this burden in patients. Future management algorithms of PsA should incorporate appropriate assessment and management of psychological and physical concerns of patients. Furthermore, patients with PsA should be managed by a multidisciplinary team that works in coordination with the patient and their family or caregivers. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Immunologic burden links periodontitis to acute coronary syndrome.

Science.gov (United States)

Liljestrand, John M; Paju, Susanna; Pietiäinen, Milla; Buhlin, Kåre; Persson, G Rutger; Nieminen, Markku S; Sinisalo, Juha; Mäntylä, Päivi; Pussinen, Pirkko J

2018-01-01

Periodontitis, a common polymicrobial inflammatory disease in the tooth supporting tissues, is a risk factor for coronary artery disease. One of the proposed underlying mechanisms is the systemic immune response to periodontal infection. We studied how serum antibodies against seven periodontal pathogens and their subgingival levels associate with each other, periodontitis, and coronary artery disease. The Parogene cohort included 505 Finnish patients (mean age 63 y) who underwent coronary angiography, and clinical and radiographic oral examinations. Coronary diagnosis was defined as no significant coronary artery disease (disease (≥50% stenosis, n = 184) and acute coronary syndrome (n = 169). Levels of subgingival Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Tannerella forsythia, Campylobacter rectus, and Fusobacterium nucleatum were determined by checkerboard DNA-DNA hybridization. Serum antibody (IgA/IgG) levels were analyzed with enzyme-linked immunosorbent assay (ELISA). Aggregate IgA/IgG burdens were calculated by summing and standardizing the serum antibody levels. Patients with active periodontitis were characterized by higher levels of subgingival bacteria and corresponding IgA/IgG response. Quartiles 2-4 of serum IgA/IgG burden indicated higher risk for acute coronary syndrome (OR 1.84, 95%CI 1.01-3.35 for IgA; OR 1.87, 95%CI 1.01-3.46 for IgG) independently of established cardiovascular risk factors, body mass index, number of teeth, subgingival bacterial levels and periodontal diagnosis. Our findings support the hypothesis that the association between periodontitis and cardiovascular diseases is partly mediated by the immunologic response for periodontal pathogens. Copyright © 2017 Elsevier B.V. All rights reserved.

[Burden, empathy, and resilience in dependent people caregivers].

Science.gov (United States)

Navarro-Abal, Yolanda; López-López, María José; Climent-Rodríguez, José Antonio; Gómez-Salgado, Juan

2018-02-10

To analyse the differences in perceived burden between family caregivers who are users of patient associations and those who are not; to assess the relationship between burden, resilience, and empathy levels. Retrospective ex post facto study of two groups, one of them quasi control. The sample was composed of 155 informal caregivers (28 men and 155 women); 109 of them were users of patient relatives' associations and 46 were not. Both descriptive and bivariate comparative analyses were carried out. Caregivers who were members of patient associations showed lower burden and empathy levels than those who were not. This highlighted that the higher their level of perceived burden, the lower their level of resilience. Belonging to carers' associations results in a lower level of perceived burden and a lower risk of developing compassion fatigue syndrome. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

40 CFR 305.33 - Burden of presentation; burden of persuasion.

Science.gov (United States)

2010-07-01

... persuasion. 305.33 Section 305.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Hearing Procedure § 305.33 Burden of presentation; burden of persuasion. The Requestor has the burden of... justified. Accordingly, the Requestor bears the burdens of presentation and persuasion. Following the...

Body burden of pesticides and wastewater-derived pollutants on freshwater invertebrates: Method development and application in the Danube River

International Nuclear Information System (INIS)

Inostroza, Pedro A.; Wicht, Anna-Jorina; Huber, Thomas; Nagy, Claudia; Brack, Werner; Krauss, Martin

2016-01-01

While environmental risk assessment is typically based on toxicant concentrations in water and/or sediment, awareness is increasing that internal concentrations or body burdens are the key to understand adverse effects in organisms. In order to link environmental micropollutants as causes of observed effects, there is an increasing demand for methods to analyse these chemicals in organisms. Here, a multi-target screening method based on pulverised liquid extraction (PuLE) and a modified QuEChERS approach with an additional hexane phase was developed. It is capable to extract and quantify organic micropollutants of diverse chemical classes in freshwater invertebrates. The method was tested on gammarids from the Danube River (within the Joint Danube Survey 3) and target compounds were analysed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Furthermore, a non-target screening using high resolution-tandem mass spectrometry (LC-HRMS/MS) was conducted. A total of 17 pollutants were detected and/or quantified in gammarids at low concentrations. Pesticide concentrations ranged from 0.1 to 6.52 ng g −1 (wet weight), those of wastewater-derived pollutants from 0.1 to 2.83 ng g −1 (wet weight). The presence of wastewater-derived pollutants was prominent at all spots sampled. Using non-target screening, we could successfully identify several chlorinated compounds. These results demonstrate for the first time the presence of pesticides and wastewater-derived pollutants in invertebrates of the Danube River. - Highlights: • A method based on pulverised liquid extraction/QuEChERS for organic micropollutants in invertebrates was developed. • The method is applicable in assessing target environmental pollutants in invertebrates by LC-MS/MS. • The method allows for a nontarget screening of extracts by LC-HRMS. • First body burden analysis of pesticides and wastewater-derived pollutants in invertebrates in the Danube River is reported. - Capsule: A multi

BODY COMPOSITION OF A MILITARY POPULATION FT. CARSON 1963. I. BODY DENSITY, FAT, AND POTASSIUM 40.

Science.gov (United States)

Body volumes were measured on 97 soldiers between the ages of 17 - 52 years by water displacement volumetry and corrected for respiratory gas by a...Effective ranking of body fat burden of populations was demonstrated by body volumetry and age differences were noted from potassium 40 counting. A

Higher order visual input to the mushroom bodies in the bee, Bombus impatiens.

Science.gov (United States)

Paulk, Angelique C; Gronenberg, Wulfila

2008-11-01

To produce appropriate behaviors based on biologically relevant associations, sensory pathways conveying different modalities are integrated by higher-order central brain structures, such as insect mushroom bodies. To address this function of sensory integration, we characterized the structure and response of optic lobe (OL) neurons projecting to the calyces of the mushroom bodies in bees. Bees are well known for their visual learning and memory capabilities and their brains possess major direct visual input from the optic lobes to the mushroom bodies. To functionally characterize these visual inputs to the mushroom bodies, we recorded intracellularly from neurons in bumblebees (Apidae: Bombus impatiens) and a single neuron in a honeybee (Apidae: Apis mellifera) while presenting color and motion stimuli. All of the mushroom body input neurons were color sensitive while a subset was motion sensitive. Additionally, most of the mushroom body input neurons would respond to the first, but not to subsequent, presentations of repeated stimuli. In general, the medulla or lobula neurons projecting to the calyx signaled specific chromatic, temporal, and motion features of the visual world to the mushroom bodies, which included sensory information required for the biologically relevant associations bees form during foraging tasks.

45 CFR 672.17 - Burden of presentation; burden of persuasion.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Burden of presentation; burden of persuasion. 672.17 Section 672.17 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION ENFORCEMENT AND HEARING PROCEDURES § 672.17 Burden of presentation; burden of persuasion. The...

Burden and correlates of non-communicable-diseases among rural residents: a cross-sectional study in Hebei, China.

Science.gov (United States)

Yang, Junjun; Yu, Wenya; Zhou, Qiang; Mahapatra, Tanmay; Li, Yiqiu; Zhang, Xiaoyan; Chen, Lei; Mahapatra, Sanchita; Yan, Yuying; Tang, Weiming

2015-06-20

Burden of non-communicable diseases (NCDs) is increasing rapidly in most of the developing countries including China, even in rural areas. Dearth of representative data called for an investigation to estimate the burden and identify the correlates of NCDs in rural China. A cross-sectional study was conducted involving a representative sample of 6003 consenting randomly selected rural residents aged 15 years or more, from 36 villages of Shijiazhuang in Hebei province of China between July 2010 and June 2011. Information on demographics and behavior were collected, body mass index (BMI) and blood pressure were measured and blood samples were tested to diagnose diabetes and hyperlipidemia. Majority participants were aged problems (12.1%) and gastrointestinal NCDs (7.8%) were identified among the participants, while proportion of subjects with one, two and three or more NCDs were 43%, 14.4% and 5.5% respectively. Higher odds of having more NCDs were associated with higher BMI (Kg/M(2)), family history of NCDs, daily and past history of smoking and drinking, passive smoking, lack of exercise, skipping breakfast and psychological disturbances. Despite limitations associated with cross-sectional design and self-reporting, observation in this large sample of rural residents could develop important insights regarding high burden of NCDs in this population. Based on the identified correlates, targeted intervention strategies seem to be required urgently to control NCDs in rural China.

137Cs radiation burden on children from a highly contaminated area of Belarus

International Nuclear Information System (INIS)

Kortmann, B.; Wendhausen, H.; Wassermann, O.; Fischer, R.; Nielsen, P.; Shaverda, V.F.

1996-01-01

The radiation burden from 137 Cs sources on 22 children from a small Byelorussian village was studied from 1992 to 1994. Foodstuff, whole body burden and urinary excretion of 137 Cs were measured, intake rates, biological half-lives and doses were calculated. The median value for the 137 Cs whole body incorporation level was found to be 124 Bq, the biological half life was calculated as 68 d for girls and 50 d for boys. The internal dose caused by 137 Cs was found to be negligible in comparison to that from external sources. No deviation from normal values could be shown in simultaneously studied clinico-chemical parameters

Global epidemiological trends and variations in the burden of gallbladder cancer.

Science.gov (United States)

Are, Chandrakanth; Ahmad, Humera; Ravipati, Advaitaa; Croo, Darren; Clarey, Dillon; Smith, Lynette; Price, Ray R; Butte, Jean M; Gupta, Sameer; Chaturvedi, Arun; Chowdhury, Sanjib

2017-04-01

The aim of this study is to describe the trends and variations in the global burden of gallbladder cancer (GBC) with an emphasis on geographic variations and female gender. Data (2012-2030) relating to GBC was extracted from GLOBOCAN 2012 database and analyzed. The results of our study document a rising global burden of GBC with geographic and gender variations. The highest burden was noted in the WPRO region (based on WHO regions), Asia (based on continents) and India, Chile, and China (based on countries). The less developed regions of the world account for the majority of the global burden of GBC. The geographic variations are also present within individual countries such as in India and Chile. Females are afflicted at a much higher rate with GBC and this predilection is exaggerated in countries with higher incidence such as India and Chile. In females, people of certain ethnic groups and lower socio-economic standing are at a higher risk. Our study demonstrates a rising global burden of GBC with some specific data on geographic and gender-based variations which can be used to develop strategies at the global as well as the high-risk individual country level. © 2017 Wiley Periodicals, Inc.

Inhaled /sup 239/PuO/sub 2/ and/or total-body gamma radiation: Early mortality and morbidity in rats and dogs

Energy Technology Data Exchange (ETDEWEB)

Filipy, R.E.; Decker, J.R.; Lai, Y.L.; Lauhala, K.E.; Buschbom, R.L.; Hiastala, M.P.; McGee, D.R.; Park, J.F.; Kuffel, E.G.; Ragan, H.A.; Cannon, W.C.; Yaniv, S.S.; Scott, B.R.

1988-08-01

Rats and beagle dogs were given doses of /sup 60/Co gamma radiation and/or body burdens of /sup 239/PuO/sub 2/ within lethal ranges in an experiment to determine and compare morbidity and mortality responses of both species within 1 year after exposure. Radiation-induced morbidity was assessed by measuring changes in body weights, hematologic parameters, and pulmonary-function parameters. Gamma radiation caused transient morbidity, reflected by immediately depressed blood cell concentrations and by long-term loss of body weight and diminished pulmonary function in animals of both species that survived the acute gamma radiation syndrome. Inhaled plutonium caused a loss of body weight and diminished pulmonary function in both species, but its only effect on blood cell concentrations was lymphocytopenia in dogs. Combined gamma irradiation and plutonium lung burdens were synergistic, in that animals receiving both radiation insults had higher morbidity and mortality rates than would be predicted based on the effect of either kind of radiation alone. Plutonium lung burdens enhanced the effect of gamma radiation in rats within the first 30 days of exposure, and gamma radiation enhanced the long-term effect of plutonium lung burdens in both species. Rats were less sensitive to both kinds of radiation, whether administered alone or in combination. 71 refs., 105 figs., 48 tabs.

Maternal body burden of cadmium and offspring size at birth

Energy Technology Data Exchange (ETDEWEB)

Romano, Megan E., E-mail: megan_romano@brown.edu [Department of Epidemiology, Brown University School of Public Health, Providence, RI (United States); Enquobahrie, Daniel A. [Department of Epidemiology, University of Washington, Seattle, WA (United States); Center for Perinatal Studies, Swedish Medical Center, Seattle, WA (United States); Simpson, Christopher [Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA (United States); Checkoway, Harvey [Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA (United States); Williams, Michelle A. [Center for Perinatal Studies, Swedish Medical Center, Seattle, WA (United States); Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA (United States)

2016-05-15

Increasing evidence suggests an inverse association between cadmium (Cd) and size at birth, potentially greatest among female neonates. We evaluated whether greater maternal body burden of Cd is associated with reduced neonatal anthropometry (birthweight, birth length, head circumference, and ponderal index) and assessed whether these associations differ by infant sex. The analytic sample for the present study (n=396) was derived from a subcohort of 750 women randomly drawn from among all participants (N=4344) in the Omega Study, a prospective pregnancy cohort. Creatinine-corrected Cd in maternal clean-catch spot urine samples (U-Cd) was quantified by inductively coupled plasma mass spectrometry. Continuous log{sub 2}-transformed Cd (log{sub 2}-Cd) and U-Cd tertiles (low<0.29 μg/g creatinine, middle 0.29–0.42 μg/g creatinine, high≥0.43 μg/g creatinine) were used in multivariable linear regression models. Females had reduced birth length with greater U-Cd tertile, whereas males birth length marginally increased [β(95% CI) females: low=reference, middle=−0.59 cm (−1.37, 0.19), high=−0.83 cm (−1.69, 0.02), p-trend=0.08; males: low=reference, middle=0.18 cm (−0.59, 0.95), high=0.78 cm (–0.04, 1.60), p-trend=0.07; p for interaction=0.03]. The log{sub 2}-Cd by infant sex interaction was statistically significant for ponderal index [p=0.003; β(95% CI): female=0.25 kg/m{sup 3} (−0.20, 0.70); male=−0.63 kg/m{sup 3} (−1.01, −0.24)] and birth length [p<0.001; β(95% CI): female=−0.47 cm (−0.74, −0.20), male=0.32 cm (0.00, 0.65)]. Our findings suggest potential sex-specific reversal of Cd’s associations on birth length and contribute to the evidence suggesting Cd impairs fetal growth. - Highlights: • Cadmium levels in the general population potentially adversely affect size at birth. • Maternal urinary cadmium was inversely related to birth length among female infants. • For male infants, maternal cadmium was positively associated

Maternal body burden of cadmium and offspring size at birth

International Nuclear Information System (INIS)

Romano, Megan E.; Enquobahrie, Daniel A.; Simpson, Christopher; Checkoway, Harvey; Williams, Michelle A.

2016-01-01

Increasing evidence suggests an inverse association between cadmium (Cd) and size at birth, potentially greatest among female neonates. We evaluated whether greater maternal body burden of Cd is associated with reduced neonatal anthropometry (birthweight, birth length, head circumference, and ponderal index) and assessed whether these associations differ by infant sex. The analytic sample for the present study (n=396) was derived from a subcohort of 750 women randomly drawn from among all participants (N=4344) in the Omega Study, a prospective pregnancy cohort. Creatinine-corrected Cd in maternal clean-catch spot urine samples (U-Cd) was quantified by inductively coupled plasma mass spectrometry. Continuous log 2 -transformed Cd (log 2 -Cd) and U-Cd tertiles (low<0.29 μg/g creatinine, middle 0.29–0.42 μg/g creatinine, high≥0.43 μg/g creatinine) were used in multivariable linear regression models. Females had reduced birth length with greater U-Cd tertile, whereas males birth length marginally increased [β(95% CI) females: low=reference, middle=−0.59 cm (−1.37, 0.19), high=−0.83 cm (−1.69, 0.02), p-trend=0.08; males: low=reference, middle=0.18 cm (−0.59, 0.95), high=0.78 cm (–0.04, 1.60), p-trend=0.07; p for interaction=0.03]. The log 2 -Cd by infant sex interaction was statistically significant for ponderal index [p=0.003; β(95% CI): female=0.25 kg/m 3 (−0.20, 0.70); male=−0.63 kg/m 3 (−1.01, −0.24)] and birth length [p<0.001; β(95% CI): female=−0.47 cm (−0.74, −0.20), male=0.32 cm (0.00, 0.65)]. Our findings suggest potential sex-specific reversal of Cd’s associations on birth length and contribute to the evidence suggesting Cd impairs fetal growth. - Highlights: • Cadmium levels in the general population potentially adversely affect size at birth. • Maternal urinary cadmium was inversely related to birth length among female infants. • For male infants, maternal cadmium was positively associated with birth length. �

Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010.

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Alize J Ferrari

2013-11-01

Full Text Available Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease.Burden was calculated for major depressive disorder (MDD and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs and disability adjusted life years (DALYs. Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders. Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%-10.8% of global YLDs and dysthymia for 1.4% (0.9%-2.0%. Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%-3.2% of global DALYs and dysthymia for 0.5% (0.3%-0.6%. There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%-3.8% to 3.8% (3.0%-4.7% of global DALYs.GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing

STUDY ON SOFTENING AND DROPPING PROPERTIES OF METALIZED BURDEN INSIDE BLAST FURNACE

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Bi-yang Tuo

2014-12-01

Full Text Available The inferences of burden metallization rate on softening-melting dropping properties were investigated through softening-melting dropping test of three kinds of metalized burden pressure drop. The results indicated that the softeningmelting temperature interval of pre-reduction mixed burden is bigger than primeval mixed burden, the melting interval narrow with the rise of metallization rate of ferric burden as well as dropping temperature interval. The average pressure drop, maximum pressure drop and softening-melting dropping properties eigenvalue decrease with the rise of metallization rate of ferric burden. Besides, the dropping temperature of burden reduces with the rise of carbon content of molten iron. The combination high metalized burden and higher carbon content of molten iron is benefit to decreasing thickness of cohesive zone and improve permeability of cohesive zone.

The burden of leishmaniasis in Iran, acquired from the global burden of disease during 1990–2010

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Alireza Badirzadeh

2017-09-01

Full Text Available Objective: To report and measure the burden of leishmaniasis in Iran using the global burden of disease (GBD results, conducted by the Institute for Health Metrics and Evaluation for the years 1990 to 2010, and provide some recommendations for reaching better conclusions about the burden of disease. Methods: GBD burden and fatality rates of leishmaniasis were compared with the findings registered by the Ministry of Health and Medical Education (MOHME. Data obtained from the GBD for the years 1990 to 2010 were used to estimate the disability-adjusted life-years and fatality rates of leishmaniasis in Iran. Results: The GBD estimated 229 714 disability-adjusted life-years due to leishmaniasis in Iranian people of all ages and both sexes. The number of deaths caused by visceral leishmaniasis (VL had decreased significantly in recent years. MOHME registered data on fewer than 30 deaths in Iran from 1990 to 2010. Conclusions: The underreporting of VL deaths is always more pronounced. Findings indicate that the GBD estimation of mortality rates was surprisingly higher than MOHME’s data. The burden of leishmaniasis decreased significantly between the years 1990 and 2010 in both data sources. The possible explanation for this decrease has been discovered through the establishment of a VL surveillance system in various parts of Iran, particularly in endemic areas.

Childhood body mass index and risk of adult pancreatic cancer

DEFF Research Database (Denmark)

Nogueira, Leticia; Stolzenberg-Solomon, Rachael; Gamborg, Michael

2017-01-01

incident pancreatic cancer cases from 1968-2012. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazard regressions. Results: During 8,207,015 person-years of follow-up, 1,268 pancreatic cancer cases were diagnosed. Childhood BMI z-scores at ages 7-13 years were......Background: Excess weight in adulthood is one of the few modifiable risk factors for pancreatic cancer, and height has associations as well. This leads to question whether body weight and height in childhood are associated with adult pancreatic cancer. Objective: To examine if childhood body mass...... from 7-13 years is positively and linearly associated with adult pancreatic cancer; the higher the BMI, the higher the risk. Excess childhood BMI may be indicative of processes initiated early in life that lead to this cancer. Prevention of childhood adiposity may decrease the burden of pancreatic...

Correlates of caregiver burden among family caregivers of older Korean Americans.

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Casado, Banghwa; Sacco, Paul

2012-05-01

Despite the rapid growth of older ethnic minority populations, knowledge is limited about informal caregiving among these groups. Our aim was to identify correlates of caregiver burden among family caregivers of older Korean Americans (KAs). A cross-sectional survey collected data from 146 KA caregivers. Using a modified stress-appraisal model, we examined background and context characteristics (caregiver sex, relationship to care recipient, college education, English proficiency, time in caregiving role, family support network, friend support network), a primary stressor (care recipient functional dependency), a primary appraisal (caregiving hours), and resources (family agreement, care management self-efficacy, service use self-efficacy) as potential correlates of caregiver burden. Interactions between the primary stressor, primary appraisal, and resources were also tested. Being female and the care recipient's spouse were associated with higher burden. Conversely, a larger family support network, greater family agreement, and greater care management self-efficacy were associated with lower burden. A significant interaction was detected between functional dependency and family agreement; higher levels of family agreement moderated the association between care recipient functional dependency and caregiver burden. Interventions to reduce caregiver burden in KA caregivers may be more effective if they include approaches specifically designed to build family support, improve family agreement, and increase caregivers' self-efficacy.

Effects of pregnancy on body temperature and locomotor performance of velvet geckos.

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Dayananda, Buddhi; Ibargüengoytía, Nora; Whiting, Martin J; Webb, Jonathan K

2017-04-01

Pregnancy is a challenging period for egg laying squamates. Carrying eggs can encumber females and decrease their locomotor performance, potentially increasing their risk of predation. Pregnant females can potentially reduce this handicap by selecting higher temperatures to increase their sprint speed and ability to escape from predators, or to speed up embryonic development and reduce the period during which they are burdened with eggs ('selfish mother' hypothesis). Alternatively, females might select more stable body temperatures during pregnancy to enhance offspring fitness ('maternal manipulation hypothesis'), even if the maintenance of such temperatures compromises a female's locomotor performance. We investigated whether pregnancy affects the preferred body temperatures and locomotor performance of female velvet geckos Amalosia lesueurii. We measured running speed of females during late pregnancy, and one week after they laid eggs at four temperatures (20°, 25°, 30° and 35°C). Preferred body temperatures of females were measured in a cost-free thermal gradient during late pregnancy and one week after egg-laying. Females selected higher and more stable set-point temperatures when they were pregnant (mean =29.0°C, T set =27.8-30.5°C) than when they were non-pregnant (mean =26.2°C, T set =23.7-28.7°C). Pregnancy was also associated with impaired performance; females sprinted more slowly at all four test temperatures when burdened with eggs. Although females selected higher body temperatures during late pregnancy, this increase in temperature did not compensate for their impaired running performance. Hence, our results suggest that females select higher temperatures during pregnancy to speed up embryogenesis and reduce the period during which they have reduced performance. This strategy may decrease a female's probability of encountering predatory snakes that use the same microhabitats for thermoregulation. Selection of stable temperatures by pregnant

The effects of military body armour on trunk and hip kinematics during performance of manual handling tasks (.).

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Lenton, Gavin; Aisbett, Brad; Neesham-Smith, Daniel; Carvajal, Alvaro; Netto, Kevin

2016-06-01

Musculoskeletal injuries are reported as burdening the military. An identified risk factor for injury is carrying heavy loads; however, soldiers are also required to wear their load as body armour. To investigate the effects of body armour on trunk and hip kinematics during military-specific manual handling tasks, 16 males completed 3 tasks while wearing each of 4 body armour conditions plus a control. Three-dimensional motion analysis captured and quantified all kinematic data. Average trunk flexion for the weightiest armour type was higher compared with control during the carry component of the ammunition box lift (p armour types compared with control during the ammunition box place component (p armour occurred independent of armour design. In order to optimise armour design, manufacturers need to work with end-users to explore how armour configurations interact with range of personal and situational factors in operationally relevant environments. Practitioner Summary: Musculoskeletal injuries are reported as burdening the military and may relate to body armour wear. Body armour increased trunk flexion and reduced trunk rotation during military-specific lifting and carrying tasks. The altered kinematics may contribute to injury risk, but more research is required.

School governing bodies - the principal's burden or the light of his ...

African Journals Online (AJOL)

In this article I focus on the relationship between principals and school governing bodies in South Africa. Although the school governing body represents many role players, this article will focus mainly on the role and function of parent representatives in the school governing body. Parents constitute the majority in the ...

The social and economic burden of frontotemporal degeneration.

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Galvin, James E; Howard, David H; Denny, Sharon S; Dickinson, Susan; Tatton, Nadine

2017-11-14

To quantify the socioeconomic burden of frontotemporal degeneration (FTD) compared to previously published data for Alzheimer disease (AD). A 250-item internet survey was administered to primary caregivers of patients with behavioral-variant FTD (bvFTD), primary progressive aphasia, FTD with motor neuron disease, corticobasal syndrome, or progressive supranuclear palsy. The survey included validated scales for disease staging, behavior, activities of daily living, caregiver burden, and health economics, as well as investigator-designed questions to capture patient and caregiver experience with FTD. The entire survey was completed by 674 of 956 respondents (70.5%). Direct costs (2016 US dollars) equaled $47,916 and indirect costs $71,737, for a total annual per-patient cost of $119,654, nearly 2 times higher than reported costs for AD. Patients ≥65 years of age, with later stages of disease, and with bvFTD correlated with higher direct costs, while patients <65 years of age and men were associated with higher indirect costs. An FTD diagnosis produced a mean decrease in household income from $75,000 to $99,000 12 months before diagnosis to $50,000 to $59,999 12 months after diagnosis, resulting from lost days of work and early departure from the workforce. The economic burden of FTD is substantial. Counting productivity-related costs, per-patient costs for FTD appear to be greater than per-patient costs reported for AD. There is a need for biomarkers for accurate and timely diagnosis, effective treatments, and services to reduce this socioeconomic burden. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden.

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van Exel, N Job A; Scholte op Reimer, Wilma J M; Brouwer, Werner B F; van den Berg, Bernard; Koopmanschap, Marc A; van den Bos, Geertrudis A M

2004-03-01

To compare the feasibility, convergent and clinical validity of three commonly used burden scales: Caregiver Strain Index (CSI), Caregiver Reaction Assessment (CRA) and Sense of Competence Questionnaire (SCQ), with a self-developed single question on self-rated burden (SRB). Stroke patients receiving support from an informal caregiver (n = 148) and their caregivers were followed up to six months after stroke. Feasibility was assessed with several measures of missing values. Convergent validity was assessed on the basis of the correlation patterns between the burden scales, and clinical validity through evaluation of expected associations between levels of burden and explanatory patients' and caregivers' characteristics. Missing values were less often observed on CSI and SRB than SCQ and CRA. Significant correlation coefficients (p CRA. Evidence for clinical validity was strongest for CSI and SRB, based on associations between higher burden scores and patients' disability, and patients' and caregivers' poor level of health-related quality of life (all p CRA. SRB could be used for quick screening of caregivers at risk. CSI is indicated for further diagnosis of the burden of informal caregivers.

Burden of tuberculosis in indigenous peoples globally: a systematic review.

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Tollefson, D; Bloss, E; Fanning, A; Redd, J T; Barker, K; McCray, E

2013-09-01

The burden of tuberculosis (TB) in the estimated 370 million indigenous peoples worldwide is unknown. To conduct a literature review to summarize the TB burden in indigenous peoples, identify gaps in current knowledge, and provide the foundation for a research agenda prioritizing indigenous health within TB control. A systematic literature review identified articles published between January 1990 and November 2011 quantifying TB disease burden in indigenous populations worldwide. Among the 91 articles from 19 countries included in the review, only 56 were from outside Australia, Canada, New Zealand and the United States. The majority of the studies showed higher TB rates among indigenous groups than non-indigenous groups. Studies from the Amazon generally reported the highest TB prevalence and incidence, but select populations from South-East Asia and Africa were found to have similarly high rates of TB. In North America, the Inuit had the highest reported TB incidence (156/100000), whereas the Metis of Canada and American Indians/Alaska Natives experienced rates of indigenous groups. Where data exist, indigenous peoples were generally found to have higher rates of TB disease than non-indigenous peoples; however, this burden varied greatly. The paucity of published information on TB burden among indigenous peoples highlights the need to implement and improve TB surveillance to better measure and understand global disparities in TB rates.

Is higher body temperature beneficial in ischemic stroke patients with normal admission CT angiography of the cerebral arteries?

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Kvistad, Christopher Elnan; Khanevski, Andrej; Nacu, Aliona; Thomassen, Lars; Waje-Andreassen, Ulrike; Naess, Halvor

2014-01-01

Low body temperature is considered beneficial in ischemic stroke due to neuroprotective mechanisms, yet some studies suggest that higher temperatures may improve clot lysis and outcomes in stroke patients treated with tissue plasminogen activator (tPA). The effect of increased body temperature in stroke patients treated with tPA and with normal computed tomography angiography (CTA) on admission is unknown. We hypothesized a beneficial effect of higher body temperature in the absence of visible clots on CTA, possibly due to enhanced lysis of small, peripheral clots. Patients with ischemic stroke admitted to our Stroke Unit between February 2006 and April 2013 were prospectively registered in a database (Bergen NORSTROKE Registry). Ischemic stroke patients treated with tPA with normal CTA of the cerebral arteries were included. Outcomes were assessed by the modified Rankin Scale (mRS) after 1 week. An excellent outcome was defined as mRS=0, and a favorable outcome as mRS=0-1. A total of 172 patients were included, of which 48 (27.9%) had an admission body temperature ≥37.0°C, and 124 (72.1%) had a body temperature temperature ≥37.0°C was independently associated with excellent outcomes (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.24-6.46; P=0.014) and favorable outcomes (OR: 2.8; 95% CI: 1.13-4.98; P=0.015) when adjusted for confounders. We found an association between higher admission body temperature and improved outcome in tPA-treated stroke patients with normal admission CTA of the cerebral arteries. This may suggest a beneficial effect of higher body temperature on clot lysis in the absence of visible clots on CTA.

The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma.

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Licht, Heather; Murray, Mark; Vassaur, John; Jupiter, Daniel C; Regner, Justin L; Chaput, Christopher D

2015-11-18

With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma. A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of obese patients and ≥ 30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups. Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥ 30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Capgras syndrome in Dementia with Lewy Bodies.

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Thaipisuttikul, Papan; Lobach, Iryna; Zweig, Yael; Gurnani, Ashita; Galvin, James E

2013-05-01

Capgras syndrome is characterized by the recurrent, transient belief that a person has been replaced by an identical imposter. We reviewed clinical characteristics of Dementia with Lewy Bodies (DLB) patients with Capgras syndrome compared to those without Capgras. We identified 55 consecutive DLB patients (11 cases with Capgras syndrome (DLB-C) and 44 cases without evidence of Capgras (DLB). Semi-structured interviews with the patient and an informant, neurological exams, and neuropsychological testing were performed. Caregivers were assessed for caregiver burden and depression. Primary comparisons were made between DLB-C and DLB. Exploratory analyses using stepwise logistic regression and bootstrap analyses were performed to determine clinical features associated with Capgras. DLB-C patients experienced more visual hallucinations and self-reported anxiety, had higher scores on the Neuropsychiatric Inventory, and were less likely to be treated with cholinesterase inhibitors at time of initial evaluation. Extrapyramidal symptoms and depression were not associated with Capgras. Caregivers of DLB-C patients had higher caregiver burden. DLB-C was associated with self-reported anxiety (OR = 10.9; 95% CI = 2.6-47.6). In a bootstrap analysis, clinical findings that were predictors of Capgras included visual hallucinations (log(OR) = 18.3; 95% CI = 17.9-19.3) and anxiety (log(OR) = 2.9; 95% CI = 0.31-20.2). Our study suggests that Capgras syndrome is common in DLB and usually occurs in the presence of anxiety and visual hallucinations, suggesting related etiopathogenesis. Early appreciation of Capgras syndrome may afford the opportunity to alleviate caregiver burden and improve patient and caregiver outcomes.

Socioeconomic burden of influenza in the Republic of Korea, 2007-2010.

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Mina Suh

Full Text Available BACKGROUND: Although the socioeconomic burden of 2009 pandemic influenza A (H1N1 was considerable, no reliable estimates have been reported. Our aim was to compared medical costs and socioeconomic burden resulting from pandemic influenza A (H1N1 2009 with that of previous seasonal influenza. METHODS: We estimated the medical costs and socioeconomic burden of influenza from May 2007 to April 2010. We used representative national data sources(data from the Health Insurance Review Agency, the National Health Insurance Corporation, the Korea Centers for Disease Control and Prevention, and the Korean National Statistics Office including medical utilization, prescription of antivirals, and vaccination. Uncertainty of data was explored through sensitivity analysis using Monte Carlo simulation. RESULTS: Compared with the seasonal influenza, total medical costs (US$291.7 million associated with pandemic (H1N1 2009 increased more than 37-fold. Compared with the 2007-2008 season, outpatient diagnostic costs (US$135.3 million were 773 times higher in the 2009-2010 season, and the mean diagnostic cost per outpatient visit was 58.8 times higher. Total socioeconomic burden of pandemic (H1N1 2009 was estimated at US$1581.3 million (10%-90%: US$1436.0-1808.3 million and those of seasonal influenza was estimated at US$44.7 million (10%-90%: US$32.4-57.9 million in 2007-2008 season and US$42.3 million (10%-90%: US$31.5-53.8 million in 2008-2009 season. Indirect costs accounted for 56.0% of total costs in pandemic (H1N1 2009, and 66.48-68.09% in seasonal influenza. The largest contributors to total burden were productivity losses of caregiver in pandemic (H1N1 2009, and productivity losses due to morbidity of outpatient in seasonal influenza. CONCLUSIONS: In the Republic of Korea, socioeconomic burden of pandemic (H1N1 2009 were considerably higher than burden of the previous two influenza seasons, primarily because of high diagnostic costs and longer sick leave.

Primary caregivers of schizophrenia outpatients: burden and predictor variables.

Science.gov (United States)

Grandón, Pamela; Jenaro, Cristina; Lemos, Serafín

2008-04-15

This article explores family burden in relation to relatives' coping strategies and social networks, as well as in relation to the patients' severity of positive and negative symptoms. Data on the severity of symptoms (Positive and Negative Syndrome Scale for Schizophrenia [PANSS]), social functioning (Social Functioning Scale [SFS]), caregivers burden (Interview on Objective and Subjective Family Burden or Entrevista de Carga Familiar Objetiva y Subjetiva [ECFOS]), coping skills (Family Coping Questionnaire [FCQ]), and social support (Social Network Questionnaire [SNQ]) were gathered from a randomized sample of 101 Chilean outpatients and their primary caregivers, mostly mothers. Low levels of burden were typically found, with the exception of moderate levels on general concerns for the ill relative. A hierarchical regression analysis with four blocks showed that clinical characteristics, such as higher frequency of relapses, more positive symptoms and lower independence-performance, together with lower self-control attributed to the patient, decrease in social interests, and less affective support, predict burden. The results support the relevance of psychoeducational interventions where families' needs are addressed.

[Secondhand smoke in hospitality venues. Exposure, body burden, economic and health aspects in conjunction with smoking bans].

Science.gov (United States)

Fromme, H; Kuhn, J; Bolte, G

2009-04-01

Secondhand smoke was classified by national and international organisations as a known cause of cancer in humans and has many adverse health effects, especially cardiovascular diseases and lung tumours. Global studies have clearly shown that hospitality venues have the highest levels of indoor air pollution containing different substances that are clearly carcinogenic--such as tobacco-related chemicals--compared with other, smoke-free indoor spaces. Data from the human biomonitoring of non-smoking employees in the food service industry confirm this high exposure level. Non-smokers exposed to secondhand smoke in these environments are at increased risk for adverse health effects. The consistent protection of non-smokers in public places such as restaurants and bars through a smoking ban results in a significant reduction of the pollutants in the air (mostly > 90%) and clearly reduces the internal body burden for users and employees. Furthermore, health complaints by non-smoking employees are reduced and the higher risk for lung tumours of employees in the food service industry compared with the general population can be effectively reduced as well. According to current standards of knowledge, other measures such as spatial separation of smoking areas or the use of mechanical venting systems do not achieve a comparably high and effective pollutant reduction under field conditions. Studies concerning the economic effects of prohibiting smoking in public places conducted in various countries have shown that beverage-focused gastronomic enterprises experience a short-term down trend but that food-focused gastronomic enterprises do not experience any negative or even positive effects. The positive effects of a ban on smoking in public places on the general population are a decline in cigarette consumption and the reduction of secondhand smoke exposure by non-smokers. Smoking bans in hospitality venues are not necessarily linked with a shift of the tobacco consumption to

A Common Allele in FGF21 Associated with Sugar Intake Is Associated with Body Shape, Lower Total Body-Fat Percentage, and Higher Blood Pressure

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Timothy M. Frayling

2018-04-01

Full Text Available Summary: Fibroblast growth factor 21 (FGF21 is a hormone that has insulin-sensitizing properties. Some trials of FGF21 analogs show weight loss and lipid-lowering effects. Recent studies have shown that a common allele in the FGF21 gene alters the balance of macronutrients consumed, but there was little evidence of an effect on metabolic traits. We studied a common FGF21 allele (A:rs838133 in 451,099 people from the UK Biobank study, aiming to use the human allele to inform potential adverse and beneficial effects of targeting FGF21. We replicated the association between the A allele and higher percentage carbohydrate intake. We then showed that this allele is more strongly associated with higher blood pressure and waist-hip ratio, despite an association with lower total body-fat percentage, than it is with BMI or type 2 diabetes. These human phenotypes of variation in the FGF21 gene will inform research into FGF21’s mechanisms and therapeutic potential. : Drugs targeting the hormone FGF21 may have beneficial health effects. Variations in human DNA in the FGF21 gene provide an indication of what those effects may be. Here, we show that variation in the FGF21 gene is associated with higher blood pressure and altered body shape, despite lower total body-fat percentage. Keywords: FGF21, BMI, waist-hip ratio, blood pressure, body fat, allele, genetic variant, UK Biobank

Indian girls have higher bone mineral content per unit of lean body than boys through puberty.

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Khadilkar, Anuradha V; Sanwalka, Neha; Mughal, M Zulf; Chiplonkar, Shashi; Khadilkar, Vaman

2018-05-01

Our aim is to describe changes in the muscle-bone unit assessed as a ratio of bone mineral content (BMC) to lean body mass (LBM) through puberty at total body and various skeletal sites in Indian boys and girls. A cross-sectional study was conducted (888 children, 480 boys, aged 5-17 years) in Pune, India. Pubertal staging was assessed. BMC, LBM and fat percentage at the arms, legs, android, gynoid and total body (less the head) were assessed by dual energy X-ray absorptiometry. The amount of BMC per unit LBM (BMC/LBM) was computed. Changes in mean BMC/LBM at 5 Tanner (pubertal) stages after adjustment for age and fat percentage were calculated. In boys, adjusted BMC/LBM was significantly higher with successive Tanner stages [legs (TS-II vs TS-I), android (TS-III vs TS-II, TS-IV vs TS-III) and gynoid region (TS-III vs TS-II and TS-II vs TS-I) (p LBM was significantly higher with successive Tanner stages at total body, legs and gynoid (TS-III vs TS-II; TS-II vs TS-I; TS-V vs TS-IV), arms (TS-I to TS-V) and android regions (TS-V vs TS-IV) (p LBM than girls at earlier Tanner stages (TS-I to TS-III), whereas girls had significantly higher adjusted BMC/LBM than boys at later Tanner stages (TS-IV, TS-V) (p LBM with successive pubertal stages. Girls had higher BMC/LBM than boys which may possibly act as a reservoir for later demands of pregnancy and lactation.

National advisory bodies in the system of public governance in science and higher education: european practices

Directory of Open Access Journals (Sweden)

I. O. Degtyarova

2015-12-01

Full Text Available The article is focused on the analysis of organizational and legal conditions for the functioning of the highest advisory bodies in the fields of research and higher education, created at the state level at the central governing institutions in Ukraine and selected European countries. The article is aimed at the research of the model of formation and functioning of the national advisory bodies on research and higher education in Poland, Germany, and Czech Republic in the system of science management, based on the national legislation. The following national bodies are studied in the paper: National Council of Science and Higher Education of Poland, the Committee of Science Policy of Poland, the Council for Research, Development and Innovation of Czech Republic, National Council for Research, Innovation and Science Policy of Hungary, the German Research Council and others. It is proved that advisory bodies are an important element of the system of public governance, as well as actors in shaping of the national science and higher education policy. They are formed in a democratic way due to the principle of shared governance and mostly of institutional representation. The article considered selected aspects of the establishment of the National R&D Council of Ukraine, as stated in the Law of Ukraine «On Scientific and R&D Activity» comparing with the relevant European institutions. The analysis of the concept for the National Council for Science and Technologies (R&D of Ukraine along with the administrative and management risks could be considered while implementation of the Law of Ukraine «On Scientific and R&D Activity».

40 CFR 179.91 - Burden of going forward; burden of persuasion.

Science.gov (United States)

2010-07-01

... persuasion. 179.91 Section 179.91 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...; burden of persuasion. (a) The party whose request for an evidentiary hearing was granted has the burden... FFDCA has the burden of persuasion in the hearing on that issue, whether the proceeding concerns the...

Urbanicity Gradients Are Associated with the Household- and Individual-Level Double Burden of Malnutrition in Sub-Saharan Africa.

Science.gov (United States)

Jones, Andrew D; Acharya, Yubraj; Galway, Lindsay P

2016-06-01

The nutrition transition is advancing throughout sub-Saharan Africa (SSA). However, the nutritional risk across urbanicity gradients associated with this transition is not clear. We aimed to determine 1) the extent to which overweight and anemia in women of childbearing age (WCBA) and stunting in preschool-age children (PSC) are spatially correlated within countries of SSA; and 2) the association of urbanicity with the individual-level nutritional double burden (i.e., concurrent overweight and anemia within an individual WCBA), the household-level double burden (i.e., overweight WCBA and stunted PSC in the same household), and the 3 components of these double burdens (i.e., overweight, anemia, and stunting). We used Demographic and Health Surveys (DHS) data for 30 countries in SSA from 2006-2012. We calculated overweight [body mass index (BMI; in kg/m(2)) ≥25] and anemia (hemoglobin concentration urbanicity. We used geolocated DHS data to calculate cluster-level mean population densities and the Moran's I statistic to assess spatial autocorrelation. Cluster-level BMI values and hemoglobin concentrations for WCBA were spatially correlated. The odds of overweight in WCBA were higher in periurban and urban areas than in rural areas (periurban, OR: 1.08; 95% CI: 1.01, 1.16; urban, OR: 1.26; 95% CI: 1.18, 1.36), as were the odds of stunting in PSC in periurban areas (OR: 1.13; 95% CI: 1.06, 1.22). The odds of both double burden conditions were higher in periurban and urban areas than in rural areas (individual-level-periurban, OR: 1.18; 95% CI: 1.05, 1.33; urban, OR: 1.43; 95% CI: 1.27, 1.61; household-level-periurban, OR: 1.24; 95% CI: 1.06, 1.44; urban, OR: 1.24; 95% CI: 1.06, 1.46). Urban and periurban areas in SSA may be particularly vulnerable to the nutritional double burden compared with rural areas. Clearly differentiating urban environments is important for assessing changing patterns of nutritional risk associated with the nutrition transition in SSA. �

Host body size and the diversity of tick assemblages on Neotropical vertebrates

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Helen J. Esser

2016-12-01

Full Text Available Identifying the factors that influence the species diversity and distribution of ticks (Acari: Ixodida across vertebrate host taxa is of fundamental ecological and medical importance. Host body size is considered one of the most important determinants of tick abundance, with larger hosts having higher tick burdens. The species diversity of tick assemblages should also be greater on larger-bodied host species, but empirical studies testing this hypothesis are lacking. Here, we evaluate this relationship using a comparative dataset of feeding associations from Panama between 45 tick species and 171 host species that range in body size by three orders of magnitude. We found that tick species diversity increased with host body size for adult ticks but not for immature ticks. We also found that closely related host species tended to have similar tick species diversity, but correcting for host phylogeny did not alter the relationships between host body size and tick species diversity. The distribution of tick species was highly aggregated, with approximately 20% of the host species harboring 80% of all tick species, following the Pareto principle or 20/80 Rule. Thus, the aggregated pattern commonly observed for tick burdens and disease transmission also holds for patterns of tick species richness. Our finding that the adult ticks in this system preferentially parasitize large-bodied host species suggests that the ongoing anthropogenic loss of large-bodied vertebrates is likely to result in host-tick coextinction events, even when immature stages feed opportunistically. As parasites play critical roles in ecological and evolutionary processes, such losses may profoundly affect ecosystem functioning and services.

Financial Burden in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.

Science.gov (United States)

Nipp, Ryan D; Kirchhoff, Anne C; Fair, Douglas; Rabin, Julia; Hyland, Kelly A; Kuhlthau, Karen; Perez, Giselle K; Robison, Leslie L; Armstrong, Gregory T; Nathan, Paul C; Oeffinger, Kevin C; Leisenring, Wendy M; Park, Elyse R

2017-10-20

Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs (≥ 10% of annual income) and issues related to financial burden (jeopardizing care or changing lifestyle) among survivors of childhood cancer and a sibling comparison group. Methods Between May 2011 and April 2012, we surveyed an age-stratified, random sample of survivors of childhood cancer and a sibling comparison group who were enrolled in the Childhood Cancer Survivor Study. Participants reported their household income, out-of-pocket medical costs, and issues related to financial burden (questions were adapted from national surveys on financial burden). Logistic regression identified associations between participant characteristics, a higher percentage of income spent on out-of-pocket medical costs, and financial burden, adjusting for potential confounders. Results Among 580 survivors of childhood cancer and 173 siblings, survivors of childhood cancer were more likely to have out-of-pocket medical costs ≥ 10% of annual income (10.0% v 2.9%; P report spending a higher percentage of their income on out-of-pocket medical costs, which may influence their health-seeking behavior and potentially affect health outcomes. Our findings highlight the need to address financial burden in this population with long-term health care needs.

Deposition and retention of 0.1 micron 67Ga2O3 aggregate aerosols in rats following whole body exposures

International Nuclear Information System (INIS)

Wolff, R.K.; Griffis, L.C.; Hobbs, C.H.; McClellan, R.O.

1982-01-01

Determinations were made of respiratory tract deposition and gastrointestinal tract burdens following whole body inhalation exposures, typical of those used in many chronic exposures; these were compared to values obtained in nose-only exposures. Fischer-344 rats were exposed in large volume chambers, in a whole body mode, to 0.1 micron volume median diameter (VMD) 67 Ga 2 O 3 particles 5 hrs/day. Deposition per unit of exposure time and retention were essentially identical following either 1 or 3 day exposures. The lung deposition of particles was 2.8 units/hr for males and 2.2 units/hr for females if the exposure concentration was expressed as 1 unit/L. These values represent a deposition of approximately 15% of the inhaled particles, similar to values obtained for nose-only exposures. Aerosol deposition per kgm body weight was 24% higher in females than males. Passage of material into the gastrointestinal tract was 1.6-fold greater for these whole body exposures as compared to nose-only exposures to the same aerosol mainly resulting from extra material ingested by grooming of the pelt. Approximately 60% of the pelt burden was calculated to be ingested following whole body exposures

Do informal caregivers in mental illness feel more burdened? A comparative study of mental versus somatic illnesses.

Science.gov (United States)

Hastrup, Lene H; Van Den Berg, Bernard; Gyrd-Hansen, Dorte

2011-08-01

This study investigates a possible added subjective burden among informal caregivers to care recipients with a mental illness or a combination of mental and somatic illnesses compared with caregivers to care recipients with a somatic illness. The study also investigates the subjective caregiver burden by caregivers' characteristics and objective burden. The association between subjective caregiver burden and socio-demographic factors, objective burden, and health-related quality of life was analyzed in a population of 865 Dutch informal caregivers, using multiple linear regression analysis. Controlling for other factors in the analysis, we found that caring for a recipient with mental illness or a combination of mental and somatic illness was associated with an extra subjective caregiver burden (measured by Caregiver Strain Index). Objective burden, in terms of more than 50 hours of care provision per week, less than three years of caregiving, or living together with the care recipients was associated with higher subjective caregiver burden. Other factors associated with higher subjective caregiver burden were being partners or a child of care recipient, having a paid job, a low health-related quality of life (EQ-5D), or having an illness. This study suggests that caregivers to care recipients with a mental and especially a combination of mental and somatic illnesses have a higher subjective caregiver burden compared with caregivers to care recipients with a somatic illness. Because the study is not representative of all caregivers, more research focusing on identifying and contacting informal caregivers is needed to confirm the result.

Introducing a GP copayment in Australia: Who would carry the cost burden?

Science.gov (United States)

Elkins, Rosemary Kate; Schurer, Stefanie

2017-05-01

Recent policy changes designed to contain unsustainable health expenditure growth imply that many more Australians may soon be charged a copayment to consult a GP. We explore the distributional consequences associated with a range of hypothetical GP copayment scenarios using nationally-representative Australian survey data. For each scenario, we estimate the cost burden that individuals and households across the income distribution would need to absorb to maintain their current GP service utilisation. Even when concessional patients are charged a third or a quarter of the non-concessional copayment rate, the average estimated cost burden in the lowest income quartile is typically between three and six times that of the highest, and the average cost burden for women is significantly higher than for men within every income quartile. These disparities are intensified for those with a chronic illness. We conclude that the widespread implementation of GP copayments would disproportionately burden lower-income families, who experience higher rates of chronic illness, higher demand for GP services, and lower capacity to absorb price increases. The regressive nature of GP copayments is reduced when concessional and child patients are exempted entirely, highlighting the importance of supporting GPs-particularly in disadvantaged areas-to maintain bulk-billing arrangements for vulnerable patient groups. Copyright © 2017 Elsevier B.V. All rights reserved.

Caregiver burden in Alzheimer's disease patients in Spain.

Science.gov (United States)

Peña-Longobardo, Luz María; Oliva-Moreno, Juan

2015-01-01

Alzheimer's disease constitutes one of the leading causes of burden of disease, and it is the third leading disease in terms of economic and social costs. To analyze the burden and problems borne by informal caregivers of patients who suffer from Alzheimer's disease in Spain. We used the Survey on Disabilities, Autonomy and Dependency to obtain information on the characteristics of disabled people with Alzheimer's disease and the individuals who provide them with personal care. Additionally, statistical multivariate analyses using probit models were performed to analyze the burden placed on caregivers in terms of health, professional, and leisure/social aspects. 46% of informal caregivers suffered from health-related problems as a result of providing care, 90% had leisure-related problems, and 75% of caregivers under 65 years old admitted to suffering from problems related to their professional lives. The probability of a problem arising for an informal caregiver was positively associated with the degree of dependency of the person cared for. In the case of caring for a greatly dependent person, the probability of suffering from health-related problems was 22% higher, the probability of professional problems was 18% higher, and there was a 10% greater probability of suffering from leisure-related problems compared to non-dependents. The results show a part of the large hidden cost for society in terms of problems related to the burden lessened by the caregivers. This information should be a useful tool for designing policies focused toward supporting caregivers and improving their welfare.

