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

NARCIS (Netherlands)

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

2018-01-01

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

Cancer risk of low dose/low dose rate radiation: a meta-analysis of cancer data of mammals exposed to low doses of radiation

International Nuclear Information System (INIS)

Ogata, Hiromitsu; Magae, Junji

2008-01-01

Full text: Linear No Threshold (LNT) model is a basic theory for radioprotection, but the adaptability of this hypothesis to biological responses at low doses or at low dose rates is not sufficiently investigated. Simultaneous consideration of the cumulative dose and the dose rate is necessary for evaluating the risk of long-term exposure to ionizing radiation at low dose. This study intends to examine several numerical relationships between doses and dose rates in biological responses to gamma radiation. Collected datasets on the relationship between dose and the incidence of cancer in mammals exposed to low doses of radiation were analysed using meta-regression models and modified exponential (MOE) model, which we previously published, that predicts irradiation time-dependent biological response at low dose rate ionizing radiation. Minimum doses of observable risk and effective doses with a variety of dose rates were calculated using parameters estimated by fitting meta-regression models to the data and compared them with other statistical models that find values corresponding to 'threshold limits'. By fitting a weighted regression model (fixed-effects meta-regression model) to the data on risk of all cancers, it was found that the log relative risk [log(RR)] increased as the total exposure dose increased. The intersection of this regression line with the x-axis denotes the minimum dose of observable risk. These estimated minimum doses and effective doses increased with decrease of dose rate. The goodness of fits of MOE-model depended on cancer types, but the total cancer risk is reduced when dose rates are very low. The results suggest that dose response curve for cancer risk is remarkably affected by dose rate and that dose rate effect changes as a function of dose rate. For scientific discussion on the low dose exposure risk and its uncertainty, the term 'threshold' should be statistically defined, and dose rate effects should be included in the risk

Multidisciplinary European Low Dose Initiative (MELODI). Strategic research agenda for low dose radiation risk research

Energy Technology Data Exchange (ETDEWEB)

Kreuzer, M. [Federal Office for Radiation Protection, BfS, Department of Radiation Protection and Health, Neuherberg (Germany); Auvinen, A. [University of Tampere, Tampere (Finland); STUK, Helsinki (Finland); Cardis, E. [ISGlobal, Barcelona Institute for Global Health, Barcelona (Spain); Durante, M. [Institute for Fundamental Physics and Applications, TIFPA, Trento (Italy); Harms-Ringdahl, M. [Stockholm University, Centre for Radiation Protection Research, Stockholm (Sweden); Jourdain, J.R. [Institute for Radiological Protection and Nuclear Safety, IRSN, Fontenay-aux-roses (France); Madas, B.G. [MTA Centre for Energy Research, Environmental Physics Department, Budapest (Hungary); Ottolenghi, A. [University of Pavia, Physics Department, Pavia (Italy); Pazzaglia, S. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome (Italy); Prise, K.M. [Queens University Belfast, Belfast (United Kingdom); Quintens, R. [Belgian Nuclear Research Centre, SCK-CEN, Mol (Belgium); Sabatier, L. [French Atomic Energy Commission, CEA, Paris (France); Bouffler, S. [Public Health England, PHE, Chilton (United Kingdom)

2018-03-15

MELODI (Multidisciplinary European Low Dose Initiative) is a European radiation protection research platform with focus on research on health risks after exposure to low-dose ionising radiation. It was founded in 2010 and currently includes 44 members from 18 countries. A major activity of MELODI is the continuous development of a long-term European Strategic Research Agenda (SRA) on low-dose risk for radiation protection. The SRA is intended to identify priorities for national and European radiation protection research programs as a basis for the preparation of competitive calls at the European level. Among those key priorities is the improvement of health risk estimates for exposures close to the dose limits for workers and to reference levels for the population in emergency situations. Another activity of MELODI is to ensure the availability of European key infrastructures for research activities, and the long-term maintenance of competences in radiation research via an integrated European approach for training and education. The MELODI SRA identifies three key research topics in low dose or low dose-rate radiation risk research: (1) dose and dose rate dependence of cancer risk, (2) radiation-induced non-cancer effects and (3) individual radiation sensitivity. The research required to improve the evidence base for each of the three key topics relates to three research lines: (1) research to improve understanding of the mechanisms contributing to radiogenic diseases, (2) epidemiological research to improve health risk evaluation of radiation exposure and (3) research to address the effects and risks associated with internal exposures, differing radiation qualities and inhomogeneous exposures. The full SRA and associated documents can be downloaded from the MELODI website (http://www.melodi-online.eu/sra.html). (orig.)

Use of BEIR V and UNSCEAR 1988 in radiation risk assessment: Lifetime total cancer mortality risk estimates at low doses and low dose rates for low-LET radiation

International Nuclear Information System (INIS)

1992-12-01

In November 1986, the Department of Defense (DoD) asked the Committee on Interagency Radiation Research and Policy Coordination (CIRRPC) to develop a coordinated Federal position on risk assessment for low levels of ionizing radiation. Since Federal risk assessment activities are based primarily on the scientific data and analyses in authoritative review documents prepared by groups like the National Academy of Sciences' Committee on the Biological Effects of Ionizing Radiation (BEIR), the National Council on Radiation Protection and Measurements (NCRP) and the United Nations' Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), DoD proposed that the CIRRPC Science Panel undertake the task of providing coordinated interagency positions on the use of information in the reports of such groups. The practice has been for individual Federal agencies to interpret and decide independently how to use the information provided in such reports. As a result of its deliberations, the Subpanel recommends two nominal risk estimates for lifetime total cancer mortality following whole-body exposure to low levels of low-LET ionizing radiation, one for the general population and one for the working-age population (see Section II). The recommended risk estimates reflect the general agreement of information in BEIR V and UNSCEAR 1988 for total cancer mortality. The Subpanel's risk estimates and associated statements are intended to meet the needs of the Federal agencies for: (a) values that are current; (b) values that are relevant to the low-dose and low dose-rate ionizing radiation exposures principally encountered in carrying out Federal responsibilities; (c) a statement of the change in the estimates of lifetime total cancer mortality relative to estimates in previous authoritative review documents; and (d) a practical statement on the scientific uncertainty associated with applying the lifetime total cancer mortality values at very low doses

Contemporary management of low-risk bladder cancer

NARCIS (Netherlands)

Falke, J.; Witjes, J.A.

2011-01-01

Bladder cancer comprises a heterogeneous group of tumors, the majority of which are non-muscle-invasive bladder cancer (NMIBC) at initial presentation. Low-risk bladder cancer--defined as pTa low-grade papillary tumors--is the type of NMIBC with the most favorable oncologic outcome. Although the

38 CFR 41.530 - Criteria for a low-risk auditee.

Science.gov (United States)

2010-07-01

... low-risk auditee and be eligible for reduced audit coverage in accordance with § 41.520: (a) Single... entity that has biennial audits does not qualify as a low-risk auditee, unless agreed to in advance by... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Criteria for a low-risk...

Low Birth Weight And Maternal Risk Factors

Directory of Open Access Journals (Sweden)

Secma Nigam

2003-06-01

Full Text Available Objectives : To study tile socio-economic and maternal risk factors associated with low birth weight babies and to measure the strength of association. Study Design : Hospital based case-control study. Setting : Shri Sayajirao General Hospital, Vadodara. Sample size : 312 cases and 312 controls. Participants : Cases Mothers who delivered single, live baby less than 2500 gms i.e. low birth weight. Controls:- Mothers who delivered single live baby more than 2500 gms. Study Variable : Maternal age, literacy, anaemia, outcome of last pregnancy. Statistical Analysis : Chi-square test and odd’s ratio. Result : Among cases, 14.5% mothers had age less titan 20 yrs as compared to 7.3% mothers in control group. 68.6% mothers amongst cases were illiterate against 46.5% mothers in control group. 53.8% mothers had haemoglobin level 10gm% or less amongst cases and no statistically significant difference was found between low birth weight and outcome of last pregnancy Conclusion : The maternal risk factors associated with low birth weight in mothers attending S.S.G. hospital age maternal anaemia (OR 2.66, illiteracy (OR 2.51, maternal age less than 20 yrs. (OR 2.OS. No association was found between low birth rate and outcome of last pregnancy

Low-level radiation risks in people

International Nuclear Information System (INIS)

Goloman, M.; Filjushkin, V. lgor

1993-01-01

Using the limited human data plus the relationships derived from the laboratory, a leukemia risk model has been developed as well as a suggested model for other cancers in people exposed to low levels of radiation. Theoretical experimental and epidemiological evidence will be presented in an integrated stochastic model for projection of radiation-induced cancer risks

High-Risk and Low-Risk Human Papillomavirus and the Absolute Risk of Cervical Intraepithelial Neoplasia or Cancer

DEFF Research Database (Denmark)

Thomsen, Louise T; Frederiksen, Kirsten; Munk, Christian

2014-01-01

OBJECTIVE: To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test. METHODS: In this prospective cohort study, consecutive liquid......-based cervical cytology samples were collected from women screened for cervical cancer in Copenhagen, Denmark, during 2002-2005. Samples were tested with a clinical test for 13 high-risk and five low-risk HPV types. The cohort (N=35,539; aged 14-90 years) was monitored in a nationwide pathology register for up...... cytology. Detection of low-risk HPV does not predict CIN 3 or worse. Cervical cancer screening should not include testing for low-risk HPV types. LEVEL OF EVIDENCE: II....

New risk estimates at low doses

International Nuclear Information System (INIS)

Fry, R.J.M.

1992-01-01

The age of molecular radiation epidemiology may be at hand. The techniques are available to establish with the degree of precision required to determine whether agent-specific mutations can be identified consistently. A concerted effort to examine radiation-induced changes in as many relevant genes as possible appears to be justified. Cancers in those exposed to low doses of ionizing radiation should be chosen for the investigation. Parallel studies of radiation-induced cancers in experimental animals would not only complement the human studies, but perhaps reveal approaches to extrapolation of risk estimates across species. A caveat should be added to this optimistic view of what molecular studies might contribute to the knotty problem of risk estimates at low doses. The suggestions are made by one with no expertise in the field of molecular biology

Low-frequency fields - health risk assessment

International Nuclear Information System (INIS)

Bernhardt, J.

1993-01-01

The author briefly reviews the biological actions and effects of low-frequency fields, epidemiological studies and discusses health risks in detail. He describes the assessment principles of the International Commission on Non-ionizing Radiation Protection (ICNIRP), medical principles for risk assessment, determination of limits and thesholds, and aspects of prevention. This is supplemented to by several fables and literature list. (Uhe) [de

Development of a low-level waste risk methodology

International Nuclear Information System (INIS)

Fisher, J.E.; Falconer, K.L.