The burden of illness in patients with hereditary angioedema.

Science.gov (United States)

Banerji, Aleena

2013-11-01

Hereditary angioedema (HAE) is a rare genetic disease characterized by long-term recurrent attacks of subcutaneous or submucosal edema in different parts of the body. A comprehensive review of the literature on burden of illness for patients with HAE is presented. A Boolean search was performed using MEDLINE and EMBASE databases and the Internet. Articles discussing aspects of the burden of illness in HAE were selected. Topics focused on the course of the disease, nature of attacks, treatment, quality of life, and costs. Hereditary angioedema is associated with a significant and multifaceted disease burden. Diagnosis is often delayed for years, with patients receiving ineffective treatment and unnecessary medical procedures before diagnosis. HAE attacks are painful, unpredictable, and debilitating and often require emergency medical attention. Attacks can affect a patient's daily activities, including work or schooling. Depression and anxiety are prevalent in patients with HAE. Recent advances in treatment provide patients with effective and well-tolerated prophylactic and on-demand therapeutic options. However, end points specific to HAE that better measure the impact of treatment on disease burden are lacking. Furthermore, there is a notable paucity of literature directed toward physicians who are instrumental in diagnosing and treating patients with HAE (eg, emergency department). More publications are broadening the understanding of HAE. However, important gaps remain. Effective management of HAE requires a more comprehensive understanding of the disease burden so that disease management can be individualized to meet specific patient needs. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

The burden on informal caregivers of people with bipolar disorder.

Science.gov (United States)

Ogilvie, Alan D; Morant, Nicola; Goodwin, Guy M

2005-01-01

Caregivers of people with bipolar disorder may experience a different quality of burden than is seen with other illnesses. A better understanding of their concerns is necessary to improve the training of professionals working with this population. Conceptualizing caregiver burden in a conventional medical framework may not focus enough on issues important to caregivers, or on cultural and social issues. Perceptions of caregivers about bipolar disorder have important effects on levels of burden experienced. It is important to distinguish between caregivers' experience of this subjective burden and objective burden as externally appraised. Caregivers' previous experiences of health services may influence their beliefs about the illness. Caregiver burden is associated with depression, which affects patient recovery by adding stress to the living environment. The objective burden on caregivers of patients with bipolar disorder is significantly higher than for those with unipolar depression. Caregivers of bipolar patients have high levels of expressed emotion, including critical, hostile, or over-involved attitudes. Several measures have been developed to assess the care burden of patients with depressive disorders, but may be inappropriate for patients with bipolar disorder because of its cyclical nature and the stresses arising from manic and hypomanic episodes. Inter-episode symptoms pose another potential of burden in patients with bipolar disorder. Subsyndromal depressive symptoms are common in this phase of the illness, resulting in severe and widespread impairment of function. Despite the importance of assessing caregiver burden in bipolar disorder, relevant literature is scarce. The specific effects of mania and inter-episode symptoms have not been adequately addressed, and there is a lack of existing measures to assess burden adequately, causing uncertainty regarding how best to structure family interventions to optimally alleviate burden. The relatively few

Identifying Sociodemographic Characteristics Associated With Burden Among Caregivers of the Urban Homebound

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Ania Wajnberg MD

2016-09-01

Full Text Available Limited research has explored whether the burden associated with caring for homebound patients varies across racial groups or by relationship status. We examined these variations for this vulnerable population. Patients self-identified informal caregivers and caregiver burden/depression were assessed using the Zarit Caregiver Burden Scale and the Center for Epidemiologic Studies–Depression scale (CES-D. Forty-nine informal caregivers completed the interview. Mean age was 58 ( SD = 14, 78% were female, 37% Black, 35% Hispanic, and 46% had completed high school. Over 60% of caregivers had moderate or severe caregiver burden and 30% had significant depression. White caregivers had greater burden than Black and Hispanic caregivers ( p = .02. Mean caregiver burden was higher among spouse/partner caregivers, versus those who identified as children or other family or friends ( p = .004. Additional research is needed to better understand the experience of racial and ethnic minorities and spouses in providing informal care to homebound adults.

Periodontal disease burden and pathological changes in organs of dogs.

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Pavlica, Zlatko; Petelin, Milan; Juntes, Polona; Erzen, Damjan; Crossley, David A; Skaleric, Uros

2008-06-01

Bacterial plaque associated periodontal disease is the most common chronic infection in man and dogs. In man, there is an association between periodontal disease and myocardial infarction and stroke, while in dogs it has also been associated with changes in internal organs. Inflamed periodontal tissues present a 'periodontal disease burden' to the host and the extent of this inflammatory disease burden is likely to affect the degree of associated pathological change in distant organs. This hypothesis was investigated in dogs with naturally occurring periodontal disease. Post-mortem investigations including periodontal assessment, standard necropsy, and organ histology were performed on 44 mature toy and miniature Poodles (related, periodontitis predisposed breeds) that died naturally or were euthanized based on clinical disease. Animals with gross primary organ pathology were excluded. The periodontal disease burden was estimated from the total surface area of periodontal pocket epithelium using six measurements of probing depth for each tooth and the tooth circumferences. Ordinal logistic regression (OR) analysis established that for each square centimeter of periodontal disease burden there was a 1.4-times higher likelihood of greater changes being present in the left atrio-ventricular valves (OR = 1.43), plus 1.2 and 1.4 times higher likelihoodfor greater liver and kidney pathology (OR = 1.21; OR = 1.42), respectively The results show that there is a link between the estimated 'periodontal disease burden' resulting from plaque-bacteria associated periodontal disease and the level of internal pathology in this population, implying that periodontitis might contribute to the development of systemic pathology in dogs.

Standardization of calibration method of whole-body counter. 1. Calibration by using anthropometric phantoms

International Nuclear Information System (INIS)

Ishikawa, Tetsuo; Matsumoto, Masaki; Uchiyama, Masafumi; Kobayashi, Sadayoshi; Mizushita, Seiichi.

1995-01-01

To standardize the calibration methods of whole-body counters, three anthropometric phantoms were manufactured based on dozens of Japanese average value of body size data. Using these phantoms, the calibrations of some whole-body counters were carried out and the comparison of counting efficiency between anthropometric phantoms and block phantoms, which used to be used for the calibration of whole-body counters generally, was implemented. Five whole-body counters, one scanning system, two stationary systems and two chair systems, were used for this study. The following results were derived: As an example, in NIRS scanning system, the counting efficiency of anthropometric phantom of 162cm height was 12.7% greater than that of block phantom of the same height. This means 137 Cs body burdens in adult men used to be estimated with the excess of about 10%. Body burdens tended to be estimated excessively in adult because the difference of counting efficiency between anthropometric phantom and block phantom increases with increase of height. To standardize body burden data measured with various whole-body counters, the calibration of each whole-body counter should be conducted using anthropometric phantoms and phantoms which used to be used for the calibration of that whole-body counter. (author)

Body lift, drag and power are relatively higher in large-eared than in small-eared bat species.

Science.gov (United States)

Håkansson, Jonas; Jakobsen, Lasse; Hedenström, Anders; Johansson, L Christoffer

2017-10-01

Bats navigate the dark using echolocation. Echolocation is enhanced by external ears, but external ears increase the projected frontal area and reduce the streamlining of the animal. External ears are thus expected to compromise flight efficiency, but research suggests that very large ears may mitigate the cost by producing aerodynamic lift. Here we compare quantitative aerodynamic measures of flight efficiency of two bat species, one large-eared ( Plecotus auritus ) and one small-eared ( Glossophaga soricina ), flying freely in a wind tunnel. We find that the body drag of both species is higher than previously assumed and that the large-eared species has a higher body drag coefficient, but also produces relatively more ear/body lift than the small-eared species, in line with prior studies on model bats. The measured aerodynamic power of P. auritus was higher than predicted from the aerodynamic model, while the small-eared species aligned with predictions. The relatively higher power of the large-eared species results in lower optimal flight speeds and our findings support the notion of a trade-off between the acoustic benefits of large external ears and aerodynamic performance. The result of this trade-off would be the eco-morphological correlation in bat flight, with large-eared bats generally adopting slow-flight feeding strategies. © 2017 The Author(s).

Disease burden of COPD in China: a systematic review

Science.gov (United States)

Zhu, Bifan; Wang, Yanfang; Ming, Jian; Chen, Wen; Zhang, Luying

2018-01-01

Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. The aim of this systematic review was to quantify the disease burden of COPD in China and to determine the risk factors of the disease. The number of studies included in the review was 47 with an average quality assessment score of 7.70 out of 10. Reported COPD prevalence varied between 1.20% and 8.87% in different provinces/cities across China. The prevalence rate of COPD was higher among men (7.76%) than women (4.07%). The disease was more prevalent in rural areas (7.62%) than in urban areas (6.09%). The diagnostic rate of COPD patients in China varied from 23.61% to 30.00%. The percentage of COPD patients receiving outpatient treatment was around 50%, while the admission rate ranged between 8.78% and 35.60%. Tobacco exposure and biomass fuel/solid fuel usage were documented as two important risk factors of COPD. COPD ranked among the top three leading causes of death in China. The direct medical cost of COPD ranged from 72 to 3,565 USD per capita per year, accounting for 33.33% to 118.09% of local average annual income. The most commonly used scales for the assessment of quality of life (QoL) included Saint George Respiratory Questionnaire, Airways Questionnaire 20, SF-36, and their revised versions. The status of QoL was worse among COPD patients than in non-COPD patients, and COPD patients were at higher risks of depression. The COPD burden in China was high in terms of economic burden and QoL. In view of the high smoking rate and considerable concerns related to air pollution and smog in China, countermeasures need to be taken to improve disease prevention and management to reduce disease burdens raised by COPD. PMID:29731623

Burden control by artificial intelligence

Energy Technology Data Exchange (ETDEWEB)

Saxen, H.; Nikus, M. [Aabo Akademi, Turku (Finland). Heat Engineering Lab.

1998-07-01

The burden distribution plays an important role for the fuel economy of the blast furnace. By an appropriate burden distribution, the operation of the furnace is smooth and the gas is utilized well, the burden descends steadily and the wear of the lining is minimal. Since it is very difficult to obtain reliable information about the burden distribution in operating blast furnaces, this research project developed methods for interpretation of burden and gas distribution in the shaft mainly based on temperature measurements from above-burden probes.

Identification of exposure to environmental chemicals in children and older adults using human biomonitoring data sorted by age

DEFF Research Database (Denmark)

Choi, Judy; Knudsen, Lisbeth E.; Mizrak, Seher

2017-01-01

/classes of chemicals with potentially higher body burden in children or older adults. Children appear to have higher body burden of bisphenol A (BPA), some phytoestrogens, perchlorate, and some metabolites of polycyclic aromatic hydrocarbons and benzene. On the other hand, older adults appear to have higher body...

Higher Facebook use predicts greater body image dissatisfaction during pregnancy: The role of self-comparison.

Science.gov (United States)

Hicks, S; Brown, A

2016-09-01

poor body image during pregnancy is a growing issue. Similarly, emerging evidence is suggesting that social media use may increase the risk of poor well-being e.g. depression, anxiety and body image concerns amongst users. Research has not examined how social media use may influence women during pregnancy. The aim of this study was to therefore to explore the relationship between body image during pregnancy and Facebook use. a cross sectional self-report questionnaire. two hundred and sixty nine pregnant women. community groups and online forums. a self-report questionnaire exploring maternal body image, use of Facebook and how mothers perceived Facebook affected their body image. Descriptive statistics were used to explore body image perceptions. Partial correlations (controlling for maternal age, education, parity and gestation) were used to explore the association between Facebook use and body image during pregnancy. negative body image was common in the sample, increased with gestation and was unrelated to pre pregnancy weight. Mothers with a Facebook account had higher body image concerns than those without a Facebook account. Of those with an account, increased Facebook use was associated with increased body image dissatisfaction, particularly in terms of postnatal concerns for how their body would look with 56.5% reporting that they frequently compared their pregnant body to other pregnant women on the site. Facebook access was frequent with 85% of participants checking it at least once per day and the average participant spending over an hour per day on the site. although causality cannot be fully explained, Facebook use may increase mother's risk of poor body image dissatisfaction during pregnancy. Mothers with already poor body image may also be drawn to the site in order to make comparisons of their appearance. the potential impact of Facebook on increasing the risk of, or promoting existing poor body image is an important message for those working to

The predictive factors for perceived social support among cancer patients and caregiver burden of their family caregivers in Turkish population.

Science.gov (United States)

Oven Ustaalioglu, Basak; Acar, Ezgi; Caliskan, Mecit

2018-03-01

We aimed to identify the predictive factors for the perceived family social support among cancer patients and caregiver burden of their family caregivers. Participants were 302 cancer patients and their family caregivers. Family social support scale was used for cancer patients, burden interview was used for family caregivers.All subjects also completed Beck depression invantery. The related socio-demographical factors with perceived social support (PSS) and caregiver burden were evaluated by correlation analysis. To find independent factors predicting caregiver burden and PSS, logistic regression analysis were conducted. Depression scores was higher among patients than their family caregivers (12.5 vs. 8). PSS was lower in depressed patients (p Family caregiver burden were also higher in depressive groups (p family caregiver role was negatively correlated (p caregiver burden. Presence of depression was the independent predictor for both, lower PSS for patients and higher burden for caregivers. The results of this study is noteworthy because it may help for planning any supportive care program not only for patients but together with their caregiver at the same time during chemotherapy period in Turkish population.

Economic and disease burden of dengue in Mexico.

Directory of Open Access Journals (Sweden)

Eduardo A Undurraga

2015-03-01

Full Text Available Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies.We estimated the annual economic and disease burden of dengue in Mexico for the years 2010-2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000-253,000 symptomatic and 119 (95%CL: 75-171 fatal dengue episodes annually on average (2010-2011, compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151-292 million, or $1.56 (95%CL: 1.38-2.68 per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87-209 million or $0.80 per capita (95%CL: 0.62-1.12 corresponds to illness. Annual disease burden averaged 65 (95%CL: 36-99 disability-adjusted life years (DALYs per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden.With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive empirical estimates of dengue burden. Burden varies annually; during an outbreak, dengue burden may be significantly higher than that of

Economic and disease burden of dengue in Mexico.

Science.gov (United States)

Undurraga, Eduardo A; Betancourt-Cravioto, Miguel; Ramos-Castañeda, José; Martínez-Vega, Ruth; Méndez-Galván, Jorge; Gubler, Duane J; Guzmán, María G; Halstead, Scott B; Harris, Eva; Kuri-Morales, Pablo; Tapia-Conyer, Roberto; Shepard, Donald S

2015-03-01

Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies. We estimated the annual economic and disease burden of dengue in Mexico for the years 2010-2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL) for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000-253,000) symptomatic and 119 (95%CL: 75-171) fatal dengue episodes annually on average (2010-2011), compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151-292) million, or $1.56 (95%CL: 1.38-2.68) per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87-209) million or $0.80 per capita (95%CL: 0.62-1.12) corresponds to illness. Annual disease burden averaged 65 (95%CL: 36-99) disability-adjusted life years (DALYs) per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden. With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive) empirical estimates of dengue burden. Burden varies annually; during an outbreak, dengue burden may be significantly higher than that of the pre

Dementia Caregiver Burden: a Research Update and Critical Analysis.

Science.gov (United States)

Cheng, Sheung-Tak

2017-08-10

This article provides an updated review of the determinants of caregiver burden and depression, with a focus on care demands and especially the differential effects of various neuropsychiatric symptoms or symptom clusters. Moreover, studies on caregivers for frontotemporal and Lewy body dementias were referred to in order to identify differences and similarities with the mainstream literature based largely on Alzheimer caregivers. As a group, neuropsychiatric symptoms are most predictive of caregiver burden and depression regardless of dementia diagnosis, but the effects appear to be driven primarily by disruptive behaviors (e.g., agitation, aggression, disinhibition), followed by delusions and mood disturbance. Disruptive behaviors are more disturbing partly because of the adverse impact on the emotional connection between the caregiver and the care-recipient and partly because they exacerbate difficulties in other domains (e.g., caring for activities of daily living). In behavioral variant frontotemporal dementia, not only are these disruptive behaviors more prominent but they are also more disturbing due to the care-recipient's insensitivity to others' feelings. In Lewy body dementia, visual hallucinations also appear to be distressing. The disturbing nature of disruptive behaviors cuts across dementia conditions, but the roles played by symptoms that are unique or particularly serious in a certain condition need to be explored further.

Effects of frequent hemodialysis on perceived caregiver burden in the Frequent Hemodialysis Network trials.

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Suri, Rita S; Larive, Brett; Hall, Yoshio; Kimmel, Paul L; Kliger, Alan S; Levin, Nathan; Tamura, Manjula Kurella; Chertow, Glenn M

2014-05-01

Patients receiving hemodialysis often perceive their caregivers are overburdened. We hypothesize that increasing hemodialysis frequency would result in higher patient perceptions of burden on their unpaid caregivers. In two separate trials, 245 patients were randomized to receive in-center daily hemodialysis (6 days/week) or conventional hemodialysis (3 days/week) while 87 patients were randomized to receive home nocturnal hemodialysis (6 nights/week) or home conventional hemodialysis for 12 months. Changes in overall mean scores over time in the 10-question Cousineau perceived burden scale were compared. In total, 173 of 245 (70%) and 80 of 87 (92%) randomized patients in the Daily and Nocturnal Trials, respectively, reported having an unpaid caregiver at baseline or during follow-up. Relative to in-center conventional dialysis, the 12-month change in mean perceived burden score with in-center daily hemodialysis was -2.1 (95% confidence interval, -9.4 to +5.3; P=0.58). Relative to home conventional dialysis, the 12-month change in mean perceived burden score with home nocturnal dialysis was +6.1 (95% confidence interval, -0.8 to +13.1; P=0.08). After multiple imputation for missing data in the Nocturnal Trial, the relative difference between home nocturnal and home conventional hemodialysis was +9.4 (95% confidence interval, +0.55 to +18.3; P=0.04). In the Nocturnal Trial, changes in perceived burden were inversely correlated with adherence to dialysis treatments (Pearson r=-0.35; P=0.02). Relative to conventional hemodialysis, in-center daily hemodialysis did not result in higher perceptions of caregiver burden. There was a trend to higher perceived caregiver burden among patients randomized to home nocturnal hemodialysis. These findings may have implications for the adoption of and adherence to frequent nocturnal hemodialysis.

Distribution of major health risks: findings from the Global Burden of Disease study.

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Anthony Rodgers

2004-10-01

Full Text Available Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness.For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity 43%-61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1-3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median.Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden.

Polygenic Risk Score Identifies Subgroup With Higher Burden of Atherosclerosis and Greater Relative Benefit From Statin Therapy in the Primary Prevention Setting.

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Natarajan, Pradeep; Young, Robin; Stitziel, Nathan O; Padmanabhan, Sandosh; Baber, Usman; Mehran, Roxana; Sartori, Samantha; Fuster, Valentin; Reilly, Dermot F; Butterworth, Adam; Rader, Daniel J; Ford, Ian; Sattar, Naveed; Kathiresan, Sekar

2017-05-30

Relative risk reduction with statin therapy has been consistent across nearly all subgroups studied to date. However, in analyses of 2 randomized controlled primary prevention trials (ASCOT [Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm] and JUPITER [Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin]), statin therapy led to a greater relative risk reduction among a subgroup at high genetic risk. Here, we aimed to confirm this observation in a third primary prevention randomized controlled trial. In addition, we assessed whether those at high genetic risk had a greater burden of subclinical coronary atherosclerosis. We studied participants from a randomized controlled trial of primary prevention with statin therapy (WOSCOPS [West of Scotland Coronary Prevention Study]; n=4910) and 2 observational cohort studies (CARDIA [Coronary Artery Risk Development in Young Adults] and BioImage; n=1154 and 4392, respectively). For each participant, we calculated a polygenic risk score derived from up to 57 common DNA sequence variants previously associated with coronary heart disease. We compared the relative efficacy of statin therapy in those at high genetic risk (top quintile of polygenic risk score) versus all others (WOSCOPS), as well as the association between the polygenic risk score and coronary artery calcification (CARDIA) and carotid artery plaque burden (BioImage). Among WOSCOPS trial participants at high genetic risk, statin therapy was associated with a relative risk reduction of 44% (95% confidence interval [CI], 22-60; P statin therapy was 3.6% (95% CI, 2.0-5.1) among those in the high genetic risk group and 1.3% (95% CI, 0.6-1.9) in all others. Each 1-SD increase in the polygenic risk score was associated with 1.32-fold (95% CI, 1.04-1.68) greater likelihood of having coronary artery calcification and 9.7% higher (95% CI, 2.2-17.8) burden of carotid plaque. Those at high genetic risk have a greater

Parental body mass index and blood pressure are associated with higher body mass index and blood pressure in their adult offspring: a cross-sectional study in a resource-limited setting in northern Peru.

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Carrillo-Larco, Rodrigo M; Bernabé-Ortiz, Antonio; Sal Y Rosas, Víctor G; Sacksteder, Katherine A; Diez-Canseco, Francisco; Cárdenas, María K; Gilman, Robert H; Miranda, J Jaime

2018-05-01

High body mass index (BMI) and blood pressure (BP) are major contributors to the high burden of non-communicable diseases in adulthood. Individual high-risk and population approaches for prevention require newer strategies to target these risk factors and focusing on the family to introduce prevention initiatives appears as a promising scenario. Characterisation of the relationship between BMI and BP among the adult members of a given family merits evaluation. We conducted a secondary analysis of an implementation study in Tumbes, Peru, benefiting from data derived from families with at least one adult offspring. The exposures of interest were the BMI, systolic BP (SBP) and diastolic BP (DBP) of the mother and father. The outcomes were the BMI, SBP and DBP of the offspring. Mixed-effects linear regression models were conducted. The mean age of the offspring, mothers and fathers was 29 (SD: 9.5), 54 (SD: 11.8) and 59 (SD: 11.6) years, respectively. Father's BMI was associated with a quarter-point increase in offspring BMI, regardless of the sex of the offspring. Mother's BMI had a similar effect on the BMI of her sons, but had no significant effect on her daughters'. Mother's SBP was associated with almost one-tenth of mmHg increase in the SBP of the adult offspring. There was no evidence of an association for DBP. In families with adult members, the higher the parents' BMI and SBP, the higher their adult offspring's levels will be. © 2018 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Is functional dependence of Duchenne muscular dystrophy patients determinant of the quality of life and burden of their caregivers?

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Maria Clara Drummond Soares de Moura

2015-01-01

Full Text Available Objective The relationship between functional dependence and quality of life (QOL in Duchenne muscular dystrophy (DMD patients and burden and QOL in caregivers is not clear. This study investigated possible relationships between functional dependence/QOL of DMD patients and QOL/burden of caregivers. Method This study included 35 boys (6-17 years and respective caregivers (above 21 years. Caregivers answered to World Health Organization Quality of Life and Zarit Burden Interview questionnaires. Patients were assessed with the Motor Function Measure and the Autoquestionnaire Qualité de vie Enfant Imagé. Spearman correlations and linear regressions were run to investigate relationships between the variables. Results The occurrence of lower QOL and higher burden among the caregivers of patients with Duchenne muscular dystrophy was evidenced. The functional dependence of patients was not considered a determinant factor. Higher caregivers’ burden was related to lower caregivers’ QOL and to higher patients’ ages.

Study of Burden Among Caregivers of Children with Cleft Lip and Palate

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Ana Paula Ribeiro Razera

Full Text Available Abstract: The psychological and physical health of caregivers of children with cleft lip and palate can be strongly influenced by the child’s condition and behavior, and care required by the treatment. This study’s objective was to identify overload levels among these caregivers. A total of 100 caregivers, whose children were in the perioperative period of cheiloplasty and/or palatoplasty, were interviewed using the Scale Burden Interview. The data were analyzed quantitatively. Moderate and moderate severe burden levels were identified in 43% of the sample. The mothers of children aged around 12 months presented significantly higher overload. The results indicate that children in this developmental stage present greater care demand because they seek autonomy in locomotion, explore objects in their surrounding environment, and continually request communicative and affective-social interaction with their reference to greater attachment (the caregiver, which may have contributed to higher burden.

Symptom burden predicts hospitalization independent of comorbidity in community-dwelling older adults.

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Salanitro, Amanda H; Hovater, Martha; Hearld, Kristine R; Roth, David L; Sawyer, Patricia; Locher, Julie L; Bodner, Eric; Brown, Cynthia J; Allman, Richard M; Ritchie, Christine S

2012-09-01

To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults. Prospective, observational study with a baseline in-home assessment of symptom burden. Central Alabama. Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence. Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined. During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity. Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Allostatic load but not medical burden predicts memory performance in late-life bipolar disorder.

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Vaccarino, Sophie R; Rajji, Tarek K; Gildengers, Ariel G; Waters, Sarah E S; Butters, Meryl A; Menon, Mahesh; Blumberger, Daniel M; Voineskos, Aristotle N; Miranda, Dielle; Mulsant, Benoit H

2018-03-01

Older patients with bipolar disorder (BD) present with variable degrees of cognitive impairment. Over time, stress, mood episodes, and comorbidities increase the body's allostatic load. We assessed the extent to which allostatic load vs more traditional measures of medical burden account for the heterogeneity in cognition in this population. Thirty-five older euthymic patients with BD and 30 age-equated, gender-equated, and education-equated comparison participants were administered a comprehensive assessment including a neuropsychological battery, and 9 physiological measures to determine allostatic load. The relationship among allostatic load, medical burden, and cognition was assessed. Compared with the mentally healthy comparators, patients were impaired globally, and in 4 cognitive domains-information-processing speed / executive functioning, delayed memory, language, and visuomotor ability, and presented with greater medical burden but not a different allostatic load. Allostatic load, but not medical burden, was associated with delayed memory performance both in a correlational analysis and in a multivariate regression analysis. Euthymic older patients with BD are impaired on several cognitive domains and have high medical burden. Their memory performance is more strongly associated with allostatic load than with traditional measures of medical burden. These findings need to be replicated and extended longitudinally. Copyright © 2017 John Wiley & Sons, Ltd.

Burden of care in the caregivers of patients with anxiety disorders

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Manu Agarwal

2017-01-01

Full Text Available Introduction: Anxiety disorders are one of the frequently encountered psychiatric disorders in psychiatric clinics which have significant impact on the psychosocial well-being of the patient as well as their caregivers. Study Design and Aims: This study is a non- invasive, cross sectional study of 91 patients with anxiety disorder (except obsessive compulsive disorder aimed to assess the burden of care on their key-relatives and to study various socio demographic and clinical variables of the patient in relation to burden of care on key-relatives. Methodology: Patients diagnosed with anxiety disorders other than obsessive compulsive disorder and their key relatives satisfying the selection criteria were enrolled in the study. Assessment was done on semi-structured proforma, ICD 10 DCR, SCAN (Schedules for Clinical Assessment in Neuropsychiatry, International Personality Disorder Examination (IPDE, Burden assessment schedule, Hamilton Anxiety Rating Scale (HAM-A. Result: Total adjusted burden score in our study was 40.41 which is suggestive of mild burden. It was found that the burden of care was higher in male gender, married individuals, in joint families, among spouses, urban background, in the age group 41 to 50 years, low income group particularly on farmers and laborers. Generalized anxiety disorder was associated with more burden of care in comparison to other anxiety disorders. Conclusion: Key relatives of patients with anxiety disorder have significant burden of care in different domains along the socio-demographic strata.

Effect of caregivers’ expressed emotion on the care burden and rehospitalization rate of schizophrenia

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Wang X

2017-09-01

Full Text Available Xia Wang,1 Qiongni Chen,2 Min Yang1 1Xiangya School of Nursing, 2Nursing Department, Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China Background: This study assessed the effect of expressed emotion (EE among caregivers of schizophrenia patients on their care burden and the illness rehospitalization rate. Subjects and methods: A total of 64 schizophrenia patients hospitalized for the first time and their key caregivers were recruited. The Chinese version of the Camberwell Family Interview (CFI-CV was used to evaluate the EE of the key caregivers. A family burden questionnaire was used to evaluate the care burden. The patients’ rehospitalization rate and medication compliance were evaluated by the self-designated criteria. The data collection was carried out at the first meeting in the hospital, at 6 months and 12 months after hospital discharge by using the same instruments. Results: The subjective stress burden and subjective demand burden scores were higher in caregivers before and after discharge with statistical difference between the various observation time points (P<0.05. Significant differences were observed in the rehospitalization rate between patients with high medication adherence and low medication adherence at 12 months (P<0.01 and between patients with high expressed emotion (HEE and low expressed emotion (LEE; P<0.05. The rehospitalization rate in patients with HEE caregivers was higher than that in those with LEE caregivers. The subjective stress burden scores were statistically significant between HEE and LEE caregivers (P<0.05.Conclusion: HEE is a predictor of rehospitalization rate in schizophrenic patients. The burdens of care scores are high in caregivers of schizophrenic patients. The caregivers with HEE have a high score in burden of care compared with those with LEE. Keywords: expressed emotion, care burden, schizophrenia, rehospitalization rate, caregivers

Body-mass or sex-biased tick parasitism in roe deer (Capreolus capreolus)? A GAMLSS approach.

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Kiffner, C; Lödige, C; Alings, M; Vor, T; Rühe, F

2011-03-01

Macroparasites feeding on wildlife hosts follow skewed distributions for which basic statistical approaches are of limited use. To predict Ixodes spp. tick burden on roe deer, we applied Generalized Additive Models for Location, Scale and Shape (GAMLSS) which allow incorporating a variable dispersion. We analysed tick burden of 78 roe deer, sampled in a forest region of Germany over a period of 20 months. Assuming a negative binomial error distribution and controlling for ambient temperature, we analysed whether host sex and body mass affected individual tick burdens. Models for larval and nymphal tick burden included host sex, with male hosts being more heavily infested than female ones. However, the influence of host sex on immature tick burden was associated with wide standard errors (nymphs) or the factor was marginally significant (larvae). Adult tick burden was positively correlated with host body mass. Thus, controlled for host body mass and ambient temperature, there is weak support for sex-biased parasitism in this system. Compared with models which assume linear relationships, GAMLSS provided a better fit. Adding a variable dispersion term improved only one of the four models. Yet, the potential of modelling dispersion as a function of variables appears promising for larger datasets. © 2010 The Authors. Medical and Veterinary Entomology © 2010 The Royal Entomological Society.

Family functioning in severe brain injuries: correlations with caregivers' burden, perceived social support and quality of life.

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Tramonti, Francesco; Bonfiglio, Luca; Di Bernardo, Carolina; Ulivi, Chiara; Virgillito, Alessandra; Rossi, Bruno; Carboncini, Maria Chiara

2015-01-01

Severe brain injuries have long-term consequences on functional status and psychosocial functioning. Family life can be greatly influenced as well, and features of high caregiver burden can emerge. Although the data on caregivers' distress are constantly increasing, less information is available about the role of family functioning. Thirty caregivers of hospitalised patients with severe brain injuries received questionnaires for the evaluation of caregiver burden, family functioning and perceived social support. A semi-structured interview was performed for the evaluation of quality of life. Family cohesion and adaptability positively correlated with caregivers' quality of life and perceived social support. Partner caregivers' scores were significantly higher on the time-dependent burden than those of sons and daughters, whereas the latter scored higher on the emotional burden.

Body composition, symptoms, and survival in advanced cancer patients referred to a phase I service.

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Parsons, Henrique A; Baracos, Vickie E; Dhillon, Navjot; Hong, David S; Kurzrock, Razelle

2012-01-01

Body weight and body composition are relevant to the outcomes of cancer and antineoplastic therapy. However, their role in Phase I clinical trial patients is unknown. We reviewed symptom burden, body composition, and survival in 104 patients with advanced cancer referred to a Phase I oncology service. Symptom burden was analyzed using the MD Anderson Symptom Assessment Inventory(MDASI); body composition was evaluated utilizing computerized tomography(CT) images. A body mass index (BMI)≥25 kg/m² was considered overweight. Sarcopenia, severe muscle depletion, was assessed using CT-based criteria. Most patients were overweight (n = 65, 63%); 53 patients were sarcopenic (51%), including 79% of patients with a BMIbody composition: 215 (71-358) (BMIcancer diagnosis predicted longer survival in multivariate analysis after controlling for age, gender, performance status, and fat index. Patients referred to a Phase I clinic had a high frequency of sarcopenia and a BMI≥25 kg/m², independent of symptom burden. Body composition variables were predictive of clinically relevant survival differences, which is potentially important in developing Phase I studies.

Disease burden of COPD in China: a systematic review

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Zhu B

2018-04-01

Full Text Available Bifan Zhu,1 Yanfang Wang,2 Jian Ming,3 Wen Chen,4 Luying Zhang4 1Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China; 2The First Affiliated Hospital of Wannan Medical College, Wuhu, China; 3IQVIA, Shanghai, China; 4School of Public Health, Fudan University, Shanghai, China Abstract: Chronic obstructive pulmonary disease (COPD is one of the main contributors to the global burden of disease. The aim of this systematic review was to quantify the disease burden of COPD in China and to determine the risk factors of the disease. The number of studies included in the review was 47 with an average quality assessment score of 7.70 out of 10. Reported COPD prevalence varied between 1.20% and 8.87% in different provinces/cities across China. The prevalence rate of COPD was higher among men (7.76% than women (4.07%. The disease was more prevalent in rural areas (7.62% than in urban areas (6.09%. The diagnostic rate of COPD patients in China varied from 23.61% to 30.00%. The percentage of COPD patients receiving outpatient treatment was around 50%, while the admission rate ranged between 8.78% and 35.60%. Tobacco exposure and biomass fuel/solid fuel usage were documented as two important risk factors of COPD. COPD ranked among the top three leading causes of death in China. The direct medical cost of COPD ranged from 72 to 3,565 USD per capita per year, accounting for 33.33% to 118.09% of local average annual income. The most commonly used scales for the assessment of quality of life (QoL included Saint George Respiratory Questionnaire, Airways Questionnaire 20, SF-36, and their revised versions. The status of QoL was worse among COPD patients than in non-COPD patients, and COPD patients were at higher risks of depression. The COPD burden in China was high in terms of economic burden and QoL. In view of the high smoking rate and considerable concerns related to air pollution and smog in China, countermeasures

Estimating the burden of disease attributable to excess body weight ...

African Journals Online (AJOL)

Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. ... Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ... lasting change in the determinants and impact of excess body weight.

Serum phosphorus levels and pill burden are inversely associated with adherence in patients on hemodialysis.

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Wang, Steven; Alfieri, Thomas; Ramakrishnan, Karthik; Braunhofer, Peter; Newsome, Britt A

2014-11-01

Phosphate binders (PBs) account for about one half of the daily pill burden for US hemodialysis (HD) patients, which may reduce adherence. Adherence can be estimated by the medication possession ratio (MPR), which is defined as the proportion of time a patient had sufficient medication to have taken it as prescribed. Gaps of time between prescription fills lower the patient's MPR. We assessed the association of PB pill burden and adherence (MPR) with phosphorus goal attainment. Using pharmacy management program data, HD patients on PB monotherapy were tracked from first PB fill during 1 January 2007-30 June 2011 for 1 year, or until PB change or censoring. Data were assessed with generalized linear models. We analyzed 8616 patients. Higher pill burden was associated with lower adherence. Lower adherence tended to be associated with higher mean phosphorus levels and lower percentage of patients with serum phosphorus ≤5.5 mg/dL (P adherence and these clinical outcomes was most pronounced in the lowest and highest pill burden strata (3-6, >12-15, >15). Adherence, as measured by the MPR, was negatively related to higher pill burden and phosphorus levels and positively related to patients in the phosphorus target range. Within pill burden strata, phosphorus increased and patients in the target range generally decreased with decreasing adherence, suggesting that patients prescribed fewer PB pills are less likely to have treatment gaps, and may be more likely to achieve phosphorus targets. © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA.

[Burden of mothers and fathers of persons with schizophrenia].

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Friedrich, Fabian; Gross, Rainer; Wrobel, Margit; Klug, Günter; Unger, Annemarie; Fellinger, Matthäus; Süßenbacher, Stefanie; Freidl, Marion; Saumer, Gertraud; Wancata, Johannes

2015-05-01

Most studies about the burden of schizophrenia carers included only one care-giving relative, usually the patients' mothers. The present study intended to analyse differences of the level of burden between mothers and fathers of the same patients. 101 mothers and 101 fathers of the same patients suffering from schizophrenia were included into this study. They were assessed by means of the "Involvement Evaluation Questionnaire" and the "Carers' Needs Assessment for Schizophrenia". Mothers showed significantly higher scores than fathers regarding the subscores "Tensions" and "Urging". Multiple linear regression analyses showed positive associations between the frequency of mothers' as well as fathers' unmet needs and dimensions of caregiver involvement. Unmet needs among mothers and fathers have negative effects on their burden. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work. © Georg Thieme Verlag KG Stuttgart · New York.

Economic and Disease Burden of Dengue in Mexico

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Undurraga, Eduardo A.; Betancourt-Cravioto, Miguel; Ramos-Castañeda, José; Martínez-Vega, Ruth; Méndez-Galván, Jorge; Gubler, Duane J.; Guzmán, María G.; Halstead, Scott B.; Harris, Eva; Kuri-Morales, Pablo; Tapia-Conyer, Roberto; Shepard, Donald S.

2015-01-01

, dengue burden may be significantly higher than that of the pre-vaccine level of rotavirus diarrhea. In sum, Mexico’s potential economic benefits from dengue control would be substantial. PMID:25786225

Psychological Resilience, Affective Mechanisms, and Symptom Burden in a Tertiary Care Sample of Patients with Fibromyalgia

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McAllister, Samantha J; Vincent, Ann; Hassett, Afton L; Whipple, Mary O; Oh, Terry H; Benzo, Roberto P; Toussaint, Loren L

2014-01-01

Research demonstrates that patients with fibromyalgia who have higher positive and lower negative affect have lower symptom burden. Affect has been shown to be associated with resilience. This study examined the relationship between affect, resilience, and fibromyalgia symptom burden in a clinical sample of patients with fibromyalgia. We hypothesized that (a) positive and negative affect would be associated with fibromyalgia symptom burden; (b) resilience would be associated with positive and negative affect; (c) resilience would be associated with fibromyalgia symptom burden; and (d) the connection between resilience and fibromyalgia symptom burden would be mediated by both positive and negative affect. A sample of 858 patients with fibromyalgia completed questionnaires. Mediation modeling revealed statistically significant direct effects of resilience on fibromyalgia symptom burden (β =−.10, P fibromyalgia symptom burden through affect (β =−.36, P fibromyalgia symptom burden. Our results suggest that improving affect through resiliency training could be studied as a modality for improving fibromyalgia symptom burden. PMID:24376184

The Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people, 2011

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Fadwa Al-Yaman

2017-10-01

Full Text Available This study estimates fatal and nonfatal disease burden among Indigenous Australians in 2011 and compares it with non-Indigenous Australians. The study found that there were 284 years lost per 1000 people because of premature death or living with ill health. Most of the disease burden was from chronic diseases (64%, particularly mental and substance-use disorders, injuries, cardiovascular diseases, cancer and respiratory diseases. The burden of disease was higher among males (54% than females (46% and higher for fatal (53% than for nonfatal burden (47%. The disease groups with the highest burden varied by age group, with mental and substance-use disorders and injuries being the largest disease groups among those aged 5–44 years, and cardiovascular disease and cancer becoming more prominent among those aged 45 and older. Large disparities existed between Indigenous and non-Indigenous Australians, with the total burden being 2.3 times the non-Indigenous rates, fatal burden being 2.7 times and nonfatal burden being 2 times.

The personal financial burden of chronic rhinosinusitis: A Canadian perspective.

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Yip, Jonathan; Vescan, Allan D; Witterick, Ian J; Monteiro, Eric

2017-07-01

Previous studies describe the financial burden of chronic rhinosinusitis (CRS) from the perspective of third-party payers, but, to our knowledge, none analyze the costs borne by patients (i.e., out-of-pocket expenses [OOPE]). Furthermore, this burden has not been previously investigated in the context of a publicly funded health care system. The purpose of this study was to characterize the financial impact of CRS on patients, specifically by evaluating its associated OOPEs and the perceived financial burden. The secondary aim was to determine the factors predictive of OOPEs and perceived burden. Patients with CRS at a tertiary care sinus center completed a self-administered questionnaire that assessed their socioeconomic characteristics, disease-specific quality of life (22-item Sino-Nasal Outcome Test [SNOT-22]), workdays missed due to CRS, perceived financial burden, and direct medical and nonmedical OOPEs over a 12-month period. Total OOPEs were calculated from the sum of direct medical and nonmedical OOPEs. Regression analyses determined factors predictive of OOPEs and the perceived burden. A total of 84 patients completed the questionnaires. After accounting for health insurance coverage and the median direct medical, direct nonmedical, and total OOPEs per patient over a 12-month period were Canadian dollars (CAD) $336.00 (2011) [U.S. $339.85], CAD $129.87 [U.S. $131.86], and CAD $607.10 [U.S. $614.06], respectively. CRS resulted in an average of 20.6 workdays missed over a 12-month period. Factors predictive of a higher financial burden included younger age, a greater number of previous sinus surgeries, financial burden and consider counseling them on strategies to offset expenses, including obtaining travel grants, using telemedicine for follow-up assessments, providing drug samples, and streamlining diagnostic testing with medical visits.

The heterogeneity in financial and time burden of caregiving to children with chronic conditions.

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Zan, Hua; Scharff, Robert L

2015-03-01

We examine the financial and time burdens associated with caring for children with chronic conditions, focusing on disparities across types of conditions. Using linked data from the 2003 to 2006 National Health Interview Survey and 2004-2008 Medical Expenditure Panel Survey, we created measures of financial burden (out-of-pocket healthcare costs, the ratio of out-of-pocket healthcare costs to family income, healthcare costs paid by insurance, and total healthcare costs) and time burden (missed school time due to illness or injury and the number of doctor visits) associated with 14 groups of children's chronic conditions. We used the two-part model to assess the effect of condition on financial burden and finite mixture/latent class model to analyze the time burden of caregiving. Controlling for the influences of other socio-demographic characteristics on caregiving burden, children with chronic conditions have higher financial and time burdens relative to caregiving burdens for healthy children. Levels of financial burden and burden sharing between families and insurance system also vary by type of condition. For example, children with pervasive developmental disorder or heart disease have a relatively low financial burden for families, while imposing a high cost on the insurance system. In contrast, vision difficulties are associated with a high financial burden for families relative to the costs borne by others. With respect to time burden, conditions such as cerebral palsy and heart disease impose a low time burden, while conditions such as pervasive developmental disorder are associated with a high time burden. This study demonstrates that differences exist in caregiving burden for children by type of chronic condition. Each condition has a unique profile of time and financial cost burden for families and the insurance system. These results have implications for policymakers and for families' savings and employment decisions.

Disability and functional burden of disease because of mental in comparison to somatic disorders in general practice patients.

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Linden, M; Linden, U; Schwantes, U

2015-09-01

Severity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause suffering to the individual and society. To study burden of disease for mental in comparison to somatic disorders, 2099 patients from 40 general practitioners filled in (a) the Burvill scale which measures acute and chronic illnesses in ten different body systems and (b) the IMET scale which measures impairment in ten different areas of life. Patients were suffering on average from acute and/or chronic illness in 3.5 (SD: 2.0) body systems and 56.6% of patients complained about acute and/or chronic mental disorders. The most significant negative impact on the IMET total score have acute and chronic mental disorders, followed by chronic neurological and musculoskeletal and acute respiratory and gastrointestinal disorders, while cardiovascular, metabolic, urogenital, haematological and ear/eye disorders have no greater impact. Acute as well as chronic mental disorders cause impairment across all areas of life and most burden of disease (functional burden of disease 1.69), followed by musculoskeletal disorders (1.62). Mental disorders are among the most frequent health problems with high negative impact across all areas of life. When combining frequency and impairment mental disorders cause most burden of disease in comparison to other illnesses. This should be reflected in the organization of medical care including family medicine. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Investigating the Burden of Chronic Pain: An Inflammatory and Metabolic Composite

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Kimberly T. Sibille

2016-01-01

Full Text Available Background. Chronic pain is associated with increased morbidity and mortality, predominated by cardiovascular disease and cancer. Investigating related risk factor measures may elucidate the biological burden of chronic pain. Objectives. We hypothesized that chronic pain severity would be positively associated with the risk factor composite. Methods. Data from 12,982 participants in the 6th Tromsø study were analyzed. Questionnaires included demographics, health behaviors, medical comorbidities, and chronic pain symptoms. The risk factor composite was comprised of body mass index, fibrinogen, C-reactive protein, and triglycerides. Chronic pain severity was characterized by frequency, intensity, time/duration, and total number of pain sites. Results. Individuals with chronic pain had a greater risk factor composite than individuals without chronic pain controlling for covariates and after excluding inflammation-related health conditions (p<0.001. A significant “dose-response” relationship was demonstrated with pain severity (p<0.001. In individuals with chronic pain, the risk factor composite varied by health behavior, exercise, lower levels and smoking, and higher levels. Discussion. The risk factor composite was higher in individuals with chronic pain, greater with increasing pain severity, and influenced by health behaviors. Conclusions. Identification of a biological composite sensitive to pain severity and adaptive/maladaptive behaviors would have significant clinical and research utility.

Caregiver burden and its determinants among the family members of patients with dementia in Iran

Directory of Open Access Journals (Sweden)

Ibrahim Abdollahpour

2012-01-01

Full Text Available Background: "Caregiver Burden" is actually an expression addressing the adverse consequences of the care provided to the patients′ with dementia. Review of the previous studies reveals a higher rate of depression and anxiety among the caregivers as compared to the general population. This study has been designed to evaluate the caregiver burden and then the factors influencing it among caregivers of patients with dementia in Iran. Methods: In this cross-sectional study, 153 patients and their caregivers registered in the Memory Clinic in Roozbeh Hospital and Iranian Alzheimer Association (IAA were included. Data collection scales were Iranian Version of Caregiver Burden, Global Deterioration scale and Barthel index. Multiple linear regression model was applied to determine the factors influencing the caregiver burden. Results: Out of the 153 patients, 90 were male. The mean age calculated for the patients and the caregivers was 77.1 and 53, respectively. The mean of caregiver burden was 55.2. Three variables, gender (P<0.01, education of the patient (P<0.005 for illiterate patients, and the patient′s dependence on the caregiver for his/her daily tasks (P<0.000 were correlated with a high level of burden on the caregiver. The recommended model explains 0.664% of the variance of the outcome variable. Conclusion: Presence of either moderate or higher levels of burden (58-116 in more than 50% of the caregivers of these patients′ highlights the need for more attention from health policy makers in Iran. Promoting the level of caregivers′ quality of life along with enabling the patients in performing their daily tasks in order to reduce the imposed burden on caregivers′ is recommended.

The global burden of dengue: an analysis from the Global Burden of Disease Study 2013

NARCIS (Netherlands)

J.D. Stanaway (Jeffrey D.); D.S. Shepard (Donald); E.A. Undurraga (Eduardo); Halasa, Y.A. (Yara A); L.E. Coffeng (Luc); Brady, O.J. (Oliver J); Hay, S.I. (Simon I); Bedi, N. (Neeraj); I.M. Bensenor (Isabela M.); C.A. Castañeda-Orjuela (Carlos A); T.-W. Chuang (Ting-Wu); K.B. Gibney (Katherine B); Z.A. Memish (Ziad); A. Rafay (Anwar); K.N. Ukwaja (Kingsley N); N. Yonemoto (Naohiro); C.J.L. Murray (Christopher)

2016-01-01

textabstractBackground Dengue is the most common arbovirus infection globally, but its burden is poorly quantified. We estimated dengue mortality, incidence, and burden for the Global Burden of Disease Study 2013. Methods We modelled mortality from vital registration, verbal autopsy, and

Objective and subjective burden in relatives of patients with schizophrenia and its influence on care relationships in Chile.

Science.gov (United States)

Caqueo-Urízar, Alejandra; Urzúa, Alfonso; Jamett, Patricio Rojas; Irarrazaval, Matias

2016-03-30

This study examined the burden on family members of patients with schizophrenia in a Chilean community. Sixty-five caregivers underwent the Subjective and Objective Family Burden Interview. The results showed moderate to high levels of subjective burden and low levels of support from others in providing care. Burden and containment of disturbed behaviour were correlated with worse relationships between patients and caregivers, with the latter spending less time working outside the home. The assessed sample showed a similar pattern of burden to that of caregivers from developed countries; however, the extent of the burden tended to be higher in Chilean caregivers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Methodological Challenges in Estimating Trends and Burden of Cardiovascular Disease in Sub-Saharan Africa

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Jacob K. Kariuki

2015-01-01

Full Text Available Background. Although 80% of the burden of cardiovascular disease (CVD is in developing countries, the 2010 global burden of disease (GBD estimates have been cited to support a premise that sub-Saharan Africa (SSA is exempt from the CVD epidemic sweeping across developing countries. The widely publicized perspective influences research priorities and resource allocation at a time when secular trends indicate a rapid increase in prevalence of CVD in SSA by 2030. Purpose. To explore methodological challenges in estimating trends and burden of CVD in SSA via appraisal of the current CVD statistics and literature. Methods. This review was guided by the Critical review methodology described by Grant and Booth. The review traces the origins and evolution of GBD metrics and then explores the methodological limitations inherent in the current GBD statistics. Articles were included based on their conceptual contribution to the existing body of knowledge on the burden of CVD in SSA. Results/Conclusion. Cognizant of the methodological challenges discussed, we caution against extrapolation of the global burden of CVD statistics in a way that underrates the actual but uncertain impact of CVD in SSA. We conclude by making a case for optimal but cost-effective surveillance and prevention of CVD in SSA.

Burden of malaria is higher among children in an internal displacement camp compared to a neighbouring village in the Democratic Republic of the Congo.

Science.gov (United States)

Charchuk, Rhianna; Paul, Makelele Katsuva Jean; Claude, Kasereka Masumbuko; Houston, Stan; Hawkes, Michael T

2016-08-25

In the Democratic Republic of the Congo (DRC), violent conflict has caused the displacement of millions of people into camps where they are exposed to poor living conditions and high rates of infectious diseases. Malaria, in particular, is a major cause of mortality in children under five; however, the burden of disease in displacement camps has not previously been described. Two cross-sectional surveys were performed. First, prevalence of Plasmodium falciparum antigenemia was measured in a random sample of 200 children living in a displacement camp and 200 children from a nearby village (control group). Second, the proportion of febrile illness attributable to malaria was measured in a study of 100 children from the displacement camp and 100 children from the control village presenting to the same health clinic with fever. All participants were tested for P. falciparum with a rapid diagnostic test and additional demographic data, clinical characteristics, and malaria risk factors were determined using a parental questionnaire. In the community survey, children living in the displacement camp had a higher prevalence of P. falciparum infection (17 %) than controls (7.5 %) (OR 2.6; 95 % CI 1.3-4.1; P = 0.0095). In the clinic-based survey, the proportion of febrile illness attributable to malaria was higher among children from the displacement camp (78 %) than controls (39 %) (OR 5.5; 95 % CI 3.0-10.3; P displacement camp than control village in both surveys. Statistically significant differences in household wealth, maternal education, and exposure to community violence were also found. Population displacement due to violent conflict appears to be a risk factor for malaria, a major cause of child mortality. Children living in displacement camps are a relatively understudied population, but have a high burden of malaria, despite control programmes focused on bed net distribution.

Higher body mass index associated with severe early childhood caries.

Science.gov (United States)

Davidson, Katherine; Schroth, Robert J; Levi, Jeremy A; Yaffe, Aaron B; Mittermuller, Betty-Anne; Sellers, Elizabeth A C

2016-08-20

Severe Early Childhood Caries (S-ECC) is an aggressive form of tooth decay in preschool children affecting quality of life and nutritional status. The purpose was to determine whether there is an association between Body Mass Index (BMI) and S-ECC. Children with S-ECC were recruited on the day of their slated dental surgery under general anesthesia. Age-matched, caries-free controls were recruited from the community. All children were participating in a larger study on nutrition and S-ECC. Analysis was restricted to children ≥ 24 months of age. Parents completed a questionnaire and heights and weights were recorded. BMI scores and age and gender adjusted BMI z-scores and percentiles were calculated. A p-value ≤ 0.05 was significant. Two hundred thirty-five children were included (141 with S-ECC and 94 caries-free). The mean age was 43.3 ± 12.8 months and 50.2 % were male. Overall, 34.4 % of participants were overweight or obese. Significantly more children with S-ECC were classified as overweight or obese when compared to caries-free children (p = 0.038) and had significantly higher mean BMI z-scores than caries-free children (0.78 ± 1.26 vs. 0.22 ± 1.36, p = 0.002). Those with S-ECC also had significantly higher BMI percentiles (69.0 % ± 29.2 vs. 56.8 % ± 31.7, p = 0.003). Multiple linear regression analyses revealed that BMI z-scores were significantly and independently associated with S-ECC and annual household income as were BMI percentiles. Children with S-ECC in our sample had significantly higher BMI z-scores than caries-free peers.

Bioassay of hair for estimation of body burden by tritium exposure

International Nuclear Information System (INIS)

Takeda, Hiroshi; Iwakura, Tetsuo

1989-01-01

For accurate estimation of radiation dose to human body from tritium exposure, it is needed to assess the concentration of tritium organically bound to the tissue constituents(OBT) as well as body water tritium. Since hair is an easily accessible tissue, it seems to be interesting to study the possibility of using hair for this purpose. In the present study, the pattern of tritium incorporation into hair and the quantitative relationship between OBT content in hair and in other internal tissues were investigated in rats exposed singly or continously to tritiated water, tritiated leucine and tritiated glycine. The rate of tritium incorporation into hair was slower than that into other tissues and the maximum concentrations were found on the 15-30th day after a single ingestion. The alterations in the concentration of OBT in internal tissues due to the difference of chemical form of ingested tritium were reflected on the OBT concentration in hair. Especially, the OBT content in hair under the condition of continuous exposure was almost the same as that in other tissues. These findings indicate the validity of hair analysis as a means for assessing OBT deposition in the body or tissues. (author)

40 CFR 22.24 - Burden of presentation; burden of persuasion; preponderance of the evidence standard.

Science.gov (United States)

2010-07-01

... persuasion; preponderance of the evidence standard. 22.24 Section 22.24 Protection of Environment... Burden of presentation; burden of persuasion; preponderance of the evidence standard. (a) The complainant has the burdens of presentation and persuasion that the violation occurred as set forth in the...

Family functioning, burden and parenting stress 2 years after very preterm birth.

Science.gov (United States)

Treyvaud, Karli; Doyle, Lex W; Lee, Katherine J; Roberts, Gehan; Cheong, Jeanie L Y; Inder, Terrie E; Anderson, Peter J

2011-06-01

Examining rates of difficulties in family functioning following very preterm birth has been a relatively neglected area of research. To examine family functioning, burden and parenting stress in families with very preterm compared with term born children, and investigate influences of parental mental health problems and child neurodevelopmental disability on family outcomes in families with preterm children. Participants were 184 very preterm and 71 term children and their parents. Parents completed the Family Assessment Device, Parenting Stress Index and Impact on Family questionnaires when their children were 2 years old (corrected for prematurity). Parental mental health and social risk information were also collected. Children were assessed for neurodevelopmental disability. Families with very preterm children reported poorer family functioning (p=.03) compared with families with term born children, with less evidence for differences between families with very preterm and term born children in parenting stress and family burden. Within very preterm families, parental mental health problems were associated with higher levels of parenting stress (p=.001), and parents of children with a neurodevelopmental disability were more likely to report higher family burden (p=.04). For families with very preterm children, parental mental health symptoms and child neurodevelopmental disability may identify families at risk of greater stress and burden who may benefit from additional support. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

The Humanistic and Economic Burden of Narcolepsy.

Science.gov (United States)

Flores, Natalia M; Villa, Kathleen F; Black, Jed; Chervin, Ronald D; Witt, Edward A

2016-03-01

To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p productivity through effective assessment and treatment of narcolepsy. © 2016 American Academy of Sleep Medicine.

Whole-body counting in the Marshall Islands

International Nuclear Information System (INIS)

Sun, L.C.; Clinton, J.; Kaplan, E.; Meinhold, C.B.

1991-01-01

In 1978 the Marshall Islands Radiological Safety Program was organized to perform radiation measurements and assess radiation doses for the people of the Bikini, Enewetak, Rongelap and Utirik Atolls. One of the major field components of this program is whole- body counting (WBC). WBC is used to monitor the quantity of gamma- emitting radionuclides present in individuals. A primary objective of the program was to establish 137 Cesium body contents among the Enewetak, Rongelap and Utirik populations. 137 Cs was the only gamma-emitting fission radionuclide detected in the 1,967 persons monitored. 137 Cs body burdens tended to increase with age for both sexes, and were higher in males. The average 137 Cs dose Annual Effective Dose for the three populations was as follows: For Enewetak, the dose was 22±4 μSv. For Utirik, the dose was 33± 3 μSv. Since 1985 the Rongelap people have been self-exiled to Mejatto. Biological elimination should have reduced their dose to virtually zero, and the measured dose was 2±2 μSv. If they had remained on Rongelap Island, the calculated dose would have been 99 μSv, which is about one-third of the background dose. 7 refs., 1 tab

Relationship between trace element content in human organs and hair - significance of hair mineral analysis as a means for assessing internal body burdens of environmental mineral pollutants. Final report for the period October 1984 - September 1988

Energy Technology Data Exchange (ETDEWEB)

Kinova, L [Bulgarian Academy of Sciences, Sofia (Bulgaria). Inst. of Nuclear Research and Nuclear Energy

1988-12-31

The purpose of the project was to establish a possibility to use hair as a monitor for internal body burden with toxic metals. For this purpose samples of human organs (heart, spleen, liver, kidney) and hair were analysed by neutron activation analysis and radiochemical techniques for the determination of As, Cd, Hg, Cu, Zn, Se, Ca, K, Mg, Mn, Na, S. 6 refs, 4 tabs.

Caregiver Burden, Care Recipient Depressive Symptomology, and Social Exchange: Does Race Matter?

Science.gov (United States)

Ejem, Deborah; Bauldry, Shawn; Bakitas, Marie; Drentea, Patricia

2018-04-01

Informal caregivers play a vital role in supporting seriously ill patients. However, informal caregiving is burdensome and can lead to negative health outcomes for the caregiver and the care recipient. The study's aim was to evaluate relationships among caregiver burden, care recipient depressive symptomology, and race. Guided by the social exchange perspective, we examined cross-sectional dyadic data from the National Long-Term Care Survey (N = 1279). Using ordinal logistic regression, we found that higher caregiver-reported objective burden was associated with higher care recipient depressive symptoms ( P exchange of the social good "helpful company" with a caregiver. These findings illustrate the importance of supporting reciprocal exchange as a promising component of maintaining balanced caregiver-care recipient relationships among black older adults and their informal caregivers.

Caregiver Burden in Alcohol Dependence Syndrome

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Ramanujam Vaishnavi

2017-01-01

Full Text Available Background. Alcoholism is a major threat to the individual as well as the society and the maximum burden of the illness is borne by the family. Aim. The study is aimed at assessing the pattern of burden on the caregivers of alcohol dependent patients and at assessing the relationship between the severity of dependence and the burden on caregivers. Settings and Design. Cross-sectional descriptive study conducted in the Department of Psychiatry, Sri Ramachandra Medical College and Research Institute. Materials and Methods. A cross-sectional assessment was done in 200 patients with alcohol dependence and their caregivers. The severity of dependence and the pattern of burden on caregivers were assessed. Statistical Analysis. The data thus collected was analyzed using SPSS version 20. Results. The study demonstrates that caregivers of alcohol dependent patients reported significant objective burden and subjective burden. Furthermore, the severity of alcohol dependence and the domains of burden such as financial burden, disruption of family interaction, and disruption of family routine activities were positively correlated with high level of significance. Conclusion. The current study has illustrated that all the caregivers experienced significant amount of burden which has to be addressed for better treatment outcome of the patients.

Curbing the burden of lung cancer.

Science.gov (United States)

Urman, Alexandra; Hosgood, H Dean

2016-06-01

Lung cancer contributes substantially to the global burden of disease and healthcare costs. New screening modalities using low-dose computerized tomography are promising tools for early detection leading to curative surgery. However, the screening and follow-up diagnostic procedures of these techniques may be costly. Focusing on prevention is an important factor to reduce the burden of screening, treatment, and lung cancer deaths. The International Agency for Research on Cancer has identified several lung carcinogens, which we believe can be considered actionable when developing prevention strategies. To curb the societal burden of lung cancer, healthcare resources need to be focused on early detection and screening and on mitigating exposure(s) of a person to known lung carcinogens, such as active tobacco smoking, household air pollution (HAP), and outdoor air pollution. Evidence has also suggested that these known lung carcinogens may be associated with genetic predispositions, supporting the hypothesis that lung cancers attributed to differing exposures may have developed from unique underlying genetic mechanisms attributed to the exposure of interest. For instance, smokingattributed lung cancer involves novel genetic markers of risk compared with HAP-attributed lung cancer. Therefore, genetic risk markers may be used in risk stratification to identify subpopulations that are at a higher risk for developing lung cancer attributed to a given exposure. Such targeted prevention strategies suggest that precision prevention strategies may be possible in the future; however, much work is needed to determine whether these strategies will be viable.

EAMJ Jan. Burden.indd

African Journals Online (AJOL)

2009-01-01

Jan 1, 2009 ... developed world where the burden of disease is accurately determined. ... Projections indicate an expected yearly incidence of 15 to 20 million new .... of global mortality and burden of diseases from 2002 to 2030. Plos. Med.

Parental burden, coping, and family functioning in primary caregivers of children with Joubert syndrome.

Science.gov (United States)

Luescher, J L; Dede, D E; Gitten, J C; Fennell, E; Maria, B L

1999-10-01

Children with Joubert syndrome have physical and intellectual disabilities. The purpose of this study was to assess the impact of Joubert syndrome on parental burden, coping, and family functioning. Forty-nine primary caregivers were surveyed. Forty-three primary caregivers were mothers and six were fathers; their mean age was 34 years. The following measures were used: Beck Depression Inventory, Child Development Inventory, Caregiver Strain Index, Family Assessment Device, and Ways of Coping Checklist-Revised. The data show that caregiver burden is not related to the severity of the child's illness, but that caregivers report significant burden. Higher burden was associated with the use of palliative coping methods, and family functioning was problematic. The results of this study suggest that for parents of children with Joubert syndrome, degree of parental burden depends more on the parents' coping skills and the level of family functioning rather than on the degree of the child's impairment. These findings highlight the importance of assessing caregiver burden, as well as decreased family functioning or coping abilities, since these problems often can be managed with psychologic intervention.

Global burden of human mycetoma: a systematic review and meta-analysis.

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Wendy W J van de Sande

2013-11-01

Full Text Available Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. This disease has been reported from countries between 30°N and 15°S since 1840 but the exact burden of disease is not known. It is currently unknown what the incidence, prevalence and the number of reported cases per year per country is. In order to estimate what the global burden of mycetoma is, a meta-analysis was performed. In total 50 studies were included, which resulted in a total of 8763 mycetoma cases. Most cases were found in men between 11 and 40 years of age. The foot was most commonly affected. Most cases were reported from Mexico, Sudan and India. Madurella mycetomatis was the most prevalent causative agent world-wide, followed by Actinomadura madurae, Streptomyces somaliensis, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides. Although this study represents a first indication of the global burden on mycetoma, the actual burden is probably much higher. In this study only cases reported to literature could be used and most of these cases were found by searching archives from a single hospital in a single city of that country. By erecting (international surveillance programs a more accurate estimation of the global burden on mycetoma can be obtained.

Impact of long-term burden of excessive adiposity and elevated blood pressure from childhood on adulthood left ventricular remodeling patterns: the Bogalusa Heart Study.

Science.gov (United States)

Lai, Chin-Chih; Sun, Dianjianyi; Cen, Ruiqi; Wang, Jian; Li, Shengxu; Fernandez-Alonso, Camilo; Chen, Wei; Srinivasan, Sathanur R; Berenson, Gerald S

2014-10-14

Cardiovascular risk factors are associated with left ventricular hypertrophy (LVH), but little is known regarding related impact of longitudinal measures of childhood adiposity and LV hemodynamic variables. The aim of this study was to examine the impact of cumulative long-term burden and trends of excessive adiposity and elevated blood pressure (BP) during childhood on adulthood LVH and LV geometric remodeling patterns. This longitudinal study consisted of 1,061 adults, age 24 to 46 years, who had been examined 4 or more times for body mass index (BMI) and BP starting in childhood, with a mean follow-up of 28.0 years. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI and BP from childhood to adulthood. Four LV geometric types were defined-normal, concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH)-all on the basis of LV mass indexed for body height (m(2.7)) and relative wall thickness. Higher values of BMI and systolic and diastolic BP in childhood and adulthood, as well as total AUC and incremental AUC, were all significantly associated with higher LV mass index and LVH, adjusted for race, sex, and age. In addition, higher values of BMI and BP in childhood and adulthood, total AUC, and incremental AUC were significantly associated with EH and CH but not with CR. Importantly, all of these measures of BMI had a consistently and significantly greater influence on EH than did measures of BP. These findings indicate that the adverse influence of excessive adiposity and elevated BP levels on LVH begins in childhood. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Investigations into the transfer of 134+137cesium from Chernobyl fall-out-contaminated grasscobs in the bodies of fallow deer and angora rabbits and on the biological half-life of radio-cesium by means of whole-body gamma spectroscopy

International Nuclear Information System (INIS)

Feiden, F.

1989-01-01

The present work concerns a feeding experiment to establish the transfer-factors of 134+137 cesium from Chernobyl fall-out-contaminated grasscobs in the bodies of fallow deer (Dama-dama) and angora rabbits (Oryctolagus cuniculus). The transfer factor from the feed-stuff in the fallow deer body amounted to 0.0311 d/kg independent of the proportion of the contaminated grasscobs in the overall daily ration of food. The 137 Cs activity/kg in the flesh of two killed deer averaged about the factor 1.35, in the joint muscles about the factor 1.44 higher. An increase in the transfer factor for the fallow deers flesh to 0.0448 d/kg is assumed. The transfer factor (whole body) for the angora rabbits amounted to 0.285 d/kg. Two animals killed in balanced condition displayed around the factor 1.35 higher cesium values in the muscles. On this base the TF (meat) could be given as at 0.385 d/kg. The biological half-life of the radio-cesium in the body of fallow deer comprised a fast component of 0.3 d and a proportion of about 37% in overall activity and a slower one of 13 d with a 63% proportion. On an average it amounted to 8.3 d for excretion of the first half of the initial burden. At 5.5 d, a fallow deer burdened by only one i.v. injection excreted 50% of the initial activity markedly more quickly. Two proportionally equal phases of 1.2 and 10 days of biological half-time were recognised. As regards the angora rabbits, the biological half-life amounted to 1.2 d for the faster component, and for a slower one about 8 d. The first half of the initial activity was excreted after about 5.5 d. (orig./MG) [de

Sports practice, resilience, body and sexual esteem, and higher educational level are associated with better sexual adjustment in men with acquired paraplegia.

Science.gov (United States)

Dos Passos Porto, Isabela; Cardoso, Fernando Luiz; Sacomori, Cinara

2016-10-12

To analyse the association of team sports practice and physical and psychological factors with sexual adjustment in men with paraplegia. More specifically, we aimed to compare athletes and non-athletes regarding sexual adjustment, resilience, body and sexual self-esteem, and functional independence. Cross-sectional study with a paired design. The study included 60 men with paraplegia (30 athletes and 30 non-athletes). We used a sociodemographic questionnaire (age, education, and time since injury); a physical and sexual esteem questionnaire; a resilience questionnaire; and Functional Independence Measure (FIM). The dependent variable, sexual adjustment, was determined by the sum of 5 questions about sexual frequency, desire, and satisfaction and physical and psychological adjustment. Data were analysed by using the χ2 test, Wilcoxon's test, Spearman's correlation test, and hierarchical multiple linear regression analysis, with p Athletes had significantly higher sexual adjustment (p = 0.001) and higher body and sexual esteem (p esteem, higher educational level, and higher resilience levels (R2 = 58%). There was an interaction between sports practice and body and sexual esteem (p = 0.024; R2 = 62%). Participation in sports influenced the sexual adjustment of the men with paraplegia, even when controlled for psychological (resilience and body and sexual esteem) and physical (functional independence) aspects.

Double Burden of Malnutrition in Rural West Java: Household-Level Analysis for Father-Child and Mother-Child Pairs and the Association with Dietary Intake

Directory of Open Access Journals (Sweden)

Makiko Sekiyama

2015-10-01

Full Text Available Indonesia is facing household-level double burden malnutrition. This study aimed at examining (1 household-level double burden for the mother-child and father-child pairs; (2 risk of adiposity of double burden households; and (3 associated dietary factors. Subjects were 5th and 6th grade elementary school children (n = 242, their mothers (n = 242, and their fathers (n = 225 in five communities (1 = urban, 4 = rural in the Bandung District. Questionnaires on socioeconomic factors, blood hemoglobin measurements, and anthropometric measurements were administered. For adults, body fat percentage (BF% was estimated by bioelectrical impedance (BF%-BI and by converting skinfold thickness (ST data using Durnin and Womersley’s (1974 formula (BF%-ST. Food frequency questionnaires were also completed. Double burden was defined as coexistence of maternal or paternal overweight (Body mass index (BMI ≥ 23 and child stunting (height-for-age z-score <−2 within households. Maternal-child double burden occurred in 30.6% of total households, whereas paternal-child double burden was only in 8.4%. Mothers from double burden households showed high adiposity; 87.3% with BF%-BI and 66.2% with BF%-ST had BF% >35%, and 60.6% had waists >80 cm. The major dietary patterns identified were “Modern” and “High-animal products”. After controlling for confounding factors, children in the highest quartile of the “High-animal products” dietary pattern had a lower risk of maternal-child double burden (Adjusted OR: 0.46, 95% CI: 0.21–1.04 than those in the lowest quartile. Given that the “High-animal products” dietary pattern was associated with the decreased risk of maternal-child double burden through a strong negative correlation with child stunting, improving child stunting through adequate intake of animal products is critical to solve the problem of maternal-child double burden in Indonesia.

Double Burden of Malnutrition in Rural West Java: Household-Level Analysis for Father-Child and Mother-Child Pairs and the Association with Dietary Intake.

Science.gov (United States)

Sekiyama, Makiko; Jiang, Hong Wei; Gunawan, Budhi; Dewanti, Linda; Honda, Ryo; Shimizu-Furusawa, Hana; Abdoellah, Oekan S; Watanabe, Chiho

2015-10-02

Indonesia is facing household-level double burden malnutrition. This study aimed at examining (1) household-level double burden for the mother-child and father-child pairs; (2) risk of adiposity of double burden households; and (3) associated dietary factors. Subjects were 5th and 6th grade elementary school children (n = 242), their mothers (n = 242), and their fathers (n = 225) in five communities (1 = urban, 4 = rural) in the Bandung District. Questionnaires on socioeconomic factors, blood hemoglobin measurements, and anthropometric measurements were administered. For adults, body fat percentage (BF%) was estimated by bioelectrical impedance (BF%-BI) and by converting skinfold thickness (ST) data using Durnin and Womersley's (1974) formula (BF%-ST). Food frequency questionnaires were also completed. Double burden was defined as coexistence of maternal or paternal overweight (Body mass index (BMI) ≥ 23) and child stunting (height-for-age z-score child double burden occurred in 30.6% of total households, whereas paternal-child double burden was only in 8.4%. Mothers from double burden households showed high adiposity; 87.3% with BF%-BI and 66.2% with BF%-ST had BF% >35%, and 60.6% had waists >80 cm. The major dietary patterns identified were "Modern" and "High-animal products". After controlling for confounding factors, children in the highest quartile of the "High-animal products" dietary pattern had a lower risk of maternal-child double burden (Adjusted OR: 0.46, 95% CI: 0.21-1.04) than those in the lowest quartile. Given that the "High-animal products" dietary pattern was associated with the decreased risk of maternal-child double burden through a strong negative correlation with child stunting, improving child stunting through adequate intake of animal products is critical to solve the problem of maternal-child double burden in Indonesia.

Infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity in Malaysian school-aged adolescents.

Directory of Open Access Journals (Sweden)

Abdullah Nurul-Fadhilah

Full Text Available Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A self-administered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy χ-ray absorptiometry (DXA. Mean age of the participants was 15.3±1.9 years. The majority of participants (71.2% fell in the normal body mass index (BMI ranges. Breakfast consumption patterns showed that only half of the participants (50% were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI, BMI z-scores, waist circumference, body fat mass and percent body fat (%BF compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth.

Self-reported depression and perceived financial burden among long-term rectal cancer survivors.

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Chongpison, Yuda; Hornbrook, Mark C; Harris, Robin B; Herrinton, Lisa J; Gerald, Joe K; Grant, Marcia; Bulkley, Joanna E; Wendel, Christopher S; Krouse, Robert S

2016-11-01

Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well-being during active treatment. However, these relationships have not been well studied among long-term survivors (≥5 years post-diagnosis). A mailed survey with 576 long-term RC survivors who were members of Kaiser Permanente was conducted in 2010-2011. Prevalence of current depression was ascertained using a score of ≤45.6 on the Short Form-12 version 2 mental component summary. Perceived financial burden was assessed using a Likert scale ranging from 0 (none) to 10 (severe). Regression analyses were used to measure associations after adjustment for covariates. The overall prevalence of depression was 24% among RC survivors with the highest prevalence among those with a history of PO (31%). The adjusted odds of depression among TO and AN survivors were lower than that among PO survivors, 0.42 (CI 95% 0.20-0.89) and 0.59 (CI 95% 0.37-0.93), respectively. Twenty-two percent perceived moderate-to-high current financial burden (≥4 points). PO survivors also reported higher mean financial burden than AN survivors (2.6 vs. 1.6, respectively; p = 0.002), but perceived burden comparably to TO survivors (2.3). Self-reported depression was associated with higher perceived financial burden (p reported frequently among these long-term RC survivors, particularly among PO survivors. Depression was associated with greater perception of financial burden. Screening for depression and assessing financial well-being might improve care among long-term RC survivors.Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

[Disease burden caused by violence in the Chinese population, in 1990 and 2013].

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Yang, L; Gao, X; Jin, Y; Ye, P P; Er, Y L; Deng, X; Wang, Y; Duan, L L

2017-10-10

Objective: To analyze the disease burden of violence in the Chinese population, in 1990 and 2013. Methods: Indicators including mortality rate, years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted of life years (DALY) related to violence, were extracted from the Global Burden of Disease 2013 and used to describe the burden of disease caused by violence in the Chinese population. Data related to corresponding parameters on disease burden of violence in 1990 and 2013 were described. Results: In 2013, a total of 20 500 people died of violent events, with the death rate as 1.44 per 100 000, in China. DALY caused by violence was 1.08 million person years in 2013. DALY caused by sharp violence was 0.47 million person years, with 0.09 million person years lost due to firearm violence. Disease burden caused by violence appeared higher in males than in females. When comparing with data from the 1990s, reductions were seen by 67.35 % on the standardized death rate of violence, by 68.07 % on the DALY attributable to violence, and by 70.47 % on the standardized DALY rate attributable to violence, respectively, in 2013. Disease burden of violence among young adults and elderly was among the highest. When comparing with data from the 1990, DALY in 2013 decreased among all the age groups except for the 70-year-old showed an increase of 9.36 % . The standardized DALY rate in 2013 showed a declining trend in all the age groups, mostly in the 0-4-year-old group. The standardized DALY rates caused by sharp violence or firearm decreased by75.11 % and 83.20 % in the 0-4-year-old group. Conclusion: In recent years, the disease burden caused by violence showed a decreasing trend but appeared higher in males however with the increase of DALY in the elder population.

The Global Cancer Burden

Centers for Disease Control (CDC) Podcasts

2012-02-02

This podcast describes the global burden of cancer and efforts by CDC and others to reduce that burden.  Created: 2/2/2012 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 2/2/2012.

Economic burden associated with hospital postadmission dehydration.

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Pash, Elizabeth; Parikh, Niraj; Hashemi, Lobat

2014-11-01

Development of dehydration after hospital admission can be a measure of quality care, but evidence describing the incidence, economic burden, and outcomes of dehydration in hospitalized patients is lacking. The objective of this study was to compare costs and resource utilization of U.S. patients experiencing postadmission dehydration (PAD) with those who do not in a hospital setting. All adult inpatient discharges, excluding those with suspected dehydration present on admission (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes for dehydration: 276.0, 276.1, 276.5), were identified from the Premier database using ICD-9-CM codes. PAD and no-PAD (NPAD) groups were matched on propensity score adjusting for demographics (age, sex, race, medical, elective patients), patient severity (All Patient Refined Diagnosis-Related Groups severity scores), and hospital characteristics (geographic location, bed size, teaching and urban hospital). Costs, length of stay (LOS), and incidence of mortality and catheter-associated urinary tract infection (CAUTI) were compared between groups using the t test for continuous variables and the χ(2) test for categorical variables. In total, 86,398 (2.1%) of all the selected patients experienced PAD. Postmatching mean total costs were significantly higher for the PAD group compared with the NPAD group ($33,945 vs $22,380; P < .0001). Departmental costs were also significantly higher for the PAD group (all P < .0001). Compared with the NPAD group, the PAD group had a higher mean LOS (12.9 vs 8.2 days), a higher incidence of CAUTI (0.6% vs 0.5%), and higher in-hospital mortality (8.6% vs 7.8%) (all P < .05). The results for subgroup analysis also showed significantly higher total cost and longer LOS days for patients with PAD (all P < .05). The economic burden associated with hospital PAD in medical and surgical patients was substantial. © 2014 American Society for Parenteral and Enteral

Childhood dual burden of under- and overnutrition in low- and middle-income countries: a critical review.

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Tzioumis, Emma; Adair, Linda S

2014-06-01

In low- and middle-income countries, the distribution of childhood nutritional diseases is shifting from a predominance of undernutrition to a dual burden of under- and overnutrition. This novel and complex problem challenges governments and health organizations to tackle opposite ends of the malnutrition spectrum. The dual burden may manifest within a community, household, or individual, but these different levels have not been addressed collectively. To critically review literature on the prevalence, trends, and predictors of the dual burden, with a focus on children from birth to 18 years of age. We reviewed literature since January 1, 1990, published in English, using the PubMed search terms nutrition transition, double burden, dual burden, nutrition status, obesity, overweight, underweight, stunting, body composition, and micronutrient deficiencies. The findings were classified and described according to dual burden level (community, household, or individual). Global trends indicate decreases in diseases of undernutrition, while overnutrition is increasing. On the community level, economic status may influence the extent of the dual burden, with obesity increasingly affecting the already undernourished poor. In a household, shared determinants of poor nutritional status among members can result in disparate nutritional status across generations. Within an individual, obesity may co-occur with stunting or anemia due to shared underlying determinants or physiologic links. The dual burden of malnutrition poses a threat to children's health in low- and middle-income countries. We must remain committed to reducing undernutrition while simultaneously preventing over-nutrition through integrated child health programs that incorporate prevention of infection, diet quality, and physical activity.

[Disease burden on road injury in the Chinese population, in 1990 and 2013].

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Wang, Y; Ye, P P; Jin, Y; Er, Y L; Deng, X; Gao, X; Ji, C R; Yang, L; Wang, W; Duan, L L; Wang, L H

2017-10-10

Objective: To explore the disease burden of road injuries in China. Methods: The results of Global Burden of Disease 2013 including death rate, disability-adjusted of life years (DALY), years of life lost due to premature mortality (YLL), years lived with disability (YLD), were used to describe the burden caused by road injuries in 2013 and the trends from 1990 to 2013, in China. Results: In 2013, there were 313 676 deaths caused by traffic accidents in China. Death rate, rates on DALY, YLL and YLD were 22.52 per 100 000, 1 076.54 per 100 000, 971.21 per 100 000 and 105.34 per 100 000, respectively. Rates on deaths, YLL and YLD appeared higher in males, pedestrians than in females and other types of road travelers. Burden of injuries caused by traffic accidents was seen higher in those aged 15 to 49-year-old. From 1990 to 2013, the overall death rate on road injuries increased by 0.54 per 100 000 in China, with an increase of 2.34 per 100 000 and 0.81 per 100 000, respectively in males and pedestrians. The rates on DALY, YLL and YLD decreased by 164.21 per 100 000, 115.06 per 100 000 and 49.06 per 100 000, respectively. Conclusions: During the past 20 years, achievements had been made on road injury prevention and control, with the decrease of disease burden caused by road accidents. Males, young adults and pedestrians should be called for more attention to prevent road injuries.

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life

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Eliana Lourenço Borges

Full Text Available ABSTRACT Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36. Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50. Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage.

The burden of occupationally-related cutaneous malignant melanoma in Britain due to solar radiation.

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Rushton, Lesley; J Hutchings, Sally

2017-02-14

Increasing evidence highlights the association of occupational exposure and cutaneous malignant melanoma (CMM). We estimated the burden of CMM and total skin cancer burden in Britain due to occupational solar radiation exposure. Attributable fractions (AF) and numbers were estimated for CMM mortality and incidence using risk estimates from the published literature and national data sources for proportions exposed. We extended existing methods to account for the exposed population age structure. The estimated total AF for CMM is 2.0% (95% CI: 1.4-2.7%), giving 48 (95% CI: 33-64) deaths in (2012) and 241 (95% CI: 168-325) registrations (in 2011) attributable to occupational exposure to solar radiation. Higher exposure and larger numbers exposed led to much higher numbers for men than women. Industries of concern are construction, agriculture, public administration and defence, and land transport. These results emphasise the urgent need to develop appropriate strategies to reduce this burden.

Burden of disease in Nariño, Colombia, 2010

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Trujillo-Montalvo, Elizabeth; Hidalgo-Patiño, Carlos; Hidalgo-Eraso, Angela

2014-01-01

Objective: This study sought to measure burden of disease and identifies health priorities from the Disability Adjusted Life Years (DALYs) indicator. Methods: This is the first study on burden of disease for a department in Colombia by using a standardized methodology. By using the DALYs indicator, burden of disease was identified in the department of Nariño according to the guidelines established by the World Health Organization. Results: The DALYs in the Department of Nariño highlight the emergence of communicable, maternal, perinatal, and nutritional diseases during the first years of life; of accidents and lesions among youth, and non-communicable diseases in older individuals. Also, accidents and lesions are highlighted in men and non-communicable diseases in women. Conclusions: This study is part of the knowledge management process in the Departmental Health Plan for Nariño - Colombia 2012-2015 and contributes to the system of indicators of the 2012 ten-year public health plan. This research evidences that communicable diseases generate the biggest part of the burden of disease in the Department of Nariño, that DALYs due to non-communicable diseases are on the rise, and that accidents and lesions, especially due to violence are an important cause of DALYs in this region, which is higher than that of the country. PMID:25386034

Increased body mass index in ankylosing spondylitis is associated with greater burden of symptoms and poor perceptions of the benefits of exercise.

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Durcan, Laura; Wilson, Fiona; Conway, Richard; Cunnane, Gaye; O'Shea, Finbar D

2012-12-01

Increased body mass index (BMI) in patients with ankylosing spondylitis (AS) is associated with a greater burden of symptoms and poor perceptions of the benefits of exercise. In AS, the effect of obesity on disease characteristics and exercise perceptions is unknown. We evaluated the prevalence of obesity in AS, to assess the attitudes of patients toward exercise and to evaluate the effect of obesity on symptoms and disease activity. Demographic data and disease characteristics were collected from 46 patients with AS. Disease activity, symptomatology, and functional disability were examined using standard AS questionnaires. BMI was calculated. Comorbidity was analyzed using the Charlson Comorbidity Index. Patients' attitudes toward exercise were assessed using the Exercise Benefits and Barriers Scale (EBBS). We compared the disease characteristics, perceptions regarding exercise, and functional limitations in those who were overweight to those who had a normal BMI. The mean BMI in the group was 27.4; 67.5% of subjects were overweight or obese. There was a statistically significant difference between those who were overweight and those with a normal BMI regarding their perceptions of exercise (EBBS 124.7 vs 136.6, respectively), functional limitation (Bath AS Functional Index 4.7 vs 2.5, Health Assessment Questionnaire 0.88 vs 0.26), and disease activity (Bath AS Disease Activity Index 4.8 vs 2.9). There was no difference between the groups in terms of their comorbid conditions or other demographic variables. The majority of patients in this AS cohort were overweight. They had a greater burden of symptoms, worse perceptions regarding the benefits of exercise, and enhanced awareness of their barriers to exercising. This is of particular concern in a disease where exercise plays a crucial role.

Whole-body retention of 65Zn during pregnancy and lactation, and its secretion into milk in mice

International Nuclear Information System (INIS)

Matsusaka, N.

1978-01-01

The relationship between the maternal whole-body retention of 65 Zn during pregnancy and lactation was studied in mice. Mice administered 65 Zn late in gestation had extremely high retention before parturition which was followed by an abrupt decrease after parturition. The magnitude of the abrupt decrease of maternal body burden becomes smaller with an increase in the interval between administration of isotope and parturition, i.e., the greater the interval between administration and parturition, the smaller the fetal uptake of 65 Zn during intrauterine life. The amount of 65 Zn secreted into milk was estimated from the pup's body burden during the nursing period. When 65 Zn was administered 5 days after parturition to dams nursing eight pups each, the maximum body burden of the litter reached 64% of the initial dose 10 days after injection. In mouse dams, the secretion of 65 Zn in milk is an important elimination pathway in addition to excretion in feces

Impact of social support on cognitive symptom burden in HIV/AIDS.

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Atkins, Jana H; Rubenstein, Sarah L; Sota, Teresa L; Rueda, Sergio; Fenta, Haile; Bacon, Jean; Rourke, Sean B

2010-07-01

As many as 50% of people living with HIV/AIDS report cognitive difficulties, which can be associated with objective neuropsychological impairments and depression. A number of studies have demonstrated an association between higher social support and lower rates of depression. Using a cross-sectional design, we examined the role social support may play in attenuating the effects of both neuropsychological status and depression on cognitive difficulties. A total of 357 participants completed a battery of neuropsychological tests, questionnaires about cognitive difficulties and depression, and an interview that included an assessment of perceived level of social support. A multivariate linear regression analysis revealed that higher levels of cognitive symptom burden were significantly associated with depression (Psocial support (Pinteraction between neuropsychological status and depression (Pinteraction between social support and depression (Psocial support was also associated with a lower cognitive symptom burden for non-depressed individuals living with HIV/AIDS. These findings have important clinical implications for promoting psychological well-being in persons living with HIV/AIDS. To improve quality of life, it is important to screen for and identify individuals with HIV/AIDS who may be depressed and to intervene appropriately. Further research should examine the potential role of social support interventions in modifying the effects of both depression and neuropsychological status on cognitive symptom burden.

The increasing burden of depression

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Lépine J-P

2011-05-01

Full Text Available Jean-Pierre Lépine1, Mike Briley21Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris Unité INSERM 705 CNRS UMR 8206, Université Paris Diderot, Paris, France; 2NeuroBiz Consulting and Communication, Castres, FranceAbstract: Recent epidemiological surveys conducted in general populations have found that the lifetime prevalence of depression is in the range of 10% to 15%. Mood disorders, as defined by the World Mental Health and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, have a 12-month prevalence which varies from 3% in Japan to over 9% in the US. A recent American survey found the prevalence of current depression to be 9% and the rate of current major depression to be 3.4%. All studies of depressive disorders have stressed the importance of the mortality and morbidity associated with depression. The mortality risk for suicide in depressed patients is more than 20-fold greater than in the general population. Recent studies have also shown the importance of depression as a risk factor for cardiovascular death. The risk of cardiac mortality after an initial myocardial infarction is greater in patients with depression and related to the severity of the depressive episode. Greater severity of depressive symptoms has been found to be associated with significantly higher risk of all-cause mortality including cardiovascular death and stroke. In addition to mortality, functional impairment and disability associated with depression have been consistently reported. Depression increases the risk of decreased workplace productivity and absenteeism resulting in lowered income or unemployment. Absenteeism and presenteeism (being physically present at work but functioning suboptimally have been estimated to result in a loss of $36.6 billion per year in the US. Worldwide projections by the World Health Organization for the year 2030 identify unipolar major depression as the leading cause of disease burden

Burden of rheumatoid arthritis in the Nordic region, 1990-2015: a comparative analysis using the Global Burden of Disease Study 2015.

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Kiadaliri, A A; Kristensen, L-E; Englund, M

2018-03-01

To report mortality and disability due to rheumatoid arthritis (RA) in the Nordic region (Denmark, Finland, Greenland, Iceland, Norway, and Sweden) using data from the Global Burden of Disease Study (GBD) 2015. Using the results of GBD 2015, we present rates and trends in prevalence, mortality, years of life lost, years lived with disability (YLD), and disability-adjusted life-years (DALYs) of RA in the Nordic region during 1990-2015. In 2015, the age-standardized prevalence of RA was higher in the Nordic region than the global level (0.44%, 95% uncertainty interval 0.40-0.48%, vs 0.35%, 0.32-0.38%). For women (men), DALYs increased by 2.4% (12.9%), from 29 263 (10 909) in 1990 to 29 966 (12 311) in 2015. The burden of RA as a proportion of total DALYs in women (men) increased from 0.90% (0.29%) in 1990 to 0.94% (0.36%) in 2015. Age-standardized DALY rates declined in all countries except Denmark and Greenland between 1990 and 2015. Of 315 conditions studied, RA was ranked as the 16th (37th) leading cause of YLD in women (men) in the region. Of 195 countries studied, Greenland, Finland, Denmark, Norway, Sweden, and Iceland had the 7th, 11th, 28th, 38th, 48th, and 78th highest age-standardized YLD rates for RA, respectively. The prevalence of RA in the Nordic region is higher than the global average. Current trends in population growth and ageing suggest a potential increase in RA burden in the coming decades in the region that should be considered in healthcare resources allocation.

Psychometrics of the Zarit Burden Interview in Caregivers of Patients With Heart Failure.

Science.gov (United States)

Al-Rawashdeh, Sami Y; Lennie, Terry A; Chung, Misook L

Identification of family caregivers who are burdened by the caregiving experience is vital to prevention of poor outcomes associated with caregiving. The Zarit Burden Interview (ZBI), a well-known measure of caregiving burden in caregivers of patients with dementia, has been used without being validated in caregivers of patients with heart failure (HF). The purpose of this study is to examine the reliability and validity of the ZBI in caregivers of patients with HF. A total of 124 primary caregivers of patients with HF completed survey questionnaires. Caregiving burden was measured by the ZBI. Reliability was examined using Cronbach's α and item-total/item-item correlations. Convergent validity was examined using correlations with the Oberst Caregiving Burden Scale. Construct validity was demonstrated by exploratory factor analysis and known hypothesis testing (ie, the hypothesis of the association between caregiving burden and depressive symptoms). Cronbach's α for the ZBI was .921. The ZBI had good item-total (r = 0.395-0.764) and item-item (mean r = 0.365) correlations. Significant correlations between the ZBI and the Oberst Caregiving Burden Scale (r = 0.466 for the caregiving time subscale and 0.583 for the caregiving task difficulty subscale; P < .001 for both) supported convergent validity. Four factors were identified (ie, consequences of caregiving, patient's dependence, exhaustion with caregiving and uncertainty, and guilt and fear for the patient's future) using factor analysis, which are consistent with previous studies. Caregivers with high burden scores had significantly higher depressive symptoms than did caregivers with lower burden scores (7.0 ± 6.8 vs 3.1 ± 4.3; P < .01). The findings provide evidence that the ZBI is a reliable and valid measure for assessing burden in caregivers of patients with HF.

[Disease burden caused by suicide in the Chinese population, in 1990 and 2013].

Science.gov (United States)

Gao, X; Wang, L H; Jin, Y; Ye, P P; Yang, L; Er, Y L; Deng, X; Wang, Y; Duan, L L

2017-10-10

Objective: To provide basic suicide prevention strategy through analyzing the disease burden of suicide in the Chinese population, in 1990 and 2013. Methods: Indicators including mortality rate, years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted of life years (DALY) on suicide, were from the results of Global Burden of Disease 2013 and used to describe the burden of disease caused by suicide in Chinese population. Data described the disease burden of suicide in China by comparing the corresponding parameters in 1990 and 2013. Results: In 2013, the standard mortality on suicide was 9.08 per 100 000, and 73.39 per 100 000 in the 80 and above year-old, with the highest rates on DALY and YLL seen in the 75-79-year-old. Each parameter related to suicide burden in males appeared higher than that in females. Compare to data in the 1990s, these parameters declined in 2013, especially seen in females. The rate of YLLs/YLDs on suicide was 90.03 in 2013, 89.83 in males and 89.00 in females. Conclusion: The disease burden of suicide decreased sharply between 1990 and 2013 but was still a serious issue in the elderly that called for more attention.

The humanistic burden of hereditary angioedema: results from the Burden of Illness Study in Europe.

Science.gov (United States)

Caballero, Teresa; Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen; Hautamaki, Emily; Sisic, Zlatko; Wait, Suzanne; Boysen, Henrik B

2014-01-01

Hereditary angioedema (HAE) is a rare but potentially life-threatening disease marked by spontaneous, recurrent attacks of swelling. The broad range of consequences of HAE on patients' lives is not well understood. The study objective was to comprehensively characterize the burden of illness and impact of HAE types I and II from the patient perspective. The HAE Burden of Illness Study in Europe was conducted in Spain, Germany, and Denmark to assess the real-world experience of HAE from the patient perspective via a one-time survey, which included items on clinical characteristics and physical and emotional impacts. One hundred eighty-six patients participated; 59% reported having an attack at least once a month, 67% reported moderate-to-severe pain during their last attack, and 74% reported moderate-to-severe swelling. The most common sites of the last attack were the abdomen and extremities; 24% experienced an attack in more than one site. The impact of HAE on daily activities was high during attacks and did not vary significantly by body site affected; patients also reported that HAE impacted their daily activities between attacks. Patients reported substantial anxiety about future attacks, traveling, and passing HAE to their children. Based on Hospital Anxiety and Depression Scale scores, 38 and 14% had clinically meaningful anxiety and depression, respectively. Despite standard of care, HAE patients still have frequent and painful attacks. Patients experience substantial impairment physically and emotionally both during and between attacks. A better understanding of these effects may help in the clinical management of HAE patients.

Chromosome aberrations in the peripheral lymphocytes of thorium workers with low body burdens of 212Bi

International Nuclear Information System (INIS)

Hoegerman, S.F.

1976-01-01

Cytogenetic analysis of 8 thorium workers and 3 controls has not shown a significant elevation in the level of chromosome breakage in the workers' peripheral lymphocytes. This finding is consistent with an estimate of the amount of damage to be expected in these cases, based on the level of chromosome breakage observed in Thorotrast cases with measured 212 Bi burdens

Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease

Directory of Open Access Journals (Sweden)

Iavarone A

2014-07-01

Full Text Available Alessandro Iavarone,1,2 Antonio Rosario Ziello,3,4 Francesca Pastore,3 Angiola Maria Fasanaro,3 Carla Poderico5 1Neurological and Stroke Unit, CTO Hospital, 2Italian Association on Alzheimer's Disease (AIMA, 3Memory Clinic, Neurological Unit, AORN Cardarelli Hospital, Naples, Italy; 4Clinical Research, Telemedicine and Telepharmacy Centre, University of Camerino, Camerino, Italy; 5Department of Psychology, Second University of Naples, Caserta, Italy Background: Alzheimer’s disease (AD causes considerable distress in caregivers who are continuously required to deal with requests from patients. Coping strategies play a fundamental role in modulating the psychologic impact of the disease, although their role is still debated. The present study aims to evaluate the burden and anxiety experienced by caregivers, the effectiveness of adopted coping strategies, and their relationships with burden and anxiety. Methods: Eighty-six caregivers received the Caregiver Burden Inventory (CBI and the ­State-Trait Anxiety Inventory (STAI Y-1 and Y-2. The coping strategies were assessed by means of the Coping Inventory for Stressful Situations (CISS, according to the model proposed by Endler and Parker in 1990.Results: The CBI scores (overall and single sections were extremely high and correlated with dementia severity. Women, as well as older caregivers, showed higher scores. The trait anxiety (STAI-Y-2 correlated with the CBI overall score. The CISS showed that caregivers mainly adopted task-focused strategies. Women mainly adopted emotion-focused strategies and this style was related to a higher level of distress. Conclusion: AD is associated with high distress among caregivers. The burden strongly correlates with dementia severity and is higher in women and in elderly subjects. Chronic anxiety affects caregivers who mainly rely on emotion-oriented coping strategies. The findings suggest providing support to families of patients with AD through tailored

Factors associated with the caregiver burden among family caregivers of patients with heart failure in southwest China.

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Hu, Xiaolin; Dolansky, Mary A; Hu, Xiuying; Zhang, Fengying; Qu, Moying

2016-03-01

We investigated the status of caregiver burden and identified the factors related to caregiver burden among family caregivers of patients with heart failure in southwest China. A cross-sectional descriptive design with a convenience sample was adopted. Patient and family caregiver dyads (n = 226) in four hospitals in Chengdu, China were recruited from June 2013 to July 2014. The instruments used in this study included the Social Support Rating Scale, the Zarit Burden Interview, and the General Self-Efficacy Scale. Multivariate analysis was used to identify the factors associated with caregiver burden. Forty-four percent of the variance of the caregiver burden was explained by the payment type for treatment, monthly family income, relationship to the patient, caregivers' self-efficacy, and social support. The caregiver burden in southwest China was higher than studies conducted in developed areas. Specific to southwest China, the financial burden and insufficient resources are the main factors associated with caregiver burden. The results suggest that self-efficacy and social support in underdeveloped areas are potential areas for future intervention. © 2016 John Wiley & Sons Australia, Ltd.

[Disease burden of liver cancer in the Chinese population, in 1990 and 2013].

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Wang, L J; Yin, P; Liu, Y N; Liu, J M; Qi, J L; Zhou, M G

2016-06-01

To analyze the disease burden of liver cancer in the Chinese population in 1990 and 2013. Data from Global Burden of Diseases 2013 (GBD2013) was used to analyze the disease burden of liver cancer in China. The main outcome measurements would include mortality and disability-adjusted life years (DALY). Again, GBD global standard population in 2013 was used as the reference population to calculate the age-standardized rate. Related changes on percentage from 1990 to 2013 were calculated to analyze the changing patterns of disease burden for liver cancer in China. In 2013, a total of 358 100 people died of liver cancer, with the crude death rate as 25.85/100 000, in China. Number of deaths due to liver cancer secondary to hepatitis B was 163 600 (accounting for 45.69%). Number of deaths due to liver cancer secondary to hepatitis C was 134 200 (accounting for 37.48%) with DALY due to liver cancer appeared as 40.80 million person years. In 2013, the leading causes of DALY related to liver cancer was liver cancer secondary to hepatitis B, followed by liver cancer secondary to hepatitis C, liver cancer secondary to alcohol use, other liver cancers, with related DALYs as 4 652.0, 3 394.3, 964.3 and 592.1 thousands person years, respectively. The disease burdens of liver cancer secondary to various kinds of liver cancer were significantly higher in males than in females. Compared with 1990, the standardized mortality of liver cancer reduced by 25.00%, the DALY attributable to liver cancer increased by 16.95% and the standardized DALY rate attributable to liver cancer reduced by 33.47%. The burden of liver cancer secondary to hepatitis C became more serious and the standardized death rate increased by 106.18%, together with the standardized DALY rate increased by 91.68% in the past 23 years. Disease burden of liver cancer among young adults and the elderly were most serious. When comparing with the data in 1990, the standardized DALY rate showed declining trend in all the

Trajectories of caregiver burden in families of adult cystic fibrosis patients.

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Wojtaszczyk, Ann; Glajchen, Myra; Portenoy, Russell K; Berdella, Maria; Walker, Patricia; Barrett, Malcolm; Chen, Jack; Plachta, Amy; Balzano, Julie; Fresenius, Ashley; Wilder, Kenya; Langfelder-Schwind, Elinor; Dhingra, Lara

2017-10-17

Little is known about the experience of family caregivers of adults with cystic fibrosis (CF). This information is important for the identification of caregivers at risk for burden. This was a longitudinal analysis of survey data obtained from caregivers of adult CF patients participating in an early intervention palliative care trial. Caregivers completed the validated Brief Assessment Scale for Caregivers (BASC) repeatedly over a 28-month period. Mixed-effects modeling evaluated multivariate associations with positive and negative caregiver perceptions over time. Of the 54 caregivers, 47.9% were spouses. The mean age was 50.9 years (SD = 13.2); 72.2% were women; 75.9% were married; and 63.0% were employed. At baseline, the BASC revealed large variations in positive and negative perceptions of caregiving. Although average scores over time were unchanging, variation was greater across caregivers than within caregivers (0.49 vs. 0.27, respectively). At baseline, the positive impact of caregiving in the sample was higher than the negative impact. Multivariate analysis revealed that patients' baseline pulmonary function and their full-time employment status predicted caregiver burden over time. Caregivers of CF patients varied in their positive and negative caregiving experiences, although burden levels in individual caregivers were stable over time. When the disease was advanced, caregivers of CF patients experienced more overall burden but also more positive impact. This suggests that the role of caregivers may become more meaningful as disease severity worsens. In addition, full-time patient employment was associated with lower caregiver burden regardless of disease severity. This suggests that burden in CF caregivers may be predicted by financial strain or benefits conferred by patient employment. These associations require further investigation to determine whether highly burdened caregivers can be identified and assisted using tailored interventions.

The economic burden of angina on households in South Asia

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2014-01-01

Background Globally, an estimated 54 million people have angina, 16 million of whom are from the WHO South-East Asia region. Despite the increasing burden of cardiovascular disease (CVD) in South Asia, there is no evidence of an economic burden of angina on households in this region. We investigated the economic burden of angina on households in South Asia. Methods We applied a novel propensity score matching approach to assess the economic burden of angina on household out-of-pocket (OOP) health spending, borrowing or selling assets, non-medical consumption expenditure, and employment status of angina-affected individual using nationally representative World Health Survey data from Bangladesh, India, Nepal and Sri Lanka collected during 2002-2003. We used multiple matching methods to match households where the respondent reported symptomatic or diagnosed angina with control households with similar propensity scores. Results Angina-affected households had significantly higher OOP health spending per person in the four weeks preceding the survey than matched controls, in Bangladesh (I$1.94, p = 0.04), in Nepal (I$4.68, p = 0.03) and in Sri Lanka (I$1.99, p angina-affected households relative to matched controls in India (9.60%, p Angina-affected households significantly relied on borrowing or selling assets to finance OOP health expenses in Bangladesh (6%, p = 0.03), India (8.20%, p angina-affected individual remained mostly unaffected. We adjusted our estimates for comorbidities, but limitations on comorbidity data in the WHS mean that our results may be upwardly biased. Conclusions Households that had the respondent reporting angina in South Asia face an economic burden of OOP health expenses (primarily on drugs and other outpatient expenses), and tend to rely on borrowing or selling assets. Our analysis underscores the need to protect South Asian households from the financial burden of CVD. PMID:24548585

The economic burden of angina on households in South Asia.