1984-01-01

A probabilistic risk assessment method is presented for performance evaluation of low-level waste disposal facilities. The associated program package calculates the risk associated with postulated radionuclide release and transport scenarios. Risk is computed as the mathematical product of two statistical variables: the dose consequence of a given release scenario, and its occurrence probability. A sample risk calculation is included which demonstrates the method. This PRA method will facilitate evaluation of facility performance, including identification of high risk scenarios and their mitigation via optimization of site parameters. The method is intended to be used in facility licensing as a demonstration of compliance with the performance objectives set forth in 10 CFR Part 61, or in corresponding state regulations. The Low-Level Waste Risk Methodology is being developed under sponsorship of the Nuclear Regulatory Commission

Low bone density risk is higher in exercising women with multiple triad risk factors.

Science.gov (United States)

Gibbs, Jenna C; Nattiv, Aurelia; Barrack, Michelle T; Williams, Nancy I; Rauh, Mitchell J; Nichols, Jeanne F; De Souza, Mary Jane

2014-01-01

The cumulative effect of the female athlete triad (Triad) risk factors on the likelihood of low bone mineral density (BMD) in exercising women is unclear. This study aimed to determine the risk of low BMD in exercising women with multiple Triad risk factors. We retrospectively examined cross-sectional data from 437 exercising women (mean ± SD age of 18.0 ± 3.5 yr, weighed 57.5 ± 7.1 kg with 24.5% ± 6.1% body fat) obtained at baseline from 4 prospective cohort studies examining Triad risk factors. Questionnaires were completed to obtain information on demographic characteristics, self-reported eating attitudes/behaviors, menstrual function, sport/activity participation, and medication use. Height and body weight were measured. BMD was measured using dual energy x-ray absorptiometry. Low BMD was defined as z-scores of exercising women. Further research should be conducted to develop a user-friendly algorithm integrating these indicators of risk for low BMD in exercising women (particularly factors associated with low BMI/body weight, menstrual dysfunction, lean sport/activity participation, and elevated dietary restraint).

Determinants of low risk of asthma exacerbation during pregnancy

DEFF Research Database (Denmark)

Ali, Z; Nilas, L; Ulrik, C S

2018-01-01

of Asthma during Pregnancy (MAP) programme at Hvidovre Hospital since 2007. Assessment of asthma control, adjustment of treatment, spirometry and measurement of exhaled nitric oxide (FENO) were performed, and baseline characteristics and exacerbation history were collected at enrolment. Determinants of low......: Clinically stable asthma at enrolment, together with no history of previous exacerbations and no prescribed controller medication, is a determinant of low risk of an asthma exacerbation during pregnancy, which may guide clinicians in individualizing surveillance of asthma during pregnancy.......BACKGROUND: Assessment of asthma control every 4-6 weeks during pregnancy is recommended to reduce risk of exacerbation, and by that improve outcome. OBJECTIVE: To identify determinants of pregnancies with low risk of asthma exacerbation. METHODS: All pregnant women enrolled into the Management...

Prematurity and low weight at birth as new conditions predisposing to an increased cardiovascular risk.

Science.gov (United States)

Mercuro, Giuseppe; Bassareo, Pier Paolo; Flore, Giovanna; Fanos, Vassilios; Dentamaro, Ilaria; Scicchitano, Pietro; Laforgia, Nicola; Ciccone, Marco Matteo

2013-04-01

Although the survival rate for preterm subjects has improved considerably, due to the progress in the field of perinatal medicine, preterm birth is frequently the cause underlying a series of notorious complications: morphological, neurological, ophthalmological, and renal alterations. In addition, it has recently been demonstrated how low gestational age and reduced foetal growth contribute towards an increased cardiovascular risk in preterm neonates. In fact, cardiovascular mortality is higher among former preterm adults than those born at term. This condition is referred to as cardiovascular perinatal programming. In the light of the above, an early, constant, and prolonged cardiological followup programme should be implemented in former preterm individuals. The aim of this paper was to perform a comprehensive literature review about two new emerging conditions predisposing to an increased cardiovascular risk: prematurity and low weight at birth.

Hypopigmentation Induced by Frequent Low-Fluence, Large-Spot-Size QS Nd:YAG Laser Treatments.

Science.gov (United States)

Wong, Yisheng; Lee, Siong See Joyce; Goh, Chee Leok

2015-12-01

The Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (QS 1064-nm Nd:YAG) laser is increasingly used for nonablative skin rejuvenation or "laser toning" for melasma. Multiple and frequent low-fluence, large-spot-size treatments are used to achieve laser toning, and these treatments are associated with the development of macular hypopigmentation as a complication. We present a case series of three patients who developed guttate hypomelanotic macules on the face after receiving laser toning treatment with QS 1064-nm Nd:YAG.

Risk management or mind control? Possible messages in the report by the working group on the risk management of low-dose exposures

International Nuclear Information System (INIS)

Onai, Takayuki; Shirabe, Masashi

2012-01-01

Fukushima accident discharged a large amount of radioactive materials to the air and brought about a long-term low-dose radiation exposure risk in contaminated area. In December 2011 the government working group (WG) on the risk management of low-dose radiation exposure issued the report on subjects: (1) health effects from annual radiation exposure of 20 mSv, (2) special consideration necessary for children and pregnant women and (3) proper way communicating citizens on radioactive materials and radiation doses in relation to health risks from low-dose radiation exposure. This article recommended making radiation protection strategies based on discussions among experts, government and citizens in consideration of “uncertainty” of scientific knowledge, and it criticized the WG's report mainly in the following respects. 1) The report mixed evacuation order level and ICRP's reference level in its discussion on “20 mSv”. 2) It was over-optimistic and frequently misleading on health risks of low-dose radiation. For example, it sometimes discussed the risks employing data and knowledge against recommendations of international authorities like UNSCEAR and ICRP. 3) It regarded Fukushima residents’ anxieties and stresses to be controlled as the only source of health risks. This attitude offered a counterpoint to UNSCEAR's deliberate attitude to “radiophobia”. 4) Against the spirit of ICRP Publ.111, only experts of WG made decisions about radiation protection in the absence of stakeholders. As its result, 5) risk communication recommended in the report was not interactive, in fact, based on “deficit model” of science communication. (author)

Adherence to low-carbohydrate and low-fat diets in relation to weight loss and cardiovascular risk factors.

Science.gov (United States)

Hu, Tian; Yao, Lu; Reynolds, Kristi; Niu, Tianhua; Li, Shengxu; Whelton, Paul K; He, Jiang; Steffen, Lyn M; Bazzano, Lydia A

2016-03-01

A low-carbohydrate diet can reduce body weight and some cardiovascular disease (CVD) risk factors more than a low-fat diet, but differential adherence may play a role in these effects. Data were used from 148 adults who participated in a 12-month clinical trial examining the effect of a low-carbohydrate diet (fat diet (fat, fat) on weight and CVD risk factors. We compared attendance at counseling sessions, deviation from nutrient goals, urinary ketone presence, and composite scores representing the overall adherence based on the distribution of these individual indicators between two interventions. Composite scores were similar between the two groups. A one-interquartile-range increase in composite score representing better adherence to a low-carbohydrate diet was associated with 2.2 kg or 2.3 % greater weight loss, 1.1 greater reduction in percent fat mass, and 1.3 greater increase in proportion of lean mass. Indicators of adherence to a low-fat diet was not associated with changes in weight, fat mass or lean mass. Despite comparable adherence between groups, a low-carbohydrate diet was associated with greater reductions in body weight and improvement in body composition, while a low-fat diet was not associated with weight loss.

Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials

Science.gov (United States)

Hu, Tian; Mills, Katherine T.; Yao, Lu; Demanelis, Kathryn; Eloustaz, Mohamed; Yancy, William S.; Kelly, Tanika N.; He, Jiang; Bazzano, Lydia A.

2012-01-01

The effects of low-carbohydrate diets (≤45% of energy from carbohydrates) versus low-fat diets (≤30% of energy from fat) on metabolic risk factors were compared in a meta-analysis of randomized controlled trials. Twenty-three trials from multiple countries with a total of 2,788 participants met the predetermined eligibility criteria (from January 1, 1966 to June 20, 2011) and were included in the analyses. Data abstraction was conducted in duplicate by independent investigators. Both low-carbohydrate and low-fat diets lowered weight and improved metabolic risk factors. Compared with participants on low-fat diets, persons on low-carbohydrate diets experienced a slightly but statistically significantly lower reduction in total cholesterol (2.7 mg/dL; 95% confidence interval: 0.8, 4.6), and low density lipoprotein cholesterol (3.7 mg/dL; 95% confidence interval: 1.0, 6.4), but a greater increase in high density lipoprotein cholesterol (3.3 mg/dL; 95% confidence interval: 1.9, 4.7) and a greater decrease in triglycerides (−14.0 mg/dL; 95% confidence interval: −19.4, −8.7). Reductions in body weight, waist circumference and other metabolic risk factors were not significantly different between the 2 diets. These findings suggest that low-carbohydrate diets are at least as effective as low-fat diets at reducing weight and improving metabolic risk factors. Low-carbohydrate diets could be recommended to obese persons with abnormal metabolic risk factors for the purpose of weight loss. Studies demonstrating long-term effects of low-carbohydrate diets on cardiovascular events were warranted. PMID:23035144

Risks of low-level radiation - the evidence of epidemiology

International Nuclear Information System (INIS)

Gloag, D.

1980-01-01

The difficulties involved in estimating risks from very low levels of radiation and the use of dose-response models for cancer incidence are discussed with reference to the third BEIR Committee report on the Effects on Populations of Exposure to low levels of Ionizing Radiation (1980). Cancer risk estimates derived from different epidemiological studies are reviewed. They include atom bomb survivors, medically irradiated groups and occupational groups. (36 references). (author)

A Study Of Risk Factors For Low Birth Weight

Directory of Open Access Journals (Sweden)

Deswal B S

1999-01-01

Full Text Available Research question: What is the extent of low weight babies born in hospitals and its association with some maternal factors? Objectives: 1. To find an overall prevalence of low birth weight babies amongst hospital births in Meerut city. 2. To identify and quantify the effects of some risk factors for low birth weight. Setting: District women Hospital of Meerut city of western U.P. Study Design: Hospital based matched case-control study. Sample size: 491 low birth weight babies as ‘cases’ and an equal number of babies of normal birth weight in ‘control’ group matched for maternal age, sex of baby, birth order and institution of delivery. Study variables: Socio-economic Status: maternal biological factors including obstetric history: antenatal factors: nutritional factors: history of abortion: toxaemia of pregnancy etc. Results: Overall proportion of low birth weight babies was found to be 21.8% amongst hospital live births and 30.9% born to mothers aged below 30 years of age. Low maternal weight, under nutrition, lack of antenatal care, short inter-pregnancy interval, toxacmia of pregnancy were independent factors increasing the risk of low birth weight significantly. Conclusions: The study suggested that a substantial proportion of low birth weight babies can be averted by improving maternal nutritional status including anemic condition, birth spacing and proper antenatal care.