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Alam, Khurshid; Mahal, Ajay

2014-02-19

Globally, an estimated 54 million people have angina, 16 million of whom are from the WHO South-East Asia region. Despite the increasing burden of cardiovascular disease (CVD) in South Asia, there is no evidence of an economic burden of angina on households in this region. We investigated the economic burden of angina on households in South Asia. We applied a novel propensity score matching approach to assess the economic burden of angina on household out-of-pocket (OOP) health spending, borrowing or selling assets, non-medical consumption expenditure, and employment status of angina-affected individual using nationally representative World Health Survey data from Bangladesh, India, Nepal and Sri Lanka collected during 2002-2003. We used multiple matching methods to match households where the respondent reported symptomatic or diagnosed angina with control households with similar propensity scores. Angina-affected households had significantly higher OOP health spending per person in the four weeks preceding the survey than matched controls, in Bangladesh (I$1.94, p = 0.04), in Nepal (I$4.68, p = 0.03) and in Sri Lanka (I$1.99, p finance OOP health expenses in Bangladesh (6%, p = 0.03), India (8.20%, p < 0.01) and Sri Lanka (7.80%, p = 0.01). However, impoverishment, non-medical consumption expenditure and employment status of the angina-affected individual remained mostly unaffected. We adjusted our estimates for comorbidities, but limitations on comorbidity data in the WHS mean that our results may be upwardly biased. Households that had the respondent reporting angina in South Asia face an economic burden of OOP health expenses (primarily on drugs and other outpatient expenses), and tend to rely on borrowing or selling assets. Our analysis underscores the need to protect South Asian households from the financial burden of CVD.

The economic burden of caregiving on families of children and adolescents with cancer: a population-based assessment.

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Pagano, Eva; Baldi, Ileana; Mosso, Maria Luisa; di Montezemolo, Luca Cordero; Fagioli, Franca; Pastore, Guido; Merletti, Franco

2014-06-01

Childhood cancer represents a relevant economic burden on families. The preferred tool to investigate family expenditure is the retrospective questionnaire, which is subject to recall errors and selection bias. Therefore, in the present study the economic burden of caregiving on families of children and adolescents (0-19 years of age) with cancer was analysed using administrative data as an alternative to retrospective questionnaires. Incident cases of cancer diagnosed in children and adolescents in 2000-2005 (N = 917) were identified from the Piedmont Childhood Cancer Registry and linked to available administrative databases to identify episodes of care during the 3 years after diagnosis (N = 13,433). The opportunity cost of informal caregiving was estimated as the value of the time spent by one of the parents, and was assumed to be equal to the number of days during which the child received inpatient care, day-care or outpatient radiotherapy. Factors affecting the level of economic burden of caregiving on families were analysed in a multivariable model. The economic burden of caregiving increased when care was supplied at the Regional Referral Centre, or when treatment complexity was high. Families with younger children had a higher level of economic burden of caregiving. Leukaemia required a higher family commitment than any other cancer considered. Estimates of the economic burden of caregiving on families of children and adolescents with cancer derived from administrative data should be considered a minimum burden. The estimated effect of the covariates is informative for healthcare decision-makers in planning support programmes. © 2013 Wiley Periodicals, Inc.

"I Have to Listen to This Old Body": Femininity and the Aging Body.

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Rutagumirwa, Sylivia Karen; Bailey, Ajay

2017-10-13

This study explores how older women with low socioeconomic status living in rural Tanzania give meaning to their (aging) body in relation to the ideals of femininity. Ten qualitative in-depth interviews and 10 focus group discussions (N = 60) were conducted among women aged 60 and older. The findings reveal that older women perceive their aging body as "a burden." This characterization of the body is linked to the inability of the aging body to live up to the women's gendered lives. The conflict between their physical limitations and the desire to perform gendered tasks (internalized feminine habitus) affect the women's process of self-identification. This led to emotional distress and subsequently threatened their survival and well-being. The results suggest that older women need to be supported through interventions that are tailored to their cultural and socioeconomic context. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America.

Caregiving burden and depression in paid caregivers of hospitalized patients: a pilot study in China

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Yao-Dan Liang

2017-07-01

Full Text Available Abstract Background Caregiving burden and depression in family caregivers have been investigated, but little is known about how they affect paid caregivers. The aim of this study was to investigate caregiving burden and depression in paid caregivers of hospitalized patients. Methods A cross-sectional survey study was conducted in a tertiary referral hospital (Chengdu, China that enrolled 108 paid caregivers who worked in the inpatient department. The Caregiver Burden Inventory (CBI and the Center for Epidemiologic Studies Depression (CES-D scale were incorporated into a self-developed questionnaire to gather demographic information on the following four aspects: general, work, income, and family. Results The mean total CBI score was 29.7 ± 12.5. The time-dependence burden had the highest score of 15.3 ± 4.0, which was followed by the physical burden score of 6.5 ± 4.6, developmental burden score of 3.7 ± 4.0, social burden score of 3.2 ± 4.0, and emotional burden score of 2.4 ± 3.1. Multiple linear regression analysis showed that a higher CBI was associated with a longer time as a paid caregiver [β=7.041, 95% Confidence Interval (CI:1.935 to 12.974, p = 0.009], lower income satisfaction (β= − 6.573, 95% CI: -11.248 to −3.020, p = 0.001, and higher frequency of meeting with their relatives (β=7.125, 95% CI: 2.019 to 12.456, p = 0.006. The mean CES-D score was 11.9 ± 8.7, and significant depression was found in 28 (25.9% paid caregivers according to the CES-D score ≥ 16 cut-off. There was a moderate positive correlation between the CBI and CES-D scores (Pearson’s r = 0.452, p < 0.001. Conclusions A high caregiving burden was commonly observed in paid caregivers of hospitalized patients in China, as was a high prevalence of depression symptoms. Several associated factors were identified that could be areas for future interventions.

Stress and Burden among Caregivers of Patients with Lewy Body Dementia

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Leggett, Amanda N.; Zarit, Steven; Taylor, Angela; Galvin, James E.

2011-01-01

Purpose: Patients with Lewy body dementia (LBD) may present a unique set of symptoms and challenges to family caregivers compared with other types of dementia. Prominent difficulties include motor impairment, activities of daily living (ADLs) disability, recurrent behavioral and emotional problems (BEPs), and diagnostic difficulties. These…

The Burden of Schizophrenia on Caregivers

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Filiz Adana

2011-06-01

Full Text Available Caregivers’ burden in schizophrenia is a complex concept often with negative connotations. The concept refers to the impact of having a schizophrenia patient in the family including emotional, psychological, physical, economic distress and feelings of shame, embarrassment, guilt, and self-blame expe-rienced by the caregivers. There are objective and subjective aspects of care-givers’ burden. The objective burden refers to observed and verifiable impact of the diseased person in the family such as the patients disturbing behaviors, economic difficulties, and loss of income, restricted social activities, distressed household atmosphere, and undesirable influences on physical and mental health of the family members. The subjective burden refers to the extent of emotional distress caused by the objective burden. The data in the pertinent literature suggest an association between caregivers’ burden and sex, ethnicity, culture, caregivers’ health and quality of life, social support, and the symptomatology as presented by the patient. In order to promote mental health of schizophrenia patients along with their caregivers, the mental health workers should strive to find the means of supporting, informing, and cooperating with the family members. Psychosocial interventions designed for families and psychosocial rehabilitations programs designed for schizophrenia patients are effective means of easing caregivers’ burden.

Economic burden and cost determinants of coronary heart disease in rural southwest China: a multilevel analysis.

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Le, C; Fang, Y; Linxiong, W; Shulan, Z; Golden, A R

2015-01-01

To estimate the economic burden of coronary heart disease (CHD) in a given year (2010), including direct and indirect costs, and examine the impact of contextual and individual socio-economic (SES) predictors on the costs of CHD among adults in rural southwest China. Cross-sectional community survey. In total, 4595 adults (aged ≥18 years) participated in this study. A prevalence-based cost-of-illness approach was used to estimate the economic burden of CHD. Information on demographic characteristics of the study population and the economic consequences of CHD was obtained using a standard questionnaire. Multilevel linear regression was used to model the variation in costs of CHD. In the study population, the overall prevalence of CHD was 2.9% (3.5% for males, 2.3% for females). The total cost of CHD was estimated to be US$17 million. Inpatient hospitalizations represented the main component of direct costs of CHD, and direct costs accounted for the greatest proportion of the economic burden of CHD. Males were more likely to have a higher economic burden of CHD than females. A positive association was found between the individual's level of education and the economic burden of CHD. Residence in a higher-income community was associated with higher costs related to CHD. This study found that both contextual and individual SES were closely associated with the costs of CHD. Future strategies for CHD interventions and improved access to affordable medications to treat and control CHD should focus on less-educated individuals and communities with lower SES. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Dietary treatment for decreasing 141Ce body burden in immature rats

International Nuclear Information System (INIS)

Kargacin, B.; Kostial, K.; Landeka, M.

1987-01-01

The purpose of this work was to evaluate the effect of prolonged (immediate or delayed) administration of dietary additives to suckling rats on the absorption and retention of radioactive cerium in the body. The experiment was performed on 6-day-old suckling rats. According to dietary treatment the animals were divided into three groups. Each group was artificially fed over 8 h for 6 or 12 days on one of the diets: the first group of animals was fed milk, the second group was given ingredients of rat diet and the third received milk during the first 2 days of the experiment and the ingredients of rat diet afterwards. At the end of the artificial feeding period the pups returned to their mothers and suckled overnight. On the 1st day of the experiment the food was labelled with 141 Ce. Whole body radioactivity was determined in a double crystal scintillation counter every 48 h over a 12-day period. Half of the animals from each group were killed 6 days after 141 Ce administration and the other half after 12 days. At these intervals retention was determined in the gut, liver, kidneys and femur. The early and delayed administration of rat diet ingredients - fish meal, sunflower meal, alfalfa, cane molasses and premix - greatly reduced whole body retention. The early treatment was more efficacious than the delayed one. The reduction was mostly due to decreased gut retention but organ retentions were also lower. The results obtained indicate that by prolonged (immediate or delayed) administration of some dietary means the retention of radioactive cerium in sucklings can be significantly decreased. (orig.)

Quality of life and burden in caregivers of patients with epilepsy.

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Westphal-Guitti, Ana Carolina; Alonso, Neide Barreira; Migliorini, Rosa Cristina Vaz Pedroso; da Silva, Tatiana Indelicato; Azevedo, Auro Mauro; Caboclo, Luís Otávio Sales Ferreira; Sakamoto, Américo Ceiki; Yacubian, Elza Márcia Targas

2007-12-01

The purpose of this study was to compare quality of life and burden in 100 caregivers of adolescent and adult patients with epilepsy that started in adolescence. We invited caregivers of 50 patients with temporal lobe epilepsy (TLE) related to mesial temporal sclerosis and caregivers of 50 patients with juvenile myoclonic epilepsy (JME) to participate. After the caregivers answered a sociodemographic questionnaire, they answered the Brazilian version of the Burden Interview (BI) Scale and we assessed their quality of life using the 36-Item Short-Form Health Survey (SF-36). The mean ages of patients were 25.4 and 36.4 years and epilepsy duration was 14 and 25.6 years in the JME and TLE groups, respectively. We found a mild to moderate burden on caregivers in both groups, with a BI average score of 25.5 for JME and 30.7 for TLE. Caregivers in the JME group had lower scores in all domains of the SF-36 and reported higher burden. Low scores were also seen in three domains for the TLE group. These results suggest that caregivers of patients with both epileptic syndromes experience interference in their lives. When we compared the two groups, we found no difference between caregiver data on SF-36 and BI. Quality of life was significantly compromised in caregivers of patients with JME and TLE, and the two groups were burdened to a similar degree (mild to moderate). Nurses can carry out psychoeducative programs with the objective of diagnosing the impact of epilepsy in the family, decreasing burden, and improving quality of life for caregivers.

A comparison of cancer burden and research spending reveals discrepancies in the distribution of research funding

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Carter Ashley JR

2012-07-01

Full Text Available Abstract Background Ideally, the distribution of research funding for different types of cancer should be equitable with respect to the societal burden each type of cancer imposes. These burdens can be estimated in a variety of ways; “Years of Life Lost” (YLL measures the severity of death in regard to the age it occurs, "Disability-Adjusted Life-Years" (DALY estimates the effects of non-lethal disabilities incurred by disease and economic metrics focus on the losses to tax revenue, productivity or direct medical expenses. We compared research funding from the National Cancer Institute (NCI to a variety of burden metrics for the most common types of cancer to identify mismatches between spending and societal burden. Methods Research funding levels were obtained from the NCI website and information for societal health and economic burdens were collected from government databases and published reports. We calculated the funding levels per unit burden for a wide range of different cancers and burden metrics and compared these values to identify discrepancies. Results Our analysis reveals a considerable mismatch between funding levels and burden. Some cancers are funded at levels far higher than their relative burden suggests (breast cancer, prostate cancer, and leukemia while other cancers appear underfunded (bladder, esophageal, liver, oral, pancreatic, stomach, and uterine cancers. Conclusions These discrepancies indicate that an improved method of health care research funding allocation should be investigated to better match funding levels to societal burden.

Burden of Gastrointestinal and Liver Diseases in Middle East and North Africa: Results of Global Burden of Diseases Study from 1990 to 2010.

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Sepanlou, Sadaf Ghajarieh; Malekzadeh, Fatemeh; Delavari, Farnaz; Naghavi, Mohsen; Forouzanfar, Mohammad Hossein; Moradi-Lakeh, Maziar; Malekzadeh, Reza; Poustchi, Hossein; Pourshams, Akram

2015-10-01

BACKGROUND Gastrointestinal and liver diseases (GILDs) are major causes of death and disability in Middle East and North Africa (MENA). However, they have different patterns in countries with various geographical, cultural, and socio-economic status. We aimed to compare the burden of GILDs in Iran with its neighboring countries using the results of the Global Burden of Disease (GBD) Study in 2010. METHODS Classic metrics of GBD have been used including: age-standardized rates (ASRs) of death, years of life lost due to premature death (YLL), years of life lost due to disability (YLD), and disability adjusted life years (DALY). All countries neighboring Iran have been selected. In addition, all other countries classified in the MENA region were included. Five major groups of gastrointestinal and hepatic diseases were studied including: infections of gastrointestinal tract, gastrointestinal and pancreatobilliary cancers, acute hepatitis, cirrhosis, and other digestive diseases. RESULTS The overall burden of GILDs is highest in Afghanistan, Pakistan, and Egypt. Diarrheal diseases have been replaced by gastrointestinal cancers and cirrhosis in most countries in the region. However, in a number of countries including Afghanistan, Pakistan, Turkmenistan, Egypt, and Yemen, communicable GILDs are still among top causes of mortality and morbidity in addition to non-communicable GILDs and cancers. These countries are experiencing the double burden. In Iran, burden caused by cancers of stomach and esophagus are considerably higher than other countries. Diseases that are mainly diagnosed in outpatient settings have not been captured by GBD. CONCLUSION Improving the infrastructure of health care system including cancer registries and electronic recording of outpatient care is a necessity for better surveillance of GILDs in MENA. In contrast to expensive treatment, prevention of most GILDs is feasible and inexpensive. The health care systems in the region can be strengthened for

Body Burden of Dichlorodiphenyl Dichloroethene (DDE and Childhood Pulmonary Function

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Pallavi P. Balte

2017-11-01

Full Text Available Longitudinal studies have shown that early life exposure to dichlorodiphenyl dichloroethene (DDE can lead to growth reduction during childhood and adolescence. In addition, DDE exposure has been linked to respiratory tract infections and an increased risk of asthma in children. Our aim was to understand the relationships between DDE exposure and pulmonary function in children, and, particularly, whether associations are mediated by the height of the children. We used data from an environmental epidemiologic study conducted in central Germany in children aged 8-10 years. The pulmonary function (forced vital capacity, FVC, and forced expiratory volume in one second, FEV1 were measured in three consecutive years. Blood DDE levels were measured at 8 and 10 years. We used linear mixed models for repeated measurements and path analyses to assess the association between blood levels of DDE and pulmonary function measurements. All models were adjusted for confounders. Linear mixed approaches and modelling concurrent effects showed no significant associations. The path analytical models demonstrated that DDE measured at eight years had significant, inverse, indirect, and total effects on FVC at ten years (n = 328; −0.18 L per μg/L of DDE and FEV1 (n = 328; −0.17 L per μg/L of DDE, mediated through effects of DDE on height and weight. The DDE burden reduces pulmonary function through its diminishing effects on height and weight in children. Further studies are required to test these associations in other samples, preferably from a region with ongoing, high DDT application.

Physio-psychological Burdens and Social Restrictions on Parents of Children With Technology Dependency are Associated With Care Coordination by Nurses.

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Suzuki, Seigo; Sato, Iori; Emoto, Shun; Kamibeppu, Kiyoko

To determine the association between parental care burdens and care coordination provided by nurses for children with technology dependency, specifically regarding physio-psychological burdens and social restrictions. A cross-sectional study was conducted between October and November 2015. Participants were recruited via home-visit nursing stations, social worker offices, and special-needs schools. A total of 246 parents of children with technology dependency completed anonymous self-report questionnaires. Parental burden was measured using the Zarit Burden Interview. Care coordination for children with technology dependency was examined using items extracted from focus group interviews involving three nursing administrators at home-visit nursing stations, two social workers, and a coordinator of school education for children with special health care needs. Multiple regression analysis was performed to examine the relationship between parental burden and care coordination among 172 parents who contracted with visiting nurses. Parents and children with nursing support were significantly younger and had higher medical care needs and higher parental role strain than those without nursing support. Care coordination from nurses predicted reduced parental burden, role strain, and personal strain (β=-0.247, p=0.002; β=-0.272, p=0.001; β=-0.221, p=0.009, respectively). Nurses' care coordination appears to be associated with a reduction in parents' care burden resulting from home medical care of children with technology dependency, especially the social restrictions and physio-psychological burdens. Strengthening nursing functioning as care coordinators may contribute to reducing care burdens for parents of children with technology dependency. Copyright © 2017 Elsevier Inc. All rights reserved.

Tackling Africa's chronic disease burden: from the local to the global

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de-Graft Aikins, Ama; Unwin, Nigel; Agyemang, Charles; Allotey, Pascale; Campbell, Catherine; Arhinful, Daniel

2010-01-01

ABSTRACT: Africa faces a double burden of infectious and chronic diseases. While infectious diseases still account for at least 69% of deaths on the continent, age specific mortality rates from chronic diseases as a whole are actually higher in sub Saharan Africa than in virtually all other regions

Family demands, social support and caregiver burden in Taiwanese family caregivers living with mental illness: the role of family caregiver gender.

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Hsiao, Chiu-Yueh

2010-12-01

The purpose of this study was to assess gender effects on family demands, social support and caregiver burden as well as to examine contributing factors of caregiver burden in caring for family members with mental illness. Providing continued care and support for people with mental illness is demanding and challenging. Findings of earlier caregiving studies on the role of caregiver gender in response to caregiver burden and caregiving-related factors have been inconsistent. Little research has been undertaken to examine gender effect on family demands, social support and caregiver burden in Taiwanese family caregivers of individuals with mental illness. Cross-sectional, descriptive correlation design. Data from 43 families, including at least one male and female family caregiver in each family, were analysed using descriptive statistics, principal component analysis and mixed linear modelling. Demographic data, Perceived Stress Scale, Perceived Social Support and Caregiver Burden Scale-Brief were used to collect data. Female family caregivers perceived less social support and experienced higher degrees of caregiver burden compared with male family caregivers. In contrast, no significant gender effect was associated with family demands. Family caregivers with greater family demands and less social support experienced higher degrees of caregiver burden. The results reinforced those of previously published studies that caregiver burden is highly prevalent among female family caregivers. Caregiver gender appears to be highly valuable for explaining family demands, social support and caregiver burden. Health care professionals should continue to collaborate with family caregivers to assess potential gender effects on available support and design gender-specific interventions to alleviate caregiver burden. © 2010 Blackwell Publishing Ltd.

[Relationship between research funding in the Spanish National Health System and the burden of disease].

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Catalá López, Ferrán; Alvarez Martín, Elena; Gènova Maleras, Ricard; Morant Ginestar, Consuelo

2009-01-01

The Carlos III Health Institute (Instituto de Salud Carlos III - Spain) allocates funding to health research support in the Spanish National Health System (NHS). This study aimed to analyse the correlation of health research fund allocations in the NHS and the burden of disease in Spanish population. Cross-sectional study. Burden of disease measures were calculated: disability-adjusted life-years (DALYs), years of life lost (YLLs) and mortality by cause. A correlation analysis (Spearman s Rho) was applied to test the association between these measures and 2006/2007 health research funding. Using disease categories (n=21), the correlation between funding and disease-burden measures is: DALY (r=0.72; p funding support. However, the higher funds allocated per DALY lost ratios were for blood and endocrine disorders, infectious and parasitic diseases and congenital anomalies. Our analysis suggests that NHS research funding is positive moderately high-associated with the burden of disease in Spain, although there exists certain diseases categories that are over or under-funded in relation to their burden generated. In health planning, burden of disease studies contributes with useful information for setting health research priorities.

The cesium -137 body burden of a control group in Stockholm, 1976

International Nuclear Information System (INIS)

Falk, R.; Eklund, G.

1977-01-01

Measurements of the 136 Cs content in a control group consisting of 20 - 30 persons have been carried out since 1959. Until 1966 the measurements were made in an 'open-both' type whole-body counter and after that in a three-crystal counter. Individual weighting factors for each member of the group is used to compensate for changes in the control group during the years. The calculation of the weighted mean of the cesium-137 level includes a correction for RaC contamination. During 1976 measurements were made on 24 members of the group, 14 men and 10 women. Measured content of potassium was 1.9+-0.3 g/kg body weight for the men and 1.6+-0.2 g/kg body weight for the women of the group. Tables show these results together with earlier results from the 'open-both' counter. The weighted mean and the highest and the lowest values within the group are indicated. The total error of the weighted mean and the highest value 1976 are about 15 percent and 12 percent respectively. For the last few years the cesium content has been below the detection limit, 10-15 pCi/gK, for some members of the group. (author)

Higher order coupling between rigid-body and elastic motion in flexible mechanisms

International Nuclear Information System (INIS)

Esat, I.I.; Ianakiev, A.

1995-01-01

The paper presents an investigation of the influence of the higher order coupling terms between the rigid-body and elastic motion into flexible mechanism dynamics. The configuration of the mechanical system is obtained by using the so called hybrid coordinates. The kinematic description of the mechanism was obtained using the D-H 4 x 4 transformation matrices. The elastic deformation of each point of the mechanism is described by the finite element modeling (FEM) type interpolation scheme. The dynamic model of the flexible mechanism consists due to the hybrid coordinates of two groups of differential equations. The first group describes the manipulator transport motion and the second group describes the vibration. In this paper the authors evaluated the contribution of the coupling terms between the two groups of differential equations and selected only those with high contribution

Identification of environmentally derived cesium-137 burdens in a worker population

International Nuclear Information System (INIS)

MacLellan, J.A.; Lynch, T.P.; Rieksts, G.A.; Brodzinski, R.L.

1993-01-01

During 1990, whole body measurements of a number of workers with little probability of onsite occupational exposure showed positive evidence of 137 Cs. Further investigation revealed that many of these workers supplemented their diet with a significant portion of wild game, mainly deer and elk. To validate the assumption of an environmental source, donated samples of venison and other game were analyzed by gamma spectroscopy. Results ranged from less than 0.1 to almost 100 Bq kg -l (0.003 to 2.7 nCi kg -1 ) and showed a correlation with the habitat from which the game was taken. Venison samples obtained from the two workers with the highest body burdens showed the highest activity. A questionnaire is now used to identify workers with an elevated potential for environmental-intakes

Rural-urban differentials of premature mortality burden in south-west China

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Chongsuvivatwong Virasakdi

2006-10-01

Full Text Available Abstract Background Yunnan province is located in south western China and is one of the poorest provinces of the country. This study examines the premature mortality burden from common causes of deaths among an urban region, suburban region and rural region of Kunming, the capital of Yunnan. Methods Years of life lost (YLL rate per 1,000 and mortality rate per 100,000 were calculated from medical death certificates in 2003 and broken down by cause of death, age and gender among urban, suburban and rural regions. YLL was calculated without age-weighting and discounting rate. Rates were age-adjusted to the combined population of three regions. However, 3% discounting rate and a standard age-weighting function were included in the sensitivity analysis. Results Non-communicable diseases contributed the most YLL in all three regions. The rural region had about 50% higher premature mortality burden compared to the other two regions. YLL from infectious diseases and perinatal problems was still a major problem in the rural region. Among non-communicable diseases, YLL from stroke was the highest in the urban/suburban regions; COPD followed as the second and was the highest in the rural region. Mortality burden from injuries was however higher in the rural region than the other two regions, especially for men. Self-inflicted injuries were between 2–8 times more serious among women. The use of either mortality rate or YLL gives a similar conclusion regarding the order of priority. Reanalysis with age-weighting and 3% discounting rate gave similar results. Conclusion Urban south western China has already engaged in epidemiological pattern of developed countries. The rural region is additionally burdened by diseases of poverty and injury on top of the non-communicable diseases.

Rural-urban differentials of premature mortality burden in south-west China.

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Cai, Le; Chongsuvivatwong, Virasakdi

2006-10-14

Yunnan province is located in south western China and is one of the poorest provinces of the country. This study examines the premature mortality burden from common causes of deaths among an urban region, suburban region and rural region of Kunming, the capital of Yunnan. Years of life lost (YLL) rate per 1,000 and mortality rate per 100,000 were calculated from medical death certificates in 2003 and broken down by cause of death, age and gender among urban, suburban and rural regions. YLL was calculated without age-weighting and discounting rate. Rates were age-adjusted to the combined population of three regions. However, 3% discounting rate and a standard age-weighting function were included in the sensitivity analysis. Non-communicable diseases contributed the most YLL in all three regions. The rural region had about 50% higher premature mortality burden compared to the other two regions. YLL from infectious diseases and perinatal problems was still a major problem in the rural region. Among non-communicable diseases, YLL from stroke was the highest in the urban/suburban regions; COPD followed as the second and was the highest in the rural region. Mortality burden from injuries was however higher in the rural region than the other two regions, especially for men. Self-inflicted injuries were between 2-8 times more serious among women. The use of either mortality rate or YLL gives a similar conclusion regarding the order of priority. Reanalysis with age-weighting and 3% discounting rate gave similar results. Urban south western China has already engaged in epidemiological pattern of developed countries. The rural region is additionally burdened by diseases of poverty and injury on top of the non-communicable diseases.

Perceived parent financial burden and asthma outcomes in low-income, urban children.

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Patel, Minal R; Brown, Randall W; Clark, Noreen M

2013-04-01

The purpose of this study was to describe the demographic characteristics of low-income parents who perceive financial burden in managing their child's asthma and related associations with their children's asthma outcomes and clinical characteristics. We hypothesized that (1) identifiable differences between parents who do and do not report burden; (2) regardless of access to care, asthma outcomes would be worse for children whose parents perceive financial burden in obtaining care for their child's condition. Baseline data from a randomized trial evaluating the effect of a school-based asthma intervention were analyzed for this research. Eight hundred thirty-five parents were interviewed by telephone regarding their child's asthma management. Associations between demographic and clinical factors and perception of financial burden were examined using bivariate analysis. Multivariate regression analyses were used to examine associations between perceptions of financial burden and asthma outcomes, including emergency department visits, hospitalizations, and missed school days. Perceived financial burden was evident in 10% (n = 79) of parents. Female heads of household (χ2 (3) = 7.41; p financial burden. In models controlling for level of asthma control, income, and having a usual source of asthma care, parents who perceived financial burden were more likely to have children who had at least one emergency department visit (OR = 1.95; 95% CI = 1.15 to 3.29), hospitalization (OR = 3.99; 95% CI = 2.03 to 7.82), or missed school days due to asthma (OR = 3.26; 95% CI = 1.60 to 6.67) in the previous year. Our results supported our hypotheses. Among low-income parents of children with asthma, the majority do not perceive financial burden to obtaining care. However, among parents that do perceive burden, urgent care use and missed school days due to asthma for their child were significantly higher, regardless of family income and having a

Lower radiation burden in state of the art fluoroscopic cystography compared to direct isotope cystography in children.

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Haid, Bernhard; Becker, Tanja; Koen, Mark; Berger, Christoph; Langsteger, Werner; Gruy, Bernhard; Putz, Ernst; Haid, Stephanie; Oswald, Josef

2015-02-01

Both, fluoroscopic voiding cystourethrography (fVCUG) and direct isotope cystography (DIC) are diagnostic tools commonly used in pediatric urology. Both methods can detect vesicoureteral reflux (VUR) with a high sensitivity. Whilst the possibility to depict anatomical details and important structures as for instance the urethra in boys or the detailed calyceal anatomy are advantages of fVCUG, a lower radiation burden is thought to be the main advantage of DIC. In the last decade, however, a rapid technical evolution has occurred in fluoroscopy by implementing digital grid-controlled, variable rate, pulsed acquisition technique. As documented in literature this led to a substantial decrease in radiation burden conferred during fVCUGs. To question the common belief that direct isotope cystography confers less radiation burden compared to state of the art fluoroscopic voiding cystography. Radiation burden of direct isotope cystography in 92 children and in additional 7 children after an adaption of protocol was compared to radiation burden of fluoroscopic voiding cystourethrography in 51. The examinations were performed according to institutional protocols. For calculation of mean effective radiation dose [mSv] for either method published physical models correcting for age and sex were used. For DIC the model published by Stabin et al., 1998 was applied, for fVCUG two different physical models were used (Schultz et al., 1999, Lee et al., 2009). The radiation burden conferred by direct isotope cystography was significantly higher as for fluoroscopic voiding cystourethrography. The mean effective radiation dose for direct isotope cystography accounted to 0.23 mSv (± 0.34 m, median 0.085 mSv) compared to 0.015 mSv (± 0.013, median 0.008 mSv, model by Schultz et al.) - 0.024 mSv (± 0.018, median 0.018 mSv, model by Lee et al.) for fluoroscopic voiding cystourethrography. After a protocol adaption to correct for a longer examination time in DIC that was caused by

Higher body mass, older age and higher monounsaturated fatty acids intake reflect better quantitative ultrasound parameters in Inuit preschoolers

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Jessy El Hayek

2012-07-01

Full Text Available Objectives. Investigate the effects of selected factors associated with quantitative ultrasound parameters among Inuit preschoolers living in Arctic communities (56° 32′–72° 40′N. Materials and methods. Children were selected randomly in summer and early fall (n=296. Dietary intake was assessed through the administration of a 24-h dietary recall (24-h recall and a food frequency questionnaire (FFQ. Anthropometry was measured using standardized procedures. Plasma 25-hydroxy vitamin D (25(OHD and parathyroid hormone (PTH were measured using a chemiluminescent assay (Liaison, Diasorin. Quantitative ultrasound parameters were measured using Sahara Sonometer, (Hologic Inc.. Results. Children divided by speed of sound (SoS and broadband ultrasound attenuation (BUA quartiles were not different for age (years, sex (M/F, calcium (mg/d and vitamin D intake (µg/d and plasma 25(OHD concentration (nmol/L. However, children in the highest BUA and SoS quartile had higher body mass index (BMI compared to those in quartile 1. Using multivariate linear regression, higher BMI, older age and monounsaturated fatty acids (MUFA intake were predictors of BUA while only BMI was a predictor of SoS. Conclusions. Further investigation assessing intakes of traditional foods (TF and nutrients affecting bone parameters along with assessment of vitamin D status of Inuit children across seasons is required.

Childhood dual burden of under- and over-nutrition in low- and middle-income countries: a critical review

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Tzioumis, Emma; Adair, Linda S.

2015-01-01

Background In low- and middle income countries, the distribution of childhood nutritional diseases is shifting from a predominance of undernutrition to a dual burden of under- and overnutrition. This novel and complex problem challenges governments and health organizations to tackle opposite ends of the malnutrition spectrum. The dual burden may manifest within a community, household, or individual, but these different levels have not been addressed collectively. Objective To critically review literature on the prevalence, trends, and predictors of the dual burden, with a focus on children from birth to 18 years. Methods We reviewed literature since January 1, 1990, published in English, using the PubMed search terms: nutrition transition, double burden, dual burden, nutrition status, obesity, overweight, underweight, stunting, body composition, and micronutrient deficiencies. Findings were classified and described according to dual burden level (community, household, individual). Results Global trends indicate decreases in diseases of undernutrition, while overnutrition is increasing. On the community level, economic status may influence the dual burden’s extent, with obesity increasingly affecting the already undernourished poor. In a household, shared determinants of poor nutritional status among members can result in disparate nutritional status across generations. Within an individual, obesity may co-occur with stunting or anemia, due to shared underlying determinants or physiologic links. Conclusions The dual burden of malnutrition poses a threat to children’s health in low- and middle-income countries. We must remain committed to reducing undernutrition while simultaneously preventing overnutrition, through integrated child health programs that incorporate prevention of infection, diet quality, and physical activity. PMID:25076771

Associations between advanced cancer patients' survival and family caregiver presence and burden.

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Dionne-Odom, J Nicholas; Hull, Jay G; Martin, Michelle Y; Lyons, Kathleen Doyle; Prescott, Anna T; Tosteson, Tor; Li, Zhongze; Akyar, Imatullah; Raju, Dheeraj; Bakitas, Marie A

2016-05-01

We conducted a randomized controlled trial (RCT) of an early palliative care intervention (ENABLE: Educate, Nurture, Advise, Before Life Ends) for persons with advanced cancer and their family caregivers. Not all patient participants had a caregiver coparticipant; hence, we explored whether there were relationships between patient survival, having an enrolled caregiver, and caregiver outcomes prior to death. One hundred and twenty-three patient-caregiver dyads and 84 patients without a caregiver coparticipant participated in the ENABLE early versus delayed (12 weeks later) RCT. We collected caregiver quality-of-life (QOL), depression, and burden (objective, stress, and demand) measures every 6 weeks for 24 weeks and every 3 months thereafter until the patient's death or study completion. We conducted survival analyses using log-rank and Cox proportional hazards models. Patients with a caregiver coparticipant had significantly shorter survival (Wald = 4.31, HR = 1.52, CI: 1.02-2.25, P = 0.04). After including caregiver status, marital status (married/unmarried), their interaction, and relevant covariates, caregiver status (Wald = 6.25, HR = 2.62, CI: 1.23-5.59, P = 0.01), being married (Wald = 8.79, HR = 2.92, CI: 1.44-5.91, P = 0.003), and their interaction (Wald = 5.18, HR = 0.35, CI: 0.14-0.87, P = 0.02) were significant predictors of lower patient survival. Lower survival in patients with a caregiver was significantly related to higher caregiver demand burden (Wald = 4.87, CI: 1.01-1.20, P = 0.03) but not caregiver QOL, depression, and objective and stress burden. Advanced cancer patients with caregivers enrolled in a clinical trial had lower survival than patients without caregivers; however, this mortality risk was mostly attributable to higher survival by unmarried patients without caregivers. Higher caregiver demand burden was also associated with decreased patient survival. © 2016 The Authors. Cancer Medicine published by

Caregiver burden among primary caregivers of patients undergoing peripheral blood stem cell transplantation: a cross sectional study.

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Akgul, Nur; Ozdemir, Leyla

2014-08-01

This study aimed to identify caregiver burden and influencing factors on the burden in primary caregivers of peripheral blood stem cell transplantation patients within 2-12 months following transplant, indicating early recovery period after discharge. This descriptive cross sectional study was carried out at hematopoietic stem cell transplantation outpatient units of three university hospitals in Turkey. A total of 55 patient and caregiver dyads were recruited and interviewed. The data were collected using questionnaires developed by the researchers and caregiver burden was measured with the Zarit Burden Interview. The mean score of Zarit Burden Interview was 28.41 (SD = 13.90). Patients' symptoms including nausea and self depreciation feeling were related to greater caregiver burden. Self-depreciation was referred to feeling undervalued. The mean score of the tool was significantly higher in caregivers who have not been educated beyond primary school and also caregivers who had lower income. Caregivers who supported their patients to fulfill physical needs and who did not receive help for meeting patients' psychological needs had statistically more elevated levels of burden. Moreover, the extent of care giving activities undertaken was positively correlated with caregiver burden scores. While positive impact of the care giving process on family relations decreased caregiver burden; negative effect increased the burden. This study suggests that caregiver burden of primary caregivers caring for peripheral blood stem cell transplantation patients varies by education, income status, and the extent of care giving activities undertaken. Changes in family ties and relations due to care giving effected caregiver burden. Copyright © 2014 Elsevier Ltd. All rights reserved.

Socioeconomic Risk Factors for Celiac Disease Burden and Symptoms.

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Oza, Sveta S; Akbari, Mona; Kelly, Ciarán P; Hansen, Joshua; Theethira, Thimmaiah; Tariq, Sohaib; Dennis, Melinda; Leffler, Daniel A

2016-04-01

Celiac disease (CD) affects approximately 1% of the population and negatively affects aspects of life including physical and social function. The relationship between socioeconomic (SE) factors, symptom severity, and perceived burden of living with CD is not well understood. The objective of this study was to assess the relationships between income, symptoms, and perceived burden of CD. In this survey study conducted at a tertiary care center, 773 patients 18 years of age or more with biopsy confirmed CD were eligible to participate. Patients completed a survey with information on SE data, the validated Celiac Symptom Index (CSI), and visual analog scales (VAS) assessing overall health, CD-related health, difficulty in following a gluten-free diet (GFD), and importance of following a GFD. Three hundred forty one patients completed the survey. Higher income predicted better overall health, better CD related health, and fewer symptoms. In the logistic regression model, low income was associated with greater CD symptoms (odds ratio=6.04, P=0.002). Other factors associated with greater symptoms were younger age, poor overall health state, and more physician visits. Factors associated with increased burden of CD included hospitalizations, more symptoms, poor overall health state, and burden of following a GFD. Patients with lower incomes have worse CD-related health and greater symptoms. Those with low income had 6 times the odds of greater symptoms compared with those with high income. Our data suggest that income is associated with perceived overall health, CD-related health, and CD symptoms.

The prevalence and burden of mental and substance use disorders in Australia: Findings from the Global Burden of Disease Study 2015.

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Ciobanu, Liliana G; Ferrari, Alize J; Erskine, Holly E; Santomauro, Damian F; Charlson, Fiona J; Leung, Janni; Amare, Azmeraw T; Olagunju, Andrew T; Whiteford, Harvey A; Baune, Bernhard T

2018-05-01

Timely and accurate assessments of disease burden are essential for developing effective national health policies. We used the Global Burden of Disease Study 2015 to examine burden due to mental and substance use disorders in Australia. For each of the 20 mental and substance use disorders included in Global Burden of Disease Study 2015, systematic reviews of epidemiological data were conducted, and data modelled using a Bayesian meta-regression tool to produce prevalence estimates by age, sex, geography and year. Prevalence for each disorder was then combined with a disorder-specific disability weight to give years lived with disability, as a measure of non-fatal burden. Fatal burden was measured as years of life lost due to premature mortality which were calculated by combining the number of deaths due to a disorder with the life expectancy remaining at the time of death. Disability-adjusted life years were calculated by summing years lived with disability and years of life lost to give a measure of total burden. Uncertainty was calculated around all burden estimates. Mental and substance use disorders were the leading cause of non-fatal burden in Australia in 2015, explaining 24.3% of total years lived with disability, and were the second leading cause of total burden, accounting for 14.6% of total disability-adjusted life years. There was no significant change in the age-standardised disability-adjusted life year rates for mental and substance use disorders from 1990 to 2015. Global Burden of Disease Study 2015 found that mental and substance use disorders were leading contributors to disease burden in Australia. Despite several decades of national reform, the burden of mental and substance use disorders remained largely unchanged between 1990 and 2015. To reduce this burden, effective population-level preventions strategies are required in addition to effective interventions of sufficient duration and coverage.

The association between higher body mass index and poor school performance in high school students.

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Tonetti, L; Fabbri, M; Filardi, M; Martoni, M; Natale, V

2016-12-01

This study aimed to examine the association between body mass index (BMI) and school performance in high school students by controlling for relevant mediators such as sleep quality, sleep duration and socioeconomic status. Thirty-seven high school students (mean age: 18.16 ± 0.44 years) attending the same school type, i.e. 'liceo scientifico' (science-based high school), were enrolled. Students' self-reported weight and height were used to calculate BMI. Participants wore an actigraph to objectively assess the quality and duration of sleep. School performance was assessed through the actual grade obtained at the final school-leaving exam, in which higher grades indicate higher performance. BMI, get-up time, mean motor activity, wake after sleep onset and number of awakenings were negatively correlated with the grade, while sleep efficiency was positively correlated. When performing a multiple regression analysis, BMI proved the only significant (negative) predictor of grade. When controlling for sleep quality, sleep duration and socioeconomic status, a higher BMI is associated with a poorer school performance in high school students. © 2015 World Obesity Federation.

Body burden of pesticides and wastewater-derived pollutants on freshwater invertebrates: Method development and application in the Danube River.

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Inostroza, Pedro A; Wicht, Anna-Jorina; Huber, Thomas; Nagy, Claudia; Brack, Werner; Krauss, Martin

2016-07-01

While environmental risk assessment is typically based on toxicant concentrations in water and/or sediment, awareness is increasing that internal concentrations or body burdens are the key to understand adverse effects in organisms. In order to link environmental micropollutants as causes of observed effects, there is an increasing demand for methods to analyse these chemicals in organisms. Here, a multi-target screening method based on pulverised liquid extraction (PuLE) and a modified QuEChERS approach with an additional hexane phase was developed. It is capable to extract and quantify organic micropollutants of diverse chemical classes in freshwater invertebrates. The method was tested on gammarids from the Danube River (within the Joint Danube Survey 3) and target compounds were analysed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Furthermore, a non-target screening using high resolution-tandem mass spectrometry (LC-HRMS/MS) was conducted. A total of 17 pollutants were detected and/or quantified in gammarids at low concentrations. Pesticide concentrations ranged from 0.1 to 6.52 ng g(-1) (wet weight), those of wastewater-derived pollutants from 0.1 to 2.83 ng g(-1) (wet weight). The presence of wastewater-derived pollutants was prominent at all spots sampled. Using non-target screening, we could successfully identify several chlorinated compounds. These results demonstrate for the first time the presence of pesticides and wastewater-derived pollutants in invertebrates of the Danube River. Copyright © 2016 Elsevier Ltd. All rights reserved.

Burden of illness in functional gastrointestinal disorder--the consequences for the individual and society.

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Glise, H; Wiklund, I; Hallerbäck, B

1998-01-01

To review the consequences of functional gastrointestinal disorders (FGD), i.e. heartburn without esophagitis, dyspepsia and IBS for the individual and society. Current publications indicate that functional gastrointestinal disorders are more prevalent than organic gastrointestinal disorders in the population. Symptoms, not the organic finding per se, are most important to the individual. Functional disorders are furthermore linked to somatic symptoms, from other parts of the body, as well as to mental health. Together they constitute a large medical burden on society in terms of consultations, drug consumption and surgery. Social costs are further increased by problems at work and a considerable increase in absenteeism. Functional gastrointestinal disorders should be taken more seriously by the medical community and society, since the burden of illness seems much larger than earlier anticipated.

Environmental Health Related Socio-Spatial Inequalities: Identifying “Hotspots” of Environmental Burdens and Social Vulnerability

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Shrestha, Rehana; Flacke, Johannes; Martinez, Javier; van Maarseveen, Martin

2016-01-01

Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as “hotspots”. This paper develops an index-based approach to assess these multiple burdens and benefits in combination with vulnerability factors at detailed intra-urban level. The method is applied to the city of Dortmund, Germany. Using non-spatial and spatial methods we assessed inequalities and identified “hotspot” areas in the city. We found modest inequalities burdening higher vulnerable groups in Dortmund (CI = −0.020 at p vulnerability, is essential to inform environmental justice debates and to mobilize local stakeholders. Locating “hotspot” areas at this detailed spatial level can serve as a basis to develop interventions that target vulnerable groups to ensure a health conducive equal environment. PMID:27409625

Caregiving burden and the quality of life of family caregivers of cancer patients: the relationship and correlates.

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Rha, Sun Young; Park, Yeonhee; Song, Su Kyung; Lee, Chung Eun; Lee, Jiyeon

2015-08-01

Family caregivers of cancer patients become responsible for many elements of cancer care, usually without preparation or training in provision of care. Their efforts of care generate caregiving burden, which could deteriorate caregivers' quality of life (QOL). A secondary data analysis of a cross-sectional descriptive study was conducted to describe the influence of caregiving burden on the QOL of family caregivers of cancer patients with consideration of correlates (N = 212). The Korean versions of Zarit Burden Interview and the World Health Organization QOL BREF were used. Multiple regression analyses were applied to analyze the relationship between the caregiving burden and QOL. Caregiving burden explained 30.3% of variance of the QOL (β = -0.534, p < 0.001). Caregivers caring for patients with functional deterioration experienced higher burden. Caregivers providing care for hospitalized patients demonstrated lower QOL. The caregiver's educational level was a positively contributing factor for the QOL. Caregiving burden was the influential, negatively affecting factor for the QOL. Assessment of caregiving burden with special attention being paid to caregivers caring for patients with functional decline would help to identify caregivers in need of support. Supportive care needs to be sought to alleviate caregiving burden and improve the QOL of caregivers, especially for the caregivers of hospitalized patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Economic burden made celiac disease an expensive and challenging condition for Iranian patients.

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Pourhoseingholi, Mohamad Amin; Rostami-Nejad, Mohammad; Barzegar, Farnoush; Rostami, Kamran; Volta, Umberto; Sadeghi, Amir; Honarkar, Zahra; Salehi, Niloofar; Asadzadeh-Aghdaei, Hamid; Baghestani, Ahmad Reza; Zali, Mohammad Reza

2017-01-01

The aim of this study was to estimate the economic burden of celiac disease (CD) in Iran. The assessment of burden of CD has become an important primary or secondary outcome measure in clinical and epidemiologic studies. Information regarding medical costs and gluten free diet (GFD) costs were gathered using questionnaire and checklists offered to the selected patients with CD. The data included the direct medical cost (including Doctor Visit, hospitalization, clinical test examinations, endoscopies, etc.), GFD cost and loss productivity cost (as the indirect cost) for CD patient were estimated. The factors used for cost estimation included frequency of health resource utilization and gluten free diet basket. Purchasing Power Parity Dollar (PPP$) was used in order to make inter-country comparisons. Total of 213 celiac patients entered to this study. The mean (standard deviation) of total cost per patient per year was 3377 (1853) PPP$. This total cost including direct medical cost, GFD costs and loss productivity cost per patients per year. Also the mean and standard deviation of medical cost and GFD cost were 195 (128) PPP$ and 932 (734) PPP$ respectively. The total costs of CD were significantly higher for male. Also GFD cost and total cost were higher for unmarried patients. In conclusion, our estimation of CD economic burden is indicating that CD patients face substantial expense that might not be affordable for a good number of these patients. The estimated economic burden may put these patients at high risk for dietary neglect resulting in increasing the risk of long term complications.

The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013

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Charara, Raghid; Forouzanfar, Mohammad; Naghavi, Mohsen; Moradi-Lakeh, Maziar; Afshin, Ashkan; Vos, Theo; Daoud, Farah; Wang, Haidong; El Bcheraoui, Charbel; Khalil, Ibrahim; Hamadeh, Randah R.; Khosravi, Ardeshir; Rahimi-Movaghar, Vafa; Khader, Yousef; Al-Hamad, Nawal; Makhlouf Obermeyer, Carla; Rafay, Anwar; Asghar, Rana; Rana, Saleem M.; Shaheen, Amira; Abu-Rmeileh, Niveen M. E.; Husseini, Abdullatif; Abu-Raddad, Laith J.; Khoja, Tawfik; Al Rayess, Zulfa A.; AlBuhairan, Fadia S.; Hsairi, Mohamed; Alomari, Mahmoud A.; Ali, Raghib; Roshandel, Gholamreza; Terkawi, Abdullah Sulieman; Hamidi, Samer; Refaat, Amany H.; Westerman, Ronny; Kiadaliri, Aliasghar Ahmad; Akanda, Ali S.; Ali, Syed Danish; Bacha, Umar; Badawi, Alaa; Bazargan-Hejazi, Shahrzad; Faghmous, Imad A. D.; Fereshtehnejad, Seyed-Mohammad; Fischer, Florian; Jonas, Jost B.; Kuate Defo, Barthelemy; Mehari, Alem; Omer, Saad B.; Pourmalek, Farshad; Uthman, Olalekan A.; Mokdad, Ali A.; Maalouf, Fadi T.; Abd-Allah, Foad; Akseer, Nadia; Arya, Dinesh; Borschmann, Rohan; Brazinova, Alexandra; Brugha, Traolach S.; Catalá-López, Ferrán; Degenhardt, Louisa; Ferrari, Alize; Haro, Josep Maria; Horino, Masako; Hornberger, John C.; Huang, Hsiang; Kieling, Christian; Kim, Daniel; Kim, Yunjin; Knudsen, Ann Kristin; Mitchell, Philip B.; Patton, George; Sagar, Rajesh; Satpathy, Maheswar; Savuon, Kim; Seedat, Soraya; Shiue, Ivy; Skogen, Jens Christoffer; Stein, Dan J.; Tabb, Karen M.; Whiteford, Harvey A.; Yip, Paul; Yonemoto, Naohiro; Murray, Christopher J. L.; Mokdad, Ali H.

2017-01-01

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25–49 age group, with a peak in the 35–39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of

Incongruence in body image and body mass index: A surrogate risk marker in Black women for type 2 diabetes mellitus

Directory of Open Access Journals (Sweden)

Rynal Devanathan

2013-07-01

Full Text Available Background: Excess weight contributes to the development and progression of Type 2 diabetes mellitus (T2DM. Distorted body image amongst urban Black women and the perception that thinness is linked with HIV, may however be compounding the problem, particularly in areas with a high HIV burden. Objectives: This study aimed to compare the perception of body image in urban Black women with and without T2DM. Methods: A cross-sectional comparative study was conducted on 328 Black women systematically sampled into two groups (with and without T2DM. Body mass index (BMI (weight [kg]/height[m2] was determined and the adapted Stunkard Body Image Silhouettes for Black women was used to determine perceived body image (PBI. Results: Seventy-two per cent had T2DM and in this group 89% were obese, with a mean BMI of 39.5 kg/m2 (s.d. ± 8.5. In the non-diabetes group (NDG 44% were obese, with a mean BMIof 31.3 kg/m2 (s.d. ± 9.0 Black women underestimated their body image across all weight categories (p < 0.05. Both groups (99% of the study group also perceived thinness as being associated with HIV. Conclusions: This study identified an incongruence between PBI and actual BMI amongst urban Black women. This, combined with their belief that thinness is associated with HIV, places those with T2DM at risk of secondary complications arising from diabetes mellitus, and those without diabetes mellitus at a higher risk of developing T2DM. A discrepancy between PBI and BMI may therefore serve as a risk marker to alert clinicians to use a more ethno-cultural specific approach in engaging with urban Black women regarding weight loss strategies in the future.