Urbanization of black South African women may increase risk of low bone mass due to low vitamin D status, low calcium intake and high bone turnover

OpenAIRE

Kruger, Annamarie; Kruger, Marlena C.; Kruger, Iolanthé Marike; Wentzel-Viljoen, Edelweiss

2011-01-01

Globally, rural to urban migration is accompanied by changes in dietary patterns and lifestyle that have serious health implications, including development of low bone mass. We hypothesized that serum 25 (OH) vitamin D3 (25[OH]D3) levels will be lower, bone turnover higher, and nutrition inadequate in urban postmenopausal black women, increasing risk for low bone mass. We aimed to assess the prevalence of risk factors for low bone mass in 1261 black women from rural and urban areas in the Nor...

Plant adaptation to frequent alterations between high and low temperatures: remodeling of membrane lipids and maintenance of unsaturation levels

OpenAIRE

Zheng, Guowei; Tian, Bo; Zhang, Fujuan; Tao, Faqing; Li, Weiqi

2011-01-01

One major strategy by which plants adapt to temperature change is to decrease the degree of unsaturation of membrane lipids under high temperature and increase it under low temperature. We hypothesize that this strategy cannot be adopted by plants in ecosystems and environments with frequent alterations between high and low temperatures, because changes in lipid unsaturation are complex and require large energy inputs. To test this hypothesis, we used a lipidomics approach to profile changes ...

Low-risk susceptibility alleles in 40 human breast cancer cell lines

International Nuclear Information System (INIS)

Riaz, Muhammad; Elstrodt, Fons; Hollestelle, Antoinette; Dehghan, Abbas; Klijn, Jan GM; Schutte, Mieke

2009-01-01

Low-risk breast cancer susceptibility alleles or SNPs confer only modest breast cancer risks ranging from just over 1.0 to1.3 fold. Yet, they are common among most populations and therefore are involved in the development of essentially all breast cancers. The mechanism by which the low-risk SNPs confer breast cancer risks is currently unclear. The breast cancer association consortium BCAC has hypothesized that the low-risk SNPs modulate expression levels of nearby located genes. Genotypes of five low-risk SNPs were determined for 40 human breast cancer cell lines, by direct sequencing of PCR-amplified genomic templates. We have analyzed expression of the four genes that are located nearby the low-risk SNPs, by using real-time RT-PCR and Human Exon microarrays. The SNP genotypes and additional phenotypic data on the breast cancer cell lines are presented. We did not detect any effect of the SNP genotypes on expression levels of the nearby-located genes MAP3K1, FGFR2, TNRC9 and LSP1. The SNP genotypes provide a base line for functional studies in a well-characterized cohort of 40 human breast cancer cell lines. Our expression analyses suggest that a putative disease mechanism through gene expression modulation is not operative in breast cancer cell lines

Outpatient thyroid remnant ablation using repeated low 131-iodine activities (740 MBq/20 mCix2) in patients with low-risk differentiated thyroid cancer.

Science.gov (United States)

Clerc, Jérôme; Bienvenu-Perrard, Marie; de Malleray, Caroline Pichard; Dagousset, Françoise; Delbot, Thierry; Dreyfuss, Marc; Groussin, Lionel; Marlowe, Robert J; Leger, Françoise Aubène; Chevalier, Alain

2012-03-01

In low-risk differentiated thyroid cancer (DTC), postoperative (131)I remnant ablation should employ a minimum effective activity; reports increasingly suggest efficacy of low activities, e.g. 1110 MBq/30 mCi. OBJECTIVES, DESIGN, PATIENTS, AND INTERVENTIONS: We retrospectively studied the ablation capability and diagnostic utility of the Minidose protocol, two 740-MBq/20 mCi outpatient administrations, 6-18 months apart, plus related diagnostic procedures, in 160 consecutive (near-) totally thyroidectomized low-risk DTC (pT1/N0-Nx) patients. Successful ablation comprised negative 740-MBq whole-body scintigraphy with cervical uptake below 0.1%, negative stimulated thyroglobulin (STg) (<1 ng/ml, negative thyroglobulin antibodies), and negative Doppler ultrasonography (performed around Minidose 2). The study took place at a referral center. Minidose imaging found unsuspected nodal or distant metastases in nine of 160 patients (5.6%). Ablation success rates after one (two) 740-MBq activity (activites) were 75.9% (90.2%) in 145 (132) evaluable imaging-negative patients. Compared with thyroid hormone withdrawal, recombinant human TSH stimulation was associated with higher urinary iodine excretion/creatinine, lower cervical uptake, and more frequent ablation success after the first 740 MBq; success rates no longer differed significantly after both administrations. Patients with STg below 10 ng/ml at Minidose 1 were oftener ablated at Minidose 2 (odds ratio=13.9, 95% confidence interval=2.5-76.4, P<0.003), attaining 92.0% final ablation success after recombinant human TSH preparation, suggesting that one 740-MBq activity should suffice in this subgroup. All 81 evaluable patients with prolonged follow-up (mean 41.8±21.9 months after Minidose 1) had no evidence of disease at the last visit. The Minidose outpatient ablation protocol is effective and diagnostically useful in low-risk DTC.

Risk of radiation-induced cancer at low doses and low dose rates for radiation protection purposes

International Nuclear Information System (INIS)

1995-01-01

The aim of this report is to provide an updated, comprehensive review of the data available for assessing the risk of radiation-induced cancer for radiation protection purposes. Particular emphasis is placed on assessing risks at low doses and low dose rates. The review brings together the results of epidemiological investigations and fundamental studies on the molecular and cellular mechanisms involved in radiation damage. Additionally, this information is supplemented by studies with experimental animals which provide further guidance on the form of the dose-response relationship for cancer induction, as well as on the effect of dose rate on the tumour yield. The emphasis of the report is on cancer induction resulting from exposure to radiations with a low linear energy transfer (LET). The work was performed under contract for the Institut de Protection et de Surete Nucleaire, Fontenay-aux-Roses, Paris, France, whose agreement to publish is gratefully ackowledged. It extends the advice on radiation risks given in Documents of the NRPB, 4 No. 4 (1993). (Author)

Association between low education and higher global cardiovascular risk.

Science.gov (United States)

Di Chiara, Tiziana; Scaglione, Alessandra; Corrao, Salvatore; Argano, Christiano; Pinto, Antonio; Scaglione, Rosario

2015-05-01

This study was designed to evaluate the impact of educational status on global cardiovascular risk in a southern Italian urban population. The study population consisted of 488 consecutive outpatients aged 18 years and older. Educational status was categorized according to the number of years of formal education as follows: (1) low education group (education group (10-15 years). In both groups, cardiometabolic comorbidities (obesity, visceral obesity, diabetes, dyslipidemia, metabolic syndrome, microalbuminuria, left ventricular hypertrophy) and global cardiovascular risk, according to international guidelines, were analyzed. Left ventricular mass index and ejection fraction by echocardiography and E/A ratio, by pulsed-wave Doppler, were calculated. The low education group was characterized by a significantly higher prevalence of patients with visceral obesity (P=.021), hypertension (P=.010), metabolic syndrome (P=.000), and microalbuminuria (P=.000) and greater global cardiovascular risk (P=.000). Significantly increased levels of microalbuminuria (P=.000) and significantly decreased values of E/A ratio (P=.000) were also detected in the low education group. Global cardiovascular risk correlated directly with waist-to-hip ratio (P=.010), microalbuminuria (P=.015), and the metabolic syndrome (P>.012) and inversely with educational status (P=.000). Education was independently (P=.000) associated with global cardiovascular risk. These data indicate a strong association between low education and cardiometabolic comorbidities suitable to influence the evolution of chronic degenerative diseases. Preventive strategies need to be more efficient and more effective in this patient population. ©2015 Wiley Periodicals, Inc.

Joint Attention Development in Low-risk Very Low Birth Weight Infants at Around 18 Months of Age.

Science.gov (United States)

Yamaoka, Noriko; Takada, Satoshi

2016-10-18

The purpose of this study was to clarify the developmental characteristics of joint attention in very low birth weight (VLBW) infants with a low risk of complications. Section B of the Checklist for Autism in Toddlers (CHAT) was administered to 31 VLBW and 45 normal birth weight (NBW) infants aged 18-22 months, while the sessions were recorded with a video camera. A semi-structured observation scale was developed to assess infants' joint attention from the video footage, and was shown to be reliable. VLBW, compared to NBW, infants showed significantly poorer skills in 2 of 4 items on responding to joint attention, and in 6 of 10 items on initiating joint attention. VLBW infants need more clues in order to produce joint attention. The difficulty was attributed to insufficient verbal and fine motor function skills. Continuous follow-up evaluation is essential for both high-risk and low-risk VLBW infants and their parents.

Evaluation of Risk Management Strategies for a Low-Cost, High-Risk Project

Science.gov (United States)

Shishko, Robert; Jorgensen, Edward J.

1996-01-01

This paper summarizes work in progress to define and implement a risk management process tailored to a low-cost, high-risk, NASA mission -the Microrover Flight Experiment (MFEX, commonly called the Mars microrover).

Image-Guided Hypofractionated Radiotherapy in Low-Risk Prostate Cancer Patients

Directory of Open Access Journals (Sweden)

Maurizio Valeriani

2014-01-01

Full Text Available Aim. To evaluate efficacy and toxicity of image-guided hypofractionated radiotherapy (HFRT in the treatment of low-risk prostate cancer. Outcomes and toxicities of this series of patients were compared to another group of 32 low-risk patients treated with conventional fractionation (CFRT. Methods. Fifty-nine patients with low-risk prostate cancer were analysed. Total dose for the prostate and proximal seminal vesicles was 60 Gy delivered in 20 fractions. Results. The median follow-up was 30 months. The actuarial 4-year overall survival, biochemical free survival, and disease specific survival were 100%, 97.4%, and 97.4%, respectively. Acute grade 1-2 gastrointestinal (GI and genitourinary (GU toxicity rates were 11.9% and 40.7%, respectively. Grade 1 GI and GU late toxicity rates were 8.5% and 13.6%, respectively. No grade ≥2 late toxicities were recorded. Acute grade 2-3 GU toxicity resulted significantly lower (P=0.04 in HFRT group compared to the CFRT group. The cumulative 4-year incidence of grade 1-2 GU toxicity was significantly higher (P<0.001 for HFRT patients. Conclusions. Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer patients. The incidence of GI and GU toxicity was low. However, HFRT presented higher cumulative incidence of low-grade late GU toxicity than CFRT.

Obesogenic dietary intake in families with 1-year-old infants at high and low obesity risk based on parental weight status: baseline data from a longitudinal intervention (Early STOPP).

Science.gov (United States)

Svensson, Viktoria; Sobko, Tanja; Ek, Anna; Forssén, Michaela; Ekbom, Kerstin; Johansson, Elin; Nowicka, Paulina; Westerståhl, Maria; Riserus, Ulf; Marcus, Claude

2016-03-01

To compare dietary intake in 1-year-old infants and their parents between families with high and low obesity risk, and to explore associations between infant dietary intake and relative weight. Baseline analyses of 1-year-old infants (n = 193) and their parents participating in a longitudinal obesity intervention (Early STOPP) were carried out. Dietary intake and diet quality indicators were compared between high- and low-risk families, where obesity risk was based on parental weight status. The odds for high diet quality in relation to parental diet quality were determined. Associations between measured infant relative weight and dietary intake were examined adjusting for obesity risk, socio-demographics, and infant feeding. Infant dietary intake did not differ between high- and low-risk families. The parents in high-risk families consumed soft drinks, French fries, and low-fat spread more frequently, and fish and fruits less frequently (p dietary intake, obesity risk, or early feeding patterns. At the age of one, dietary intake in infants is not associated with family obesity risk, nor with parental obesogenic food intake. Milk cereal drink consumption but no other infant dietary marker reflects relative weight at this young age.

Dose-response relationships and risk estimates for the induction of cancer due to low doses of low-LET radiation

International Nuclear Information System (INIS)

Elaguppillai, V.

1981-01-01

Risk estimates for radiation-induced cancer at low doses can be obtained only by extrapolation from the known effects at high doses and high dose rates, using a suitable dose-response model. The applicability of three different models, linear, sublinear and supralinear, are discussed in this paper. Several experimental studies tend to favour a sublinear dose-response model (linear-quadratic model) for low-LET radiation. However, human epidemiological studies do not exclude any of the dose-response relationships. The risk estimates based on linear and linear quadratic dose-response models are compared and it is concluded that, for low-LET radiation, the linear dose-response model would probably over-estimate the actual risk of cancer by a factor of two or more. (author)

Commercial low-level radioactive waste transportation liability and radiological risk

Energy Technology Data Exchange (ETDEWEB)

Quinn, G.J.; Brown, O.F. II; Garcia, R.S.

1992-08-01

This report was prepared for States, compact regions, and other interested parties to address two subjects related to transporting low-level radioactive waste to disposal facilities. One is the potential liabilities associated with low-level radioactive waste transportation from the perspective of States as hosts to low-level radioactive waste disposal facilities. The other is the radiological risks of low-level radioactive waste transportation for drivers, the public, and disposal facility workers.

Commercial low-level radioactive waste transportation liability and radiological risk

International Nuclear Information System (INIS)

Quinn, G.J.; Brown, O.F. II; Garcia, R.S.

1992-08-01

This report was prepared for States, compact regions, and other interested parties to address two subjects related to transporting low-level radioactive waste to disposal facilities. One is the potential liabilities associated with low-level radioactive waste transportation from the perspective of States as hosts to low-level radioactive waste disposal facilities. The other is the radiological risks of low-level radioactive waste transportation for drivers, the public, and disposal facility workers

Delayed Prenatal Care and the Risk of Low Birth Weight Delivery.

Science.gov (United States)

Hueston, William J.; Gilbert, Gregory E.; Davis, Lucy; Sturgill, Vanessa

2003-01-01

Assessed whether the timing of prenatal care related to low birth weight delivery, adjusting for sociodemographic and behavioral risk factors. Data on births to white and African American women showed no benefits for early initiation of prenatal care in reducing the risk of low birth weight.(SM)

Emergency caesarean section in low risk nulliparous women

DEFF Research Database (Denmark)

Haerskjold, Ann; Hegaard, H K; Kjaergaard, H

2012-01-01

and identifies maternal and fetal risk factors associated with ECS. We included 2,748 low-risk women and 8.7% had ECS. Failure-to-progress (FTP) accounted for 68.3% of the ECS and 30.4% were performed due to suspected fetal distress (SFD). Multivariate logistic regression analyses were done to estimate.......26-3.20) were associated with increased risk of ECS due to FTP....

Incidence And Potential Risk Factors Of Low Birth Weight Among ...

African Journals Online (AJOL)

Incidence And Potential Risk Factors Of Low Birth Weight Among Full Term Deliveries. ... (LBW) is a reliable indicator in monitoring and evaluating the success of maternal and child ... Key words: Low birth weight- incidence- associated factors.

Low self-concept in poor readers: prevalence, heterogeneity, and risk.

Science.gov (United States)

McArthur, Genevieve; Castles, Anne; Kohnen, Saskia; Banales, Erin

2016-01-01

There is evidence that poor readers are at increased risk for various types of low self-concept-particularly academic self-concept. However, this evidence ignores the heterogeneous nature of poor readers, and hence the likelihood that not all poor readers have low self-concept. The aim of this study was to better understand which types of poor readers have low self-concept. We tested 77 children with poor reading for their age for four types of self-concept, four types of reading, three types of spoken language, and two types of attention. We found that poor readers with poor attention had low academic self-concept, while poor readers with poor spoken language had low general self-concept in addition to low academic self-concept. In contrast, poor readers with typical spoken language and attention did not have low self-concept of any type. We also discovered that academic self-concept was reliably associated with reading and receptive spoken vocabulary, and that general self-concept was reliably associated with spoken vocabulary. These outcomes suggest that poor readers with multiple impairments in reading, language, and attention are at higher risk for low academic and general self-concept, and hence need to be assessed for self-concept in clinical practice. Our results also highlight the need for further investigation into the heterogeneous nature of self-concept in poor readers.

Low self-concept in poor readers: prevalence, heterogeneity, and risk

Science.gov (United States)

Castles, Anne; Kohnen, Saskia; Banales, Erin

2016-01-01

There is evidence that poor readers are at increased risk for various types of low self-concept—particularly academic self-concept. However, this evidence ignores the heterogeneous nature of poor readers, and hence the likelihood that not all poor readers have low self-concept. The aim of this study was to better understand which types of poor readers have low self-concept. We tested 77 children with poor reading for their age for four types of self-concept, four types of reading, three types of spoken language, and two types of attention. We found that poor readers with poor attention had low academic self-concept, while poor readers with poor spoken language had low general self-concept in addition to low academic self-concept. In contrast, poor readers with typical spoken language and attention did not have low self-concept of any type. We also discovered that academic self-concept was reliably associated with reading and receptive spoken vocabulary, and that general self-concept was reliably associated with spoken vocabulary. These outcomes suggest that poor readers with multiple impairments in reading, language, and attention are at higher risk for low academic and general self-concept, and hence need to be assessed for self-concept in clinical practice. Our results also highlight the need for further investigation into the heterogeneous nature of self-concept in poor readers. PMID:27867764

Differences in gay men's AIDS risk knowledge and behavior patterns in high and low AIDS prevalence cities.

Science.gov (United States)

St Lawrence, J S; Hood, H V; Brasfield, T; Kelly, J A

1989-01-01

Several studies have found reductions in acquired immunodeficiency syndrome (AIDS) risk practices among gay men in high AIDS-prevalence cities since the start of the AIDS crisis. Much less is known about risk behavior patterns among gay men in smaller cities, where AIDS cases are less common and the prevalence of human immunodeficiency virus infection is relatively lower. In the study, men entering gay bars in three cities, one large and two small, completed anonymous surveys of sexual practices and AIDS risk knowledge. Men in high AIDS-prevalence areas were found to have had a greater number of sexual partners, were more knowledgeable about AIDS, were much more likely to engage in low-risk practices (such as mutual masturbation or body rubbing), and had unprotected anal intercourse less frequently than gay men in smaller cities. The most common sexual activity among gay men in the larger city was mutual masturbation, a low-risk practice. The most common sexual activity among gay men in the smaller cities was unprotected anal intercourse. Increased efforts are needed to educate gay men and to promote risk behavior changes among those living in smaller cities and in communities outside the prominent AIDS epicenters.

Pre-Feedback Risk Expectancies and Reception of Low-Risk Health Feedback: Absolute and Comparative Lack of Reassurance.

Science.gov (United States)

Gamp, Martina; Renner, Britta

2016-11-01

Personalised health-risk assessment is one of the most common components of health promotion programs. Previous research on responses to health risk feedback has commonly focused on the reception of bad news (high-risk feedback). The reception of low-risk feedback has been comparably neglected since it is assumed that good news is reassuring and readily received. However, field studies suggest mixed responses to low-risk health feedback. Accordingly, we examine whether pre-feedback risk expectancies can mitigate the reassuring effects of good news. In two studies (N = 187, N = 565), after assessing pre-feedback risk expectancies, participants received low-risk personalised feedback about their own risk of developing (the fictitious) Tucson Chronic Fatigue Syndrome (TCFS). Study 2 also included peer TCFS risk status feedback. Afterwards, self- and peer-related risk perception for TCFS was assessed. In both studies, participants who expected to be at high risk but received good news (unexpected low-risk feedback) showed absolute lack of reassurance. Specifically, they felt at significantly greater TCFS risk than participants who received expected good news. Moreover, the unexpected low-risk group even believed that their risk was as high as (Study 1) or higher (Study 2) than that of their peers (comparative lack of reassurance). Results support the notion that high pre-feedback risk expectancies can mitigate absolute and comparative reassuring effects of good news. © 2016 The International Association of Applied Psychology.

75 FR 66298 - Prompt Corrective Action; Amended Definition of Low-Risk Assets

Science.gov (United States)

2010-10-28

...; Amended Definition of Low-Risk Assets AGENCY: National Credit Union Administration (NCUA). ACTION: Interim...-weighting of zero, reflecting the absence of credit risk. The amendment will expand the definition of ``low... exists today, the NGNs held by a natural person credit union would fall within the ``investments'' risk...

Predictive risk factors for chronic low back pain in Parkinson's disease.