Caregiver burden in atypical dementias: comparing frontotemporal dementia, Creutzfeldt-Jakob disease, and Alzheimer's disease.

Science.gov (United States)

Uflacker, Alice; Edmondson, Mary C; Onyike, Chiadi U; Appleby, Brian S

2016-02-01

Caregiver burden is a significant issue in the treatment of dementia and a known contributor to institutionalization of patients with dementia. Published data have documented increased caregiver burden in behavioral variant frontotemporal dementia (bvFTD) compared to Alzheimer's disease (AD). Another atypical dementia with high-perceived caregiver burden is sporadic Creutzfeldt-Jakob disease (sCJD), but no formal studies have assessed this perception. The aim of this study was to compare caregiver burden across atypical dementia etiologies. 76 adults with atypical dementia (young-onset AD [YOAD], bvFTD, language variant FTD [lvFTD], and sCJD) were administered an abbreviated version of the Zarit Burden Interview (ZBI), Neuropsychiatric Inventory (NPI-Q), and other assessment instruments during a five-year time period at Johns Hopkins Hospital (JHH). A Cox regression model examined differences between disease categories that impact mean ZBI scores. Mean ZBI scores were significantly different between dementia etiologies, with bvFTD and sCJD having the highest caregiver burden (p = 0.026). Mean NPI-Q caregiver distress scores were highest in bvFTD and sCJD (p = 0.002), with sCJD and bvFTD also having the highest number of endorsed symptom domains (p = 0.012). On regression analyses, an interactive variable combining final diagnosis category and NPI-Q total severity score demonstrated statistically significant differences in mean ZBI scores for sCJD and bvFTD. This study demonstrates that bvFTD and sCJD have increased levels of caregiver burden, NPI-Q caregiver distress, total severity scores, and number of endorsed symptom domains. These results suggest that higher caregiver burden in bvFTD and sCJD are disease specific and possibly related to neuropsychiatric symptoms.

Financial burdens and mental health needs in families of children with congenital heart disease.

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McClung, Nancy; Glidewell, Jill; Farr, Sherry L

2018-04-06

To examine the financial burdens and mental health needs of families of children with special healthcare needs (CSHCN) with congenital heart disease (CHD). Data from the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) were used to examine parent-reported financial burdens (out-of-pocket expenses, financial problems, employment impact, caregiving hours) and family members' need for mental health services in families of CSHCN with CHD. Multivariable logistic regression was used to compare financial burdens and family members' need for mental health services among CSHCN with and without CHD. Among CSHCN with CHD, multivariable logistic regression, stratified by age (0-5 and 6-17 years), was used to assess characteristics associated with the outcomes. Overall, families of 89.1% of CSHCN with CHD experienced at least one financial burden and 14.9% needed mental health services due to the child's condition. Compared with CSHCN without CHD, those with CHD had families with a higher prevalence of all financial burdens (adjusted prevalence ratio [aPR] range: 1.4-1.8) and similar family member need for mental health services (aPR = 1.3, 95% CI [1.0, 1.6]). Across both age groups, insurance type, activity limitations, and comorbidities were significantly associated with financial burdens and/or family members' need for mental health services. CSHCN with CHD, compared with those without CHD, lived in families with more financial burdens. Interventions that reduce financial burdens and improve mental health of family members are needed, especially among CSHCN with CHD who are uninsured and have comorbidities or activity limitations. © 2018 Wiley Periodicals, Inc.

The Burden of Schizophrenia on Caregivers

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Filiz Adana; Hulya Arslantas

2011-01-01

Caregivers’ burden in schizophrenia is a complex concept often with negative connotations. The concept refers to the impact of having a schizophrenia patient in the family including emotional, psychological, physical, economic distress and feelings of shame, embarrassment, guilt, and self-blame expe-rienced by the caregivers. There are objective and subjective aspects of care-givers’ burden. The objective burden refers to observed and verifiable impact of the diseased person in the family suc...

The effect of gender and social capital on the dual burden of malnutrition: a multilevel study in Indonesia.

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Masoud Vaezghasemi

Full Text Available INTRODUCTION: The paradoxical phenomenon of the coexistence of overweight and underweight individuals in the same household, referred to as the "dual burden of malnutrition", is a growing nutrition dilemma in low- and middle-income countries (LMICs. AIMS: The objectives of this study were (i to examine the extent of the dual burden of malnutrition across different provinces in Indonesia and (ii to determine how gender, community social capital, place of residency and other socio-economic factors affect the prevalence of the dual burden of malnutrition. METHODS: The current study utilized data from the fourth wave of the Indonesian Family Life Survey (IFLS conducted between November 2007 and April 2008. The dataset contains information from 12,048 households and 45,306 individuals of all ages. This study focused on households with individuals over two years old. To account for the multilevel nature of the data, a multilevel multiple logistic regression was conducted. RESULTS: Approximately one-fifth of all households in Indonesia exhibited the dual burden of malnutrition, which was more prevalent among male-headed households, households with a high Socio-economic status (SES, and households in urban areas. Minimal variation in the dual burden of malnutrition was explained by the community level differences (<4%. Living in households with a higher SES resulted in higher odds of the dual burden of malnutrition but not among female-headed households and communities with the highest social capital. CONCLUSION: To improve household health and reduce the inequality across different SES groups, this study emphasizes the inclusion of women's empowerment and community social capital into intervention programs addressing the dual burden of malnutrition.

Endoparasites in a Norwegian moose (Alces alces population – Faunal diversity, abundance and body condition

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Rebecca K. Davidson

2015-04-01

Female moose had higher mean abomasal nematode counts than males, particularly among adults. However, adult males had higher faecal egg counts than adult females which may reflect reduction in faecal volume with concentration of eggs among males during the rut. We found no strong evidence for the development of acquired immunity to abomasal nematodes with age, although there was a higher Protostrongylid and Moniezia infection prevalence in younger animals. High burdens of several parasites were associated with poor body condition in terms of slaughter weight relative to skeletal size but unrelated to visually evaluated fat reserves. Given findings from earlier experimental studies, our results imply sub-clinical effects of GI parasite infection on host condition. Managers should be aware that autumn faecal egg counts and field assessments of fat reserves may not be reliable indicators of parasitism and may underestimate impacts on wildlife populations.

The burden of parasitic zoonoses in Nepal: a systematic review.

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Brecht Devleesschauwer

Full Text Available Parasitic zoonoses (PZs pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY. However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding.We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs.Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI: 5450-27,694] and 9255 DALYs [95% CrI: 6135-13,292], respectively, followed by cystic echinococcosis (251 DALYs [95% CrI: 105-458]. Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur.In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this study would enable additional burden estimates, and a more

More accurate picture of human body organs

International Nuclear Information System (INIS)

Kolar, J.

1985-01-01

Computerized tomography and nucler magnetic resonance tomography (NMRT) are revolutionary contributions to radiodiagnosis because they allow to obtain a more accurate image of human body organs. The principles are described of both methods. Attention is mainly devoted to NMRT which has clinically only been used for three years. It does not burden the organism with ionizing radiation. (Ha)

Metallic Burden of Deciduous Teeth and Childhood Behavioral Deficits

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Tony J.H. Chan

2015-06-01

Full Text Available Attention Deficit/Hyperactivity Disorder (ADHD affects 5%–8% of children in the U.S. (10% of males and 4% of females. The contributions of multiple metal exposures to the childhood behavioral deficits are unclear, although particular metals have been implicated through their neurotoxicity. The objective of this study was to test the hypothesis that the body burden of Mn is positively correlated with ADHD symptoms. We also investigated the putative roles of Ca, Fe, Pb, and Hg. We collected shed molars from 266 children (138 boys and 128 girls who lost a tooth between 11 and 13 years of age. The molars were analyzed for metals using ICP-OES. The third grade teacher of each child completed the Teacher’s Disruptive Behavior Disorders Rating Scale (DBD to produce a score for “Total Disruptive Behavior” and subscale scores for “Attention Deficit Hyperactivity Disorder”, Hyperactivity/Impulsivity, Inattention, and Oppositional/Defiant. The mean Mn, Fe, Pb and Ca concentrations found in teeth was 6.1 ± 5.7 µg/g, 22.7 ± 24.1 µg/g, 0.9 ± 1.4 µg/g, and 6.0 × 105 ± 1.6 × 105 µg/g, respectively. Hg was not detected. No significant association was found between Mn and behavioral deficits. Ca was significantly negatively associated, and Pb showed a significant positive association with Hyperactivity/Impulsivity, Inattention, and Oppositional/Defiant Disorders. These findings call into question the putative independent association of manganese exposure and behavioral deficits in children, when the balance of other metallic burden, particularly Ca and Pb burdens play significant roles.

The association of living conditions and lifestyle factors with burden of cysts among neurocysticercosis patients in Ecuador.

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Kelvin, Elizabeth A; Yung, Janette; Fong, Man Wah; Carpio, Arturo; Bagiella, Emilia; Leslie, Denise; Leon, Pietro; Andrews, Howard; Allen Hauser, W

2012-12-01

We used baseline data on 154 symptomatic neurocysticercosis (NCC) patients in Ecuador to identify predictors of the burden of cysts. We ran logistic regression models with the burden of cysts as the outcome, defined as the number of cysts in the brain (1 vs >1), and having cysts in all 3 phases of evolution (active, transitional and calcifications) vs restaurants or street vendors, working in a manual labour job. We found that the odds of having multiple NCC cysts was higher among those working in manual labour (OR=3.5, p=0.004), and those who ate most meals outside the home had higher odds of having cysts in all 3 phases (OR=5.0, p=0.007). Burden of cysts may be a useful outcome when looking to identify exposure risk factors in the absence of an uninfected control group. Copyright © 2012 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Systematic review of general burden of disease studies using disability-adjusted life years

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Polinder Suzanne

2012-11-01

Full Text Available Abstract Objective To systematically review the methodology of general burden of disease studies. Three key questions were addressed: 1 what was the quality of the data, 2 which methodological choices were made to calculate disability adjusted life years (DALYs, and 3 were uncertainty and risk factor analyses performed? Furthermore, DALY outcomes of the included studies were compared. Methods Burden of disease studies (1990 to 2011 in international peer-reviewed journals and in grey literature were identified with main inclusion criteria being multiple-cause studies that quantified the burden of disease as the sum of the burden of all distinct diseases expressed in DALYs. Electronic database searches included Medline (PubMed, EMBASE, and Web of Science. Studies were collated by study population, design, methods used to measure mortality and morbidity, risk factor analyses, and evaluation of results. Results Thirty-one studies met the inclusion criteria of our review. Overall, studies followed the Global Burden of Disease (GBD approach. However, considerable variation existed in disability weights, discounting, age-weighting, and adjustments for uncertainty. Few studies reported whether mortality data were corrected for missing data or underreporting. Comparison with the GBD DALY outcomes by country revealed that for some studies DALY estimates were of similar magnitude; others reported DALY estimates that were two times higher or lower. Conclusions Overcoming “error” variation due to the use of different methodologies and low-quality data is a critical priority for advancing burden of disease studies. This can enlarge the detection of true variation in DALY outcomes between populations or over time.

Sharply Reduced but Still Heavy Self-Harm Burdens in Hubei Province, China, 1990–2015

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Jingju Pan

2018-02-01

Full Text Available The aims of this study were to describe fatal and non-fatal self-harm burdens, as well as burdens from the main preventable risk factors, and to investigate the different suicide methods in Hubei province in central China utilizing data from both Global Burden of Disease Study 2015 and Hubei Disease Surveillance Points system. All self-harm burdens including mortality, years of life lost (YLLs, prevalence, years lived with disability (YLDs, and disability adjusted life-years (DALYs consistently demonstrated downward trends in Hubei from 1990 to 2015, with a bigger decline gap observed among females and narrower decreasing amplitudes among the elderly. Hubei experienced much higher age-standardized rates for self-harm mortality (22.0 per 100,000, YLLs (560.1 per 100,000 and DALYs (563.9 per 100,000 than the national (9.0, 292.3 and 295.0 per 100,000 respectively and global levels (11.5, 453.3 and 457.9 per 100,000 respectively in 2015. Self-harm burdens have begun shifting from females to males and the elderly suffered more self-harm burdens than other age groups. Alcohol use accounted for 20.9% of all self-harm DALYs for males, whereas intimate partner violence accounted for 24.4% of all self-harm DALYs for females. Poisoning, mainly pesticide self-poisoning, was still the most common method of suicide. Effective interventions by multi-sectoral collaboration are urgently needed to reduce the alarmingly heavy self-harm burdens in Hubei.

12 CFR 508.10 - Burden of persuasion.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Burden of persuasion. 508.10 Section 508.10 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY REMOVALS, SUSPENSIONS, AND PROHIBITIONS WHERE A CRIME IS CHARGED OR PROVEN § 508.10 Burden of persuasion. The petitioner has the burden of...

A step forward for understanding the morbidity burden in Guinea: a national descriptive study

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Hu Guoqing

2011-06-01

Full Text Available Abstract Background Little evidence on the burden of disease has been reported about Guinea. This study was conducted to demonstrate the morbidity burden in Guinea and provide basic evidence for setting health priorities. Methods A retrospective descriptive study was designed to present the morbidity burden of Guinea. Morbidity data were extracted from the National Health Statistics Report of Guinea of 2008. The data are collected based on a pyramid of facilities which includes two national hospitals (teaching hospitals, seven regional hospitals, 26 prefectural hospitals, 8 communal medical centers, 390 health centers, and 628 health posts. Morbidity rates were calculated to measure the burden of non-fatal diseases. The contributions of the 10 leading diseases were presented by sex and age group. Results In 2008, a total of 3,936,599 cases occurred. The morbidity rate for males was higher than for females, 461 versus 332 per 1,000 population. Malaria, respiratory infections, diarrheal diseases, helminthiases, and malnutrition ranked in the first 5 places and accounted for 74% of the total burden, respectively having a rate of 148, 64, 33, 32, and 14 per 1,000 population. The elderly aged 65+ had the highest morbidity rate (611 per 1,000 population followed by working-age population (458 per 1,000 population and children (396 per 1,000 population while the working-age population aged 25-64 contributed the largest part (39% to total cases. The sex- and age-specific spectrum of morbidity burden showed a similar profile except for small variations. Conclusion Guinea has its unique morbidity burden. The ten leading causes of morbidity burden, especially for malaria, respiratory infections, diarrheal diseases, helminthiases, and malnutrition, need to be prioritized in Guinea.

[Burden of salmonellosis and shigellosis in four departments of Guatemala, 2010].

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Díaz, Sheilee L; Jarquin, Claudia; Morales, Ana Judith; Morales, Melissa; Valenzuela, Claudia

2015-10-01

Estimate the burden of disease from Salmonella spp. and Shigella spp. in four departments of Guatemala in 2010. Burden of disease study based on document analysis of published population surveys, laboratory files, and surveillance data from the Health Management Information System (SIGSA) in four departments of Guatemala: Huehuetenango, Jutiapa, Quetzaltenango, and Santa Rosa, in 2010. Information was supplemented by a laboratory survey. Burden of disease was estimated using methodology adapted by the World Health Organization from the United States Centers for Disease Control and Prevention. Surveillance data yielded 72 salmonellosis and 172 shigellosis cases. According to population surveys, the percentage of the population that consults health services for diarrhea is 64.7% (95% CI: 60.6%-68.7%) in Quetzaltenango and 61.0% (95% CI: 56.0%-66.0%) in Santa Rosa. In the 115 laboratories that answered the survey (72.8% response rate), 6 051 suspected samples were collected for stool culture and 3 290 for hemoculture; 39.4% and 100.0% of them were processed, respectively. In all, 85 Salmonella spp. and 113 Shigella spp. strains were isolated. For each reported case of salmonellosis and shigellosis, it was estimated that 40 cases are not reported in Quetzaltenango, 55 in Huehuetenango, 345 in Santa Rosa, and 466 in Jutiapa. Estimated burden of disease ranged from 5 to 2 230 cases per 100 000 population for salmonellosis and from 60 to 1 195 cases per 100 000 population for shigellosis. Salmonellosis and shigellosis are a major public health problem in the departments studied and in Guatemala. Burden of disease from these pathogens is higher than that reported by SIGSA.

Economic burden of underweight and overweight among adults in the Asia-Pacific region: a systematic review.

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Hoque, Mohammad Enamul; Mannan, Munim; Long, Kurt Z; Al Mamun, Abdullah

2016-04-01

To assess the economic burden of underweight and overweight among adults in the Asia-Pacific region. Systematic review of articles published until March 2015. Seventeen suitable articles were found, of which 13 assess the economic burden of overweight/obesity and estimate that it accounts for 1.5-9.9% of a country's total healthcare expenditure. Four articles on the economic burden of underweight estimate it at 2.5-3.8% of the country's total GDP. Using hospital data, and compared to normal weight individuals, four articles estimated extra healthcare costs for overweight individuals of 7-9.8% and more, and extra healthcare costs for obese individuals of 17-22.3% and higher. Despite methodological diversity across the studies, there is a consensus that both underweight and overweight impose a substantial financial burden on healthcare systems in the Asia-Pacific region. © 2016 John Wiley & Sons Ltd.

Burden of childhood-onset arthritis

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Hassett Afton L

2010-07-01

Full Text Available Abstract Juvenile arthritis comprises a variety of chronic inflammatory diseases causing erosive arthritis in children, often progressing to disability. These children experience functional impairment due to joint and back pain, heel pain, swelling of joints and morning stiffness, contractures, pain, and anterior uveitis leading to blindness. As children who have juvenile arthritis reach adulthood, they face possible continuing disease activity, medication-associated morbidity, and life-long disability and risk for emotional and social dysfunction. In this article we will review the burden of juvenile arthritis for the patient and society and focus on the following areas: patient disability; visual outcome; other medical complications; physical activity; impact on HRQOL; emotional impact; pain and coping; ambulatory visits, hospitalizations and mortality; economic impact; burden on caregivers; transition issues; educational occupational outcomes, and sexuality. The extent of impact on the various aspects of the patients', families' and society's functioning is clear from the existing literature. Juvenile arthritis imposes a significant burden on different spheres of the patients', caregivers' and family's life. In addition, it imposes a societal burden of significant health care costs and utilization. Juvenile arthritis affects health-related quality of life, physical function and visual outcome of children and impacts functioning in school and home. Effective, well-designed and appropriately tailored interventions are required to improve transitioning to adult care, encourage future vocation/occupation, enhance school function and minimize burden on costs.

Patient Perception of Treatment Burden is High in Celiac Disease Compared to Other Common Conditions

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Shah, Sveta; Akbari, Mona; Vanga, Rohini; Kelly, Ciaran P.; Hansen, Joshua; Theethira, Thimmaiah; Tariq, Sohaib; Dennis, Melinda; Leffler, Daniel A.

2014-01-01

Introduction The only treatment for celiac disease (CD) is life-long adherence to a gluten-free diet (GFD). Noncompliance is associated with signs and symptoms of celiac disease, yet long-term adherence rates are poor. It is not known how the burden of the GFD compares to other medical treatments, and there are limited data on the socio-economic factors influencing treatment adherence. In this study we compared treatment burden and health state in CD compared with other chronic illnesses and evaluated the relationship between treatment burden and adherence. Methods A survey was mailed to participants with: CD, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), and end stage renal disease on dialysis (ESRD). Surveys included demographic information and visual analog scales measuring treatment burden, importance of treatment, disease-specific and overall health status. Results We collected surveys from 341 celiac and 368 non-celiac participants. Celiac participants reported high treatment burden, greater than participants with GERD or HTN and comparable to ESRD. Conversely, patients with CD reported the highest health state of all groups. Factors associated with high treatment burden in CD included poor adherence, concern regarding food cost, eating outside the home, higher income, lack of college education and time limitations in preparing food. Poor adherence in CD was associated with increased symptoms, income, and low perceived importance of treatment. Discussion Participants with CD have high treatment burden but also excellent overall health status in comparison with other chronic medical conditions. The significant burden of dietary therapy for celiac disease argues for the need for safe adjuvant treatment as well as interventions designed to lower the perceived burden of the GFD. PMID:24980880

Examination of some chelating agents to decorporate fixed body-burdens of cadmium

International Nuclear Information System (INIS)

Jones, C.W.; Lloyd, R.D.; Mays, C.W.

1979-01-01

Male and female C57BL/Do mice, five to six months old, were injected intraperitoneally with 2.0 mg/kg cadmium citrate labeled with about 2.0 μCi 109 Cd per mouse. Three days after cadmium injection, male mice were injected subcutaneously with 2,3 dimercaptopropanesulfonate (DMPS), and female mice were injected subcutaneously with calcium disodium ethylenediaminetetra-acetate (CaEDTA), salicylic acid (SA), or 2,3 dimercaptopropanesulfonate, alone, or in combination. A total of four treatment injections were administered to each group of mice. Cadmium total-body retention was measured by in vivo counting using NaI(T1) spectrometry. Male mice given DMPS, and groups of females given EDTA, SA, EDTA + DMPS, EDTA + SA, or EDTA + DMPS + SA had total-body retentions of cadmium no different from saline controls (P > 0.05). Measurement of cadmium content in kidneys, livers, gonads, and femora excised from test animals also showed no difference from corresponding organs in control animals

The influence of medical burden severity and cognition on functional competence in older community-dwelling individuals with schizophrenia.

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Tsoutsoulas, Christopher; Mulsant, Benoit H; Kalache, Sawsan M; Kumar, Sanjeev; Ghazala, Zaid; Voineskos, Aristotle N; Butters, Meryl A; Menon, Mahesh; Rajji, Tarek K

2016-02-01

Cognition predicts functional competence among individuals with schizophrenia across the lifespan. However, as these individuals age, increasing levels of medical burden may also contribute to functional deficits both directly and indirectly through cognition. Thus, we assessed the relationship among, cognition, medical burden, and functional competence in older individuals with schizophrenia. We analyzed data obtained from 60 community-dwelling participants with schizophrenia and 30 control participants aged 50 or above. Cognition was assessed using the MATRICS Consensus Cognitive Battery (MCCB), functional competence was assessed using the USCD Performance-Based Skills Assessment (UPSA), and medical burden was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Group differences were assessed using independent samples t-tests or chi-square tests. Mediation analyses using bootstrapping techniques were used to assess whether cognition mediated the effects of medical burden on functional competence. Participants with schizophrenia had higher levels of medical burden, cognitive deficits, and functional impairments. In participants with schizophrenia, cognition, but not medical burden, predicted functional competence after adjusting for age, education, gender, clinical symptoms, and anticholinergic burden of medications. In control participants, cognition and medical burden both predicted functional competence after adjusting for age, education, and gender. Further, cognition was found to fully mediate the association between medical burden and functional competence in control participants. Cognition is a robust predictor of functional competence among older individuals with schizophrenia, regardless of medical burden. Cognitive deficits associated with schizophrenia may mask any further cognitive impairment associated with medical burden and its impact on function. Copyright © 2015 Elsevier B.V. All rights reserved.

Economic burden of stroke in a large county in Sweden

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Persson Josefine

2012-09-01

Full Text Available Abstract Background Stroke remains to be a major burden of disease, often causing death or physical impairment or disability. This paper estimates the economic burden of stroke in a large county of 1.5 million inhabitants in western Sweden. Methods The economic burden of stroke was estimated from a societal perspective with an incidence approach. Data were collected from clinical registries and 3,074 patients were included. In the cost calculations, both direct and indirect costs were estimated and were based on costs for 12 months after a first-ever stroke. Results The total excess costs in the first 12 months after the first-ever stroke for a population of 1.5 million was 629 million SEK (€69 million. Men consumed more acute care in hospitals, whereas women consumed more rehabilitation and long-term care provided by the municipalities. Younger patients brought a significantly higher burden on society compared with older patients due to the loss of productivity and the increased use of resources in health care. Conclusions The results of this cost-of-illness study were based on an improved calculation process in a number of fields and are consistent with previous studies. In essence, 50% of costs for stroke care fall on acute care hospital, 40% on rehabilitation and long-time care and informal care and productivity loss explains 10% of total cost for the stroke disease. The result of this study can be used for further development of the methods for economic analyses as well as for analysis of improvements and investments in health care.

Comprehensive Geriatric Assessment (CGA) based risk factors for increased caregiver burden among elderly Asian patients with cancer.

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Rajasekaran, Tanujaa; Tan, Tira; Ong, Whee Sze; Koo, Khai Nee; Chan, Lili; Poon, Donald; Roy Chowdhury, Anupama; Krishna, Lalit; Kanesvaran, Ravindran

2016-05-01

This study aims to identify Comprehensive Geriatric Assessment (CGA) based risk factors to help predict caregiver burden among elderly patients with cancer. The study evaluated 249 patients newly diagnosed with cancer, aged 70years and above, who attended the geriatric oncology clinic at the National Cancer Centre Singapore between 2007 and 2010. Out of 249 patients, 244 patients had information available on family caregiver burden and were analysed. On univariate analysis, ADL dependence, lower IADL scores, ECOG performance status of 3-4, higher fall risk, lower scores in dominant hand grip strength test and mini mental state examination, polypharmacy, higher nutritional risk, haemoglobin geriatric syndromes were significantly associated with mild to severe caregiver burden. On multivariate analysis, only ECOG performance status of 3-4 (odds ratio [OR], 4.47; 95% confidence interval [CI], 2.27-8.80) and haemoglobin patients were stratified into 3 risk groups with different proportion of patients with increased caregiver burden (low risk: 3.9% vs intermediate risk: 18.8% vs high risk: 39.6%; ppatients with cancer. Using these two factors in the clinic may help clinicians identify caregivers at risk and take preventive action to mitigate that. Copyright © 2016 Elsevier Inc. All rights reserved.

Gastroesophageal reflux disease burden in Iran.

Science.gov (United States)

Delavari, Alireza; Moradi, Ghobad; Elahi, Elham; Moradi-Lakeh, Maziar

2015-02-01

Gastroesophageal reflux disease is one of the most common disorders of the gastrointestinal tract. The prevalence of this disease ranges from 5% to 20% in Asia, Europe, and North America. The aim of this study was to estimate the burden of gastroesophageal reflux disease in Iran. Burden of gastroesophageal reflux disease in Iran was estimated for one year from 21 March 2006 to 20 March 2007. The definition was adjusted with ICD-code of K21. Incident-based disability-adjusted life year (DALY) was used as the unit of analysis to quantify disease burden. A simplified disease model and DisMod II software were used for modeling. The annual incidence for total population of males and females in Iran was estimated 17.72 and 28.06 per 1000, respectively. The average duration of gastroesophageal reflux disease as a chronic condition was estimated around 10 years in both sexes. Total DALYs for an average of 59 symptomatic days per year was estimated 153,554.3 (60,330.8 for males and 93,223.5 for females).   The results of this study showed that reflux imposes high burden and high financial costs on the Iranian population. The burden of this disease in Iran is more similar to that of European countries rather than Asian countries. It is recommended to consider the disease as a public health problem and make decisions and public health plans to reduce the burden and financial costs of the disease in Iran.

Dietary treatment for decreasing /sup 141/Ce body burden in immature rats

Energy Technology Data Exchange (ETDEWEB)

Kargacin, B; Kostial, K; Landeka, M

1987-02-01

The purpose of this work was to evaluate the effect of prolonged (immediate or delayed) administration of dietary additives to suckling rats on the absorption and retention of radioactive cerium in the body. The experiment was performed on 6-day-old suckling rats. According to dietary treatment the animals were divided into three groups. Each group was artificially fed over 8 h for 6 or 12 days on one of the diets: the first group of animals was fed milk, the second group was given ingredients of rat diet and the third received milk during the first 2 days of the experiment and the ingredients of rat diet afterwards. At the end of the artificial feeding period the pups returned to their mothers and suckled overnight. On the 1st day of the experiment the food was labelled with /sup 141/Ce. Whole body radioactivity was determined in a double crystal scintillation counter every 48 h over a 12-day period. Half of the animals from each group were killed 6 days after /sup 141/Ce administration and the other half after 12 days. At these intervals retention was determined in the gut, liver, kidneys and femur. The early and delayed administration of rat diet ingredients - fish meal, sunflower meal, alfalfa, cane molasses and premix - greatly reduced whole body retention. The early treatment was more efficacious than the delayed one. The reduction was mostly due to decreased gut retention but organ retentions were also lower. The results obtained indicate that by prolonged (immediate or delayed) administration of some dietary means the retention of radioactive cerium in sucklings can be significantly decreased.

[Quality of life of caregivers for patients of cerebrovascular accidents: association of (socio-demographic) characteristics and burden].

Science.gov (United States)

Costa, Tatiana Ferreira da; Costa, Kátia Nêyla de Freitas Macêdo; Fernandes, Maria das Graças Melo; Martins, Kaisy Pereira; Brito, Silmery da Silva

2015-04-01

Investigating the association between quality of life with socio-demographic characteristics and the burden of caregivers for individuals with cerebrovascular accident sequelae. A descriptive, cross-sectional study with a sample composed of 136 caregivers. For data collection, a semi-structured questionnaire, the Barthel, Burden Interview and Short-Form-36 scales were used. Correlation analysis, t-Student test and F-test were used for the analysis in order to compare averages. Significant averages in quality of life were demonstrated in association with female caregivers and those over 60 years in the field 'functional capacity,' and in the domains of 'mental health' and 'vitality' for those with higher income. Regarding burden association, the highlighted areas were 'functional capacity,' 'physical aspects,' 'emotional aspects' and 'pain.' The creation of public policies and social support to effectively reduce the burden on caregivers is a necessity.

Body dissatisfaction and the wish for different silhouette is associated with higher adiposity and fat intake in female ballet dancers than male.

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Da Silva, Camila Lacerda; De Oliveira, Erick Prado; De Sousa, Maysa Vieira; Pimentel, Gustavo D

2016-01-01

It is known that behavioral disorders and altered food intake are linked to ballet dancers. Thus, the aim of the present study was to investigate the body composition, dietetic profile, self-perceived body image and social desirability in professional ballet dancers. This study was conducted from April to October 2010 in athletes screened for nutritional evaluation. Anthropometric, dietary, social desirability and self-perceived body image evaluation were performed to attend the aim of study. We found that ballet dancers are highly trained and eutrophic, although female dancers had higher adiposity and fat intake than male dancers. In addition, it was observed low consumption of calcium, dietary fiber, potassium, magnesium and vitamin A. Moreover, 30% of male ballet dancers have a strong desire for social acceptance. When the body image was evaluated by Body Shape Questionnaire (BSQ), was reported that 40% of the ballet female dancers have of moderate to severe alteration in body image and 20% of male dancers had slight alteration. Furthermore, the Drawings and Silhouettes Scale showed that 80% of male dancers wish to have a smaller or larger silhouette than the current self-perceived and 60% of the female dancers would like to have a silhouette lower than the self-perceive as current. Collectively, our results shown that most of the dancers were eutrophic, but female athletes have higher adiposity and present strong desire for a different shape of current. Furthermore, was found increased fat intake in female group; however, deficiencies in consumption of dietary fiber, calcium, potassium, magnesium and vitamin A were found in both gender.

Nerve Sheath Tumors in Neurofibromatosis Type 1: Assessment of Whole-Body Metabolic Tumor Burden Using F-18-FDG PET/CT.

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Johannes Salamon

Full Text Available To determine the metabolically active whole-body tumor volume (WB-MTV on F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT in individuals with neurofibromatosis type 1 (NF1 using a three-dimensional (3D segmentation and computerized volumetry technique, and to compare PET WB-MTV between patients with benign and malignant peripheral nerve sheath tumors (PNSTs.Thirty-six NF1 patients (18 patients with malignant PNSTs and 18 age- and sex-matched controls with benign PNSTs were examined by F-18-FDG PET/CT. WB-MTV, whole-body total lesion glycolysis (WB-TLG and a set of semi-quantitative imaging-based parameters were analyzed both on a per-patient and a per-lesion basis.On a per-lesion basis, malignant PNSTs demonstrated both a significantly higher MTV and TLG than benign PNSTs (p < 0.0001. On a per-patient basis, WB-MTV and WB-TLG were significantly higher in patients with malignant PNSTs compared to patients with benign PNSTs (p < 0.001. ROC analysis showed that MTV and TLG could be used to differentiate between benign and malignant tumors.WB-MTV and WB-TLG may identify malignant change and may have the potential to provide a basis for investigating molecular biomarkers that correlate with metabolically active disease manifestations. Further evaluation will determine the potential clinical impact of these PET-based parameters in NF1.

Modeling the Health and Economic Burden of Hepatitis C Virus in Switzerland.

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Müllhaupt, Beat; Bruggmann, Philip; Bihl, Florian; Blach, Sarah; Lavanchy, Daniel; Razavi, Homie; Semela, David; Negro, Francesco

2015-01-01

Chronic hepatitis C virus infection is a major cause of liver disease in Switzerland and carries a significant cost burden. Currently, only conservative strategies are in place to mitigate the burden of hepatitis C in Switzerland. This study expands on previously described modeling efforts to explore the impact of: no treatment, and treatment to reduce HCC and mortality. Furthermore, the costs associated with untreated HCV were modeled. Hepatitis C disease progression and mortality were modeled. Baseline historical assumptions were collected from the literature and expert interviews and strategies were developed to show the impact of different levels of intervention (improved drug cure rates, treatment and diagnosis) until 2030. Under the historical standard of care, the number of advanced stage cases was projected to increase until 2030, at which point the annual economic burden of untreated viremic infections was projected to reach €96.8 (95% Uncertainty Interval: €36 - €232) million. Scenarios to reduce HCV liver-related mortality by 90% by 2030 required treatment of 4,190 ≥F2 or 3,200 ≥F3 patients annually by 2018 using antivirals with a 95% efficacy rate. Delaying the implementation of these scenarios by 2 or 5 years reduced the impact on mortality to 75% and 57%, respectively. With today's treatment efficacy and uptake rates, hepatitis C disease burden is expected to increase through 2030. A substantial reduction in disease burden can be achieved by means of both higher efficacy drugs and increased treatment uptake. However, these efforts cannot be undertaken without a simultaneous effort to diagnose more infections.

Projections of global mortality and burden of disease from 2002 to 2030.

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Mathers, Colin D; Loncar, Dejan

2006-11-01

Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. Relatively simple models were used to project future health trends under three scenarios-baseline, optimistic, and pessimistic-based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which

Projections of global mortality and burden of disease from 2002 to 2030.

Directory of Open Access Journals (Sweden)

Colin D Mathers

2006-11-01

Full Text Available BACKGROUND: Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. METHODS AND FINDINGS: Relatively simple models were used to project future health trends under three scenarios-baseline, optimistic, and pessimistic-based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs

Projections of Global Mortality and Burden of Disease from 2002 to 2030

Science.gov (United States)

Mathers, Colin D; Loncar, Dejan

2006-01-01

Background Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. Methods and Findings Relatively simple models were used to project future health trends under three scenarios—baseline, optimistic, and pessimistic—based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012

An experimental test on large animals of MCNP application for whole body counting

International Nuclear Information System (INIS)

Borisov, N.; Yatsenko, V.; Kochetkov, O.; Gusev, I.; Vlasov, P.; Kalistratova, V.; Nisimov, P.; Levochkin, F.; Borovkov, M.; Stolyarov, V.; Tsedish, S.; Tyurin, I.; Franck, D.; Carlan, L. de

2005-01-01

Measurements of actinide body burden using whole body counting spectrometry is hampered due to intensive absorption of γ-rays inside the patient's body, which depends on the anatomy of a patient. To establish the correspondence between pulse-height-spectra intensity and radionuclide activity, Monte Carlo calculations are widely used. For such calculations, the radiation transport geometry is usually described in terms of small rectangular boxes (voxels) retrieved from computed tomography or magnetic resonance images. The software for Monte Carlo-assisted calibration of whole body counting, which performs automatic creation of individual MCNP voxel phantoms, was checked in a quasi-in vivo experiment on large animals. During the experiment, pigs of 35-40 kg body mass were used as phantoms for measurement of actinides body burden. 241 Am was administered (via injection of a radioactive solution or via implantation of plastic capsules containing the radioactive material) into the lungs of pigs. The pigs were measured using the pure germanium low-energy γ-spectrometers. The images of animals were obtained using the computed tomography machine. On the base of these tomograms, MCNP4c2 calculations were done to obtain the pulse-height-spectra of the whole body counters. The experimental results were reproduced in calculations with error of less than 30% for 241 Am administered via injection and less than 10% for 241 Am administered inside the capsules. (authors)

Economic burden of malaria in rural Tanzania: variations by socioeconomic status and season.

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Somi, Masha F; Butler, James R G; Vahid, Farshid; Njau, Joseph D; Kachur, S Patrick; Abdulla, Salim

2007-10-01

To determine the economic burden of malaria in a rural Tanzanian setting and identify any differences by socioeconomic status and season. Interviews of 557 households in south eastern Tanzania between May and December 2004, on consumption and malaria-related costs. Malaria-related expenses were significantly higher in the dry, non-malarious season than in the rainy season. Households sought treatment more frequently and from more expensive service providers in the dry season, when they have more money. Malaria expenses did not vary significantly across socioeconomic status quintiles, but poorer households spent a higher proportion of their consumption in both seasons. Poorer households bear a greater economic burden from malaria relative to their consumption than better-off households. Households are particularly vulnerable to malaria in the rainy season, when malaria prevalence is highest but liquidity is lower. Alternative strategies to assist households to cope with seasonal liquidity issues, including insurance, should be investigated.

Cultural differences are reflected in variables associated with carer burden in FTD: a comparison study between India and Australia

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Mekala, Shailaja; Alladi, Suvarna; Chandrasekar, Kammammettu; Fathima, Safiya; M.O.'Connor, Claire; McKinnon, Colleen; Hornberger, Michael; Piguet, Olivier; Hodges, John R.; Mioshi, Eneida

2013-01-01

There is great need to understand variables behind carer burden, especially in FTD. Carer burden is a complex construct, and its factors are likely to vary depending on the type of dementia, carer characteristics and cultural background. OBJECTIVE The present study aimed to compare profiles and severity of carer burden, depression, anxiety and stress in carers of FTD patients in India in comparison to Australia; to investigate which carer variables are associated with carer burden in each country. METHODS Data of 138 participants (69 dyads of carers-patients) from India and Australia (India, n=31; Australia, n=38). Carer burden was assessed with the short Zarit Burden Inventory; carer depression, anxiety and stress were measured with the Depression, Anxiety and Stress-21. Dementia severity was determined with the Frontotemporal Dementia Rating Scale (FTD-FRS), and a range of demographic variables regarding the carer and patient were also obtained. RESULTS Overall, levels of carer burden were not significantly different across India and Australia, despite more hours delivering care and higher dementia severity in India. Variables associated with burden, however, differed between countries, with carer depression, anxiety and stress strongly associated with burden in India. By contrast, depression, stress, and dementia severity were associated with burden in Australia. CONCLUSION This study demonstrated that variables associated with carer burden in FTD differ between cultures. Consequently, cultural considerations should be taken into account when planning for interventions to reduce burden. This study suggests that addressing carers' skills and coping mechanisms are likely to result in more efficacious outcomes than targeting patient symptoms alone. PMID:29213826

Contribution of cardiac and extra-cardiac disease burden to risk of cardiovascular outcomes varies by ejection fraction in heart failure

DEFF Research Database (Denmark)

Wolsk, Emil; Claggett, Brian; Køber, Lars

2018-01-01

AIMS: Patients with heart failure (HF) often have multiple co-morbidities that contribute to the risk of adverse cardiovascular (CV) and non-CV outcomes. We assessed the relative contribution of cardiac and extra-cardiac disease burden and demographic factors to CV outcomes in HF patients...... Association class, systolic blood pressure, time since HF diagnosis, HF medication use), extra-cardiac (body mass index, creatinine, diabetes mellitus, chronic obstructive pulmonary disease, smoker), and demographic (age, gender) categories, and calculated subscores for each patient representing the burden......EF patients (PAR: 76% cardiac disease vs. 58% extra-cardiac disease, P vs. 49% extra-cardiac disease, P

Self-stigma, insight, and family burden among Israeli mothers of people with serious mental illness: Ethno-national considerations.

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Zisman-Ilani, Yaara; Hasson-Ohayon, Ilanit; Levy-Frank, Itamar; Tuval-Mashiach, Rivka; Roe, David

2017-06-01

The current cross-sectional study investigated and compared the associations between insight, self-stigma, and family burden among Jewish and Arab mothers of an adult son or daughter with serious mental illness (SMI) in Israel. A total of 162 Israeli mothers of a person with SMI participated in the study; 95 were Jewish (58.6%), and 67 were Arab (41.4%). Insight, self-stigma, and family burden scales were administered. Jewish mothers reported higher levels of insight into their son's or daughter's illness and reported greater family burden compared to Arab mothers. No significant differences in self-stigma scores were found between Jewish and Arab mothers. The pattern of associations between insight, self-stigma, and burden differed between Jewish and Arab mothers. Self-stigma was found to mediate the relationship between insight and burden among Jewish mothers but not among Arab mothers. Ethno-national affiliation should be taken into consideration regarding how family members conceptualize and experience mental illness, as this might affect care.

BURDEN AND QUALITY OF LIFE– A COMPARISON OF THOSE CARING FOR PSYCHIATRICALLY ILL AND MEDICALLY ILL

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Shweta Rupendu

2018-02-01

Full Text Available BACKGROUND Despite epidemiological transitions, communicable diseases are widely prevalent world over, concomitantly non-communicable diseases are also on the rise. Mental and behavioural disorders account for 12% of the global burden of disease. Caregiving for both groups of patients, rests with an identified primary caregiver. Caregiving lays a great deal of burden on the caregiver, adversely affecting his quality of life. These factors influence the quality of caregiving, and thereby the long-term well-being of the patient. Differences between the two groups of caregivers has not been studied, more so in the Indian context. MATERIALS AND METHODS 60 caregivers of psychiatrically ill and 63 caregivers of the medically ill were studied. Burden of care was assessed using Elmstahl burden scale, and quality of life (QOL using WHOQOL BREF. RESULTS The socio demographic profile of both groups was similar. All subjects experienced a burden of care, with those caring for the psychiatrically ill experiencing a greater burden. QOL was poorer in the care givers of the psychiatrically ill, especially in those married, employed, and in a lower income group. The female care giver, mostly the spouse, experienced a greater burden of care and a poorer QOL. CONCLUSION Chronicity, stigma, poor insight and disabling dependence of the psychiatrically ill, are probably contributory. A higher caregiver burden and a lower QOL will influence quality of caregiving, and have an adverse effect on the course and prognosis of the illness. There is thus a need for routine assessment of the caregiver, and planned intervention for the same.

The Effect of Cancer Patients' and Their Family Caregivers' Physical and Emotional Symptoms on Caregiver Burden.

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Johansen, Safora; Cvancarova, Milada; Ruland, Cornelia

Although there is significant evidence that the family caregivers (FCs) of cancer patients can experience significant caregiver burden and symptoms, less is known about the relationships between FCs and patient characteristics that influence caregiver burden. The purpose of this study was to examine the effect of cancer patients' and FCs' symptoms and demographic characteristics on caregiver burden at initiation of the patients' radiation treatment. Two hundred eighty-one dyads of FCs and cancer patients who received a diagnosis of breast, prostate, melanoma, lymphoma, and head and neck cancers were recruited at the beginning of the patients' radiation treatment. Measures of depression, sleep disturbance, fatigue, social support, and self-efficacy were obtained from both FCs and cancer patients. The family caregivers were also assessed for caregiver burden. Associations between patients' and caregivers' symptoms and demographic characteristics and caregiver burden were investigated using multivariate analyses. There were significant associations between caregiver burden and the patient-related variables such as self-efficacy (P = .02), sleep disturbance (P = .03), and social support (P = .04). Among FC-related variables, higher scores of depression (P caregiver burden. Being a female, either as a patient or FC, increased the likelihood of experiencing fatigue and sleep disturbance. Caregiver burden in FCs is influenced by interplay of patients' and their own symptoms and problems. These interdependencies exist from the beginning of treatment. Nurses should systematically assess the problems and symptoms of the patients and FCs and support them from the time of diagnosis to help prevent symptom development and deterioration.

Caregiver burden of Mexican dementia patients: the role of dysexecutive syndrome, sleep disorders, schooling and caregiver depression.

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Rosas-Carrasco, Óscar; Guerra-Silla, María de Guadalupe; Torres-Arreola, Laura Del Pilar; García-Peña, Carmen; Escamilla-Jiménez, Cristopher Isaac; González-González, César

2014-01-01

As a result of the accelerated growth of the elderly population, reconfiguration of families and member roles, and the increase of mental disorders, it is necessary to investigate the effects of this set of factors on the caregivers of patients with dementia in Mexico. Mental disorders of individuals have a negative impact on their physical and emotional quality of life, leading to greater dependence and making the caring experience a heavy burden. Several studies (none in Mexico) have used either the characteristics of the patient or caregiver to determine the burden, but few studies have included both profiles within a single study. The objective of the present study was to analyze the characteristics of the patients and caregivers associated with caregiver burden. A multicenter study was carried out in six health institutions located in Mexico City, including 175 patients (and their caregivers) diagnosed with different types of dementia. We used the Spanish Caregiver Burden Screen. Descriptive analysis and logistic regressions were used to estimate the effect of the covariates on the caregiver burden. The results showed that patient variables have a greater impact on caregiver burden than caregiver-associated variables. Dysexecutive syndrome, sleep disorders, schooling and caregiver depression are associated with a higher level of caregiver burden. Caregiver burden is a complex phenomenon. The results of the present study showed the need to implement multifactorial interventions targeting the caregiver to reduce the burden, strengthen the skills for patient management to avoid depression, improve patient health, and diminish functional dependence and future hospitalization. © 2013 Japan Geriatrics Society.

Burden of emergency conditions and emergency care utilization: New estimates from 40 countries

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Chang, Cindy Y.; Abujaber, Samer; Reynolds, Teri A.; Camargo, Carlos A.; Obermeyer, Ziad

2016-01-01

Objective To estimate the global and national burden of emergency conditions, and compare them to emergency care utilization rates. Methods We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care utilization rates were obtained from a systematic literature review on emergency care facilities in low- and middle-income countries (LMICs), supplemented by national health system reports. Findings All 15 leading causes of death and DALYs globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency utilization. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47,728 per 100,000 population (IQR 45,253-50,085) in low-income, 25,186 (IQR 21,982-40,480) in middle-income, and 15,691 (IQR 14,649-16,382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency utilization rates were the lowest in low-income countries, with median 8 visits per 1,000 population (IQR 6-10), 78 (IQR 25-197) in middle-income, and 264 (IQR 177-341) in high-income countries. Conclusion Despite higher burden of emergency conditions, emergency utilization rates are substantially lower in LMICs, likely due to limited access to emergency care. PMID:27334758

A high-glycemic diet is associated with cerebral amyloid burden in cognitively normal older adults.

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Taylor, Matthew K; Sullivan, Debra K; Swerdlow, Russell H; Vidoni, Eric D; Morris, Jill K; Mahnken, Jonathan D; Burns, Jeffrey M

2017-12-01

Background: Little is known about the relation between dietary intake and cerebral amyloid accumulation in aging. Objective: We assessed the association of dietary glycemic measures with cerebral amyloid burden and cognitive performance in cognitively normal older adults. Design: We performed cross-sectional analyses relating dietary glycemic measures [adherence to a high-glycemic-load diet (HGLDiet) pattern, intakes of sugar and carbohydrates, and glycemic load] with cerebral amyloid burden (measured by florbetapir F-18 positron emission tomography) and cognitive performance in 128 cognitively normal older adults who provided eligibility screening data for the University of Kansas's Alzheimer's Prevention through Exercise (APEX) Study. The study began in November 2013 and is currently ongoing. Results: Amyloid was elevated in 26% ( n = 33) of participants. HGLDiet pattern adherence ( P = 0.01), sugar intake ( P = 0.03), and carbohydrate intake ( P = 0.05) were significantly higher in participants with elevated amyloid burden. The HGLDiet pattern was positively associated with amyloid burden both globally and in all regions of interest independently of age, sex, and education (all P ≤ 0.001). Individual dietary glycemic measures (sugar intake, carbohydrate intake, and glycemic load) were also positively associated with global amyloid load and nearly all regions of interest independently of age, sex, and educational level ( P ≤ 0.05). Cognitive performance was associated only with daily sugar intake, with higher sugar consumption associated with poorer global cognitive performance (global composite measure and Mini-Mental State Examination) and performance on subtests of Digit Symbol, Trail Making Test B, and Block Design, controlling for age, sex, and education. Conclusion: A high-glycemic diet was associated with greater cerebral amyloid burden, which suggests diet as a potential modifiable behavior for cerebral amyloid accumulation and subsequent Alzheimer

The cesium-137 body burden of a control group in Stockholm, 1975

International Nuclear Information System (INIS)

Hagberg, N.; Eklund, G.

1976-03-01

Measurements of the 137 Cs content in a control group consisting of 20-30 persons have been carried out since 1959 (1,4,6,7,9,10). Unitl 1966 the measurements were made in an open-booth type whole-body counter (Fig. 1) (2). From observation series 30 the measurements were made in the three-crystal counter (Fig. 1) in the new low-activity laboratory described in refs. (3) and (5). The use of individual weighting factors for each member of the group makes it possible to calculate a weighted mean of the 137 Cs level (1,5), to compensate for the changes in the control group during the years. The calculation includes a correction for RaC contamination. During 1975 measurements were made on 25 members of the group, 14 men and 11 women. The mean age and weight were 44 years and 71 kg respectively for men and 51 years and 61 kg respectively for women. For all the measured persons the mean age was 47 years and the mean weight was 67 kg. Measured content of potassium was 1,95+-0,20 g/kg body weight (1 sigma) for the men and 1,60+-0,15 g/kg body weight for the women of the group. Table 1 shows the results of the 137 Cs measurements obtained with the three-crystal counter. Fig. 2 shows these results together with earlier results from the open-booth counter. The weighted mean and the highest and the lowest values within the group are indicated. The total error of the weighted mean and the highest value 1975 are about 10 percent and 16 percent respectively. For the last few years the cesium content has been below the detection limit, 10-15 pCi/gK, for some members of the group. (author)

Burden of Proof in Bioethics.

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Koplin, Julian J; Selgelid, Michael J

2015-11-01

A common strategy in bioethics is to posit a prima facie case in favour of one policy, and to then claim that the burden of proof (that this policy should be rejected) falls on those with opposing views. If the burden of proof is not met, it is claimed, then the policy in question should be accepted. This article illustrates, and critically evaluates, examples of this strategy in debates about the sale of organs by living donors, human enhancement, and the precautionary principle. We highlight general problems with this style of argument, and particular problems with its use in specific cases. We conclude that the burden ultimately falls on decision-makers (i.e. policy-makers) to choose the policy supported by the best reasons. © 2015 John Wiley & Sons Ltd.

Environmental and Body Concentrations of Heavy Metals at Sites Near and Distant from Industrial Complexes in Ulsan, Korea.