Science.gov (United States)

Ozturk, Erhan Arif; Kocer, Bilge Gonenli

2018-01-01

Although previous studies have reported that the prevalence of low back pain in Parkinson's disease was over 50% and low back pain was often classified as chronic, risk factors of chronic low back pain have not been previously investigated. The aim of this study was to determine the predictive risk factors of chronic low back pain in Parkinson's disease. One hundred and sixty-eight patients with Parkinson's disease and 179 controls were consecutively included in the study. Demographic data of the two groups and disease characteristics of Parkinson's disease patient group were recorded. Low back pain lasting for ≥3 months was evaluated as chronic. Firstly, the bivariate correlations were calculated between chronic low back pain and all possible risk factors. Then, a multivariate regression was used to evaluate the impact of the predictors of chronic low back pain. The frequency of chronic low back pain in Parkinson's disease patients and controls were 48.2% and 26.7%, respectively (p chronic low back pain in Parkinson's disease were general factors including age (odds ratio = 1.053, p = 0.032) and Hospital Anxiety and Depression Scale - Depression subscore (odds ratio = 1.218, p = 0.001), and Parkinson's disease-related factors including rigidity (odds ratio = 5.109, p = 0.002) and posture item scores (odds ratio = 5.019, p = 0.0001). The chronic low back pain affects approximately half of the patients with Parkinson's disease. Prevention of depression or treatment recommendations for managing depression, close monitoring of anti- parkinsonian medication to keep motor symptoms under control, and attempts to prevent, correct or reduce abnormal posture may help reduce the frequency of chronic low back pain in Parkinson's disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Low HDL cholesterol as a cardiovascular risk factor in rural, urban, and rural-urban migrants: PERU MIGRANT cohort study.

Science.gov (United States)

Lazo-Porras, María; Bernabe-Ortiz, Antonio; Málaga, Germán; Gilman, Robert H; Acuña-Villaorduña, Ana; Cardenas-Montero, Deborah; Smeeth, Liam; Miranda, J Jaime

2016-03-01

Whilst the relationship between lipids and cardiovascular mortality has been well studied and appears to be controversial, very little has been explored in the context of rural-to-urban migration in low-resource settings. Determine the profile and related factors for HDL-c patterns (isolated and non-isolated low HDL-c) in three population-based groups according to their migration status, and determine the effect of HDL-c patterns on the rates of cardiovascular outcomes (i.e. non-fatal stroke and non-fatal myocardial infarction) and mortality. Cross-sectional and 5-year longitudinal data from the PERU MIGRANT study, designed to assess the effect of migration on cardiovascular risk profiles and mortality in Peru. Two different analyses were performed: first, we estimated prevalence and associated factors with isolated and non-isolated low HDL-c at baseline. Second, using longitudinal information, relative risk ratios (RRR) of composite outcomes of mortality, non-fatal stroke and non-fatal myocardial infarction were calculated according to HDL-c levels at baseline. Data from 988 participants, rural (n = 201), rural-to-urban migrants (n = 589), and urban (n = 199) groups, was analysed. Low HDL-c was present in 56.5% (95%CI: 53.4%-59.6%) without differences by study groups. Isolated low HDL-c was found in 36.5% (95%CI: 33.5-39.5%), with differences between study groups. In multivariable analysis, urban group (vs. rural), female gender, overweight and obesity were independently associated with isolated low HDL-c. Only female gender, overweight and obesity were associated with non-isolated low HDL-c. Longitudinal analyses showed that non-isolated low HDL-c increased the risk of negative cardiovascular outcomes (RRR = 3.46; 95%CI: 1.23-9.74). Isolated low HDL-c was the most common dyslipidaemia in the study population and was more frequent in rural subjects. Non-isolated low HDL-c increased three-to fourfold the 5-year risk of cardiovascular outcomes. Copyright © 2015 The

Urbanization of black South African women may increase risk of low bone mass due to low vitamin D status, low calcium intake, and high bone turnover.

Science.gov (United States)

Kruger, Marlena C; Kruger, Iolanthé M; Wentzel-Viljoen, Edelweiss; Kruger, Annamarie

2011-10-01

Globally, rural to urban migration is accompanied by changes in dietary patterns and lifestyle that have serious health implications, including development of low bone mass. We hypothesized that serum 25 (OH) vitamin D3 (25[OH]D3) levels will be lower, bone turnover higher, and nutrition inadequate in urban postmenopausal black women, increasing risk for low bone mass. We aimed to assess the prevalence of risk factors for low bone mass in 1261 black women from rural and urban areas in the North West Province of South Africa (Prospective Urban and Rural Epidemiology-South Africa project). Fasting blood samples were taken; and participants were interviewed to complete questionnaires on self-reported diseases, fractures, and dietary intakes. Bone health markers were assessed in a subgroup of 658 women older than 45 years. Specific lifestyle risk factors identified were inactivity, smoking, injectable progestin contraception use, and high alcohol consumption. Dietary risk factors identified were low calcium and high animal protein, phosphorous, and sodium intakes. The 25(OH)D3 and C-terminal telopeptide (CTX) levels were significantly higher in the rural vs the urban women older than 50 years. Parathyroid hormone (PTH) levels increased with age in both groups. The 25(OH)D levels were inversely correlated with CTX and PTH in rural women. In urban women, PTH and CTX were correlated while dietary calcium was inversely correlated with CTX and PTH with 25(OH)D3. The combination of low dietary calcium (<230 mg/d), marginally insufficient 25(OH)D3 status, and raised PTH may result in increased bone resorption. Further research is required to assess bone health and fracture risk in black African women. Copyright © 2011 Elsevier Inc. All rights reserved.

Low-socioeconomic status workers: their health risks and how to reach them.

Science.gov (United States)

Harris, Jeffrey R; Huang, Yi; Hannon, Peggy A; Williams, Barbara

2011-02-01

To help workplace health promotion practitioners reach low-socioeconomic status workers at high risk for chronic diseases. We describe low-socioeconomic status workers' diseases, health status, demographics, risk behaviors, and workplaces, using data from the Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and Bureau of Labor Statistics. Workers with household annual incomes less than $35,000, or a high school education or less, report more chronic diseases and lower health status. They tend to be younger, nonwhite, and have much higher levels of smoking and missed cholesterol screening. They are concentrated in the smallest and largest workplaces and in three low-wage industries that employ one-quarter of the population. To decrease chronic diseases among low-socioeconomic status workers, we need to focus workplace health promotion programs on workers in low-wage industries and small workplaces.

The carcinogenic risks of low-LET and high-LET ionizing radiations

International Nuclear Information System (INIS)

Fabrikant, J.I.

1991-08-01

This report presents a discussion on risk from ionizing radiations to human populations. Important new information on human beings has come mainly from further follow-up of existing epidemiological studies, notably the Japanese atomic bomb survivors and the ankylosing spondylitis patients; from new epidemiological surveys, such as the patients treated for cancer of the uterine cervix; and from combined surveys, including workers exposed in underground mines. Since the numerous and complex differences among the different study populations introduce factors that influence the risk estimates derived in ways that are not completely understood, it is not clear how to combine the different risk estimates obtained. These factors involve complex biological and physical variables distributed over time. Because such carcinogenic effects occur too infrequently to be demonstrated at low doses, the risks of low-dose radiation can be estimated only by interpolation from observations at high doses on the basis of theoretical concepts, mathematical models and available empirical evidence, primarily the epidemiological surveys of large populations exposed to ionizing radiation. In spite of a considerable amount of research, only recently has there has been efforts to apply the extensive laboratory data in animals to define the dose-incidence relationship in the low dose region. There simply are insufficient data in the epidemiological studies of large human populations to estimate risk coefficients directly from exposure to low doses. The risk estimates for the carcinogenic effects of radiation have been, in the past, somewhat low and reassessment of the numerical values is now necessary

Relationship between dose and risk, and assessment of carcinogenic risks associated with low doses of ionizing radiation

International Nuclear Information System (INIS)

Tubiana, M.; Aurengo, A.

2005-01-01

This report raises doubts on the validity of using LNT (linear no-threshold) relationship for evaluating the carcinogenic risk of low doses (< 100 mSv) and even more for very low doses (< 10 mSv). The LNT concept can be a useful pragmatic tool for assessing rules in radioprotection for doses above 10 mSv; however since it is not based on biological concepts of our current knowledge, it should not be used without precaution for assessing by extrapolation the risks associated with low and even more so, with very low doses (< 10 mSv), especially for benefit-risk assessments imposed on radiologists by the European directive 97-43. The biological mechanisms are different for doses lower than a few dozen mSv and for higher doses. The eventual risks in the dose range of radiological examinations (0.1 to 5 mSv, up to 20 mSv for some examinations) must be estimated taking into account radiobiological and experimental data. An empirical relationship which has been just validated for doses higher than 200 mSv may lead to an overestimation of risks (associated with doses one hundred fold lower), and this overestimation could discourage patients from undergoing useful examinations and introduce a bias in radioprotection measures against very low doses (< 10 mSv). Decision makers confronted with problems of radioactive waste or risk of contamination, should re-examine the methodology used for the evaluation of risks associated with very low doses and with doses delivered at a very low dose rate. This report confirms the inappropriateness of the collective dose concept to evaluate population irradiation risks

Risk of cancer subsequent to low-dose radiation

International Nuclear Information System (INIS)

Warren, S.

1980-01-01

The author puts low dose irradiation risks in perspective using average background radiation doses for standards. He assailed irresponsible media coverage during the height of public interest in the Three-Mile Island Reactor incident

Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones.

Science.gov (United States)

Prochaska, Megan; Taylor, Eric; Vaidya, Anand; Curhan, Gary

2017-08-07

Previous studies have demonstrated lower bone density in patients with kidney stones, but no longitudinal studies have evaluated kidney stone risk in individuals with low bone density. Small studies with short follow-up reported reduced 24-hour urine calcium excretion with bisphosphonate use. We examined history of low bone density and bisphosphonate use and the risk of incident kidney stone as well as the association with 24-hour calcium excretion. We conducted a prospective analysis of 96,092 women in the Nurses' Health Study II. We used Cox proportional hazards models to adjust for age, body mass index, thiazide use, fluid intake, supplemental calcium use, and dietary factors. We also conducted a cross-sectional analysis of 2294 participants using multivariable linear regression to compare 24-hour urinary calcium excretion between participants with and without a history of low bone density, and among 458 participants with low bone density, with and without bisphosphonate use. We identified 2564 incident stones during 1,179,860 person-years of follow-up. The multivariable adjusted relative risk for an incident kidney stone for participants with history of low bone density compared with participants without was 1.39 (95% confidence interval [95% CI], 1.20 to 1.62). Among participants with low bone density, the multivariable adjusted relative risk for an incident kidney stone for bisphosphonate users was 0.68 (95% CI, 0.48 to 0.98). In the cross-sectional analysis of 24-hour urine calcium excretion, the multivariable adjusted mean difference in 24-hour calcium was 10 mg/d (95% CI, 1 to 19) higher for participants with history of low bone density. However, among participants with history of low bone density, there was no association between bisphosphonate use and 24-hour calcium with multivariable adjusted mean difference in 24-hour calcium of -2 mg/d (95% CI, -25 to 20). Low bone density is an independent risk factor for incident kidney stone and is associated with

Lifetime radiation risks from low-dose rate radionuclides in beagles

International Nuclear Information System (INIS)

Goldman, M.; Rosenblatt, L.S.

1985-01-01

One of the largest, long-term (25-yr) animal studies on the effects of low-dose internal irradiation is almost completed. Some 335 beagles were given continuous exposure to graded 90 Sr [low linear energy transfer (LET)] in their diets (D-dogs) through adulthood. A second group (R-dogs) was given fractionated doses of 225 Ra (high LET) as young adults. A third group of 44 was given a single injection of 90 Sr as adults (S-dogs) to compare single to continuous dosages. All dogs were followed through their lifetimes. Only one of the 848 dogs is still alive. The animals were whole-body counted over their entire life span and were examined frequently for assessment of medical status. There were no acute radiation lethalities. Analyses of the large data base from these dogs have begun and preliminary indications are that 90 Sr, which was tested over a 1500-fold skeletal dose rate range, does not cause significant life shortening at average accumulation skeletal doses of ∼2500 rads (25 Gy) and that a curvilinear dose response curve for life shortening was seen at higher accumulation doses. The data will be discussed in terms of modern epidemiological concepts and quantifications will be related to certain parameters of human risk from acute or chronic radiation exposures

Stochastic Model for Population Exposed to Low Level Risk

International Nuclear Information System (INIS)

Merkle, J.M.

1996-01-01

In this paper the stochastic model for population size, i.e. calculation of the number of deaths due to lethal stochastic health effects caused by the exposure to low level ionising radiation is presented. The model is defined for subpopulation with parameter (a, b) being fixed. Using the corresponding density function, it is possible to find all the quantities of interest by averaging over whole possible values for (a, l). All processes ar at first defined for one radionuclide, exposure pathway and the health effect under consideration. The results obtained in this paper are the basic quantities in the risk assessment, loss of life expectancy etc. The results presented in this paper are also applicable to the other sources of low level risk, not only the radiation risk

Low cultural identification, low parental involvement and adverse peer influences as risk factors for delinquent behaviour among Filipino youth in Hawai'i.

Science.gov (United States)

Guerrero, Anthony P S; Nishimura, Stephanie T; Chang, Janice Y; Ona, Celia; Cunanan, Vanessa L; Hishinuma, Earl S

2010-07-01

Among Filipino youth in Hawai'i, low Filipino cultural identification and low family support may be important risk factors for delinquency. To examine, in a sample of Filipino youth in Hawai'i, correlations between delinquent behaviour and the aforementioned - as well as other, potentially mediating - variables. A youth risk survey and Filipino Culture Scale were administered to Filipino students (N = 150) in Hawai'i. A parent risk survey was administered to available and consenting parents. Delinquent behaviour correlated positively with acculturative stress, low cultural identification and adverse peer influences; and negatively with total Filipino Culture Scale score. Structural equation modelling suggested that absent/ineffective adults and adverse peer influences might be more important variables compared to low self-esteem and less religiosity, linking low cultural identification to delinquent behaviour. Although further studies are warranted, to be effective, efforts to prevent delinquency by enhancing Filipino youths' cultural connectedness may also need to enhance family connectedness and address adverse peer influences.

Both Low Blood Glucose and Insufficient Treatment Confer Risk of Neurodevelopmental Impairment in Congenital Hyperinsulinism

DEFF Research Database (Denmark)

Rasmussen, Annett Helleskov; Melikyan, Maria; Globa, Evgenia

2017-01-01

BACKGROUND/AIMS: Congenital hyperinsulinism (CHI) is a heterogeneous disease most frequently caused by KATP-channel (ABCC8 and KCNJ11) mutations, with neonatal or later onset, variable severity, and with focal or diffuse pancreatic involvement as the two major histological types. CHI confers a high...... seen in uni- or multivariate analysis. CONCLUSION: Not only very low blood glucose, but also insufficient treatment as expressed by delay until expert center hospitalization, increased the risk of neurodevelopmental impairment. This novel finding calls for improvements in spread of knowledge about CHI...

Cost-effective treatment of low-risk carcinoma not invading bladder muscle.

Science.gov (United States)

Green, David A; Rink, Michael; Cha, Eugene K; Xylinas, Evanguelos; Chughtai, Bilal; Scherr, Douglas S; Shariat, Shahrokh F; Lee, Richard K

2013-03-01

Study Type - Therapy (cost effectiveness analysis) Level of Evidence 2a What's known on the subject? and What does the study add? Bladder cancer is one of the costliest malignancies to treat throughout the life of a patient. The most cost-effective management for low-risk non-muscle-invasive bladder cancer is not known. The current study shows that employing cystoscopic office fulguration for low-risk appearing bladder cancer recurrences can materially impact the cost-effectiveness of therapy. In a follow-up protocol where office fulguration is routinely employed for low-risk bladder cancers, peri-operative intravesical chemotherapy may not provide any additional cost-effectiveness benefit. To examine the cost-effectiveness of fulguration vs transurethral resection of bladder tumour (TURBT) with and without perioperative intravesical chemotherapy (PIC) for managing low-risk carcinoma not invading bladder muscle (NMIBC). Low-risk NMIBC carries a low progression rate, lending support to the use of office-based fulguration for small recurrences rather than traditional TURBT. A Markov state transition model was created to simulate treatment of NMIBC with vs without PIC, with recurrence treated by formal TURBT vs treatment with fulguration. Costing data were obtained from the Medicare Resource Based Relative Value Scale. Data regarding the success of PIC were obtained from the peer-reviewed literature, as were corresponding utilities for bladder cancer-related procedures. Sensitivity analyses were performed. At 5-year follow-up, a strategy of fulguration without PIC was the most cost-effective (mean cost-effectiveness = US $654.8/quality-adjusted life year), despite a lower recurrence rate with PIC. Both fulguration strategies dominated each TURBT strategy. Sensitivity analysis showed that fulguration without PIC dominated all other strategies when the recurrence rate after PIC was increased to ≥14.2% per year. Similarly, the cost-effectiveness of TURBT becomes more

[C-section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks].

Science.gov (United States)

Librero, Julián; Peiró, Salvador; Belda, Ana; Calabuig, Julia

2014-01-01

the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset). A low-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.

Low-density lipoprotein cholesterol and risk of gallstone disease

DEFF Research Database (Denmark)

Stender, Stefan; Frikke-Schmidt, Ruth; Benn, Marianne

2013-01-01

Drugs which reduce plasma low-density lipoprotein cholesterol (LDL-C) may protect against gallstone disease. Whether plasma levels of LDL-C per se predict risk of gallstone disease remains unclear. We tested the hypothesis that elevated LDL-C is a causal risk factor for symptomatic gallstone...

Managing Risk Aversion for Low-Carbon Supply Chains with Emission Abatement Outsourcing.

Science.gov (United States)

Wang, Qinpeng; He, Longfei

2018-02-21

Reducing carbon emissions, including emission abatement outsourcing at the supply-chain level, is becoming a significant but challenging problem in practice. Confronting this challenge, we therefore break down the practice to focus on a low-carbon supply chain consisting of one supplier, one manufacturer and one third-party emission-reducing contractor. The contractor offers a carbon reduction service to the manufacturer. In view of the increasing proportion of Greenhouse Gases (GHG) emissions and absence of carbon reduction policies in developing countries, we adopt the prospect of consumers' low-carbon preferences to capture the demand sensitivity on carbon emission. By exploiting the Mean-Variance (MV) model, we develop a supply chain game model considering risk aversion. Comparing the supply chain performances of the cases under risk neutrality and risk aversion, we investigate the impact of the risk aversion of the supplier and the manufacturer on the low-carbon supply chain performances, respectively. We show that the risk aversion of chain members will not influence the relationship underlain by the profit-sharing contract between the manufacturer and contractor, whereas they may extend the supplier's concerning range. Although the manufacturer's risk aversion has a positive impact on the wholesale price, interestingly, the supplier's impact on the wholesale price is negative. Furthermore, we propose a contract to coordinate the risk-averse low-carbon supply chain by tuning the aversion levels of the supplier and the manufacturer, respectively. Through numerical study, we draw on managerial insights for industrial practitioners to adopt a low carbon strategy potentially by managing the risk attitudes along the supply chain channel.

Steroidogenic factor-1 (SF-1 gene mutation as a frequent cause of primary amenorrhea in 46,XY female adolescents with low testosterone concentration

Directory of Open Access Journals (Sweden)

Servant Nadège

2010-03-01

Full Text Available Abstract Background Primary amenorrhea due to 46,XY disorders of sex differentiation (DSD is a frequent reason for consultation in endocrine and gynecology clinics. Among the genetic causes of low-testosterone primary amenorrhea due to 46,XY DSD, SRY gene is reported to be frequently involved, but other genes, such as SF1 and WT1, have never been studied for their prevalence. Methods We directly sequenced SRY, SF1 and WT1 genes in 15 adolescent girls with primary amenorrhea, low testosterone concentration, and XY karyotype, to determine the prevalence of mutations. We also analyzed the LH receptor gene in patients with high LH and normal FSH concentrations. Results Among the 15 adolescents with primary amenorrhea and low testosterone concentration, we identified two new SRY mutations, five new SF1 mutations and one new LH receptor gene mutation. Our study confirms the 10-15% prevalence of SRY mutations and shows the high prevalence (33% of SF1 abnormalities in primary amenorrhea due to 46,XY DSD with low plasma testosterone concentration. Conclusions The genetic analysis of low-testosterone primary amenorrhea is complex as several factors may be involved. This work underlines the need to systematically analyze the SF1 sequence in girls with primary amenorrhea due to 46,XY DSD and low testosterone, as well as in newborns with 46,XY DSD.

[Spanish adolescents' low perception of risk in alcohol consumption].

Science.gov (United States)

Suárez-Relinque, Cristian; Arroyo, Gonzalo Del Moral; Ferrer, Belén Martínez; Ochoa, Gonzalo Musitu

2017-08-07

According to recent studies, Spanish adolescents show low perception of risk in alcohol consumption. The current study aims to analyze the factors that favor this low perception based on the opinion of a group of 32 professional experts on adolescence, family, school, mass media, and local policies. A qualitative methodology was used, based on Grounded Theory, using information from 5 focus groups guided by semi-structured interviews. Twelve factors or subcategories were identified, grouped in 4 general categories: short-term risk, immediacy, and perception of invulnerability ("adolescent thinking" category); benevolent view of alcohol, normalization of consumption, and alcohol-entertainment binomial ("social norms" category); parents' habitual consumption, verbal/non-verbal inconsistency in parental model, risk-free consumption depicted in the mass media, consumption with positive results in the media ("social models" category); and excessive health content, long-term risk ("preventive discourse" category). After discussing the results in the context of the current scientific literature, the article offers various proposals for increasing risk perception in adolescents: stronger impact of contents on short-term risks of alcohol; educational strategies targeted to adolescents to include agents of socialization, especially parents; and policies centered on the substance and reduction of supply.