Science.gov (United States)

Sung, Joo Hyun; Oh, Inbo; Kim, Ahra; Lee, Jiho; Sim, Chang Sun; Yoo, Cheolin; Park, Sang Jin; Kim, Geun Bae; Kim, Yangho

2018-01-29

Industrial pollution may affect the heavy metal body burden of people living near industrial complexes. We determined the average concentrations of atmospheric heavy metals in areas close to and distant from industrial complexes in Korea, and the body concentrations of these heavy metals in residents living near and distant from these facilities. The atmospheric data of heavy metals (lead and cadmium) were from the Regional Air Monitoring Network in Ulsan. We recruited 1,148 participants, 872 who lived near an industrial complex ("exposed" group) and 276 who lived distant from industrial complexes ("non-exposed" group), and measured their concentrations of blood lead, urinary cadmium, and urinary total mercury. The results showed that atmospheric and human concentrations of heavy metals were higher in areas near industrial complexes. In addition, residents living near industrial complexes had higher individual and combined concentrations (cadmium + lead + mercury) of heavy metals. We conclude that residents living near industrial complexes are exposed to high concentrations of heavy metals, and should be carefully monitored. © 2018 The Korean Academy of Medical Sciences.

Association of impairments of older persons with caregiver burden among family caregivers: Findings from rural South India.

Science.gov (United States)

Ajay, Shweta; Kasthuri, Arvind; Kiran, Pretesh; Malhotra, Rahul

In India, owing to cultural norms and a lack of formal long-term care facilities, responsibility for care of the older person falls primarily on the family. Based on the stress process model, we assessed the association of type and number of impairments of older persons (∼primary stressors) with caregiver burden among their family caregivers in rural South India. All impaired older persons (aged ≥60, with impairment in activities of daily living (ADL) or cognition or vision or hearing) residing in 8 villages in Bangalore district, Karnataka, India, and their primary informal caregivers were interviewed. Caregiver burden was measured using the Zarit Burden Interview (ZBI; higher score indicating greater perceived burden). Linear regression models, adjusting for background characteristics of older persons and caregivers, assessed the association of type of impairment (physical [Yes/No], cognitive [Yes/No], vision [Yes/No] and hearing [Yes/No]) and number (1 or 2 or 3 or 4) of older person impairments with caregiver burden. A total of 140 caregivers, caring for 149 older persons, were interviewed. The mean (standard deviation) ZBI score was 21.2 (12.9). Of the various older person impairments, ZBI score was associated only with physical impairment (β=6.6; 95% CI: 2.1-11.1). Relative to caregivers of older person with one impairment, those caring for an older person with all 4 impairments had significantly higher ZBI score (β=13.9; CI: 2.5-25.4). Caregivers of older persons with multiple impairments, especially physical impairment, are vulnerable. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The ties that bind: the relationship between caregiver burden and the neuropsychological functioning of TBI survivors.

Science.gov (United States)

Lehan, Tara; Arango-Lasprilla, Juan Carlos; de los Reyes, Carlos José; Quijano, María Cristina

2012-01-01

Advances in medical and assistive technology have increased the likelihood of survival following a traumatic brain injury (TBI). Consequently, families frequently must provide care to individuals with TBI. Because they are rarely prepared for the associated demanding medical needs and financial burden, family caregivers are at risk for physical and emotional problems, which can negatively influence their individual and family functioning. Whereas scholars have examined the influence of survivor functioning on caregiver burden, few have explicitly recognized that caregiver burden also influences survivor functioning. Results of a multivariate linear regression suggest that, in a sample of 51 pairs of TBI survivors and their caregivers living in Colombia, survivors receiving care from a family member who reported a higher level of burden had poorer objective neuropsychological functioning than those receiving care from a family member who reported a lower level of burden, after controlling for survivor education and history of occupational therapy. Therefore, a family-focused approach might maximize intervention effectiveness, especially for Latin American and Hispanic families, which tend to be characterized by a strong sense of familism. The emphasis on family can create problems in a healthcare system that views the individual as the primary unit.

Quality of life of caregivers for patients of cerebrovascular accidents: association of (socio-demographic characteristics and burden

Directory of Open Access Journals (Sweden)

Tatiana Ferreira da Costa

2015-04-01

Full Text Available OBJECTIVE Investigating the association between quality of life with socio-demographic characteristics and the burden of caregivers for individuals with cerebrovascular accident sequelae. METHOD A descriptive, cross-sectional study with a sample composed of 136 caregivers. For data collection, a semi-structured questionnaire, the Barthel, Burden Interview and Short-Form-36 scales were used. Correlation analysis, t-Student test and F-test were used for the analysis in order to compare averages. RESULTS Significant averages in quality of life were demonstrated in association with female caregivers and those over 60 years in the field 'functional capacity,' and in the domains of 'mental health' and 'vitality' for those with higher income. Regarding burden association, the highlighted areas were 'functional capacity,' 'physical aspects,' 'emotional aspects' and 'pain.' CONCLUSION The creation of public policies and social support to effectively reduce the burden on caregivers is a necessity.

A comparison of mercury burdens between St. Marks National Wildlife Refuge and St. Andrew Bay, Florida: Evaluation of fish body burdens and physiological responses in largemouth bass, spotted seatrout, striped mullet, and sunfish

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Huge, D.H.; Rauschenberger, R.H.; Wieser, F.M.; Hemming, J.M.

2011-01-01

Musculature from the dorsal region of 130 largemouth bass (Micropterus salmoides), 140 sunfish (Lepomis sp.), 41 spotted seatrout (Cynoscion nebulosus) and 67 striped mullet (Mugil cephalus) were collected from five estuarine and five freshwater sites within the St. Marks National Wildlife Refuge and two estuarine and two freshwater sites from St. Andrew Bay, Florida, United States of America. Musculature was analyzed for total mercury content, sagittal otoliths were removed for age determination and physiological responses were measured. Largemouth bass and sunfish from the refuge had higher mercury concentrations in musculature than those from the bay. Male spotted seatrout, male striped mullet, male and female sunfish and female largemouth bass had mercury burdens positively correlated with length. The majority of all four species of fish from both study areas contained mercury levels below 1.5 part per million, the limit for safe consumption recommended the Florida Department of Health. In comparison, a significant percentage of largemouth bass and sunfish from several sampled sites, most notably Otter Lake and Lake Renfroe within St. Marks National Wildlife Refuge, had mercury levels consistent with the health department's guidelines of 'limited consumption' or 'no consumption guidelines.'

Whole body effective dose measurements in a fan beam bone mineral densitometer, Lunar expert

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Sathiakumar, C.; Griffiths, M.; Cross, P.; Pocock, N.; Freund, J. [St Vincents Hospital, Sydney, NSW (Australia) Department of Nuclear Medicine; Kron, T.; Duggan, L. [Newcastle Mater Misericordiae Hospital, Newcastle, NSW (Australia). Department of Radiation Oncology; Holley, L. [University of Technology, Sydney, NSW (Australia). Department of Health Services

1998-06-01

Full text: The most recent generation of DXA machines employ a fan beam geometry and high resolution imaging detector, resulting in decreased scanning time and increased image resolution compared to previous rectilinear scanners, but with higher radiation burden to the patient because of an increasing number of bone mineral density scans, it was felt that independent evaluation of the radiation dose was necessary. The whole body effective dose for an AP lumbar spine scan and femur scan using the EXPERT bone densitometer was calculated for the fast and turbo scanning modes, using thermoluminescence dosimetry (TLD). A method was developed to determine the absorbed dose of the irradiated volume of an organ by summing the dose for each of the coronal areas, which results in a volume dose. The Whole Body Effective dose for AP lumbar spine fast scanning mode is 84.1 {mu}Sv and turbo scanning mode is 56.4 {mu}Sv. The Whole Body Effective dose for femur fast scanning mode is 6.6 {mu}Sv and turbo scanning mode is 4.2 {mu}Sv, with no ovary exposure. A theoretical method has been developed to calculate the organ dose from which whole body effective dose was calculated

The relationship between burden and well-being among caregivers of Italian people diagnosed with severe neuromotor and cognitive disorders.

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Fianco, Andrea; Sartori, Raffaela D G; Negri, Luca; Lorini, Saverio; Valle, Giovanni; Delle Fave, Antonella

2015-04-01

In studies on caregiving, high levels of perceived burden are commonly considered as synonymous with poor well-being. This study aimed at better disentangling the relationship between burden and well-being dimensions through their joint investigation. To this purpose, perceived well-being and social resources were evaluated among caregivers reporting different levels of burden. Participants were 91 caregivers (mean age=50.4; SD=9.6), parents of people diagnosed with severe neuromotor and cognitive disorders. Participants completed a semi-structured interview and a set of scaled questionnaires: Caregiver Burden Inventory (CBI), Satisfaction with Life Scale, Positive and Negative Affect Schedule, Depression Anxiety Stress Scale, Eudaimonic and Hedonic Happiness Investigation, Resilience Scale for Adults, and Multidimensional Scale of Perceived Social Support. Participants were divided into two groups according to their perceived burden level, assessed through CBI. In both groups, the subjective components of burden accounted for the major fraction of the total burden level. Participants perceiving high burden reported higher levels of depression related emotions, lower life satisfaction and lower resilience than participants perceiving low burden. No group difference emerged in perceived meaningfulness and social support. A regression analysis showed that the best predictor of perceived burden was life satisfaction, followed to a lesser extent by resilience, while depression related emotions did not provide significant contribution. Findings suggest that the joint assessment of burden and well-being dimensions, that are co-existing in caregivers' experience, allow for the identification of personal and relational resources that can be usefully included in interventions addressed to caregivers. Copyright © 2015 Elsevier Ltd. All rights reserved.

CAREGIVER BURDEN AMONG PEOPLE CARING FOR PATIENTS WITH SCHIZOPHRENIA

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Shivani Bansal

2017-04-01

Full Text Available BACKGROUND Caregivers of patients suffering from mental illness report burden in different areas including effects on family functioning, psychological problems, financial problems and health. The aim of the study is to determine the sociodemographic profile and caregiver burden among caregivers of persons with schizophrenia and to study the effect of patients’ psychopathology on caregiver burden scale. MATERIALS AND METHODS The present study was conducted in the Psychiatry Department, Government Medical College, Amritsar. A sample size of 34 was taken who were primary caregivers (preferably parents or spouse of schizophrenia patients diagnosed using ICD10. Measures included caregiver’s demographic variables and caregiver’s burden using the Zarit burden interview and PANSS scale in patients. Statistical Analysis- Data was analysed using SPSS software version 21. RESULTS The mean age of the caregiver was 42 SD (12.16 years. The majority of the caregivers were parents, married and employed. The mean average score of the responses to Zarit burden interview was (SD=59.52 ± 20.92. Majority of the caregivers experienced severe burden (52.9%, 9 (26.4% caregivers had reported moderate burden and 6 (17.6% had reported mild burden. The mean duration of illness was 6.89 (SD=5.03 years. The level of burden experienced was significantly associated with total PANSS score, negative symptoms, positive symptoms, general psychopathology score and duration of schizophrenia illness (p=0.00. CONCLUSION There is need for psychological assistance and social support for the vulnerable caregivers to help them reduce the burden levels and employ positive coping strategies.

Economic burden of disease-associated malnutrition in China.

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Linthicum, Mark T; Thornton Snider, Julia; Vaithianathan, Rhema; Wu, Yanyu; LaVallee, Chris; Lakdawalla, Darius N; Benner, Jennifer E; Philipson, Tomas J

2015-05-01

Disease-associated malnutrition (DAM) is a well-recognized problem in many countries, but the extent of its burden on the Chinese population is unclear. This article reports the results of a burden-of-illness study on DAM in 15 diseases in China. Using data from the World Health Organization (WHO), the China Health and Nutrition Survey, and the published literature, mortality and disability-adjusted life years (DALYs) lost because of DAM were calculated; a financial value of this burden was calculated following WHO guidelines. DALYs lost annually to DAM in China varied across diseases, from a low of 2248 in malaria to a high of 1 315 276 in chronic obstructive pulmonary disease. The total burden was 6.1 million DALYs, for an economic burden of US$66 billion (Chinese ¥ 447 billion) annually. This burden is sufficiently large to warrant immediate attention from public health officials and medical providers, especially given that low-cost and effective interventions are available. © 2014 APJPH.

High protein intake along with paternal part-time employment is associated with higher body fat mass among girls from South China.

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Yang, Ming-Zhe; Xue, Hong-Mei; Pan, Jay; Libuda, Lars; Muckelbauer, Rebecca; Yang, Min; Quan, Liming; Cheng, Guo

2017-05-23

Protein intake has been suggested to be associated with body composition among western children. Our aim was to determine whether protein intake is associated with body composition among Chinese children and to investigate whether parental socioeconomic status modifies these associations. Cross-sectional data were collected from the baseline survey of an ongoing population-based prospective open cohort study conducted in 2013. In this survey, 2039 children in South China were recruited using cluster random sampling. Information of 1704 children (47% girls), aged 7-12 years from three primary schools (42 classes), on diet and anthropometry was included finally. Their daily protein intake was obtained by 3-day 24-h dietary recalls. Skinfold thickness, body height, and weight were measured to calculate percent body fat (%BF), fat mass index (FMI), and fat-free mass index (FFMI). Parental characteristics were collected by questionnaires. Among girls, protein intake was positively associated with %BF and FMI [estimate (SE) for %BF: 0.007 (0.003), p = 0.04; for FMI: 0.092 (0.002), p = 0.03], adjusted for pubertal stage, breast-feeding, maternal overweight, carbohydrate intake, energy intake, and physical activity level. Furthermore, there was interaction between paternal occupation and the relations of dietary protein with %BF and FMI (p for interaction  ≤ 0.04). None of the associations between protein intake and %BF, FMI, or FFMI was found among boys. Our data indicate that school-aged girls, but not boys, living in South China with higher dietary protein intake might have higher body fat mass, which could be modified by paternal occupation.

Factors of caregiver burden and family functioning among Taiwanese family caregivers living with schizophrenia.

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Hsiao, Chiu-Yueh; Tsai, Yun-Fang

2015-06-01

To assess the degree of caregiver burden and family functioning among Taiwanese primary family caregivers of people with schizophrenia and to test its association with demographic characteristics, family demands, sense of coherence and family hardiness. Family caregiving is a great concern in mental illness. Yet, the correlates of caregiver burden and family functioning in primary family caregivers of individuals with schizophrenia still remain unclear. A cross-sectional descriptive study. A convenience sample of 137 primary family caregivers was recruited from two psychiatric outpatient clinics in Taiwan. Measures included a demographic information sheet and the Chinese versions of the Family Stressors Index, Family Strains Index, 13-item Sense of Coherence Scale, 18-item Caregiver Burden Scale, Family Hardiness Index and Family Adaptability, Partnership, Growth, Affection, and Resolve Index. Data analysis included descriptive statistics, Pearson's product-moment correlation coefficients, t-test, one-way analysis of variance and a stepwise multiple linear regression. Female caregivers, additional dependent relatives, increased family demands and decreased sense of coherence significantly increased caregiver burden, whereas siblings as caregivers reported lower degrees of burden than parental caregivers. Family caregivers with lower family demands, increased family hardiness and higher educational level had significantly enhanced family functioning. Sense of coherence was significantly correlated with family hardiness. Our findings highlighted the importance of sense of coherence and family hardiness in individual and family adaptation. Special attention needs to focus on therapeutic interventions that enhance sense of coherence and family hardiness, thereby improving the perception of burden of care and family functioning. Given the nature of family caregiving in schizophrenia, understanding of correlates of caregiver burden and family functioning would help

Modifiable factors associated with caregiver burden among family caregivers of terminally ill Korean cancer patients.

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Yoon, Seok-Joon; Kim, Jong-Sung; Jung, Jin-Gyu; Kim, Sung-Soo; Kim, Samyong

2014-05-01

Higher caregiver burden is associated with poor quality of life among family caregivers. However, in Korea, very few studies have examined factors associated with caregiver burden. The present study investigated factors associated with caregiver burden among family caregivers of terminally ill Korean cancer patients, particularly modifiable factors as a potential target of intervention strategies. A cross-sectional study using self-administered questionnaires was performed. Sixty-four family caregivers of terminally ill cancer patients who were admitted to the hospice-palliative care unit of a university hospital in South Korea were included. To identify caregiver burden, the Caregiver Reaction Assessment scale (CRA) was used in this study. Time spent in providing care per day, number of visits per week from other family members, family functioning, and a positive subscale, self-esteem, of the CRA were deemed as modifiable factors. Other sociodemographic, caregiving characteristics of the subjects were non-modifiable factors. Longer time spent providing care per day, fewer weekly visits from other family members, poor family functioning, and low self-esteem were considered as modifiable factors associated with caregiver burden. Low monthly income and the spouse being the family caregiver were non-modifiable factors. Our study has practical significance in that it identifies modifiable factors that can be used to devise intervention strategies. Developing and applying such intervention strategies for alleviating the factors associated with high caregiver burden could be important for improving the quality of life of both patients and their families.

Burden of Rabies

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... this? Submit Button Past Emails The Burden of Rabies Recommend on Facebook Tweet Share Compartir Learn how ... bitten by an animal that has the disease. Rabies in the U.S. Rabies continues to be a ...

Excess of Radiation Burden for Young Testicular Cancer Patients using Automatic Exposure Control and Contrast Agent on Whole-body Computed Tomography Imaging.

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Niiniviita, Hannele; Kulmala, Jarmo; Pölönen, Tuukka; Määttänen, Heli; Järvinen, Hannu; Salminen, Eeva

2017-06-01

The aim of the study was to assess patient dose from whole-body computed tomography (CT) in association with patient size, automatic exposure control (AEC) and intravenous (IV) contrast agent. Sixty-five testicular cancer patients (mean age 28 years) underwent altogether 279 whole-body CT scans from April 2000 to April 2011. The mean number of repeated examinations was 4.3. The GE LightSpeed 16 equipped with AEC and the Siemens Plus 4 CT scanners were used for imaging. Whole-body scans were performed with (216) and without (63) IV contrast. The ImPACT software was used to determine the effective and organ doses. Patient doses were independent (p < 0.41) of patient size when the Plus 4 device (mean 7.4 mSv, SD 1.7 mSv) was used, but with the LightSpeed 16 AEC device, the dose (mean 14 mSv, SD 4.6 mSv) increased significantly (p < 0.001) with waist cirfumference. Imaging with the IV contrast agent caused significantly higher (13% Plus 4, 35% LightSpeed 16) exposure than non-contrast imaging (p < 0.001). Great caution on the use of IV contrast agent and careful set-up of the AEC modulation parameters is recommended to avoid excessive radiation exposure on the whole-body CT imaging of young patients.

Differences in Symptom Burden Among Cancer Patients With Different Stages of Cachexia.

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Zhou, Ting; Yang, Kaixiang; Thapa, Sudip; Liu, Huiquan; Wang, Bangyan; Yu, Shiying

2017-05-01

Cancer patients with cachexia may suffer from significant burden of symptoms and it can severely impair patients' quality of life. However, only few studies have targeted the symptom burden in cancer cachexia patients, and whether the symptom burden differed in different cachexia stages is still unclear. The aims of this study were to evaluate the symptom burden in cancer cachexia patients and to compare the severity and occurrence rates of symptoms among cancer patients with non-cachexia, pre-cachexia, cachexia, and refractory cachexia. Advanced cancer patients (n = 306) were included in this cross-sectional study. Patients were divided into four groups, based on the cachexia stages of the international consensus. The M.D. Anderson Symptom Inventory added with eight more cachexia-specific symptoms were evaluated in our patients. Differences in symptom severity and occurrence rates among the four groups were compared using one-way ANOVA or Kruskal-Wallis test analyses. Lack of appetite, disturbed sleep, fatigue, lack of energy, and distress were the symptoms with highest occurrence rates and severity scores in all four groups and were exacerbated by the severity of cachexia stages. After confounders were adjusted for, significant differences were seen in symptoms of pain, fatigue, disturbed sleep, remembering problems, lack of appetite, dry mouth, vomiting, numbness, feeling dizzy, early satiety, lack of energy, tastes/smell changes, and diarrhea. This study identified higher symptom burden in cancer patients with cachexia and it increased with the stages of cachexia, which emphasized the importance of screening in multiple co-occurring symptoms for cachexia patients. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Beyond Attributable Burden: Estimating the Avoidable Burden of Disease Associated with Household Air Pollution.

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Randall Kuhn

Full Text Available The Global Burden of Disease (GBD studies have transformed global understanding of health risks by producing comprehensive estimates of attributable disease burden, or the current disease that would be eliminated if a risk factor did not exist. Yet many have noted the greater policy significance of avoidable burden, or the future disease that could actually be eliminated if a risk factor were eliminated today. Avoidable risk may be considerably lower than attributable risk if baseline levels of exposure or disease are declining, or if a risk factor carries lagged effects on disease. As global efforts to deliver clean cookstoves accelerate, a temporal estimation of avoidable risk due to household air pollution (HAP becomes increasingly important, particularly in light of the rapid uptake of modern stoves and ongoing epidemiologic transitions in regions like South and Southeast Asia.We estimate the avoidable burden associated with HAP using International Futures (IFs, an integrated forecasting system that has been used to model future global disease burdens and risk factors. Building on GBD and other estimates, we integrated a detailed HAP exposure estimation and exposure-response model into IFs. We then conducted a counterfactual experiment in which HAP exposure is reduced to theoretical minimum levels in 2015. We evaluated avoidable mortality and DALY reductions for the years 2015 to 2024 relative to a Base Case scenario in which only endogenous changes occurred. We present results by cause and region, looking at impacts on acute lower respiratory infection (ALRI and four noncommunicable diseases (NCDs. We found that just 2.6% of global DALYs would be averted between 2015 and 2024, compared to 4.5% of global DALYs attributed to HAP in the 2010 GBD study, due in large part to the endogenous tendency towards declining traditional stove usage in the IFs base case forecast. The extent of diminished impact was comparable for ALRI and affected NCDs

Cancer burden in Africa and opportunities for prevention.

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Jemal, Ahmedin; Bray, Freddie; Forman, David; O'Brien, Meg; Ferlay, Jacques; Center, Melissa; Parkin, D Maxwell

2012-09-15

Cancer is an emerging public health problem in Africa. About 715,000 new cancer cases and 542,000 cancer deaths occurred in 2008 on the continent, with these numbers expected to double in the next 20 years simply because of the aging and growth of the population. Furthermore, cancers such as lung, female breast, and prostate cancers are diagnosed at much higher frequencies than in the past because of changes in lifestyle factors and detection practices associated with urbanization and economic development. Breast cancer in women and prostate cancer in men have now become the most commonly diagnosed cancers in many Sub-Saharan African countries, replacing cervical and liver cancers. In most African countries, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This paper reviews the current patterns of cancer in Africa and the opportunities for reducing the burden through the application of resource level interventions, including implementation of vaccinations for liver and cervical cancers, tobacco control policies for smoking-related cancers, and low-tech early detection methods for cervical cancer, as well as pain relief at the palliative stage of cancer. Copyright © 2012 American Cancer Society.

ANALYSIS OF TAX BURDEN PARAMETERS OF UKRAINE'S ECONOMY

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I. Moyseyenko

2017-11-01

Full Text Available The need to solve the problems of macro-economic stabilization of the country's economy on the basis of determining the tax system efficiency led to the actuality and importance of developing methodological issues of macro-economic tax regulation. In terms of macro-financial stability for the purpose of strategic analysis, the macroeconomic category of tax burden and its fiscal efficiency in terms of direct and indirect taxation is considered. Tax burden indicators at a macro-level quantitatively measure the total level of tax payment and pumping up the budget. Based on the analysis of tax burden it is found that in Ukraine the major fiscal function is performed by consumption taxes (indirect taxes. The methodological principles of the diagnostics of tax burden influence on macro-indices of economic stabilization are as follows: selecting parameters of monitoring tax burden state and fiscal burden efficiency; the assessment of an impact on fiscal efficiency on macro-indices. To prognosticate the efficiency of fiscal burden performance in terms of indirect taxes linear and exponential trend equations are calculated. In terms of the analysis of macro-financial stability the usage of tax rates of indirect taxes as indicators of fiscal efficiency provides sufficient reasons for the conclusions regarding long-term trends of pumping the budget.

Subjective burden on spouses of schizophrenia patients

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Surekha Kumari

2009-01-01

Full Text Available Background : There is limited information from India on subjective burden on spouses of schizophrenia patients. The aim of the present study was to assess and compare patterns of subjective burden on spouses of schizophrenia patients. Materials and Methods: The present study was conducted at the OPD level, and follow-up was done at the Ranchi Institute of Neuropsychiatry and Sciences (RINPAS during the period May 2008 to November 2008. Tools utilized were sociodemographic data sheet, Family Burden Interview Schedule developed by Pai and R. L. Kapur (1981. The sample comprised of 50 samples of spouses (25 male and 25 female spouses of schizophrenia patients. Results: The findings suggest that both the groups, viz., male and female spouses of schizophrenia patients, showed moderate level of subjective burden, i.e., 13 (52% and 15 (60% male and female spouses, respectively, which was statistically found to be insignificant. Conclusion : No significant difference was found between male and female spouses of schizophrenia patients with regard to the level of subjective burden.

Higher burden of supraventricular ectopic complexes early after catheter ablation for atrial fibrillation is associated with increased risk of recurrent atrial fibrillation

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Alhede, Christina; Johannessen, Arne; Dixen, Ulrik

2018-01-01

AIMS: Early identification of patients who could benefit from early re-intervention after catheter ablation is highly warranted. Our aim was to investigate the association between post-procedural burden of supraventricular ectopic complexes (SVEC) and the risk of long-term atrial fibrillation (AF...

Double burden of malnutrition: A silent driver of double burden of disease in low– and middle–income countries

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Ivana Kolcˇic´

2012-09-01

Full Text Available Double burden of malnutrition, characterised by undernutrition among poor children and obesity among deprived adults, is a serious global problem and an important promoter of ‘double burden of disease’ which is currently affecting low– and middle–income countries. Possible ways to reduce this burden is through education on the importance of equilibrium between energy intake and expenditure; ensuring conditions for optimal fetal and early child development; and reducing poverty as one of the main drivers of both undernutrition and obesity, through empowering local communities.

Plasma Total Cysteine and Cardiovascular Risk Burden: Action and Interaction

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Benedetta De Chiara

2012-01-01

Full Text Available We hypothesized that redox analysis could provide sensitive markers of the oxidative pathway associated to the presence of an increasing number of cardiovascular risk factors (RFs, independently of type. We classified 304 subjects without cardiovascular disease into 4 groups according to the total number of RFs (smoking, hypertension, hypercholesterolaemia, hyperhomocysteinaemia, diabetes, obesity, and their combination. Oxidative stress was evaluated by measuring plasma total and reduced homocysteine, cysteine (Cys, glutathione, cysteinylglycine, blood reduced glutathione, and malondialdehyde. Twenty-seven percent of subjects were in group 0 RF, 26% in 1 RF, 31% in 2 RF, and 16% in ≥3 RF. By multivariable ordinal regression analysis, plasma total Cys was associated to a higher number of RF (OR = 1.068; 95% CI = 1.027–1.110, =0.002. Total RF burden is associated with increased total Cys levels. These findings support a prooxidant effect of Cys in conjunction with RF burden, and shed light on the pathophysiologic role of redox state unbalance in preclinical atherosclerosis.

Whole body monitoring - Goiania

International Nuclear Information System (INIS)

Oliveira, C.A.N. de; Lourenco, M.C.; Bertelli Neto, L.; Lucena, E.A. de; Becker, P.H.B.

1988-01-01

Due to the radiological Cs accident in Goiania, Goias in September 1987, it became necessary to evaluate internal contamination levels of: - Individual from the general public that for any reason had direct or indirect involvement with the radioactive source (group 1). - Occupationally involved persons (group 2). For each of these groups, procedures of whole body monitoring were developped. In order to attend group 1 individuals, the IRD/CNEN installed a whole body unit in the INAMPS General Hospital of Goiania in 11.08.87, which was later transferred to 121,57 street, Central Sector in Goiania in 2.06.88. In this unit 547 people were monitored, 356 from group 1 and 241 from group 2, until 04.13.88. In the IRD whole body counter installation, 194 individuals were counted, 185 from group 2 and 9 from group 1. The frequency of monitoring of each individual was established according to the Cs activity present in the body or to the job to be assigned. In this paper we will present some burden activity curves for Cs 137 as a function of the time elapsed from the first measurement. There people from group 1 were measured in both counters, the IRD and the Goiania ones. The values obtained in both installations are compatible with the body activity x time curve. (author) [pt

Socioeconomic burden of hereditary angioedema

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Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen

2014-01-01

who were working or in school (n = 120), 72 provided work/school absenteeism data, resulting in an estimated 20 days missing from work/school on average per year; 51% (n = 84) indicated that HAE has hindered their career/educational advancement. CONCLUSION: HAE poses a considerable burden on patients...... and their families in terms of direct medical costs and indirect costs related to lost productivity. This burden is substantial at the time of attacks and in between attacks....

Adult informal caregivers reporting financial burden in Hawaii, Kansas, and Washington: Results from the 2007 Behavioral Risk Factor Surveillance System.

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Kusano, Claudia T; Bouldin, Erin D; Anderson, Lynda A; McGuire, Lisa C; Salvail, Florentina R; Simmons, Katrina Wynkoop; Andresen, Elena M

2011-10-01

Given the unpaid nature of the work, informal caregiving can create a financial burden for caregivers. Little has been done to identify specific predictors of experiencing financial burden. This study investigated demographic and health factors comparing caregivers who reported having or not having financial burden. Data are derived from adult caregivers (N = 3,317) as part of the 2007 Behavioral Risk Factor Surveillance System in Hawaii, Kansas, and Washington. The adjusted odds ratios for reporting a financial burden were estimated for demographic and other risk factors. Caregivers who reported a financial burden were younger, had lower incomes, were more likely to be current smokers, have had a stroke, and rate their health as fair or poor compared to caregivers who did not report a financial burden. Caregivers who were younger (ages 18-34), resided with care recipients, spent 20-39 hours per week providing care, and reported having a disability were at a statistically significantly higher odds of reporting a financial burden. Given the current economic difficulties faced by many Americans, further insights into the perceived financial burdens experienced by informal caregivers as well as linkages to policy and programs designed to support caregivers are critical for public health professionals to address the expanding needs in states and communities. Published by Elsevier Inc.

Care burden and its predictive factors in parents of newly diagnosed children with acute lymphoblastic leukemia in academic hospitals in China.

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Wang, Jingting; Shen, Nanping; Zhang, Xiaoyan; Shen, Min; Xie, Anwei; Howell, Doris; Yuan, Changrong

2017-12-01

Caring for children with acute lymphoblastic leukemia (ALL) is a distressing experience for parents without medical training. The experience can lead to parents' care burden. This study explored care burden among parents of children with ALL and its related factors. A total of 130 parents were surveyed with the Zarit Burden Inventory (ZBI), Perceived Social Support Scale (PSSS), Zung's Self-rating Anxiety Scale (SAS), Zung's Self-rating Depression Scale (SDS), Medical Outcome Study Short Form 36 (SF-36), and a study specific demographic information questionnaire. Independent-samples T test, one-way ANOVA, Pearson correlation analysis and multivariate linear regression analysis (stepwise method), and binomial logistic regression were used in data analysis. The mean score of parents' care burden overall was 37.74 ± 16.57, 17 (13.08%) had little or no burden, 57 (43.85%) had mild-to-moderate burden, 44 (33.84%) had moderate-to-severe burden, and 12 (9.23%) had severe burden. Regression analyses indicated daily care time, anxiety, general health, average monthly family income, social support, and number of co-caregivers were factors associated with care burden. These variables accounted for 51% of the variance in care burden. Other demographic information of parents and children, depression, and other dimensions of SF-36 were not related to care burden. The severe burden level was associated the increase risk of emotional distress compared with little or no burden group (OR = 37.500, 95% CI = 4.515-311.348, P = 0.001). The results indicated that care burden in parents of children newly diagnosed with ALL is high. Parents with lower levels of care burden tend to have less daily care time, more co-caregivers, higher income, less anxiety, better general health, and social support. Strategies are needed to help reduce parents' care burden.

Economic cost and burden of dengue during epidemics and non-epidemic years in Taiwan

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Dih-Ling Luh

2018-03-01

Full Text Available Background: Determining the disease and economic burden of dengue is critical for the allocation of public health resources. Several studies have used disability-adjusted life-years (DALYs to estimate the disease burden of dengue in different regions. However, there are no published studies discussing the estimates of dengue-related economic and disease burden specifically in Taiwan. Objectives: We assessed the economic cost and disease burden of dengue infections in Taiwan for the period 1998–2014, and compared these during epidemic and non-epidemic years. Methods: We estimated the annual DALYs per million population using the disability weights for dengue fever (DF, dengue hemorrhagic fever (DHF, dengue shock syndrome (DSS, and death cases. Economic costs were estimated and divided into direct (medical costs and indirect costs (lost work days and caregiver fees. Results: For the period 1998–2014, a mean of 115.3 (range: 6.3–934.3 DALYs per million population annually were lost to dengue. In epidemic years, direct costs associated with dengue resulted mostly from hospitalization (86.09%, emergency (7.77%, outpatient (6.10%, and drug costs (0.03%. For indirect costs, lost productivity due to death (70.76% was the dominant contributor. Overall, the costs were 12.3 times higher in epidemic years than in non-epidemic years (Wilcoxon rank sum test, p < 0.05. Conclusions: This study is the first to evaluate the economic costs and disease burden of dengue infections for this period in Taiwan, and reveals significant differences in economic impact between epidemic and non-epidemic years. Keywords: Economic cost of disease, Disease burden, Disability-adjusted life years (DALYs, Dengue, Epidemic

A systematic analysis of global anemia burden from 1990 to 2010

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Jasrasaria, Rashmi; Naghavi, Mohsen; Wulf, Sarah K.; Johns, Nicole; Lozano, Rafael; Regan, Mathilda; Weatherall, David; Chou, David P.; Eisele, Thomas P.; Flaxman, Seth R.; Pullan, Rachel L.; Brooker, Simon J.; Murray, Christopher J. L.

2014-01-01

Previous studies of anemia epidemiology have been geographically limited with little detail about severity or etiology. Using publicly available data, we estimated mild, moderate, and severe anemia from 1990 to 2010 for 187 countries, both sexes, and 20 age groups. We then performed cause-specific attribution to 17 conditions using data from the Global Burden of Diseases, Injuries and Risk Factors (GBD) 2010 Study. Global anemia prevalence in 2010 was 32.9%, causing 68.36 (95% uncertainty interval [UI], 40.98 to 107.54) million years lived with disability (8.8% of total for all conditions [95% UI, 6.3% to 11.7%]). Prevalence dropped for both sexes from 1990 to 2010, although more for males. Prevalence in females was higher in most regions and age groups. South Asia and Central, West, and East sub-Saharan Africa had the highest burden, while East, Southeast, and South Asia saw the greatest reductions. Iron-deficiency anemia was the top cause globally, although 10 different conditions were among the top 3 in regional rankings. Malaria, schistosomiasis, and chronic kidney disease–related anemia were the only conditions to increase in prevalence. Hemoglobinopathies made significant contributions in most populations. Burden was highest in children under age 5, the only age groups with negative trends from 1990 to 2010. PMID:24297872

Tuberculosis among older adults in Zambia: burden and characteristics among a neglected group.

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Coffman, Jenna; Chanda-Kapata, Pascalina; Marais, Ben J; Kapata, Nathan; Zumla, Alimuddin; Negin, Joel

2017-10-12

The 2010 Global Burden of Disease estimates show that 57% of all TB deaths globally occurred among adults older than 50 years of age. Few studies document the TB burden among older adults in Southern Africa. We focused on adults older than 55 years to assess the relative TB burden and associated demographic factors. A cross sectional nationally representative TB prevalence survey conducted of Zambian residents aged 15 years and above from 66 clusters across all the 10 provinces of Zambia. Evaluation included testing for TB as well as an in-depth questionnaire. We compared survey data for those aged 55 and older to those aged 15-54 years. Survey results were also compared with 2013 routinely collected programmatic notification data to generate future hypotheses regarding active and passive case finding. Among older adults with TB, 30/ 54 (55.6%) were male, 3/27 (11.1%) were HIV infected and 35/54 (64.8%) lived in rural areas. TB prevalence was higher in those aged ≥55 (0.7%) than in the 15-54 age group (0.5%). Males had higher rates of TB across both age groups with 0.7% (15-54) and 1.0% (≥55) compared with females 0.4% (15-54) and 0.6% (≥55). In rural areas, the prevalence of TB was significantly higher among older than younger adults (0.7% vs 0.3%), while the HIV infection rate was among TB patients was lower (11.1% vs 30.8%). The prevalence survey detected TB in 54/7484 (0.7%) of older adults compared to 3619/723,000 (0.5%) reported in 2013 programmatic data. High TB rates among older adults in TB endemic areas justify consideration of active TB case finding and prevention strategies.

Disease burden and mental health system capacity: WHO Atlas study of 117 low- and middle-income countries.

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McBain, Ryan; Salhi, Carmel; Morris, Jodi E; Salomon, Joshua A; Betancourt, Theresa S

2012-12-01

Treatment coverage for mental disorders ranges from less than 10% to more than 90% across low- and middle-income (LAMI) countries. Studies have yet to examine whether the capacity of mental health systems might be adversely affected by the burdens of unrelated conditions such as HIV/AIDS. To examine whether the magnitude of disease burden from communicable, perinatal, maternal and nutritional conditions - commonly referred to as Group 1 diseases - is inversely associated with mental health system capacity in LAMI countries. Multiple regression analyses were undertaken using data from 117 LAMI countries included in the 2011 World Health Organization (WHO) Mental Health Atlas. Capacity was defined in terms of human resources and infrastructure. Regressions controlled for effects of political stability, government health expenditures, income inequality and neuropsychiatric disease burden. Higher Group 1 disease burden was associated with fewer psychiatrists, psychologists and nurses in the mental health sector, as well as reduced numbers of out-patient facilities and psychiatric beds in mental hospitals and general hospitals (t = -2.06 to -7.68, Pmental health system capacity in LAMI countries may be adversely affected by the magnitude of their Group 1 disease burden.

Factor analysis of the Zarit Burden Interview in family caregivers of patients with amyotrophic lateral sclerosis.

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Oh, Juyeon; Kim, Jung A

2018-02-01

The Zarit Burden Interview has been used in many studies to assess caregiver burden in family caregivers of patients with amyotrophic lateral sclerosis, but the factor structure of the Zarit Burden Interview in the caregivers of amyotrophic lateral sclerosis patients is unknown. The aim of this study was to explore the factor structure of the Zarit Burden Interview in family caregivers of amyotrophic lateral sclerosis patients using exploratory factor analysis. The exploratory factor analysis was performed using generalized least squares with oblique rotation in a sample of 202 family caregivers. Three factors had an eigenvalue greater than 1 and accounted for 60.33% of the total variance. The three factors were named as follows: (factor 1) "Social restrictions" (items 2, 3, and 10-15); (factor 2) "Self-criticism" (items 20-21); and (factor 3) "Anger and frustration" (items 1, 4-6, 9, and 16-19). The correlation between factors 1 and 3 was much higher (r = 0.79) than that between factors 1 and 2 (r = 0.14) or factors 2 and 3 (r = 0.15). The findings of this study enriched our understanding of several meaningful dimensions of the caregiving burden in caregivers of an amyotrophic lateral sclerosis population and provided opportunities for future intervention.

Association of pro-inflammatory cytokines and iron regulatory protein 2 (IRP2 with Leishmania burden in canine visceral leishmaniasis.

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Paulo Ricardo Porfírio do Nascimento

Full Text Available Leishmania infantum infection in humans and dogs can evolve with a wide range of clinical presentations, varying from asymptomatic infections to visceral leishmaniasis. We hypothesized that the immune response elicited by L. infantum infection could modulate whether the host will remain asymptomatic or progress to disease. A total of 44 dogs naturally infected with L. infantum were studied. Leishmania burden was estimated in the blood and spleen by qPCR. The expression of IFN-γ, TNF-α, IL-10 and Iron Regulatory Protein 2 (IRP2 were determined in the spleen by quantitative PCR. Sera cytokines were evaluated by ELISA. Dogs were grouped in quartiles according parasite burden. Increased expression of IFN-γ and TNF-α was associated with reduced Leishmania burden, whereas increased IL-10 and IRP2 expressions were associated with higher Leishmania load. Increased plasma albumin and IFN-γ expression explained 22.8% of the decrease in parasite burden in the spleen. These data confirm that lower IFN-γ response and higher IL-10 correlated with increased parasite load and severity of the visceral leishmaniasis in dogs. The balance between the branches of immune response and the intracellular iron availability could determine, in part, the course of Leishmania infection.

Obesity treatment by very low-calorie-ketogenic diet at two years: reduction in visceral fat and on the burden of disease.

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Moreno, Basilio; Crujeiras, Ana B; Bellido, Diego; Sajoux, Ignacio; Casanueva, Felipe F

2016-12-01

The long-term effect of therapeutic diets in obesity treatment is a challenge at present. The current study aimed to evaluate the long-term effect of a very low-calorie-ketogenic (VLCK) diet on excess adiposity. Especial focus was set on visceral fat mass, and the impact on the individual burden of disease. A group of obese patients (n = 45) were randomly allocated in two groups: either the very low-calorie-ketogenic diet group (n = 22), or a standard low-calorie diet group; (n = 23). Both groups received external support. Adiposity parameters and the cumulative number of months of successful weight loss (5 or 10 %) over a 24-month period were quantified. The very low-calorie-ketogenic diet induced less than 2 months of mild ketosis and significant effects on body weight at 6, 12, and 24 months. At 24 months, a trend to regress to baseline levels was observed; however, the very low-calorie-ketogenic diet induced a greater reduction in body weight (-12.5 kg), waist circumference (-11.6 cm), and body fat mass (-8.8 kg) than the low-calorie diet (-4.4 kg, -4.1 cm, and -3.8 kg, respectively; p ketogenic diet group experienced a reduction in the individual burden of obesity because reduction in disease duration. Very low-calorie-ketogenic diet patients were 500 months with 5 % weight lost vs. the low-calorie diet group (350 months; p ketogenic diet was effective 24 months later, with a decrease in visceral adipose tissue and a reduction in the individual burden of disease.

Higher body mass index is associated with episodic memory deficits in young adults.

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Cheke, Lucy G; Simons, Jon S; Clayton, Nicola S

2016-11-01

Obesity has become an international health crisis. There is accumulating evidence that excess bodyweight is associated with changes to the structure and function of the brain and with a number of cognitive deficits. In particular, research suggests that obesity is associated with hippocampal and frontal lobe dysfunction, which would be predicted to impact memory. However, evidence for such memory impairment is currently limited. We hypothesised that higher body mass index (BMI) would be associated with reduced performance on a test of episodic memory that assesses not only content, but also context and feature integration. A total of 50 participants aged 18-35 years, with BMIs ranging from 18 to 51, were tested on a novel what-where-when style episodic memory test: the "Treasure-Hunt Task". This test requires recollection of object, location, and temporal order information within the same paradigm, as well as testing the ability to integrate these features into a single event recollection. Higher BMI was associated with significantly lower performance on the what-where-when (WWW) memory task and all individual elements: object identification, location memory, and temporal order memory. After controlling for age, sex, and years in education, the effect of BMI on the individual what, where, and when tasks remained, while the WWW dropped below significance. This finding of episodic memory deficits in obesity is of concern given the emerging evidence for a role for episodic cognition in appetite regulation.

The economic burden of schizophrenia in Malaysia.

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Teoh, Siew Li; Chong, Huey Yi; Abdul Aziz, Salina; Chemi, Norliza; Othman, Abdul Razak; Md Zaki, Nurzuriana; Vanichkulpitak, Possatorn; Chaiyakunapruk, Nathorn

2017-01-01

Schizophrenia (SCZ) is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia. A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL). The medical charts were identified electronically by matching the unique patient's identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted. The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million (M) which was equivalent to 0.04% of the national gross domestic product. On average, the mean cost per patient was USD 6,594. Of the total economic burden of SCZ, 72% was attributed to indirect cost, costing at USD 72M, followed by direct medical cost (26%), costing at USD 26M, and direct non-medical cost (2%), costing at USD 1.7M. This study highlights the magnitude of economic burden of SCZ and informs the policy-makers that there is an inadequate support for SCZ patients. More resources should be allocated to improve the condition of SCZ patients and to reduce the economic burden.

Uncertainties in Organ Burdens Estimated from PAS

International Nuclear Information System (INIS)

La Bone, T.R.

2004-01-01

To calculate committed effective dose equivalent, one needs to know the quantity of the radionuclide in all significantly irradiated organs (the organ burden) as a function of time following the intake. There are two major sources of uncertainty in an organ burden estimated from personal air sampling (PAS) data: (1) The uncertainty in going from the exposure measured with the PAS to the quantity of aerosol inhaled by the individual, and (2) The uncertainty in going from the intake to the organ burdens at any given time, taking into consideration the biological variability of the biokinetic models from person to person (interperson variability) and in one person over time (intra-person variability). We have been using biokinetic modeling methods developed by researchers at the University of Florida to explore the impact of inter-person variability on the uncertainty of organ burdens estimated from PAS data. These initial studies suggest that the uncertainties are so large that PAS might be considered to be a qualitative (rather than quantitative) technique. These results indicate that more studies should be performed to properly classify the reliability and usefulness of using PAS monitoring data to estimate organ burdens, organ dose, and ultimately CEDE

Symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors: A cohort analysis.

Science.gov (United States)

Wong, Angela T T; Lai, Stephen Y; Gunn, G Brandon; Beadle, Beth M; Fuller, Clifton D; Barrow, Martha P; Hofstede, Theresa M; Chambers, Mark S; Sturgis, Erich M; Mohamed, Abdallah Sherif Radwan; Lewin, Jan S; Hutcheson, Katherine A

2017-03-01

The purpose is to examine the relationship between mandibular osteoradionecrosis (ORN) and chronic dysphagia in long-term oropharynx cancer (OPC) survivors, and to determine the perceived symptom burden associated with ORN. Medical records of 349 OPC patients treated with bilateral IMRT and systemic therapy were reviewed. ORN was graded using a published 4-point classification schema. Patients were considered to have chronic dysphagia if they had aspiration pneumonia, stricture or aspiration detected by fluoroscopy or endoscopy, and/or feeding tube dependence in long-term follow-up ⩾1year following radiotherapy. MD Anderson Symptom Inventory - Head and Neck Module (MDASI-HN) scores were analyzed in a nested cross-sectional survey sample of 118 patients. 34 (9.7%, 95% CI: 6.8-13.3%) patients developed ORN and 45 (12.9%, 95% CI: 9.6-16.9%) patients developed chronic dysphagia. Prevalence of chronic dysphagia was significantly higher in ORN cases (12/34, 35%) compared to those who did not develop ORN (33/315, 11%, pdysphagia (pdysphagia. Summary MDASI-HN symptom scores did not significantly differ by ORN grade. Significantly higher symptom burden was reported, however, among ORN cases compared to those without ORN for MDASI-HN swallowing (p=0.033), problems with teeth and/or gums (p=0.016) and change in activity (p=0.015) item scores. ORN is associated with excess burden of chronic dysphagia and higher symptom severity related to swallowing, dentition and activity limitations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dose-effect relationship between the thorium lung burden and the hepatic function of the miners at the Bayan Obo Rare-earth Iron Mine

International Nuclear Information System (INIS)

Cheng, Yong-e; Chen, Xing-an

2008-01-01

The purpose of this paper is to present the dose effect relationship between the thorium lung burden and the hepatic function of the miners at the Bayun Obo Rare-earth Iron Mine. The methods we used is to carry out the measurement of each miner.s exhaled thoron activity and the thorium lung burden along with the four hepatic functions (thymol turbidity test, glutamic pyruvic transaminase, thymol flocculation test and alkaline phosphatase)of the dust exposed miners in Bayun Obo Rare-earth Iron Mine. We have carried out three investigations in 1983, 1984-1987 and 1994 respectively. Results showed that during the period 1983-1994, 1158 measurements of thorium lung burden estimates and 1158 measurement of every four hepatic functions(altogether 4632 measurements) were performed on 638 dust-exposed miners. No adverse effects were observed. In the same time, none of the above-mentioned 638 exposed miners had a thorium lung burden higher than 11.11 Bq. It is concluded that if any miners. thorium lung burden not higher than 11.11 Bq, his four hepatic functions should not be affected. This first possible threshold for thorium lung burden affecting the hepatic functions was put forward by the authors and confirmed by the Information Center of Chinese Academy of Medical Science in 2003 after searching 23.6 million references. (author)

Overfat Adults and Children in Developed Countries: The Public Health Importance of Identifying Excess Body Fat

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Philip B. Maffetone

2017-07-01

Full Text Available The global overfat pandemic is a serious public health crisis that places a substantial burden on economic resources in developed countries. The term overfat refers to the presence of excess body fat that can impair health, even for normal weight non-obese individuals. Excess body fat is associated with cardiometabolic dysfunction, a clinical situation that can progressively worsen, potentially leading to various common disease risk factors, chronic diseases, increased morbidity and mortality, and reduced quality of life. The prevalence of overfat populations in 30 of the world’s most developed countries is substantially higher than recent global estimations, with the largest growth due to a relatively recent increased number of people with excess abdominal fat. Abdominal overfat is the most unhealthful form of this condition, so it is concerning that average waist circumference measures, generally indicative of abdominal overfat, have increased. Despite a leveling off appearance of being overweight and/or obese in some developed countries, the overfat pandemic continues to grow.

Equity implications of two burden-sharing rules for stabilizing greenhouse-gas concentrations

International Nuclear Information System (INIS)

Miketa, Asami; Schrattenholzer, Leo

2006-01-01

This paper focuses on the equity aspects of international burden sharing for global CO 2 emission stabilization. It first summarizes and classifies equity principles proposed in the published literature of the field. Of these, the authors selected three major equity principles, i.e., egalitarian equity, horizontal equity, and proportional equality (often referred to also as sovereign equity) to carry out a detailed examination of two sets of quantitative emission entitlements, which are based on two burden-sharing rules, i.e., the equal emissions per capita approach and the carbon intensity approach. The two burden-sharing rules were chosen as not only particularly popular, but also because their application results in distinctly different burden sharing among countries. To make the two rules comparable, we used a global carbon-emission path until the year 2050 that leads to an atmospheric CO 2 concentration of 550 ppm. We then used the two rules for allocating the global emissions described by that path to allocate carbon emission entitlements to 67 countries and 9 world regions. In general, developing countries receive relatively higher entitlements under the equal emissions per capita approach whereas industrialized countries are relatively better off under the carbon intensity approach. In some countries and regions, emission entitlements as calculated by any of the two burden-sharing rules are so low that it would be unrealistic to assume that actual emissions can be limited to the emission entitlements assigned to them without using flexibility mechanisms such as those defined in the Kyoto Protocol. In this sense, the calculated entitlements can be also interpreted as the initial allocation of tradable emission allowances of countries or regions. Nonetheless, we considered any numerical determination of resulting carbon trade flows to be outside the scope of our paper

Burden of Diarrhea in the Eastern Mediterranean Region, 1990–2013: Findings from the Global Burden of Disease Study 2013

Science.gov (United States)

Khalil, Ibrahim; Colombara, Danny V.; Forouzanfar, Mohammad Hossein; Troeger, Christopher; Daoud, Farah; Moradi-Lakeh, Maziar; El Bcheraoui, Charbel; Rao, Puja C.; Afshin, Ashkan; Charara, Raghid; Abate, Kalkidan Hassen; El Razek, Mohammed Magdy Abd; Abd-Allah, Foad; Abu-Elyazeed, Remon; Kiadaliri, Aliasghar Ahmad; Akanda, Ali Shafqat; Akseer, Nadia; Alam, Khurshid; Alasfoor, Deena; Ali, Raghib; AlMazroa, Mohammad A.; Alomari, Mahmoud A.; Al-Raddadi, Rajaa Mohammad Salem; Alsharif, Ubai; Alsowaidi, Shirina; Altirkawi, Khalid A.; Alvis-Guzman, Nelson; Ammar, Walid; Antonio, Carl Abelardo T.; Asayesh, Hamid; Asghar, Rana Jawad; Atique, Suleman; Awasthi, Ashish; Bacha, Umar; Badawi, Alaa; Barac, Aleksandra; Bedi, Neeraj; Bekele, Tolesa; Bensenor, Isabela M.; Betsu, Balem Demtsu; Bhutta, Zulfiqar; Bin Abdulhak, Aref A.; Butt, Zahid A.; Danawi, Hadi; Dubey, Manisha; Endries, Aman Yesuf; Faghmous, Imad D. A.; Farid, Talha; Farvid, Maryam S.; Farzadfar, Farshad; Fereshtehnejad, Seyed-Mohammad; Fischer, Florian; Fitchett, Joseph Robert Anderson; Gibney, Katherine B.; Ginawi, Ibrahim Abdelmageem Mohamed; Gishu, Melkamu Dedefo; Gugnani, Harish Chander; Gupta, Rahul; Hailu, Gessessew Bugssa; Hamadeh, Randah Ribhi; Hamidi, Samer; Harb, Hilda L.; Hedayati, Mohammad T.; Hsairi, Mohamed; Husseini, Abdullatif; Jahanmehr, Nader; Javanbakht, Mehdi; Jibat, Tariku; Jonas, Jost B.; Kasaeian, Amir; Khader, Yousef Saleh; Khan, Abdur Rahman; Khan, Ejaz Ahmad; Khan, Gulfaraz; Khoja, Tawfik Ahmed Muthafer; Kinfu, Yohannes; Kissoon, Niranjan; Koyanagi, Ai; Lal, Aparna; Latif, Asma Abdul Abdul; Lunevicius, Raimundas; El Razek, Hassan Magdy Abd; Majeed, Azeem; Malekzadeh, Reza; Mehari, Alem; Mekonnen, Alemayehu B.; Melaku, Yohannes Adama; Memish, Ziad A.; Mendoza, Walter; Misganaw, Awoke; Mohamed, Layla Abdalla Ibrahim; Nachega, Jean B.; Le Nguyen, Quyen; Nisar, Muhammad Imran; Peprah, Emmanuel Kwame; Platts-Mills, James A.; Pourmalek, Farshad; Qorbani, Mostafa; Rafay, Anwar; Rahimi-Movaghar, Vafa; Ur Rahman, Sajjad; Rai, Rajesh Kumar; Rana, Saleem M.; Ranabhat, Chhabi L.; Rao, Sowmya R.; Refaat, Amany H.; Riddle, Mark; Roshandel, Gholamreza; Ruhago, George Mugambage; Saleh, Muhammad Muhammad; Sanabria, Juan R.; Sawhney, Monika; Sepanlou, Sadaf G.; Setegn, Tesfaye; Sliwa, Karen; Sreeramareddy, Chandrashekhar T.; Sykes, Bryan L.; Tavakkoli, Mohammad; Tedla, Bemnet Amare; Terkawi, Abdullah S.; Ukwaja, Kingsley; Uthman, Olalekan A.; Westerman, Ronny; Wubshet, Mamo; Yenesew, Muluken A.; Yonemoto, Naohiro; Younis, Mustafa Z.; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Al Rabeeah, Abdullah A.; Wang, Haidong; Naghavi, Mohsen; Vos, Theo; Lopez, Alan D.; Murray, Christopher J. L.; Mokdad, Ali H.

2016-01-01

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0–1) in Bahrain and Oman to 471 (95% UI = 245–763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520–989) in Syria to 40,869 (95% UI = 21,540–65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden. PMID:27928080

Caregiver Stigma and Burden in Memory Disorders: An Evaluation of the Effects of Caregiver Type and Gender

Directory of Open Access Journals (Sweden)

Phoebe V. Kahn

2016-01-01

Full Text Available Despite considerable gains in public awareness of dementia, dementia patients and their caregivers continue to be stigmatized. Previous work has explored stigma and burden among adult children of persons with dementia in Israel, but no similar data exist for spousal caregivers or caregivers in general in the United States. This study examines the differences in stigma and burden experienced by spousal and adult child caregivers and male and female caregivers of persons with dementia. Eighty-two caregivers were given the Zarit Burden Inventory Short Form (ZBI and the Caregiver Section of the Family Stigma in Alzheimer’s Disease Scale (FS-ADS-C. Scores on the FS-ADS-C and ZBI were positively correlated (rs=.51, p<.001. Female caregivers reported experiencing more stigma on the FS-ADS-C (t(80 = −4.37, p<.001 and more burden on the ZBI (t(80 = −2.68, p=.009 compared to male caregivers, and adult child caregivers reported experiencing more stigma on the FS-ADS-C (t(30.8 = −2.22, p=.034 and more burden on the ZBI (t(80 = −2.65, p=.010 than spousal caregivers. These results reinforce the importance of support for caregivers, particularly adult child and female caregivers who may experience higher levels of stigma and burden.

The high burden of cholera in children: comparison of incidence from endemic areas in Asia and Africa.

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Jacqueline L Deen

Full Text Available BACKGROUND: Cholera remains an important public health problem. Yet there are few reliable population-based estimates of laboratory-confirmed cholera incidence in endemic areas around the world. METHODS: We established treatment facility-based cholera surveillance in three sites in Jakarta (Indonesia, Kolkata (India, and Beira (Mozambique. The annual incidence of cholera was estimated using the population census as the denominator and the age-specific number of cholera cases among the study cohort as the numerator. FINDINGS: The lowest overall rate was found in Jakarta, where the estimated incidence was 0.5/1000 population/year. The incidence was three times higher in Kolkata (1.6/1000/year and eight times higher in Beira (4.0/1000/year. In all study sites, the greatest burden was in children under 5 years of age. CONCLUSION: There are considerable differences in cholera incidence across these endemic areas but in all sites, children are the most affected. The study site in Africa had the highest cholera incidence consistent with a growing impression of the large cholera burden in Africa. Burden estimates are useful when considering where and among whom interventions such as vaccination would be most needed.

Measuring the burden of neglected tropical diseases: the global burden of disease framework.

Directory of Open Access Journals (Sweden)

Colin D Mathers

2007-11-01

Full Text Available Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY.This paper describes key features of the Global Burden of Disease analytic approach, which provides a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and a systematic approach to the evaluation of data. The paper describes the evolution of the GBD, starting from the first study for the year 1990, summarizes the methodological improvements incorporated into GBD revisions for the years 2000-2004 carried out by the World Health Organization, and examines priorities and issues for the next major GBD study, funded by the Bill & Melinda Gates Foundation, and commencing in 2007.The paper presents an overview of summary results from the Global Burden of Disease study 2002, with a particular focus on the neglected tropical diseases, and also an overview of the comparative risk assessment for 26 global risk factors. Taken together, trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis, intestinal nematode infections, Japanese encephalitis, dengue, and leprosy accounted for an estimated 177,000 deaths worldwide in 2002, mostly in sub-Saharan Africa, and about 20 million DALYs, or 1.3% of the global burden of disease and injuries. Further research is currently underway to revise and update these estimates.

Body image mediates the effect of cancer-related stigmatization on depression

DEFF Research Database (Denmark)

Esser, Peter; Mehnert, Anja; Johansen, Christoffer

2018-01-01

OBJECTIVE: Because cancer-related stigmatization is prevalent but difficult to change, research on its impact on psychological burden and respective intervening variables is needed. Therefore, we investigated the effect of stigmatization on depressive symptomatology and whether body image mediates...... this relationship. METHODS: This bicentric study assessed patients of 4 major tumor entities. We measured stigmatization (SIS-D), depressive symptomatology (PHQ-9), and body image (FKB-20). Applying multiple mediator analyses, we calculated the total effect of stigmatization on depressive symptomatology...

Estimation of thorium lung burden in mineral separation plant workers by thoron-in-breath measurements

International Nuclear Information System (INIS)

Radhakrishnan, Sujata; Sreekumar, K.; Tripathi, R.M.; Puranik, V.D.; Selvan, Esai

2010-01-01

The Minerals Separation Plant (MSP) of M/s Indian Rare Earths Ltd. (IREL) at Manavalakurichi in Tamil Nadu is engaged in the processing of beach sands to separate ilmenite, monazite, rutile, sillimanite, garnet, and zircon. The present study has been carried out on nearly 200 workers of the mineral separation plant who are chronically exposed to the radiation hazards. Measurement of thoron in the exhaled breath of the worker is an indirect method of estimating the body burden with regard to Th

Impact of JAK2V617F Mutation Burden on Disease Phenotype in Chinese Patients with JAK2V617F-positive Polycythemia Vera (PV) and Essential thrombocythemia (ET).

Science.gov (United States)

Zhao, Shixiang; Zhang, Xiang; Xu, Yang; Feng, Yufeng; Sheng, Wenhong; Cen, Jiannong; Wu, Depei; Han, Yue

2016-01-01

Most patients with polycythemia vera (PV) and half of essential thrombocythemia (ET) possess an activating JAK2V617F mutation. The objective of this study was to better define the effect of JAK2V617F mutant allele burden on clinical phenotypes in Chinese patients, especially thrombosis. By real-time polymerase chain reaction (RT-PCR), the JAK2V617F mutation burden was detected in 170 JAK2V617F-positive patients, including 54 PV and 116 ET. The results showed that JAK2V617F allele burden was higher in PV than in ET (PET (68.5% VS 26.7%) (PET patients showed increased JAK2V617F allele burden in the group with higher hemoglobin (HGB above 150 g/L) (PET. In PV patients, JAK2V617F mutation burden had influence on WBC counts. And the clinical characteristics of ET patients, such as WBC counts, hemoglobin level, splenomegaly and thrombosis, were influenced by JAK2V617F mutation burden. Male, high hemoglobin (HGB above 150 g/L), and increased JAK2V617F mutation burden (JAK2V617F allele burden ≥ 16.5%) were risks of thrombosis (PET patients by Logistic Regression.

Some remarks on the natural radiation burden of population

International Nuclear Information System (INIS)

Feher, I.; Gemesi, J.; Toth, A.

1975-04-01

A large scale of the population's radiation burden is due to the natural radioactivity of building materials. An appropriate model has been developed for the calculation of the burden of population from the concentration of radioisotopes in building materials. The external and internal radiation burden of Hungary's population were determined (weighted means were 33 mrem/year and the bronhial dose 730 mrad/year, respectively) and the effect of new building technologies and materials on the radiation burden was studied. In dwellings built of precast concrete slabs containing low-activity ballast available in Hungary the radiation burden was found to be significantly lower than the present average. The increase in the contamination hazard expected from the peaceful uses of atomic energy could be compensated by reducing the average external radiation burden together with the average bronchial dose. This reduction can be 1.6 mrem/year and 58 mrad/year, respectively (according to our estimations based on simple assumptions), requiring acceptable excess cost. (K.A.)

Dioxin body burden of persons living near incinerators and sintering plants: results from Belgium; Evaluation de la charge corporelle en dioxines des riverains d'incinerateurs et de la siderurgie: resultats d'une etude realisee en Belgique

Energy Technology Data Exchange (ETDEWEB)

Fierens, S.; Bernard, A. [Universite Catholique de Louvain (UCL), Unite de Toxicologie Industrielle et de Medecine du Travail, Faculte de Medecine, Louvain-la-Neuve (Belgium); Focant, J.F.; Eppe, G.; Pauw, E. de [Liege Univ., Lab. de Spectrometrie de Masse (CART) (Belgium)

2005-01-15

The aim of this study was to evaluate the impact on local residents' exposure to dioxines and coplanar PCBs (polychlorinated biphenyls) of two municipal solid waste incinerators (MSWI), one in an industrial area and the other in a rural zone, and two sintering plants, all located in Wallonia (Belgium). In all, 142 volunteers subjects living around these facilities and 63 volunteer referents from an unpolluted rural area were recruited and compared. They completed a self-administered questionnaire that furnished information about dietary habits, smoking habits, anthropometric characteristics, residential history and health status. They also provided blood samples under fasting conditions so that the body burden of dioxines (17 PCDD/Fs congeners) and coplanar PCBs could be assessed. After adjustment for co-variates determined by multiple linear regression analysis, serum concentrations of dioxines and coplanar PCBs in subjects living in the vicinity of the MSWI in the industrial area and of the sintering plants were similar to those of referents. In contrast, subjects living in the vicinity of the rural MSWI had significantly higher serum levels of dioxines (geometric mean, 38 vs 24 pg TEQ/g fat, p{<=}0.0001) and coplanar PCBs (geometric mean, 10.8 vs 7.0 pg TEQ/g fat, p{<=}0.05). Age-adjusted dioxin levels in referents did not vary with local animal fat consumption, but dioxin concentrations in subjects living around the MSWIs correlated positively with their intake of local animal fat, with levels almost doubled in subjects with the highest intake. These results show that the dioxines and coplanar PCBs emitted by MSWIs can indeed accumulate in the body of residents who consume animal products of local origin. (authors)

Estimating the true global burden of mental illness.

Science.gov (United States)

Vigo, Daniel; Thornicroft, Graham; Atun, Rifat

2016-02-01

We argue that the global burden of mental illness is underestimated and examine the reasons for under-estimation to identify five main causes: overlap between psychiatric and neurological disorders; the grouping of suicide and self-harm as a separate category; conflation of all chronic pain syndromes with musculoskeletal disorders; exclusion of personality disorders from disease burden calculations; and inadequate consideration of the contribution of severe mental illness to mortality from associated causes. Using published data, we estimate the disease burden for mental illness to show that the global burden of mental illness accounts for 32·4% of years lived with disability (YLDs) and 13·0% of disability-adjusted life-years (DALYs), instead of the earlier estimates suggesting 21·2% of YLDs and 7·1% of DALYs. Currently used approaches underestimate the burden of mental illness by more than a third. Our estimates place mental illness a distant first in global burden of disease in terms of YLDs, and level with cardiovascular and circulatory diseases in terms of DALYs. The unacceptable apathy of governments and funders of global health must be overcome to mitigate the human, social, and economic costs of mental illness. Copyright © 2016 Elsevier Ltd. All rights reserved.

The global burden of periodontal disease

DEFF Research Database (Denmark)

Petersen, Poul E; Ogawa, Hiroshi

2012-01-01

Chronic diseases are accelerating globally, advancing across all regions and pervading all socioeconomic classes. Unhealthy diet and poor nutrition, physical inactivity, tobacco use, excessive use of alcohol and psychosocial stress are the most important risk factors. Periodontal disease...... is a component of the global burden of chronic disease, and chronic disease and periodontal disease have the same essential risk factors. In addition, severe periodontal disease is related to poor oral hygiene and to poor general health (e.g. the presence of diabetes mellitus and other systemic diseases......). The present report highlights the global burden of periodontal disease: the ultimate burden of periodontal disease (tooth loss), as well as signs of periodontal disease, are described from World Health Organization (WHO) epidemiological data. High prevalence rates of complete tooth loss are found in upper...

The burden experienced by family caregivers of patients with ...

African Journals Online (AJOL)

BACKGROUND: Caring for patients with chronic medical and psychiatric disorders is associated with significant burden. However little is known about the burden experience by caregivers of patients with epilepsy in Nigeria. The objective of this study, therefore, was to assess the level and correlates of burden among ...

Caregiving burden and psychological distress in Chinese spousal caregivers: gender difference in the moderating role of positive aspects of caregiving.

Science.gov (United States)

Wong, Daniel Fu Keung; Ng, Ting Kin; Zhuang, Xiao Yu

2018-05-21

This study endeavors to advance the current literature by examining the gender differences in the caregiving experiences and the stress-buffering role of positive aspects of caregiving (PAC) among Chinese spousal caregivers of frail elders in Hong Kong. Forty-nine husband caregivers and 121 wife caregivers of frail elders in Hong Kong (N = 170) responded to the Positive Aspects of Caregiving (PAC) scale, the Zarit Burden Interview (ZBI), the 21-item Depression, Anxiety, and Stress Scales (DASS-21), and demographic questions. These spousal caregivers were diverse in age, and their care receivers were diverse in terms of age and health condition. As predicted, there were significant gender differences in the moderating effects of PAC on the relationships of caregiving burden to depression, anxiety, and overall psychological distress. While PAC significantly buffered the effects of caregiving burden on depression, anxiety, and overall psychological distress for wife caregivers, the moderating effects of PAC were not significant for husband caregivers. Unexpectedly, wife caregivers reported lower PAC, higher caregiving burden, and higher psychological distress. As these findings suggest that PAC is lower but more beneficial for Chinese wife caregivers than Chinese husband caregivers, helping professionals are recommended to use strengths-based interventions that target PAC when working with Chinese wife caregivers.

Deep brain stimulation for patients with Parkinson's disease: Effect on caregiver burden.

Science.gov (United States)

Crespo-Burillo, J A; Rivero-Celada, D; Saenz-de Cabezón, A; Casado-Pellejero, J; Alberdi-Viñas, J; Alarcia-Alejos, R

2018-04-01

Our aim is to assess the burden on caregivers of patients with Parkinson's disease treated with deep brain stimulation (DBS) compared to those caring for patients at advanced stages and undergoing other treatments. We have also assessed the variables associated with presence of caregiver overload. We included consecutive patients with Parkinson's disease treated with DBS. Our control group included patients in advanced stages of Parkinson's disease undergoing other treatments. Patients were assessed with the following scales: UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn and Yahr, Schwab & England, Barthel, PDQ-39, MoCA, Apathy Evaluation Scale, HADS, and the abbreviated QUIP. Caregiver burden was evaluated with the Zarit caregiver burden interview and their moods were assessed with the HADS scale. We included 11 patients treated with DBS and 11 with other treatments. For patients treated with DBS, we observed a better quality of life according to the PDQ-39 questionnaire (P=.028), and a lower score on the HADS anxiety subscale (P=.010). Caregiver overload was observed in 54.5% of the caregivers of patients in both groups (P=1.000); Zarit scores were similar (P=.835). Caregiver overload was associated with higher scores on the caregiver's Apathy Evaluation Scale (P=.048) and on the HADS anxiety subscale (P=.006). According to our results, treatment with DBS is not associated with lower caregiver burden. Apathy in patients and anxiety in caregivers are factors associated with the appearance of overload. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Action to address the household economic burden of non-communicable diseases.

Science.gov (United States)

Jan, Stephen; Laba, Tracey-Lea; Essue, Beverley M; Gheorghe, Adrian; Muhunthan, Janani; Engelgau, Michael; Mahal, Ajay; Griffiths, Ulla; McIntyre, Diane; Meng, Qingyue; Nugent, Rachel; Atun, Rifat

2018-05-19

The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals. Copyright © 2018 Elsevier Ltd. All rights reserved.

Exposure to violence in childhood is associated with higher body mass index in adolescence.

Science.gov (United States)

Gooding, Holly C; Milliren, Carly; Austin, S Bryn; Sheridan, Margaret A; McLaughlin, Katie A

2015-12-01

To determine whether different types of childhood adversity are associated with body mass index (BMI) in adolescence, we studied 147 adolescents aged 13-17 years, 41% of whom reported exposure to at least one adversity (maltreatment, abuse, peer victimization, or witness to community or domestic violence). We examined associations between adversity type and age- and sex-specific BMI z-scores using linear regression and overweight and obese status using logistic regression. We adjusted for potential socio-demographic, behavioral, and psychological confounders and tested for effect modification by gender. Adolescents with a history of sexual abuse, emotional abuse, or peer victimization did not have significantly different BMI z-scores than those without exposure (p>0.05 for all comparisons). BMI z-scores were higher in adolescents who had experienced physical abuse (β=0.50, 95% CI 0.12-0.91) or witnessed domestic violence (β=0.85, 95% CI 0.30-1.40). Participants who witnessed domestic violence had almost 6 times the odds of being overweight or obese (95% CI: 1.09-30.7), even after adjustment for potential confounders. No gender-by-adversity interactions were found. Exposure to violence in childhood is associated with higher adolescent BMI. This finding highlights the importance of screening for violence in pediatric practice and providing obesity prevention counseling for youth. Copyright © 2015 Elsevier Ltd. All rights reserved.

Visual field impairment captures disease burden in multiple sclerosis.

Science.gov (United States)

Ortiz-Perez, Santiago; Andorra, Magí; Sanchez-Dalmau, Bernardo; Torres-Torres, Rubén; Calbet, David; Lampert, Erika J; Alba-Arbalat, Salut; Guerrero-Zamora, Ana M; Zubizarreta, Irati; Sola-Valls, Nuria; Llufriu, Sara; Sepúlveda, María; Saiz, Albert; Villoslada, Pablo; Martinez-Lapiscina, Elena H

2016-04-01

Monitoring disease burden is an unmeet need in multiple sclerosis (MS). Identifying patients at high risk of disability progression will be useful for improving clinical-therapeutic decisions in clinical routine. To evaluate the role of visual field testing in non-optic neuritis eyes (non-ON eyes) as a biomarker of disability progression in MS. In 109 patients of the MS-VisualPath cohort, we evaluated the association between visual field abnormalities and global and cognitive disability markers and brain and retinal imaging markers of neuroaxonal injury using linear regression models adjusted for sex, age, disease duration and use of disease-modifying therapies. We evaluated the risk of disability progression associated to have baseline impaired visual field after 3 years of follow-up. Sixty-two percent of patients showed visual field defects in non-ON eyes. Visual field mean deviation was statistically associated with global disability; brain (normalized brain parenchymal, gray matter volume and lesion load) and retinal (peripapillary retinal nerve fiber layer thickness and macular ganglion cell complex thickness) markers of neuroaxonal damage. Patients with impaired visual field had statistically significative greater disability, lower normalized brain parenchymal volume and higher lesion volume than patients with normal visual field testing. MS patients with baseline impaired VF tripled the risk of disability progression during follow-up [OR = 3.35; 95 % CI (1.10-10.19); p = 0.033]. The association of visual field impairment with greater disability and neuroaxonal injury and higher risk of disability progression suggest that VF could be used to monitor MS disease burden.

Holding fat stereotypes is associated with lower body dissatisfaction in normal weight Caucasian women who engage in body surveillance.

Science.gov (United States)

Kim, Jean; Jarry, Josée L

2014-09-01

This study examined the moderating effect of body surveillance on the relationship between fat stereotype endorsement and body dissatisfaction in normal weight women. Participants (N=225) completed online measures of fat stereotyping, body surveillance, body dissatisfaction, and internalized thin ideals. After accounting for thin ideals, body surveillance moderated the relationship between fat stereotypes and body dissatisfaction. Contrary to hypotheses, higher fat stereotype endorsement predicted lower body dissatisfaction in women with higher body surveillance. Conversely, higher fat stereotype endorsement predicted greater body dissatisfaction in women with lower body surveillance. Thus, endorsing fat stereotypes appears protective against body dissatisfaction in normal weight women who extensively engage in body surveillance. For women who hold fat stereotypes and report high body surveillance, we propose that downward appearance comparison may create a contrast between themselves and the people with overweight whom they denigrate, thus improving body dissatisfaction. Copyright © 2014 Elsevier Ltd. All rights reserved.

Zarit Burden Interview Psychometric Indicators Applied in Older People Caregivers of Other Elderly 1

Science.gov (United States)

Bianchi, Mariana; Flesch, Leticia Decimo; Alves, Erika Valeska da Costa; Batistoni, Samila Sathler Taveres; Neri, Anita Liberalesso

2016-01-01

ABSTRACT Objective: to derive psychometric indicators of construct validity and internal consistence of the Zarit Burden Interview scale for caregivers, describing associations of the scale with metrics related to care demands, coping strategies and depression in aged caregivers. Method: crosscutting descriptive and correlational study. The convenience sample was composed by a hundred and twenty one senior caregivers (Avg=70.5 ± 7.2 years, 73% women). They answered a questionnaire to check the physical and cognitive demands of care, the Zarit Burden Interview (ZBI), the California Inventory of Coping Strategies and the Geriatric Depression Scale (GDS-15). Results: ZBI showed good internal consistency and also for the three factors emerging from factor analysis, explaining 44% of variability. ZBI is positively related with objective care demands (p < 0.001), depression (p = 0.006) and use of dysfunctional coping strategies (p = 0.0007). Conclusion: ZBI is of interest to be applied to aged caregivers and the association of higher degrees of burden, dysfunctional coping and depression show a vulnerability scenario that may affect to older people taking care of other elderly. PMID:27901220

Chronic disease burden predicts food insecurity among older adults.

Science.gov (United States)

Jih, Jane; Stijacic-Cenzer, Irena; Seligman, Hilary K; Boscardin, W John; Nguyen, Tung T; Ritchie, Christine S

2018-06-01

Increased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity. Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS. USA. Respondents of the 2013 HRS HCNS with household incomes insecurity was 27·8 %. Compared with those having 0-1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2-4 conditions being 2·12 (95 % CI 1·45, 3·09) and for those with ≥5 conditions being 3·64 (95 % CI 2·47, 5·37). A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

6 CFR 27.325 - Burden of proof.

Science.gov (United States)

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Burden of proof. 27.325 Section 27.325 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM... burden of proving the facts necessary to support the challenged administrative action at every proceeding...

Formalising arguments about the burden of persuasion.

NARCIS (Netherlands)

Prakken, H.; Sartor, G.

2007-01-01

This paper presents an argument-based logic for reasoning about allocations of the burden of persuasion. The logic extends the system of Prakken (2001), which in turn modified the system of Prakken & Sartor (1996) with the possibility to distribute the burden of proof over both sides in an argument

Dehydration in the Elderly: A Review Focused on Economic Burden.

Science.gov (United States)

Frangeskou, M; Lopez-Valcarcel, B; Serra-Majem, L

2015-06-01

Dehydration is the most common fluid and electrolyte problem among elderly patients. It is reported to be widely prevalent and costly to individuals and to the health care system. The purpose of this review is to summarize the literature on the economic burden of dehydration in the elderly. A comprehensive search of several databases from database inception to November 2013, only in English language, was conducted. The databases included Pubmed and ISI Web of Science. The search terms «dehydration» / "hyponaremia" / "hypernatremia" AND «cost» AND «elderly» were used to search for comparative studies of the economic burden of dehydration. A total of 15 papers were identified. Dehydration in the elderly is an independent factor of higher health care expenditures. It is directly associated with an increase in hospital mortality, as well as with an increase in the utilization of ICU, short and long term care facilities, readmission rates and hospital resources, especially among those with moderate to severe hyponatremia. Dehydration represents a potential target for intervention to reduce healthcare expenditures and improve patients' quality of life.

The burden of diagnosed and undiagnosed diabetes in Native Hawaiian and Asian American hospitalized patients

Directory of Open Access Journals (Sweden)

T.L. Sentell

2015-12-01

Conclusions: Hospitalized Native Hawaiians (41% and Asian subgroups had significantly higher overall diabetes burdens compared to Whites (23%. Potentially undiagnosed diabetes was associated with poor outcomes. Hospitalized patients, irrespective of race/ethnicity, may require more effective inpatient identification and management of previously undiagnosed diabetes to improve clinical outcomes.

Double burden of disease in the slums of Kenya

NARCIS (Netherlands)

Oti, S.O.

2015-01-01

The goal of this thesis was to provide evidence of a double burden of disease in the slums of Nairobi and to make a case for an integrated health systems approach to tackling this situation. A double burden of disease refers to the coexistence of a high burden of communicable and non-communicable

Burden attributable to child maltreatment in Australia.

Science.gov (United States)

Moore, Sophie E; Scott, James G; Ferrari, Alize J; Mills, Ryan; Dunne, Michael P; Erskine, Holly E; Devries, Karen M; Degenhardt, Louisa; Vos, Theo; Whiteford, Harvey A; McCarthy, Molly; Norman, Rosana E

2015-10-01

Child maltreatment is a complex phenomenon, with four main types (childhood sexual abuse, physical abuse, emotional abuse, and neglect) highly interrelated. All types of maltreatment have been linked to adverse health consequences and exposure to multiple forms of maltreatment increases risk. In Australia to date, only burden attributable to childhood sexual abuse has been estimated. This study synthesized the national evidence and quantified the burden attributable to the four main types of child maltreatment. Meta-analyses, based on quality-effects models, generated pooled prevalence estimates for each maltreatment type. Exposure to child maltreatment was examined as a risk factor for depressive disorders, anxiety disorders and intentional self-harm using counterfactual estimation and comparative risk assessment methods. Adjustments were made for co-occurrence of multiple forms of child maltreatment. Overall, an estimated 23.5% of self-harm, 20.9% of anxiety disorders and 15.7% of depressive disorders burden in males; and 33.0% of self-harm, 30.6% of anxiety disorders and 22.8% of depressive disorders burden in females was attributable to child maltreatment. Child maltreatment was estimated to cause 1.4% (95% uncertainty interval 0.4-2.3%) of all disability-adjusted life years (DALYs) in males, and 2.4% (0.7-4.1%) of all DALYs in females in Australia in 2010. Child maltreatment contributes to a substantial proportion of burden from depressive and anxiety disorders and intentional self-harm in Australia. This study demonstrates the importance of including all forms of child maltreatment as risk factors in future burden of disease studies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Fewer Resources, More Debt: Loan Debt Burdens Students at Historically Black Colleges and Universities

Science.gov (United States)

Saunders, Katherine M.; Williams, Krystal L.; Smith, Cheryl L.

2016-01-01

Student loans have become an increasingly important way for students and their families to pay for college, but for students at historically black colleges and universities (HBCUs), student loan debt is a substantial burden. Students who attend these institutions--many of whom are low-income and first-generation--must borrow at higher rates and,…

The personal, societal, and economic burden of schizophrenia in the People's Republic of China: implications for antipsychotic therapy.

Science.gov (United States)

Montgomery, William; Liu, Li; Stensland, Michael D; Xue, Hai Bo; Treuer, Tamas; Ascher-Svanum, Haya

2013-01-01

This article describes the personal, societal, and economic burden attributable to schizophrenia in the People's Republic of China and highlights the potential for effective outpatient treatment to reduce this burden given recent changes in the Chinese health care system. The importance of effective antipsychotic therapy in reducing the burden of schizophrenia is also examined. Published research on the burden, disability, management, and economic costs of schizophrenia in the People's Republic of China was examined in the context of the larger body of global research. Research written in English or Chinese and published before June 2012 was identified using PubMed, CNKI, and Wanfang Med database searches. The contribution of effective antipsychotic therapy in reducing the risk for relapse and hospitalization and improving patients' functioning is described. Schizophrenia imposes a substantial burden on Chinese society, with indirect costs accounting for the majority of the total cost. Functional impairment is high, leading to lost wages and work impairment. In the People's Republic of China, schizophrenia is the most common diagnosis among hospitalized psychiatric patients. Ongoing changes in the Chinese health care system may reduce some barriers to effective relapse prevention in schizophrenia and potentially reduce hospitalizations. The use of antipsychotics for acute episodes and maintenance treatment has been shown to decrease symptom severity and reduce the risk for relapse and hospitalization. However, discontinuing antipsychotic medication appears common and is a strong predictor of relapse. Cost-effectiveness research in the People's Republic of China is needed to examine the potential gains from improved outpatient antipsychotic treatment. Schizophrenia is a very costly mental illness in terms of personal, economic, and societal burden, both in the People's Republic of China and globally. When treated effectively, patients tend to persist longer with

Private prayer among Alzheimer's caregivers: mediating burden and resiliency.

Science.gov (United States)

Wilks, Scott E; Vonk, M Elizabeth

2008-01-01

This study examined whether the coping method of private prayer served as a protective factor of resiliency among a sample (N = 304) of Alzheimer's caregivers. Participants in caregiver support groups completed questionnaires that assessed a number of constructs, including caregiving burden; prayer frequency; use of private prayer as a means of coping; and perceived resiliency. The sample averaged a moderate level of burden and a great extent of prayer usage. Caregiving burden had positively affected the extent of prayer usage and negatively influenced perceived resiliency. Findings from hierarchical regression analysis showed that caregiving burden and private prayer significantly influenced variation in perceived resiliency scores. Results from a regression equation series and path analysis provided support for prayer as a mediator between burden and perceived resiliency. Implications for social work practice and education are discussed.

Does published research on non-communicable disease (NCD in Arab countries reflect NCD disease burden?

Directory of Open Access Journals (Sweden)

Abla M Sibai

Full Text Available To review trends in non-communicable (NCD research output in the Arab region, in terms of quantity and quality, study design, setting and focus. We also examined differences by time and place, and assessed gaps between research output and NCD burden.A scoping review of a total of 3,776 NCD-related reports published between 2000 and 2013 was conducted for seven Arab countries. Countries were selected to represent diverse socio-economic development levels in the region: Regression analyses were used to assess trends in publications over time and by country. Research gaps were assessed by examining the degree of match between proportionate literature coverage of the four main NCDs (CVD, cancer, DM, and COPD and cause-specific proportional mortality rates (PMR.The annual number of NCD publications rose nearly 5-fold during the study period, with higher income countries having the higher publication rates (per million populations and the most rapid increases. The increase in the publication rate was particularly prominent for descriptive observational studies, while interventional studies and systematic reviews remained infrequent (slope coefficients = 13.484 and 0.883, respectively. Gap analysis showed a mismatch between cause-specific PMR burden and NCD research output, with a relative surplus of reports on cancer (pooled estimate +38.3% and a relative deficit of reports on CVDs (pooled estimate -30.3%.The widening disparity between higher and lower-income countries and the discordance between research output and disease burden call for the need for ongoing collaboration among Arab academic institutions, funding agencies and researchers to guide country-specific and regional research agendas, support and conduct.

Economic and humanistic burden of illness in generalized anxiety disorder: an analysis of patient survey data in Europe

Directory of Open Access Journals (Sweden)

Toghanian S

2014-04-01

Full Text Available Samira Toghanian,1 Marco DiBonaventura,2 Krister Järbrink,1 Julie C Locklear31AstraZeneca R&D, Mölndal, Sweden; 2Kantar Health, New York, NY, USA; 3AstraZeneca Pharmaceuticals, Wilmington, DE, USABackground: Whilst studies suggest that generalized anxiety disorder (GAD represents a considerable health care burden in Europe, there is a paucity of published evidence. This study investigated the burden of illness associated with GAD across five European countries (France, Germany, Italy, Spain, and the UK.Methods: Information from the 2008 European National Health and Wellness Survey database was analyzed. Bivariate, multivariate, and cost analyses were used to compare patients with GAD and propensity-matched controls.Results: Compared with non-GAD controls, patients with GAD had more comorbidities and were more likely to smoke but less likely to be employed, use alcohol, or take exercise. They also had significantly worse health-related quality of life, and significantly greater work impairment and resource use, which increased as GAD severity increased. Within-country analyses demonstrated results similar to those for the five European countries overall, with the largest differences in resource use between patients with GAD and non-GAD controls documented in France and Germany. The average mean differences in direct costs were relatively small between the GAD groups and controls; however, indirect costs differed substantially. Costs were particularly high in Germany, mainly due to higher salaries leading to higher costs associated with absence from work. The limitation of this study was that the data were from a self-reported Internet survey, making them subject to reporting bias and possibly sample bias.Conclusion: Across all five European countries, GAD had a significant impact on work impairment, resource use, and economic costs, representing a considerable individual and financial burden that increased with severity of disease. These data

20 CFR 498.215 - The hearing and burden of proof.

Science.gov (United States)

2010-04-01

... burden of going forward and the burden of persuasion with respect to affirmative defenses and any... persuasion with respect to all other issues. (c) The burden of persuasion will be judged by a preponderance...

The economic burden of cancer in Korea in 2009.

Science.gov (United States)

Kim, So Young; Park, Jong-Hyock; Kang, Kyoung Hee; Hwang, Inuk; Yang, Hyung Kook; Won, Young-Joo; Seo, Hong-Gwan; Lee, Dukhyoung; Yoon, Seok-Jun

2015-01-01

Cancer imposes a significant economic burden on individuals, families and society. The purpose of this study was to estimate the economic burden of cancer using the healthcare claims and cancer registry data in Korea in 2009. The economic burden of cancer was estimated using the prevalence data where patients were identified in the Korean Central Cancer Registry. We estimated the medical, non-medical, morbidity and mortality cost due to lost productivity. Medical costs were calculated using the healthcare claims data obtained from the Korean National Health Insurance (KNHI) Corporation. Non-medical costs included the cost of transportation to visit health providers, costs associated with caregiving for cancer patients, and costs for complementary and alternative medicine (CAM). Data acquired from the Korean National Statistics Office and Ministry of Labor were used to calculate the life expectancy at the time of death, age- and gender-specific wages on average, adjusted for unemployment and labor force participation rate. Sensitivity analysis was performed to derive the current value of foregone future earnings due to premature death, discounted at 3% and 5%. In 2009, estimated total economic cost of cancer amounted to $17.3 billion at a 3% discount rate. Medical care accounted for 28.3% of total costs, followed by non-medical (17.2%), morbidity (24.2%) and mortality (30.3%) costs. Given that the direct medical cost sharply increased over the last decade, we must strive to construct a sustainable health care system that provides better care while lowering the cost. In addition, a comprehensive cancer survivorship policy aimed at lower caregiving cost and higher rate of return to work has become more important than previously considered.

Family burden related to mental and physical disorders in the world: results from the WHO World Mental Health (WMH surveys

Directory of Open Access Journals (Sweden)

Maria Carmen Viana

2013-06-01

Full Text Available Objective: To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide. Methods: Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial and subjective (distress, embarrassment burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided. Results: Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+. Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings. Conclusions: The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers.

Prevalence and burden of Sickle Cell Disease among ...

African Journals Online (AJOL)

femi oloka

the variables pain severity, monthly income, the psychological and ... 44% had significant psychological burden while 37.3% have socio-cultural burden. The ..... 6. Otis-Green S. Psychosocial Pain. Assessment Form. In Dow (Ed.), Nursing.

Genetics Modulate Gray Matter Variation Beyond Disease Burden in Prodromal Huntington’s Disease

Directory of Open Access Journals (Sweden)

Jingyu Liu

2018-03-01

Full Text Available Huntington’s disease (HD is a neurodegenerative disorder caused by an expansion mutation of the cytosine–adenine–guanine (CAG trinucleotide in the HTT gene. Decline in cognitive and motor functioning during the prodromal phase has been reported, and understanding genetic influences on prodromal disease progression beyond CAG will benefit intervention therapies. From a prodromal HD cohort (N = 715, we extracted gray matter (GM components through independent component analysis and tested them for associations with cognitive and motor functioning that cannot be accounted for by CAG-induced disease burden (cumulative effects of CAG expansion and age. Furthermore, we examined genetic associations (at the genomic, HD pathway, and candidate region levels with the GM components that were related to functional decline. After accounting for disease burden, GM in a component containing cuneus, lingual, and middle occipital regions was positively associated with attention and working memory performance, and the effect size was about a tenth of that of disease burden. Prodromal participants with at least one dystonia sign also had significantly lower GM volume in a bilateral inferior parietal component than participants without dystonia, after controlling for the disease burden. Two single-nucleotide polymorphisms (SNPs: rs71358386 in NCOR1 and rs71358386 in ADORA2B in the HD pathway were significantly associated with GM volume in the cuneus component, with minor alleles being linked to reduced GM volume. Additionally, homozygous minor allele carriers of SNPs in a candidate region of ch15q13.3 had significantly higher GM volume in the inferior parietal component, and one minor allele copy was associated with a total motor score decrease of 0.14 U. Our findings depict an early genetical GM reduction in prodromal HD that occurs irrespective of disease burden and affects regions important for cognitive and motor functioning.

Burden of mortality in Greenland--today and tomorrow

DEFF Research Database (Denmark)

Nielsen, Lasse Christian; Hansen, Kristian Schultz; Nielsen, Ulla Ringgren

2004-01-01

: Concerted multi-sectoral approaches and broad holistic health strategies related to health promotion and prevention today will strategically improve the capability of the Greenlandic society to manage the future disease burden from ageing via its health care sector and the institutional sector for care......OBJECTIVES: Investigation of the relative impact of three factors expected to influence the future mortality burden in Greenland: demographic change, epidemiological transition and behavioural patterns. STUDY DESIGN: To identify general trends in public health status, evaluating the effect...... of public health campaigns and providing the basis for making predictions of future trends in the mortality burden data from the Greenlandic Death Causes Register to estimate Years of Life Lost (YLL) in the period 1976-1998 has been used. METHODS: YLL were estimated according to the Burden of Disease Method...

The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia : findings from the Global Burden of Disease study 2013

NARCIS (Netherlands)

Melaku, Yohannes Adama; Temesgen, Awoke Misganaw; Deribew, Amare; Tessema, Gizachew Assefa; Deribe, Kebede; Sahle, Berhe W.; Abera, Semaw Ferede; Bekele, Tolesa; Lemma, Ferew; Amare, Azmeraw T.; Seid, Oumer; Endris, Kedir; Hiruye, Abiy; Worku, Amare; Adams, Robert; Taylor, Anne W.; Gill, Tiffany K.; Shi, Zumin; Afshin, Ashkan; Forouzanfar, Mohammad H.

2016-01-01

Background: The burden of non-communicable diseases (NCDs) has increased in sub-Saharan countries, including Ethiopia. The contribution of dietary behaviours to the NCD burden in Ethiopia has not been evaluated. This study, therefore, aimed to assess diet-related burden of disease in Ethiopia

The Burden of Suicide in Rural Bangladesh: Magnitude and Risk Factors.

Science.gov (United States)

Sharmin Salam, Shumona; Alonge, Olakunle; Islam, Md Irteja; Hoque, Dewan Md Emdadul; Wadhwaniya, Shirin; Ul Baset, Md Kamran; Mashreky, Saidur Rahman; El Arifeen, Shams

2017-09-09

The aim of the paper is to quantify the burden and risk factors of fatal and non-fatal suicidal behaviors in rural Bangladesh. A census was carried out in seven sub-districts encompassing 1.16 million people. Face-to-face interviews were conducted at the household level. Descriptive analyses were done to quantify the burden and Poisson regression was run to determine on risk factors. The estimated rates of fatal and non-fatal suicide were 3.29 and 9.86 per 100,000 person years (PY) observed, respectively. The risk of suicide was significantly higher by 6.31 times among 15-17 and 4.04 times among 18-24 olds compared to 25-64 years old. Married adolescents were 22 times more likely to commit suicide compared to never-married people. Compared to Chandpur/Comilla district, the risk of suicide was significantly higher in Narshingdi. Students had significantly lower risk of non-fatal suicidal behavior compared to skilled laborers. The risk of non-fatal suicidal behavior was lower in Sherpur compared to Chandpur/Comilla. Among adolescents, unskilled laborers were 16 times more likely to attempt suicide than students. The common methods for fatal and non-fatal suicidal behaviors were hanging and poisoning. Suicide is a major public health problem in Bangladesh that needs to be addressed with targeted interventions.

Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study.

Science.gov (United States)

2017-12-02

increased substantially in India from 1990 to 2016, and a modest decrease was recorded in the age-standardised NCD DALY rates. The major risk factors for NCDs, including high systolic blood pressure, high fasting plasma glucose, high total cholesterol, and high body-mass index, increased from 1990 to 2016, with generally higher levels in higher ETL states; ambient air pollution also increased and was highest in the low ETL group. The incidence rate of the leading causes of injuries also increased from 1990 to 2016. The five leading individual causes of DALYs in India in 2016 were ischaemic heart disease, chronic obstructive pulmonary disease, diarrhoeal diseases, lower respiratory infections, and cerebrovascular disease; and the five leading risk factors for DALYs in 2016 were child and maternal malnutrition, air pollution, dietary risks, high systolic blood pressure, and high fasting plasma glucose. Behind these broad trends many variations existed between the ETL state groups and between states within the ETL groups. Of the ten leading causes of disease burden in India in 2016, five causes had at least a five-times difference between the highest and lowest state-specific DALY rates for individual causes. Per capita disease burden measured as DALY rate has dropped by about a third in India over the past 26 years. However, the magnitude and causes of disease burden and the risk factors vary greatly between the states. The change to dominance of NCDs and injuries over CMNNDs occurred about a quarter century apart in the four ETL state groups. Nevertheless, the burden of some of the leading CMNNDs continues to be very high, especially in the lowest ETL states. This comprehensive mapping of inequalities in disease burden and its causes across the states of India can be a crucial input for more specific health planning for each state as is envisioned by the Government of India's premier think tank, the National Institution for Transforming India, and the National Health Policy

The household economic burden for acute coronary syndrome survivors in Australia

Directory of Open Access Journals (Sweden)

Karice K. Hyun

2016-11-01

Full Text Available Abstract Background Studies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship. Methods Australian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship. Results Of 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614 in Australian dollars was A$258.06 (median: A$126.50 per month. The average spending for medical services was A$120.18 (SD: A$310.35 and medications was A$66.25 (SD: A$80.78. In total, 350 (51 % of patients reported experiencing economic hardship, 78 (12 % were unable to pay for medical services and 81 (12 % could not pay for medication. Younger age (18–59 vs ≥80 years (OR: 1.89, no private health insurance (OR: 2.04, pensioner concession card (OR: 1.80, residing in more disadvantaged area (group 1 vs 5 (OR: 1.77, history of CVD (OR: 1.47 and higher out-of-pocket expenses (group 4 vs 1 (OR: 4.57 were more likely to experience hardship. Conclusion Subgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended management for patients.

The relationship of metabolic burden to productivity levels in CHO cell lines.

Science.gov (United States)

Zou, Wu; Edros, Raihana; Al-Rubeai, Mohamed

2018-03-01

The growing demand for recombinant therapeutics has driven biotechnologists to develop new production strategies. One such strategy for increasing the expression of heterologous proteins has focused on enhancing cell-specific productivity through environmental perturbations. In this work, the effects of hypothermia, hyperosmolarity, high shear stress, and sodium butyrate treatment on growth and productivity were studied using three (low, medium, and high producing) CHO cell lines that differed in their specific productivities of monoclonal antibody. In all three cell lines, the inhibitory effect of these parameters on proliferation was demonstrated. Additionally, compared to the control, specific productivity was enhanced under all conditions and exhibited a consistent cell line specific pattern, with maximum increases (50-290%) in the low producer, and minimum increases (7-20%) in the high producer. Thus, the high-producing cell line was less responsive to environmental perturbations than the low-producing cell line. We hypothesize that this difference is most likely due to the bottleneck associated with a higher metabolic burden caused by higher antibody expression. Increased recombinant mRNA levels and pyruvate carboxylase activities due to low temperature and hyperosmotic stress were found to be positively associated with the metabolic burden. © 2017 International Union of Biochemistry and Molecular Biology, Inc.

[Burden of proof in medical cases--presumption of fact and prima facie evidence. 1. Burden of proof].

Science.gov (United States)

Sliwka, Marcin

2004-01-01

The aim of this paper was to present the main rules concerning the burden of proof in polish civil trials, including medical cases. This paper also describes the subject of evidence were presented and explained. The court influence on evidence procedure was also analysed. The effect of the institution of informed consent on burden of proof in polish civil law is also described. This paper includes numerous High Court sentences on evidential and medical issues.

Whole-body monitoring: Goiania case, Brazil

International Nuclear Information System (INIS)

Oliveira, C.A.N. de; Lourenco, M.C.; Dantas, B.M.; Lucena, E.A. de; Becker, P.H.B.

1988-01-01

Due to the radiological Cs accident in Goiania, Goias in September 1987, it became necessary to evaluate internal contamination levels of: individuals from the general public that for any reason had direct or indirect involvement with the radioactive source (group 1); occupationally involved persons (group 2). For each of these groups, procedures of whole body monitoring were developped. In order to attend group 1 individuals, the IRD/CNEN installed a whole body unit in the INAMPS General Hospital of Goiania in 11.08.87, which was later transferred to 121, 57 street, Central Sector in Goiania in 2.06.88. In this unit 547 people were monitored, 356 from group 1 and 241 from group 2, until 04.13.88. In the IRD whole body counter installation, 194 individuals were counted, 185 from group 2 and 9 from group 1. The frequency of monitoring of each individual was stablished according to the Cs activity present in the body or to the job that will be done. Some body burden activity curves for Cs 137 as a function of the time elapsed from the first measurement, are presented. There people from group 1 were measured in both counters, the IRD and the Goiania ones. The values obtained in both installations are compatible with the body activity X time curve. (author) [pt

State-level income inequality and family burden of U.S. families raising children with special health care needs.

Science.gov (United States)

Parish, Susan L; Rose, Roderick A; Dababnah, Sarah; Yoo, Joan; Cassiman, Shawn A

2012-02-01

Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Global Burden of Cancer 2013

OpenAIRE

2015-01-01

Importance Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies. Objective To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013. Evidence Review The general methodology of the Global Burden of Disease (GBD) 2013 study was us...

The Global Burden of Occupational Disease.

Science.gov (United States)

Rushton, Lesley

2017-09-01

Burden of occupational disease estimation contributes to understanding of both magnitude and relative importance of different occupational hazards and provides essential information for targeting risk reduction. This review summarises recent key findings and discusses their impact on occupational regulation and practice. New methods have been developed to estimate burden of occupational disease that take account of the latency of many chronic diseases and allow for exposure trends and workforce turnover. Results from these studies have shown in several countries and globally that, in spite of improvements in workplace technology, practices and exposures over the last decades, occupational hazards remain an important cause of ill health and mortality worldwide. Major data gaps have been identified particularly regarding exposure information. Reliable data on employment and disease are also lacking especially in developing countries. Burden of occupational disease estimates form an important part of decision-making processes.

The unrecognized burden of typhoid fever.

Science.gov (United States)

Obaro, Stephen K; Iroh Tam, Pui-Ying; Mintz, Eric Daniel

2017-03-01

Typhoid fever (TF), caused by Salmonella enterica serovar Typhi, is the most common cause of enteric fever, responsible for an estimated 129,000 deaths and more than 11 million cases annually. Although several reviews have provided global and regional TF disease burden estimates, major gaps in our understanding of TF epidemiology remain. Areas covered: We provide an overview of the gaps in current estimates of TF disease burden and offer suggestions for addressing them, so that affected communities can receive the full potential of disease prevention offered by vaccination and water, sanitation, and hygiene interventions. Expert commentary: Current disease burden estimates for TF do not capture cases from certain host populations, nor those with atypical presentations of TF, which may lead to substantial underestimation of TF cases and deaths. These knowledge gaps pose major obstacles to the informed use of current and new generation typhoid vaccines.

Burdens of Proof, Presumptions and Standards of Proof in Criminal ...

African Journals Online (AJOL)

Worku_Y

evidential and persuasive burdens of proof as between the state and the ..... scholars have observed that the evidential burden is a function of the burden of ..... required to convince judges by creating such an intensity of belief in their minds.

Tackling Africa's chronic disease burden: from the local to the global

OpenAIRE

de-Graft Aikins, Ama; Unwin, Nigel; Agyemang, Charles; Allotey, Pascale; Campbell, Catherine; Arhinful, Daniel

2010-01-01

Abstract Africa faces a double burden of infectious and chronic diseases. While infectious diseases still account for at least 69% of deaths on the continent, age specific mortality rates from chronic diseases as a whole are actually higher in sub Saharan Africa than in virtually all other regions of the world, in both men and women. Over the next ten years the continent is projected to experience the largest increase in death rates from cardiovascular disease, cancer, respiratory disease and...

Comparing the economic burden of ischemic stroke patients with and without atrial fibrillation: a retrospective study in Beijing, China.