Low-fat versus low-carbohydrate weight reduction diets: effects on weight loss, insulin resistance, and cardiovascular risk: a randomized control trial.

Science.gov (United States)

Bradley, Una; Spence, Michelle; Courtney, C Hamish; McKinley, Michelle C; Ennis, Cieran N; McCance, David R; McEneny, Jane; Bell, Patrick M; Young, Ian S; Hunter, Steven J

2009-12-01

Low-fat hypocaloric diets reduce insulin resistance and prevent type 2 diabetes in those at risk. Low-carbohydrate, high-fat diets are advocated as an alternative, but reciprocal increases in dietary fat may have detrimental effects on insulin resistance and offset the benefits of weight reduction. We investigated a low-fat (20% fat, 60% carbohydrate) versus a low-carbohydrate (60% fat, 20% carbohydrate) weight reduction diet in 24 overweight/obese subjects ([mean +/- SD] BMI 33.6 +/- 3.7 kg/m(2), aged 39 +/- 10 years) in an 8-week randomized controlled trial. All food was weighed and distributed, and intake was calculated to produce a 500 kcal/day energy deficit. Insulin action was assessed by the euglycemic clamp and insulin secretion by meal tolerance test. Body composition, adipokine levels, and vascular compliance by pulse-wave analysis were also measured. Significant weight loss occurred in both groups (P loss with no difference between groups (P = 0.71). The change in overall systemic arterial stiffness was, however, significantly different between diets (P = 0.04); this reflected a significant decrease in augmentation index following the low-fat diet, compared with a nonsignificant increase within the low-carbohydrate group. This study demonstrates comparable effects on insulin resistance of low-fat and low-carbohydrate diets independent of macronutrient content. The difference in augmentation index may imply a negative effect of low-carbohydrate diets on vascular risk.

[Postoperative radioiodine ablation in patients with low risk differentiated thyroid carcinoma].

Science.gov (United States)

Díez, Juan J; Grande, Enrique; Iglesias, Pedro

2015-01-06

Most patients with newly diagnosed differentiated thyroid carcinoma have tumors with low risk of mortality and recurrence. Standard therapy has been total or near total thyroidectomy followed by postoperative radioiodine remnant ablation (RRA). Although RRA provides benefits, current clinical guidelines do not recommend it universally, since an increase in disease-free survival or a decrease in mortality in low risk patients has not been demonstrated so far. Advancements in our understanding of the biological behavior of thyroid cancer have been translated into the clinic in a personalized approach to the patients based on their individual risk of recurrence and mortality. Current evidence suggests that RRA is not indicated in most low-risk patients, especially those with papillary carcinomas smaller than 1cm, without extrathyroidal extension, unfavorable histology, lymph node involvement or distant metastases. Follow-up of these patients with serial measurements of serum thyroglobulin and neck ultrasound is adequate. Careful evaluation of all risk factors of clinical relevance will allow a more realistic assessment of each individual patient. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Randomized phase 2 study of low-dose decitabine vs low-dose azacitidine in lower-risk MDS and MDS/MPN.

Science.gov (United States)

Jabbour, Elias; Short, Nicholas J; Montalban-Bravo, Guillermo; Huang, Xuelin; Bueso-Ramos, Carlos; Qiao, Wei; Yang, Hui; Zhao, Chong; Kadia, Tapan; Borthakur, Gautam; Pemmaraju, Naveen; Sasaki, Koji; Estrov, Zeev; Cortes, Jorge; Ravandi, Farhad; Alvarado, Yesid; Komrokji, Rami; Sekeres, Mikkael A; Steensma, David P; DeZern, Amy; Roboz, Gail; Kantarjian, Hagop; Garcia-Manero, Guillermo

2017-09-28

Hypomethylating agents (HMAs) improve survival in patients with higher-risk myelodysplastic syndromes (MDS) but are less well-studied in lower-risk disease. We compared the safety and efficacy of low-dose decitabine vs low-dose azacitidine in this group of patients. Adults with low- or intermediate 1-risk MDS or MDS/myeloproliferative neoplasm (MPN), including chronic myelomonocytic leukemia, according to the International Prognostic Scoring System, were randomly assigned using a Bayesian adaptive design to receive either azacitidine 75 mg/m 2 intravenously/subcutaneously daily or decitabine 20 mg/m 2 intravenously daily for 3 consecutive days on a 28-day cycle. The primary outcome was overall response rate (ORR). Between November 2012 and February 2016, 113 patients were treated: 40 (35%) with azacitidine and 73 (65%) with decitabine. The median age was 70 years; 81% of patients were intermediate 1-risk patients. The median number of cycles received was 9. The ORRs were 70% and 49% ( P = .03) for patients treated with decitabine and azacitidine, respectively. Thirty-two percent of patients treated with decitabine became transfusion independent compared with 16% of patients treated with azacitidine ( P = .2). Cytogenetic response rates were 61% and 25% ( P = .02), respectively. With a median follow-up of 20 months, the overall median event-free survival was 18 months: 20 and 13 months for patients treated with decitabine and azacitidine, respectively ( P = .1). Treatment was well tolerated, with a 6-week mortality rate of 0%. The use of low-dose HMAs is safe and effective in patients with lower-risk MDS and MDS/MPN. Their effect on the natural history of lower-risk disease needs to be further studied. This trial was registered at clinicaltrials.gov (identifier NCT01720225). © 2017 by The American Society of Hematology.

Barriers in using cardiometabolic risk information among consumers with low health literacy.

Science.gov (United States)

Damman, Olga C; Bogaerts, Nina M M; van Dongen, Diana; Timmermans, Danielle R M

2016-02-01

To identify the barriers from the perspective of consumers with low health literacy in using risk information as provided in cardiometabolic risk assessments. A qualitative thematic approach using cognitive interviews was employed. We performed interviews with 23 people with low health literacy/health numeracy, who were recruited through (1) several organisations and snowball sampling and (2) an online access panel. Participants completed the risk test of the Dutch national cardiometabolic risk assessment and viewed the personalized information about their risk. They were asked to answer probing questions about different parts of the information. The qualitative data were analysed by identifying main themes related to barriers in using the information, using a descriptive thematic approach. The four main themes identified were as follows: (1) People did not fully accept the risk message, partly because numerical information had ambiguous meaning; (2) people lacked an adequate framework for understanding their risk; (3) the purpose and setting of the risk assessment was unclear; and (4) current information tells nothing new: A need for more specific risk information. The main barriers were that the current presentation seemed to provoke undervaluation of the risk number and that texts throughout the test, for example about cardiometabolic diseases, did not match people's existing knowledge, failing to provide an adequate framework for understanding cardiometabolic risk. Our findings have implications for the design of disease risk information, for example that alternative forms of communication should be explored that provide more intuitive meaning of the risk in terms of good versus bad. What is already known on this subject? Online disease risk assessments have become widely available internationally. People with low SES and health literacy tend to participate less in health screening. Risk information is difficult to understand, yet little research has been

Managing Risk Aversion for Low-Carbon Supply Chains with Emission Abatement Outsourcing

Science.gov (United States)

Wang, Qinpeng; He, Longfei

2018-01-01

Reducing carbon emissions, including emission abatement outsourcing at the supply-chain level, is becoming a significant but challenging problem in practice. Confronting this challenge, we therefore break down the practice to focus on a low-carbon supply chain consisting of one supplier, one manufacturer and one third-party emission-reducing contractor. The contractor offers a carbon reduction service to the manufacturer. In view of the increasing proportion of Greenhouse Gases (GHG) emissions and absence of carbon reduction policies in developing countries, we adopt the prospect of consumers’ low-carbon preferences to capture the demand sensitivity on carbon emission. By exploiting the Mean-Variance (MV) model, we develop a supply chain game model considering risk aversion. Comparing the supply chain performances of the cases under risk neutrality and risk aversion, we investigate the impact of the risk aversion of the supplier and the manufacturer on the low-carbon supply chain performances, respectively. We show that the risk aversion of chain members will not influence the relationship underlain by the profit-sharing contract between the manufacturer and contractor, whereas they may extend the supplier’s concerning range. Although the manufacturer’s risk aversion has a positive impact on the wholesale price, interestingly, the supplier’s impact on the wholesale price is negative. Furthermore, we propose a contract to coordinate the risk-averse low-carbon supply chain by tuning the aversion levels of the supplier and the manufacturer, respectively. Through numerical study, we draw on managerial insights for industrial practitioners to adopt a low carbon strategy potentially by managing the risk attitudes along the supply chain channel. PMID:29466281

Managing Risk Aversion for Low-Carbon Supply Chains with Emission Abatement Outsourcing

Directory of Open Access Journals (Sweden)

Qinpeng Wang

2018-02-01

Full Text Available Reducing carbon emissions, including emission abatement outsourcing at the supply-chain level, is becoming a significant but challenging problem in practice. Confronting this challenge, we therefore break down the practice to focus on a low-carbon supply chain consisting of one supplier, one manufacturer and one third-party emission-reducing contractor. The contractor offers a carbon reduction service to the manufacturer. In view of the increasing proportion of Greenhouse Gases (GHG emissions and absence of carbon reduction policies in developing countries, we adopt the prospect of consumers’ low-carbon preferences to capture the demand sensitivity on carbon emission. By exploiting the Mean-Variance (MV model, we develop a supply chain game model considering risk aversion. Comparing the supply chain performances of the cases under risk neutrality and risk aversion, we investigate the impact of the risk aversion of the supplier and the manufacturer on the low-carbon supply chain performances, respectively. We show that the risk aversion of chain members will not influence the relationship underlain by the profit-sharing contract between the manufacturer and contractor, whereas they may extend the supplier’s concerning range. Although the manufacturer’s risk aversion has a positive impact on the wholesale price, interestingly, the supplier’s impact on the wholesale price is negative. Furthermore, we propose a contract to coordinate the risk-averse low-carbon supply chain by tuning the aversion levels of the supplier and the manufacturer, respectively. Through numerical study, we draw on managerial insights for industrial practitioners to adopt a low carbon strategy potentially by managing the risk attitudes along the supply chain channel.

Low Nicotine Content Descriptors Reduce Perceived Health Risks and Positive Cigarette Ratings in Participants Using Very Low Nicotine Content Cigarettes.