Science.gov (United States)

Wen, Liankui; Wu, Jingjing; Feng, Lin; Yang, Li; Qian, Feng

2017-10-01

Little is known about the economic burden for ischemic stroke (IS) patients with atrial fibrillation (AF) in China. We aimed to compare the economic burden of treatment-related costs in IS patients with AF vs. without AF in China. This retrospective analysis used economic burden data from the Beijing urban health insurance database. Using a random sampling method, 10% of the patients diagnosed with IS from 1 January through 31 December 2012 were enrolled. First hospitalization was considered as the index event and hospital utilization after the index event was followed up until September 2013. Overall healthcare cost during the study period was analyzed. In 4061 patients with IS (mean ± SD age, 68.45 ± 13.95 years; AF: 992; without AF: 3069), the AF group had a higher percentage of patients with co-morbidities at baseline. Compared with the non-AF group, the AF group had significantly greater hospitalization at the index event (p economic burden in patients with IS. Therefore, prevention of cardio-embolic events in patients with AF by anticoagulants may decrease the economic burden in patients with IS.

34 CFR 34.14 - Burden of proof.

Science.gov (United States)

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Burden of proof. 34.14 Section 34.14 Education Office of the Secretary, Department of Education ADMINISTRATIVE WAGE GARNISHMENT § 34.14 Burden of proof. (a... those in § 34.24. (d)(1) If you object on the ground that applicable law bars us from collecting the...

Higher accumulation of F1-V fusion recombinant protein in plants after induction of protein body formation.

Science.gov (United States)

Alvarez, M Lucrecia; Topal, Emel; Martin, Federico; Cardineau, Guy A

2010-01-01

Improving foreign protein accumulation is crucial for enhancing the commercial success of plant-based production systems since product yields have a major influence on process economics. Cereal grain evolved to store large amounts of proteins in tightly organized aggregates. In maize, gamma-Zein is the major storage protein synthesized by the rough endoplasmic reticulum (ER) and stored in specialized organelles called protein bodies (PB). Zera (gamma-Zein ER-accumulating domain) is the N-terminal proline-rich domain of gamma-zein that is sufficient to induce the assembly of PB formation. Fusion of the Zera domain to proteins of interest results in assembly of dense PB-like, ER-derived organelles, containing high concentration of recombinant protein. Our main goal was to increase recombinant protein accumulation in plants in order to enhance the efficiency of orally-delivered plant-made vaccines. It is well known that oral vaccination requires substantially higher doses than parental formulations. As a part of a project to develop a plant-made plague vaccine, we expressed our model antigen, the Yersinia pestis F1-V antigen fusion protein, with and without a fused Zera domain. We demonstrated that Zera-F1-V protein accumulation was at least 3x higher than F1-V alone when expressed in three different host plant systems: Ncotiana benthamiana, Medicago sativa (alfalfa) and Nicotiana tabacum NT1 cells. We confirmed the feasibility of using Zera technology to induce protein body formation in non-seed tissues. Zera expression and accumulation did not affect plant development and growth. These results confirmed the potential exploitation of Zera technology to substantially increase the accumulation of value-added proteins in plants.

Estimating the Global Burden of Endemic Canine Rabies

Science.gov (United States)

Hampson, Katie; Coudeville, Laurent; Lembo, Tiziana; Sambo, Maganga; Kieffer, Alexia; Attlan, Michaël; Barrat, Jacques; Blanton, Jesse D.; Briggs, Deborah J.; Cleaveland, Sarah; Costa, Peter; Freuling, Conrad M.; Hiby, Elly; Knopf, Lea; Leanes, Fernando; Meslin, François-Xavier; Metlin, Artem; Miranda, Mary Elizabeth; Müller, Thomas; Nel, Louis H.; Recuenco, Sergio; Rupprecht, Charles E.; Schumacher, Carolin; Taylor, Louise; Vigilato, Marco Antonio Natal; Zinsstag, Jakob; Dushoff, Jonathan

2015-01-01

Background Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries. Methodology/Principal Findings We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%). Conclusions/Significance This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to

Estimating the global burden of endemic canine rabies.

Directory of Open Access Journals (Sweden)

Katie Hampson

2015-04-01

Full Text Available Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries.We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000 human deaths, over 3.7 million (95% CIs: 1.6-10.4 million disability-adjusted life years (DALYs and 8.6 billion USD (95% CIs: 2.9-21.5 billion economic losses annually. The largest component of the economic burden is due to premature death (55%, followed by direct costs of post-exposure prophylaxis (PEP, 20% and lost income whilst seeking PEP (15.5%, with only limited costs to the veterinary sector due to dog vaccination (1.5%, and additional costs to communities from livestock losses (6%.This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.

The economic burden of kidney disorders in Korea.

Science.gov (United States)

Kim, Ju Hee; Ho, Seung Hee; Kim, Hyun-Jin; Lee, Sol

2018-03-01

To estimate the economic burden of kidney disorders in Korea. The economic burden of kidney disorders was estimated using a prevalence-based approach. Related kidney diseases in patients with kidney disorders (RPWKD) were defined using codes from the tenth International Classification of Disease (E70-E90, F30-F48, F60-F69, F90-F99, K65-K67, N00-N08, N17-N19, and N30-N39). All diseases in patients with kidney disorders (APWKD) were defined as kidney disorders that involved all disease codes. Economic costs were divided into direct costs (medical costs and non-medical costs) and indirect costs (productivity loss because of morbidity and premature mortality). The prevalence of kidney disorders increased from 0.08% (2008) to 0.11% (2011). The total economic burden of RPWKD also substantially increased from $898.9 million (2008) to $1.43 billion (2011). This ∼59.4% increase in the economic burden was equal to 0.12% of the Korean gross domestic product. The economic burden of APWKD also increased during the study period: $1.06 billion (2008), $1.23 billion (2009), $1.44 billion (2010), and $1.46 billion (2011). The present study provides the first data regarding the economic burden of kidney disorders in Korea. The findings support the need for early intervention services and prevention programs to prevent, identify, and manage kidney disorders.

Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi.

Science.gov (United States)

Yang, Teng-Kai; Yang, Hung-Ju; Lee, Liang-Min; Liao, Chun-Hou

2013-07-01

Effective stone disintegration by extracorporeal shockwave lithotripsy (ESWL) may depend on patient- and stone-related factors. We investigated predictors of disintegration failure in ESWL for a solitary ureteral calculus. From July 2008 to May 2010, 203 patients who underwent ESWL for a solitary ureteral calculus were enrolled. Clinical and radiologic data were collected, and factors related to ESWL failure were analyzed. Fifty-two patients (25.6%) showed ESWL failure, with a mean follow-up of 41 days. Forty patients (19.7%) required retreatment, including 12 who underwent repeat ESWL and 28 who underwent curative ureteroscopy. Patients with ESWL failure had significantly higher body weight, body mass index (BMI), and buttock circumference (BC) than patients for whom ESWL was successful. Univariate analysis showed that stone burden (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.06) and BC (OR, 1.06; 95% CI, 1.01-1.11) were predictors of ESWL failure, while BMI was a potential predictor with borderline significance (OR, 1.09; 95% CI, 0.99-1.20). Multivariate analysis showed that stone burden (OR, 1.04; 95% CI, 1.03-1.06) was a significant predictor for all patients. On stratifying patients according to the level of ureteral calculi, BC was found to be an independent predictor (OR, 1.35; 95% CI, 1.02-1.80) for ESWL failure for middle/lower ureteral calculi and BMI (OR, 1.47; 95% CI, 1.13-1.91) for upper ureteral calculi. Stone burden is the main predictor of ESWL failure for all patients with ureteral calculi. BC and BMI are independent predictors for ESWL failure for middle/lower and upper ureteral calculi, respectively. Copyright © 2012. Published by Elsevier B.V.

Napping in older people 'at risk' of dementia: relationships with depression, cognition, medical burden and sleep quality.

Science.gov (United States)

Cross, Nathan; Terpening, Zoe; Rogers, Naomi L; Duffy, Shantel L; Hickie, Ian B; Lewis, Simon J G; Naismith, Sharon L

2015-10-01

Sleep disturbance is prevalent in older adults, particularly so in those at a greater risk of dementia. However, so far the clinical, medical and neuropsychological correlates of daytime sleep have not been examined. The aims of this study were to investigate the characteristics and effects of napping using actigraphy in older people, particularly in those 'at risk' of dementia. The study used actigraphy and sleep diaries to measure napping habits in 133 older adults 'at risk' of dementia (mean age = 65.5 years, SD = 8.4 years), who also underwent comprehensive medical, psychiatric and neuropsychological assessment. When defined by actigraphy, napping was present in 83.5% (111/133) of participants; however, duration and timing varied significantly among subjects. Nappers had significantly greater medical burden and body mass index, and higher rates of mild cognitive impairment. Longer and more frequent naps were associated with poorer cognitive functioning, as well as higher levels of depressive symptoms, while the timing of naps was associated with poorer nocturnal sleep quality (i.e. sleep latency and wake after sleep onset). This study highlights that in older adults 'at risk' of dementia, napping is associated with underlying neurobiological changes such as depression and cognition. Napping characteristics should be more routinely monitored in older individuals to elucidate their relationship with psychological and cognitive outcomes. © 2015 European Sleep Research Society.

44-h ambulatory blood pressure monitoring: revealing the true burden of hypertension in pediatric hemodialysis patients.

Science.gov (United States)

Haskin, Orly; Wong, Cynthia J; McCabe, Lonisa; Begin, Brandy; Sutherland, Scott M; Chaudhuri, Abanti

2015-04-01

The blood pressure (BP) burden is high in pediatric hemodialysis (HD) patients and adversely affects prognosis. The aim of this study was to examine whether 44-h ambulatory BP monitoring (ABPM) provides additional relevant BP data compared with 24-h ABPM. ABPM was initiated at the end of the mid-week dialysis run in 13 stable pediatric HD patients and continued until the next run for 44 h. Day 1 was defined as the initial 24-h ABPM and Day 2 as the time period after that until the next dialysis run. All patients had an echocardiogram to calculate the left ventricular mass index (LVMI). A higher percentage of patients were diagnosed with hypertension from the 44-h ABPM than from the 24-h ABPM. All BP indexes and loads (except nighttime diastolic load) were significantly higher on Day 2 than on Day 1. Patients with BP loads of ≥ 25 % on 44-h ABPM had significantly higher LVMI than those patients with normal BP loads. No such association was found with 24-h ABPM and LVMI. Higher interdialytic weight gain was associated with higher Day-2 nighttime systolic BP load. The 44-h ABPM provides more information than the 24-h ABPM in terms of diagnosing and assessing the true burden of hypertension in pediatric HD patients. Elevated BP loads from 44-h ABPM correlate with a higher LVMI on the echocardiogram.

The economic burden of tuberculosis in Indonesia.

Science.gov (United States)

Collins, D; Hafidz, F; Mustikawati, D

2017-09-01

Indonesia has a high prevalence of tuberculosis (TB) and is one of the 22 countries with the highest TB burdens in the world. To understand the economic burden of TB in Indonesia. TB data for 2015 were combined with cost data using a simple type of cost-benefit analysis in a decision tree model to show the economic burden under different scenarios. In Indonesia, there were an estimated 1 017 378 new active TB cases in 2015, including multidrug-resistant TB. It is estimated that 417 976 of these cases would be treated and cured, 160 830 would be unsuccessfully treated and would die, 131 571 would be untreated and would achieve cure spontaneously, and 307 000 would be untreated and would die. The total economic burden related to treated and untreated cases would be approximately US$6.9 billion. Loss of productivity due to premature death would be by far the largest element, comprising US$6.0 billion (discounted), which represents 86.6% of the total cost. Loss of productivity due to illness would be US$700 million (10.1%), provider medical costs US$156 million (2.2%), and direct non-medical costs incurred by patients and their households US$74 million (1.1%). The economic burden of TB in Indonesia is extremely high. Detecting and treating more cases would result not only in major reductions in suffering but also in economic savings to society.

Global burden of disease--a race against time

DEFF Research Database (Denmark)

Meyrowitsch, Dan W; Bygbjerg, Ib Christian

2007-01-01

Low-income communities will within the next decades undergo rapid changes. The burden of non-communicable diseases (NCDs), such as diabetes, cardio-vascular disease and cancer, will comprise an increasing proportion of the total disease burden. The results of projections indicate that the already...... constrained health systems will face a double burden of disease, in which HIV/AIDS and other common infectious diseases will co-exist with the new NCDs. In order for preventive measures directed towards NCD to be cost-effective, these have to be implemented within the next 10-20 years....

The economic burden of schizophrenia in Malaysia

Directory of Open Access Journals (Sweden)

Teoh SL

2017-07-01

Full Text Available Siew Li Teoh,1 Huey Yi Chong,1 Salina Abdul Aziz,2 Norliza Chemi,2 Abdul Razak Othman,2 Nurzuriana Md Zaki,2 Possatorn Vanichkulpitak,3 Nathorn Chaiyakunapruk1,4–6 1School of Pharmacy, Monash University Malaysia, Selangor, 2Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 3Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, 4Center of Pharmaceutical Outcomes Research (CPOR, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; 5School of Pharmacy, University of Wisconsin, Madison, WI, USA; 6Health and Well-being Cluster, Global Asia in the 21st Century (GA21 Platform, Monash University Malaysia, Selangor, MalaysiaIntroduction: Schizophrenia (SCZ is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia.Methods: A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL. The medical charts were identified electronically by matching the unique patient’s identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted.Results: The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million

Hazardous organic compounds in biogas plant end products-Soil burden and risk to food safety

International Nuclear Information System (INIS)

Suominen, K.; Verta, M.; Marttinen, S.

2014-01-01

The end products (digestate, solid fraction of the digestate, liquid fraction of the digestate) of ten biogas production lines in Finland were analyzed for ten hazardous organic compounds or compound groups: polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), polychlorinated biphenyls (PCB(7)), polyaromatic hydrocarbons (PAH(16)), bis-(2-ethylhexyl) phthalate (DEHP), perfluorinated alkyl compounds (PFCs), linear alkylbenzene sulfonates (LASs), nonylphenols and nonylphenol ethoxylates (NP + NPEOs), polybrominated diphenyl ethers (PBDEs), hexabromocyclododecane (HBCD) and tetrabromobisphenol A (TBBPA). Biogas plant feedstocks were divided into six groups: municipal sewage sludge, municipal biowaste, fat, food industry by-products, animal manure and others (consisting of milling by-products (husk) and raw former foodstuffs of animal origin from the retail trade). There was no clear connection between the origin of the feedstocks of a plant and the concentrations of hazardous organic compounds in the digestate. For PCDD/Fs and for DEHP, the median soil burden of the compound after a single addition of digestate was similar to the annual atmospheric deposition of the compound or compound group in Finland or other Nordic countries. For PFCs, the median soil burden was somewhat lower than the atmospheric deposition in Finland or Sweden. For NP + NPEOs, the soil burden was somewhat higher than the atmospheric deposition in Denmark. The median soil burden of PBDEs was 400 to 1000 times higher than the PBDE air deposition in Finland or in Sweden. With PBDEs, PFCs and HBCD, the impact of the use of end products should be a focus of further research. Highly persistent compounds, such as PBDE- and PFC-compounds may accumulate in agricultural soil after repeated use of organic fertilizers containing these compounds. For other compounds included in this study, agricultural use of biogas plant end products is unlikely to cause risk to food safety in Finland. - Highlights: �

Hazardous organic compounds in biogas plant end products-Soil burden and risk to food safety

Energy Technology Data Exchange (ETDEWEB)

Suominen, K., E-mail: kimmo.suominen@evira.fi [Finnish Food Safety Authority Evira, Risk Assessment Research Unit, Mustialankatu 3, 00790 Helsinki (Finland); Verta, M. [Finnish Environmental Institute (SYKE), Mechelininkatu 34a, P.O. Box 140, 00251 Helsinki (Finland); Marttinen, S. [MTT Agrifood Research Finland, 31600 Jokioinen (Finland)

2014-09-01

The end products (digestate, solid fraction of the digestate, liquid fraction of the digestate) of ten biogas production lines in Finland were analyzed for ten hazardous organic compounds or compound groups: polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), polychlorinated biphenyls (PCB(7)), polyaromatic hydrocarbons (PAH(16)), bis-(2-ethylhexyl) phthalate (DEHP), perfluorinated alkyl compounds (PFCs), linear alkylbenzene sulfonates (LASs), nonylphenols and nonylphenol ethoxylates (NP + NPEOs), polybrominated diphenyl ethers (PBDEs), hexabromocyclododecane (HBCD) and tetrabromobisphenol A (TBBPA). Biogas plant feedstocks were divided into six groups: municipal sewage sludge, municipal biowaste, fat, food industry by-products, animal manure and others (consisting of milling by-products (husk) and raw former foodstuffs of animal origin from the retail trade). There was no clear connection between the origin of the feedstocks of a plant and the concentrations of hazardous organic compounds in the digestate. For PCDD/Fs and for DEHP, the median soil burden of the compound after a single addition of digestate was similar to the annual atmospheric deposition of the compound or compound group in Finland or other Nordic countries. For PFCs, the median soil burden was somewhat lower than the atmospheric deposition in Finland or Sweden. For NP + NPEOs, the soil burden was somewhat higher than the atmospheric deposition in Denmark. The median soil burden of PBDEs was 400 to 1000 times higher than the PBDE air deposition in Finland or in Sweden. With PBDEs, PFCs and HBCD, the impact of the use of end products should be a focus of further research. Highly persistent compounds, such as PBDE- and PFC-compounds may accumulate in agricultural soil after repeated use of organic fertilizers containing these compounds. For other compounds included in this study, agricultural use of biogas plant end products is unlikely to cause risk to food safety in Finland. - Highlights: �

Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden.

Science.gov (United States)

Eton, David T; Yost, Kathleen J; Lai, Jin-Shei; Ridgeway, Jennifer L; Egginton, Jason S; Rosedahl, Jordan K; Linzer, Mark; Boehm, Deborah H; Thakur, Azra; Poplau, Sara; Odell, Laura; Montori, Victor M; May, Carl R; Anderson, Roger T

2017-02-01

The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden-the Patient Experience with Treatment and Self-management (PETS). A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation. A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (α range 0.79-0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps health literacy, less adherence to medications, and more financial difficulties reported higher PETS scores (Ps < 0.01). A comprehensive patient-reported measure of treatment burden can help to better characterize the impact of treatment and self-management burden on patient well-being and guide care toward minimally disruptive medicine.

Housing as a Social Determinant of Health: Exploring the Relationship between Rent Burden and Risk Behaviors for Single Room Occupancy Building Residents.

Science.gov (United States)

Bowen, Elizabeth A; Mitchell, Christopher G

2016-01-01

A growing body of health determinants research recognizes that housing and health are intimately linked. This study explores the relationship between rent burden (the ratio of rent to income) and health risk behaviors among a sample of single room occupancy (SRO) building residents. Cross-sectional data were gathered from a sample of 162 residents living in privately owned, for-profit SROs in Chicago. Findings indicated that participants who had full rental subsidies and thus were designated in a no-rent-burden category were more likely to engage in risk behaviors including illicit drug use, having multiple sexual partners, and having sex without a condom, in comparison to participants with moderate or high-rent burdens. These findings suggest that interventions to increase housing stability and affordability and bolster reliable income sources (in addition to rental subsidies) may be key in reducing risk behaviors and improving health for vulnerably housed populations such as SRO residents.

Higher incidence of hip fracture in newly diagnosed schizophrenic ...

African Journals Online (AJOL)

Higher incidence of hip fracture in newly diagnosed schizophrenic patients in Taiwan. Hip fracture is a major public health concern due to its poor outcome and serious socioeconomic burden in older people (1). Evidence has shown that many factors are related to increased risk of hip fracture, but psychiatric diseases are ...

Whole-body MR imaging including angiography: Predicting recurrent events in diabetics

Energy Technology Data Exchange (ETDEWEB)

Bertheau, Robert C.; Kauczor, Hans-Ulrich; Weckbach, Sabine; Schlett, Christopher L. [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Bamberg, Fabian [Ludwig Maximilians University, Klinikum Grosshadern, Department of Clinical Radiology, Munich (Germany); University Hospital Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Lochner, Elena [Ludwig Maximilians University, Klinikum Grosshadern, Department of Clinical Radiology, Munich (Germany); Findeisen, Hannes M. [University Hospital Muenster, Department of Cardiology and Angiology, Muenster (Germany); Parhofer, Klaus G. [Ludwig Maximilians University, Klinikum Grosshadern, Department of Internal Medicine II, Munich (Germany); Schoenberg, Stefan O. [University Medical Center Mannheim, Department of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

2016-05-15

Whether whole-body MRI can predict occurrence of recurrent events in patients with diabetes mellitus. Whole-body MRI was prospectively applied to 61 diabetics and assessed for arteriosclerosis and ischemic cerebral/myocardial changes. Occurrence of cardiocerebral events and diabetic comorbidites was determined. Patients were stratified whether no, a single or recurrent events arose. As a secondary endpoint, events were stratified into organ system-specific groups. During a median follow-up of 70 months, 26 diabetics developed a total of 39 events; 18 (30 %) developed one, 8 (13 %) recurrent events. Between diabetics with no, a single and recurrent events, a stepwise higher burden was observed for presence of left ventricular (LV) hypo-/akinesia (3/28/75 %, p < 0.0001), myocardial delayed-contrast-enhancement (17/33/63 %, p = 0.001), carotid artery stenosis (11/17/63 %, p = 0.005), peripheral artery stenosis (26/56/88 %, p = 0.0006) and vessel score (1.00/1.30/1.76, p < 0.0001). After adjusting for clinical characteristics, LV hypo-/akinesia (hazard rate ratio = 6.57, p < 0.0001) and vessel score (hazard rate ratio = 12.29, p < 0.0001) remained independently associated. Assessing organ system risk, cardiac and cerebral MR findings predicted more strongly events in their respective organ system. Vessel-score predicted both cardiac and cerebral, but not non-cardiocerebral, events. Whole-body MR findings predict occurrence of recurrent events in diabetics independent of clinical characteristics, and may concurrently provide organ system-specific risk. (orig.)

Whole-body MR imaging including angiography: Predicting recurrent events in diabetics

International Nuclear Information System (INIS)

Bertheau, Robert C.; Kauczor, Hans-Ulrich; Weckbach, Sabine; Schlett, Christopher L.; Bamberg, Fabian; Lochner, Elena; Findeisen, Hannes M.; Parhofer, Klaus G.; Schoenberg, Stefan O.

2016-01-01

Whether whole-body MRI can predict occurrence of recurrent events in patients with diabetes mellitus. Whole-body MRI was prospectively applied to 61 diabetics and assessed for arteriosclerosis and ischemic cerebral/myocardial changes. Occurrence of cardiocerebral events and diabetic comorbidites was determined. Patients were stratified whether no, a single or recurrent events arose. As a secondary endpoint, events were stratified into organ system-specific groups. During a median follow-up of 70 months, 26 diabetics developed a total of 39 events; 18 (30 %) developed one, 8 (13 %) recurrent events. Between diabetics with no, a single and recurrent events, a stepwise higher burden was observed for presence of left ventricular (LV) hypo-/akinesia (3/28/75 %, p < 0.0001), myocardial delayed-contrast-enhancement (17/33/63 %, p = 0.001), carotid artery stenosis (11/17/63 %, p = 0.005), peripheral artery stenosis (26/56/88 %, p = 0.0006) and vessel score (1.00/1.30/1.76, p < 0.0001). After adjusting for clinical characteristics, LV hypo-/akinesia (hazard rate ratio = 6.57, p < 0.0001) and vessel score (hazard rate ratio = 12.29, p < 0.0001) remained independently associated. Assessing organ system risk, cardiac and cerebral MR findings predicted more strongly events in their respective organ system. Vessel-score predicted both cardiac and cerebral, but not non-cardiocerebral, events. Whole-body MR findings predict occurrence of recurrent events in diabetics independent of clinical characteristics, and may concurrently provide organ system-specific risk. (orig.)

The ACCUSCAN-II vertical scanning germanium whole body counter

International Nuclear Information System (INIS)

Bronson, F.L.

1987-01-01

The ACCUSCAN-II is manufactured by Canberra Industries, and represents a new generation of WBC systems. One or two Germanium detectors are used for precise nuclide identification. The detectors scan the total body and can accurately quantify radioactive material anywhere in the body. The shield is a full 4'' thick steel or 2'' lead and weighs about 9000 lbs. The subject can be counted standing for full body scans, or seated for longer counting times of limited portions of the body. Optional electronics also generate a count rate vs. body position profile, as an aid to interpretation of the dose implications of the count. Typical LLD's are 5 - 10 nCi for a 5 minute total body count and 0.5 - 0.7 nCi for a 5 minute long screening count. The system is available in several flavors. The manual version is an inexpensive system intended for universities, hospitals and small industrial facilities. The automatic system includes a MicroVAX-II computer and runs ABACOS0-II Body Burden Software, and is ideal for facilities with large numbers of people to count and where automated analysis of the data is desirable

Decision Making Regarding the Place of End-of-Life Cancer Care: The Burden on Bereaved Families and Related Factors.

Science.gov (United States)

Yamamoto, Sena; Arao, Harue; Masutani, Eiko; Aoki, Miwa; Kishino, Megumi; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho; Miyashita, Mitsunori

2017-05-01

Decision making regarding the place of end-of-life (EOL) care is an important issue for patients with terminal cancer and their families. It often requires surrogate decision making, which can be a burden on families. To explore the burden on the family of patients dying from cancer related to the decisions they made about the place of EOL care and investigate the factors affecting this burden. This was a cross-sectional mail survey using a self-administered questionnaire. Participants were 700 bereaved family members of patients with cancer from 133 palliative care units in Japan. The questionnaire covered decisional burdens, depression, grief, and the decision-making process. Participants experienced emotional pressure as the highest burden. Participants with a high decisional burden reported significantly higher scores for depression and grief (both P decision making without knowing the patient's wishes and values (P making the decision because of a due date for discharge from a former facility or hospital (P = 0.005). Decision making regarding the place of EOL care was recalled as burdensome for family decision makers. An early decision-making process that incorporates sharing patients' and family members' values that are relevant to the desired place of EOL care is important. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Body burdens of metals in spiders from the Lidice coal dump near Ostrava (Czech Republic)

Energy Technology Data Exchange (ETDEWEB)

Wilczek, G.; Babczynska, A.; Majkus, Z. [Silesian University, Katowice (Poland)

2005-09-01

Spiders' feeding behaviour and external digestion expose them to man-made pollutants, especially those easily transferred along the food chain. The problem for this study was whether the levels of heavy metals in selected species of spiders from the Lidice coal dump reflect adaptation to environmental pollutants. We used flameless and flame AAS to measure the whole-body concentrations of Cd, Pb, Cu, Zn, Fe, Ni and Mg in male and female spiders differing in their hunting strategies, type of web construction, prey, and taxonomic position (Araneidae, Agelenidae, Linyphiidae, Theridiidae, Tetragnathidae, Lycosidae, Salticidae, Pisauridae, Clubionidae, Philodromidae). The levels of metals found in the spiders were species-dependent, indicating differences related to the hunting strategy and type of prey. Accumulation of Pb, Cu and Zn was always higher in ground spiders than in web-constructing species. Sheet-web spiders Linyphia triangularis and wandering spiders Clubiona lutescens had the lowest Cd, Mg and Cu content of all the studied species. Web-building spiders of the Tetragnathidae family showed the highest Cd, Cu and Pb content, even in species with feeding behaviour similar to spiders of other families. There were no interspecific differences in accumulation only for Fe and Mg. The concentrations of Cd, Ni and Pb were lower in females than in males, irrespective of their taxonomic position and the intensity of their hunting activity. This may suggest that females have better metal-excretion ability than males.

Economic burden of COPD in a Swedish cohort: the ARCTIC study

Directory of Open Access Journals (Sweden)

Lisspers K

2018-01-01

Full Text Available Karin Lisspers,1 Kjell Larsson,2 Gunnar Johansson,1 Christer Janson,3 Madlaina Costa-Scharplatz,4 Jean-Bernard Gruenberger,5 Milica Uhde,6 Leif Jorgensen,7 Florian S Gutzwiller,5 Björn Ställberg1 1Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, 2Department of Work Environment Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Solna, 3Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, 4Novartis AB, Täby, Sweden; 5Novartis, Basel, Switzerland; 6IQVIA, Solna, Sweden; 7IQVIA, Copenhagen, Denmark Background: We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC setting.Patients and methods: Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related and indirect health care costs (loss of income, absenteeism, loss of productivity were assessed.Results: A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179 versus the reference population (€2,716, largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient were the largest economic burden in COPD patients of working age during 2013.Conclusion: As non-COPD-related hospital nights represent the largest direct cost, management of

The economic burden of physical inactivity: a global analysis of major non-communicable diseases.

Science.gov (United States)

Ding, Ding; Lawson, Kenny D; Kolbe-Alexander, Tracy L; Finkelstein, Eric A; Katzmarzyk, Peter T; van Mechelen, Willem; Pratt, Michael

2016-09-24

The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide. Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality. Conservatively estimated, physical inactivity cost health-care systems international $ (INT$) 53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates. In addition to morbidity and premature mortality, physical inactivity is

The Burden of Craft in Arthroscopic Rotator Cuff Repair: Where Have We Been and Where We Are Going.

Science.gov (United States)

Burkhart, Stephen S

2015-08-01

The rather turbulent history of arthroscopic rotator cuff repair went through stages of innovation, conflict, disruption, assimilation, and transformation that might be anticipated when a new and advanced technology (arthroscopic cuff repair) displaces an entrenched but outdated discipline (open cuff repair). The transition from open to arthroscopic rotator cuff repair has been a major paradigm shift that has greatly benefited patients. However, this technical evolution/revolution has also imposed a higher "burden of craft" on the practitioners of arthroscopic rotator cuff repair. Technological advancements in surgery demand that surgeons accept this burden of craft and master the advanced technology for the benefit of their patients. This article outlines the author's involvement in the development of arthroscopic rotator cuff repair, and it also explores the surgeon's obligation to accept the burden of craft that is imposed by this discipline.

The disproportionate economic burden associated with severe and complicated obesity: a systematic review.

Science.gov (United States)

Grieve, E; Fenwick, E; Yang, H-C; Lean, M

2013-11-01

Burden of disease studies typically classify individuals with a body mass index (BMI) ≥ 30 kg m(-2) as a single group ('obese') and make comparisons to those with lower BMIs. Here, we review the literature on the additional economic burden associated with severe obesity or classes 3 and 4 obesity (BMI ≥ 40 kg m(-2) ), the fastest growing category of obesity, with the aim of exploring and disaggregating differences in resource use as BMI increases beyond 40 kg m(-2) . We recognize the importance of comparing classes 3 and 4 obesity to less severe obesity (classes 1 and 2) as well as quantifying the single sub-class impacts (classes 3 and 4). Although the latter analysis is the aim of this review, we include results, where found in the literature, for movement between the recognized subclasses and within classes 3 and 4 obesity. Articles presenting data on the economic burden associated with severe obesity were identified from a search of Ovid MEDLINE, EMBASE, EBSCO CINAHL and Cochrane Library databases. Data were extracted on the direct costs, productivity costs and resource use associated with severe obesity along with estimates of the multiplier effects associated with increasing BMI. Fifteen studies were identified, of which four disaggregated resource use for BMI ≥ 40 kg m(-2) . The multiplier effects derived for a variety of different types of costs incurred by the severely obese compared with those of normal weight (18.5 kg m(-2)  productivity costs. There are few published data on the economic burden of obesity disaggregated by BMI ≥ 40 kg m(-2) . By grouping people homogenously above a threshold of BMI 40 kg m(-2) , the multiplier effects for those at the highest end of the spectrum are likely to be underestimated. This will, in turn, impact on the estimates of cost-effectiveness for interventions and policies aimed at the severely obese. © 2013 The Authors. obesity reviews © 2013 International

Investigations of foreign bodies in the fore-stomach of cattle at Ngoma Slaughterhouse, Rwanda.

Science.gov (United States)

Mushonga, Borden; Habarugira, Gervais; Musabyemungu, Aline; Udahemuka, Jean C; Jaja, Festus I; Pepe, Dunisani

2015-07-30

Ingestion of indigestible foreign bodies in cattle is a pathological condition of both economic and health importance. It is has mostly been reported in association with feed scarcity. The aim of this study was to investigate the occurrence and nature of indigestible foreign materials in abattoir fore-stomach specimens in Ngoma district, Rwanda. Each chamber was opened by incision, then given a thorough macroscopic examination by visual inspection and palpation for the presence of foreign materials. The results show that there is an overall occurrence of 17.4% foreign bodies in cattle. The highest occurrence (25.3%) was recorded in June (the driest month). Results further show that the majority of the foreign bodies were plastics (65.0%). More foreign bodies (29.5%) were found in older animals (5 years and above) than in younger and middle-aged animals (16.5 % and 6.0%, respectively). There was a higher prevalence of foreign bodies in female cattle (20.0%) than in males (15.7%). The presence of cassette tape, as observed in the study, has not been reported elsewhere. The high representation of plastics in animals (65.5%) in the light of a government plastic bag ban in supermarkets presents a major challenge to livestock production in Rwanda. What is disturbing is that it is not known if this problem is increasing or decreasing as there are no previous studies for comparison. However, the results will serve as a reference point for future studies to understand the true trend and true burden of plastic bags in livestock.

Investigations of foreign bodies in the fore-stomach of cattle at Ngoma Slaughterhouse, Rwanda

Directory of Open Access Journals (Sweden)

Borden Mushonga

2015-07-01

Full Text Available Ingestion of indigestible foreign bodies in cattle is a pathological condition of both economic and health importance. It is has mostly been reported in association with feed scarcity. The aim of this study was to investigate the occurrence and nature of indigestible foreign materials in abattoir fore-stomach specimens in Ngoma district, Rwanda. Each chamber was opened by incision, then given a thorough macroscopic examination by visual inspection and palpation for the presence of foreign materials. The results show that there is an overall occurrence of 17.4% foreign bodies in cattle. The highest occurrence (25.3% was recorded in June (the driest month. Results further show that the majority of the foreign bodies were plastics (65.0%. More foreign bodies (29.5% were found in older animals (5 years and above than in younger and middle-aged animals (16.5 % and 6.0%, respectively. There was a higher prevalence of foreign bodies in female cattle (20.0% than in males (15.7%. The presence of cassette tape, as observed in the study, has not been reported elsewhere. The high representation of plastics in animals (65.5% in the light of a government plastic bag ban in supermarkets presents a major challenge to livestock production in Rwanda. What is disturbing is that it is not known if this problem is increasing or decreasing as there are no previous studies for comparison. However, the results will serve as a reference point for future studies to understand the true trend and true burden of plastic bags in livestock.

Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey

Directory of Open Access Journals (Sweden)

Kodama Yuko

2012-04-01

Full Text Available Abstract Background The financial burden of medical expenses has been increasing for cancer patients. We investigated the relationship between household income and financial burden among patients with chronic myelogenous leukaemia (CML who have been treated with imatinib. Methods A questionnaire was distributed to 1200 patients between May and August 2009. We retrospectively surveyed their household incomes, out-of-pocket medical expenses, final co-payments after refunds, and the perceived financial burden of their medical expenses in 2000, 2005 and 2008. Results A total of 577 patients completed the questionnaire. Their median age was 61 years (range, 15–94. A financial burden was felt by 41.2 % (28 of 68 of the patients treated with imatinib in 2000, 70.8 % (201 of 284 in 2005, and 75.8 % (400 of 528 in 2008. Overall, 182 patients (31.7 % considered its discontinuation because of the financial burden and 15 (2.6 % temporarily stopped their imatinib prescription. In 2000, 2005 and 2008, the patients’ median annual household incomes were 49,615 US Dollars (USD, 38,510 USD and 36,731 USD, respectively, with an average currency exchange rate of 104 Yen/USD in 2008. Their median annual out-of-pocket expenses were 11,548, 12,067 and 11,538 USD and their median final annual co-payments were 4,375, 4,327 and 3,558 USD, respectively. Older patients (OR = 0.96, 95 % CI: 0.95–0.98, p ≪ 0.0001 for 1-year increments, and patients with higher household incomes (OR = 0.92, 95 % CI: 0.85–0.99, p = 0.03 for 10,000 USD-increments were less likely to have considered discontinuing their imatinib treatment. Conversely, patients with higher annual final co-payments (OR = 2.21, 95 % CI: 1.28–4.28, p = 0.004 for 10,000 USD-increments were more likely to have considered discontinuing their imatinib treatment. Conclusions The proportion of CML patients who sensed a financial burden increased between 2000 and 2008

Estimating the Direct Medical Economic Burden of Health Care-Associated Infections in Public Tertiary Hospitals in Hubei Province, China.

Science.gov (United States)

Li, Hao; Liu, Xinliang; Cui, Dan; Wang, Quan; Mao, Zongfu; Fang, Liang; Zhang, Furong; Yang, Ping; Wu, Huiling; Ren, Nili; He, Jianyun; Sun, Jing

2017-07-01

This study estimated the attributable direct medical economic burden of health care-associated infections (HAIs) in China. Data were extracted from hospitals' information systems. Inpatient cases with HAIs and non-HAIs were grouped by the propensity score matching (PSM) method. Attributable hospitalization expenditures and length of hospital stay were measured to estimate the direct medical economic burden of HAIs. STATA 12.0 was used to conduct descriptive analysis, bivariate χ 2 test, paired Z test, PSM ( r = 0.25σ, nearest neighbor 1:1 matching), and logistic regress analysis. The statistically significant level was set at .05. The HAIs group had statistically significant higher expenditures and longer hospitalization stay than the non-HAIs group during 2013 to 2015 ( P economic burden of HAIs calls for more effective HAI surveillance and better control with appropriate incentives.

Burden of gout in the Nordic region, 1990-2015: findings from the Global Burden of Disease Study 2015.

Science.gov (United States)

Kiadaliri, A A; Uhlig, T; Englund, M

2018-01-29

To explore the burden of gout in the Nordic region, with a population around 27 million in 2015 distributed across six countries. We used the findings of the 2015 Global Burden of Diseases study to report prevalence and disability associated with gout in the Nordic region. From 1990 to 2015, the number of prevalent gout cases rose by 30% to 252 967 [95% uncertainty interval (UI) 223 478‒287 288] in the Nordic region. In 2015, gout contributed to 7982 (95% UI 5431‒10 800) years lived with disability (YLDs) in the region, an increase of 29% (95% UI 24‒35%) from 1990. While the crude YLD rate of gout increased by 12.9% (95% UI 7.8‒18.1%) between 1990 and 2015, the age-standardized YLD rate remained stable. Gout was ranked as the 63rd leading cause of total YLDs in the region in 2015, with the highest rank in men aged 55-59 years (38th leading cause of YLDs). The corresponding rank at the global level was 94. Of 195 countries studied, four Nordic countries [Greenland (2nd), Iceland (12th), Finland (14th), and Sweden (15th)] were among the top 15 countries with the highest age-standardized YLD rate of gout. The burden of gout is rising in the Nordic region. Gout's contribution to the total burden of diseases in the region is more significant than the global average. Expected increases in gout burden owing to population growth and ageing call for stronger preventive and therapeutic strategies for gout management in Nordic countries.

Association between somatic symptom burden and health-related quality of life in people with chronic low back pain.

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Fujii, Tomoko; Oka, Hiroyuki; Katsuhira, Junji; Tonosu, Juichi; Kasahara, Satoshi; Tanaka, Sakae; Matsudaira, Ko

2018-01-01

Depression is a relevant risk factor for low back pain and is associated with the outcomes of low back pain. Depression also often overlaps with somatisation. As previous studies have suggested that somatisation or a higher somatic symptom burden has a role in the outcomes of low back pain, the aim of the present cross-sectional study was to examine whether somatic symptom burden was associated with health-related quality of life in individuals with chronic low back pain independent of depression. We analyzed internet survey data on physical and mental health in Japanese adults aged 20-64 years with chronic low back pain (n = 3,100). Health-related quality of life was assessed using the EuroQol five dimensions (EQ-5D) questionnaire. Somatic symptom burden and depression were assessed using the Somatic Symptom Scale-8 (SSS-8) and the Patient Health Questionnaire-2 (PHQ-2), respectively. SSS-8 score was categorized as no to minimal (0-3), low (4-7), medium (8-11), high (12-15), and very high (16-32). The association between SSS-8 and EQ-5D was examined using linear regression models, adjusting for depression and other covariates, including age, sex, BMI, smoking, marital status, education, exercise, employment, and the number of comorbid diseases. A higher somatic symptom burden was significantly associated with a lower health-related quality of life independent of depression and the number of comorbid diseases (regression coefficient = 0.040 for SSS-8 high vs. very high and 0.218 for non to minimal vs. very high, p trend low back pain.

State plans to force companies to eliminate environmental burdens

International Nuclear Information System (INIS)

Marcan, P.

2004-01-01

The Ministry of Environment is preparing legislation aimed at forcing the state and especially private enterprises to map and eliminate tips, refuse from company premises and farmyards, and manure heaps. It is expected that the main burden will fall on private enterprises. The department is still working on the wording of this new Act on environmental burdens and so it is not yet clear whether it will be of assistance in the elimination of environmental burdens. The Ministry is aware that economic aspects must also be taken into account when exercising pressure on the companies. Closing down a company that cannot meet environmental criteria would result in redundancies and so the time schedule for the elimination of environmental burdens will be adjusted to fit the financial situation of the company involved. The ministry plans to first find companies responsible for environmental debts and then set a deadline for the preparation of a project to eliminate the environmental burden. The project would have to contain a description of elimination methods, in addition to a time schedule and cost assessment. If a private company does not report an environmental burden, the competent public authority will have the power to request access to the premises to undertake an inspection. (author)

Whole-Body MR Imaging Including Angiography: Predicting Recurrent Events in Diabetics.

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Bertheau, Robert C; Bamberg, Fabian; Lochner, Elena; Findeisen, Hannes M; Parhofer, Klaus G; Kauczor, Hans-Ulrich; Schoenberg, Stefan O; Weckbach, Sabine; Schlett, Christopher L

2016-05-01

Whether whole-body MRI can predict occurrence of recurrent events in patients with diabetes mellitus. Whole-body MRI was prospectively applied to 61 diabetics and assessed for arteriosclerosis and ischemic cerebral/myocardial changes. Occurrence of cardiocerebral events and diabetic comorbidites was determined. Patients were stratified whether no, a single or recurrent events arose. As a secondary endpoint, events were stratified into organ system-specific groups. During a median follow-up of 70 months, 26 diabetics developed a total of 39 events; 18 (30%) developed one, 8 (13%) recurrent events. Between diabetics with no, a single and recurrent events, a stepwise higher burden was observed for presence of left ventricular (LV) hypo-/akinesia (3/28/75%, p < 0.0001), myocardial delayed-contrast-enhancement (17/33/63%, p = 0.001), carotid artery stenosis (11/17/63%, p = 0.005), peripheral artery stenosis (26/56/88%, p = 0.0006) and vessel score (1.00/1.30/1.76, p < 0.0001). After adjusting for clinical characteristics, LV hypo-/akinesia (hazard rate ratio = 6.57, p < 0.0001) and vessel score (hazard rate ratio = 12.29, p < 0.0001) remained independently associated. Assessing organ system risk, cardiac and cerebral MR findings predicted more strongly events in their respective organ system. Vessel-score predicted both cardiac and cerebral, but not non-cardiocerebral, events. Whole-body MR findings predict occurrence of recurrent events in diabetics independent of clinical characteristics, and may concurrently provide organ system-specific risk. • Patients with long-standing diabetes mellitus are at high risk for recurrent events. • Whole-body MRI predicts occurrence of recurrent events independently of clinical characteristics. • The vessel score derived from whole-body angiography is a good general risk-marker. • Whole-body MRI may also provide organ-specific risk assessment. • Current findings may indicate benefits of

Can measures of the consumer debt burden reliably predict an economic slowdown?

OpenAIRE

C. Alan Garner

1996-01-01

Some analysts and business executives are becoming concerned that recent increases in the consumer debt burden may foreshadow an economic slowdown. Higher debt increases the risk that a household may experience financial distress in the event of an adverse economic shock, such as the loss of a job or large uninsured medical expenses. As the risk of financial distress rises, households may become less willing to spend on consumer goods, particularly big ticket items such as automobiles and hom...

Depressive and post-traumatic stress symptoms following termination of pregnancy in South African women: A longitudinal study measuring the effects of chronic burden, crisis support and resilience.

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Subramaney, Ugasvaree; Wyatt, Gail Elizabeth; Williams, John K; Zhang, Muyu; Liu, Hong Hu; Chin, Dorothy

2015-11-01

Termination of pregnancy (TOP) remains a controversial issue, regardless of legislation. Access to services as well as psychological effects may vary across the world. To better understand the psychological effects of TOP, this study describes the circumstances of 102 women who underwent a TOP from two socioeconomic sites in Johannesburg, South Africa, one serving women with few economic resources and the other serving women with adequate resources. The relationship between demographic characteristics, resilience and symptoms of post-traumatic stress disorder (PTSD) and depression before, 1 month after and 3 months after the procedure was also examined. Time since TOP, age, chronic burden, resilience and the interaction of site with religion and site with chronic burden were significant. In addition, site differences were found for religion and chronic burden in predicting depression scores. Women from both sites had significant decreases in depression scores over time. The interaction of time with site was not significant. Higher chronic burden scores correlated with higher depression scores. No variables were significant in the bivariate analysis for PTSD. Resilience, religion and chronic burden emerge as significant variables in women undergoing a first-trimester TOP, and warrant further assessment in studies of this nature.

Assessing burden in families of critical care patients.

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Kentish-Barnes, Nancy; Lemiale, Virginie; Chaize, Marine; Pochard, Frédéric; Azoulay, Elie

2009-10-01

To provide critical care clinicians with information on validated instruments for assessing burden in families of critical care patients. PubMed (1979-2009). We included all quantitative studies that used a validated instrument to evaluate the prevalence of, and risk factors for, burden on families. We extracted the descriptions of the instruments used and the main results. Family burden after critical illness can be detected reliably and requires preventive strategies and specific treatments. Using simple face-to-face interviews, intensivists can learn to detect poor comprehension and its determinants. Instruments for detecting symptoms of anxiety, depression, or stress can be used reliably even by physicians with no psychiatric training. For some symptoms, the evaluation should take place at a distance from intensive care unit discharge or death. Experience with families of patients who died in the intensive care unit and data from the literature have prompted studies of bereaved family members and the development of interventions aimed at decreasing guilt and preventing complicated grief. We believe that burden on families should be assessed routinely. In clinical studies, using markers for burden measured by validated tools may provide further evidence that effective communication and efforts to detect and to prevent symptoms of stress, anxiety, or depression provide valuable benefits to families.

Global economic burden of schizophrenia: a systematic review

Directory of Open Access Journals (Sweden)

Chong HY

2016-02-01

Full Text Available Huey Yi Chong,1 Siew Li Teoh,1 David Bin-Chia Wu,1 Surachai Kotirum,1 Chiun-Fang Chiou,2 Nathorn Chaiyakunapruk1,3–5 1School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; 2Janssen Pharmaceutical Companies Asia Pacific, Singapore; 3Center of Pharmaceutical Outcomes Research (CPOR, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; 4School of Pharmacy, University of Wisconsin, Madison, WI, USA; 5School of Population Health, University of Queensland, Brisbane, Australia Background: Schizophrenia is one of the top 25 leading causes of disability worldwide in 2013. Despite its low prevalence, its health, social, and economic burden has been tremendous, not only for patients but also for families, caregivers, and the wider society. The magnitude of disease burden investigated in an economic burden study is an important source to policymakers in decision making. This study aims to systematically identify studies focusing on the economic burden of schizophrenia, describe the methods and data sources used, and summarize the findings of economic burden of schizophrenia. Methods: A systematic review was performed for economic burden studies in schizophrenia using four electronic databases (Medline, EMBASE, PsycINFO, and EconLit from inception to August 31, 2014. Results: A total of 56 articles were included in this review. More than 80% of the studies were conducted in high-income countries. Most studies had undertaken a retrospective- and prevalence-based study design. The bottom-up approach was commonly employed to determine cost, while human capital method was used for indirect cost estimation. Database and literature were the most commonly used data sources in cost estimation in high-income countries, while chart review and interview were the main data sources in low and middle-income countries. Annual costs for the schizophrenia population in the country ranged from US$94

Economic Burden for Lung Cancer Survivors in Urban China.

Science.gov (United States)

Zhang, Xin; Liu, Shuai; Liu, Yang; Du, Jian; Fu, Wenqi; Zhao, Xiaowen; Huang, Weidong; Zhao, Xianming; Liu, Guoxiang; Mao, Zhengzhong; Hu, Teh-Wei

2017-03-15

With the rapid increase in the incidence and mortality of lung cancer, a growing number of lung cancer patients and their families are faced with a tremendous economic burden because of the high cost of treatment in China. This study was conducted to estimate the economic burden and patient responsibility of lung cancer patients and the impact of this burden on family income. This study uses data from a retrospective questionnaire survey conducted in 10 communities in urban China and includes 195 surviving lung cancer patients diagnosed over the previous five years. The calculation of direct economic burden included both direct medical and direct nonmedical costs. Indirect costs were calculated using the human capital approach, which measures the productivity lost for both patients and family caregivers. The price index was applied for the cost calculation. The average economic burden from lung cancer was $43,336 per patient, of which the direct cost per capita was $42,540 (98.16%) and the indirect cost per capita was $795 (1.84%). Of the total direct medical costs, 35.66% was paid by the insurer and 9.84% was not covered by insurance. The economic burden for diagnosed lung cancer patients in the first year following diagnosis was $30,277 per capita, which accounted for 171% of the household annual income, a percentage that fell to 107% after subtracting the compensation from medical insurance. The economic burden for lung cancer patients is substantial in the urban areas of China, and an effective control strategy to lower the cost is urgently needed.

Therapeutic use of fractionated total body and subtotal body irradiation

International Nuclear Information System (INIS)

Loeffler, R.K.

1981-01-01

Ninety-one patients were treated using fractionated subtotal body (STBI) or total body irradiation (TBI). These patients had generalized lymphomas, Hodgkin's disease, leukemias, myelomas, seminomas, or oat-cell carcinomas. Subtotal body irradiation is delivered to the entire body, except for the skull and extremities. It was expected that a significantly higher radiation dose could be administered with STBI than with TBI. A five- to ten-fold increase in tolerance for STBI was demonstrated. Many of these patients have had long-term emissions. There is little or no treatment-induced symptomatology, and no sanctuary sites

Developing a nursing personnel policy to address body art using an evidence-based model.

Science.gov (United States)

Dorwart, Shawna D; Kuntz, Sandra W; Armstrong, Myrna L

2010-12-01

An increase in the prevalence of body art as a form of self-expression has motivated health care organizations to develop policies addressing nursing personnel's body art. A systematic review of literature on body art was completed and a telephone survey of 15 hospitals was conducted to query existing policy statements addressing nursing personnel's body art. The literature established no prevalence of body art among nurses or effect of nurses' body art. Of the 13 hospitals (86%) that shared their policy on body art, none provided a rationale or references to support their existing policies. A lack of published evidence identifying the effect of body art among nurses shifts the burden of determining care outcomes to the leadership of individual hospitals. Further research on patients' perception of nursing personnel with visible body art, using an evidence-based model, is recommended. Copyright 2010, SLACK Incorporated.

Gender Differences in Anxiety Disorders: Prevalence, Course of Illness, Comorbidity and Burden of Illness

Science.gov (United States)

McLean, Carmen P.; Asnaani, Anu; Litz, Brett T.; Hofmann, Stefan G.

2011-01-01

Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N = 20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men. PMID:21439576