Science.gov (United States)

Denlinger-Apte, Rachel L; Joel, Danielle L; Strasser, Andrew A; Donny, Eric C

2017-10-01

Understanding how smokers perceive reduced nicotine content cigarettes will be important if the FDA and global regulatory agencies implement reduced nicotine product standards for cigarettes. Prior research has shown that some smokers incorrectly believe "light" cigarettes are less harmful than regular cigarettes. Similar misunderstandings of health risk could also apply to reduced nicotine cigarettes. To date, most studies of reduced nicotine cigarettes have blinded subjects to the nicotine content. Therefore, little is known about how smokers experience reduced nicotine content cigarettes when they are aware of the reduced content, and how use may be impacted. The present study was a within-subjects experiment with 68 adult daily smokers who smoked two identical very low nicotine content Quest 3 (0.05 mg nicotine yield) cigarettes. Subjects were told that one cigarette contained "average" nicotine content, and the other contained "very low" nicotine content. After smoking each cigarette, subjects completed subjective measures about their smoking experience. Subjects rated the "very low" nicotine cigarette as less harmful to their health overall compared to the "average" nicotine cigarette; this effect held true for specific smoking-related diseases. Additionally, they rated the "very low" nicotine cigarette as having less desirable subjective effects than the "average" nicotine cigarette and predicted having greater interest in quitting smoking in the future if only the "very low" nicotine cigarette was available. Explicit knowledge of very low nicotine content changes smokers' perceptions of very low nicotine content cigarettes, resulting in reduced predicted harm, subjective ratings and predicted future use. Before a reduced nicotine product standard for cigarettes can be implemented, it is important to understand how product information impacts how smokers think about and experience very low nicotine content cigarettes. Prior research has shown that smokers

Risks to health from radiation at low dose rates

International Nuclear Information System (INIS)

Gentner, N.E.; Osborne, R.V.

1997-01-01

Our focus is on whether, using a balance-of-evidence approach, it is possible to say that at a low enough dose, or at a sufficiently low dose rate, radiation risk reduces to zero in a population. We conclude that insufficient evidence exists at present to support such a conclusion. In part this reflects statistical limitations at low doses, and in part (although mechanisms unquestionably exist to protect us against much of the damage induced by ionizing radiation) the biological heterogeneity of human populations, which means these mechanisms do not act in all members of the population at all times. If it is going to be possible to demonstrate that low doses are less dangerous than we presently assume, the evidence, paradoxically, will likely come from studies of higher dose and dose rate scenarios than are encountered occupationally. (author)

Review of European research trends of low dose radiation risk

International Nuclear Information System (INIS)

Iwasaki, Toshiyasu; Yoshida, Kazuo

2010-01-01

Large research projects on low dose radiation effects in Europe and US over the past decade have provided limited scientific knowledge which could underpin the validation of radiation protection systems. Recently in Europe, there have been repeated discussions and dialogues to improve the situation, and as the consequence, the circumstances surrounding low dose radiation risks are changing. In 2009, Multidisciplinary European Low Dose Initiative (MELODI) was established as a trans-national organization capable of ensuring appropriate governance of research in the pursuit of a long term shared vision, and Low Dose Research towards Multidisciplinary Integration (DoReMi) network was launched in 2010 to achieve fairly short term results in order to prove the validity of the MELODI approach. It is expected to be very effective and powerful activities to facilitate the reduction of uncertainties in the understanding of low dose risks, but the regulatory requests rushing the reinforcement of radiological protection regulations based on the precautional principles are more increasing. To develop reasonable radiological protection systems based on scientific evidences, we need to accelerate to collect scientific evidences which could directly underpin more appropriate radiation protection systems even in Japan. For the purpose, we Japan need to develop from an independent standpoint and share as a multidisciplinary vision a long term and holistic research strategy which enables to enhance Japanese advantages such as low dose rate facilities and animal facilities, as soon as possible. (author)

Risk indicators for dystocia in low-risk nulliparous women: a study on lifestyle and anthropometrical factors

DEFF Research Database (Denmark)

Kjaergaard, H; Dykes, A K; Ottesen, B

2010-01-01

We examined background information and course of labour from a cohort of 2,810 low-risk nulliparas to identify possible lifestyle and anthropometrical risk indicators for dystocia. Criteria for dystocia: cervical dilatation or =4 h per week appeared protective for dystocia (OR 0.63, CI 0.45-0.89)......We examined background information and course of labour from a cohort of 2,810 low-risk nulliparas to identify possible lifestyle and anthropometrical risk indicators for dystocia. Criteria for dystocia: cervical dilatation or =4 h per week appeared protective for dystocia (OR 0.63, CI 0...

Determinants of attaining and maintaining a low cardiovascular risk profile--the Doetinchem Cohort Study.

Science.gov (United States)

Hulsegge, Gerben; van der Schouw, Yvonne T; Daviglus, Martha L; Smit, Henriëtte A; Verschuren, W M Monique

2016-02-01

While maintenance of a low cardiovascular risk profile is essential for cardiovascular disease (CVD) prevention, few people maintain a low CVD risk profile throughout their life. We studied the association of demographic, lifestyle, psychological factors and family history of CVD with attainment and maintenance of a low risk profile over three subsequent 5-year periods. Measurements of 6390 adults aged 26-65 years at baseline were completed from 1993 to 97 and subsequently at 5-year intervals until 2013. At each wave, participants were categorized into low risk profile (ideal levels of blood pressure, cholesterol and body mass index, non-smoking and no diabetes) and medium/high risk profile (all others). Multivariable-adjusted modified Poisson regression analyses were used to examine determinants of attainment and maintenance of low risk; risk ratios (RR) and 95% confidence intervals (95% CI) were obtained. Generalized estimating equations were used to combine multiple 5-year comparisons. Younger age, female gender and high educational level were associated with higher likelihood of both maintaining and attaining low risk profile (P risk was 9% higher with each 1-unit increment in Mediterranean diet score (RR: 1.09, 95% CI: 1.02-1.16), twice as high with any physical activity versus none (RR: 2.17, 95% CI: 1.16-4.04) and 35% higher with moderate alcohol consumption versus heavy consumption (RR: 1.35, 95% CI: 1.06-1.73). Healthy lifestyle factors such as adherence to a Mediterranean diet, physical activity and moderate as opposed to heavy alcohol consumption were associated with a higher likelihood of attaining a low risk profile. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Mother-Child Interactional Patterns in High- and Low-Risk Mothers.

Science.gov (United States)

Dolz, Laura; Cerezo, M. Angeles; Milner, Joel S.

1997-01-01

A study of 10 high-risk (of child physical abuse) and 10 demographically similar low-risk Spanish mother-child dyads investigated interactional patterns in the home. High-risk mothers made fewer neutral approaches to their children, displayed more negative behaviors toward their children, and made more indiscriminate responses to their children's…

Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries.

OpenAIRE

Yusuf, S; Rangarajan, S; Teo, K; Islam, S; Li, W; Liu, L; Bo, J; Lou, Q; Lu, F; Liu, T; Yu, L; Zhang, S; Mony, P; Swaminathan, S; Mohan, V

2014-01-01

: More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. : We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater r...

Maternal risk factors associated with low birth weight

International Nuclear Information System (INIS)

Khan, N.; Jamal, M.

2003-01-01

Objective: To determine the association of socio-demographic, maternal, medical and obstetric risk factors with low birth weight. Results: The mean weight of cases was 2.08 kg as compared to 3.1 in controls. Forty-sixty percent of cases were preterm. The factors like maternal malnutrition, young age of the mothers, poverty, close birth spacing, hypertension and antenatal per vagamin (p/v) bleeding during pregnancy have independent effect in causing low birth weight (LBW). Conclusion: Maternal bio social, medical and obstetric factors have strong association with LBW. To overcome this problem, special attention is required to strengthen the mother and child health care services in the community. (author)

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

Science.gov (United States)

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

2015-09-01

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

Biological risk indicators for recurrent non-specific low back pain in adolescents.

Science.gov (United States)

Jones, M A; Stratton, G; Reilly, T; Unnithan, V B

2005-03-01

A matched case-control study was carried out to evaluate biological risk indicators for recurrent non-specific low back pain in adolescents. Adolescents with recurrent non-specific low back pain (symptomatic; n = 28; mean (SD) age 14.9 (0.7) years) and matched controls (asymptomatic; n = 28; age 14.9 (0.7) years) with no history of non-specific low back pain participated. Measures of stature, mass, sitting height, sexual maturity (Tanner self assessment), lateral flexion of the spine, lumbar sagittal plane mobility (modified Schober), hip range of motion (Leighton flexometer), back and hamstring flexibility (sit and reach), and trunk muscle endurance (number of sit ups) were performed using standardised procedures with established reliability. Backward stepwise logistic regression analysis was performed, with the presence/absence of recurrent low back pain as the dependent variable and the biological measures as the independent variables. Hip range of motion, trunk muscle endurance, lumbar sagittal plane mobility, and lateral flexion of the spine were identified as significant risk indicators of recurrent low back pain (plow back pain in a group of adolescents. These risk indicators identify the potential for exercise as a primary or secondary prevention method.

Evaluating Fall Risk in People with Low Vision: A Case Series

OpenAIRE

Kierstyn Napier-Dovorany, OD; Victoria Graham, DPT

2013-01-01

Background: People with low vision have increased risk for falls and preventable health conditions due to sedentary lifestyle and reduced participation in social activities. This case series describes an interprofessional low vision, balance, and mobility evaluation of two patients referred to our low vision optometric clinic. Case Report: RM, an 82-year-old white female with diabetic retinopathy, and PC, a 55-year-old white female with retinopathy of prematurity, completed a comprehensive lo...

Review of the controversy on risks from low levels of radiation

International Nuclear Information System (INIS)

Higson, D.

2001-01-01

The need for regulation of low levels of radiation exposure, and the estimation of risks from such exposures, are based on the assumption that risk is proportional to dose without a threshold, the 'linear no-threshold (LNT) hypothesis'. This assumption is not supported by scientific data. There is no clear evidence of harm from low levels of exposure, up to at least 20 mSv (acute dose) or total dose rates of at least 50 mSv per year. Even allowing for reasonable extrapolation from radiation levels at which harmful effects have been observed, the LNT assumption should not be used to estimate risks from doses less than 100 mSv. Laboratory and epidemiological evidence, and evolutionary expectations of biological effects from low level radiation, suggest that beneficial health effects (sometimes called 'radiation hormesis') are at least as likely as harmful effects from such exposures. Controversy on this matter strikes at the basis of radiation protection practice

Low Testosterone

DEFF Research Database (Denmark)

Holmboe, Stine Agergaard; Jensen, Tina Kold; Linneberg, Allan René

2016-01-01

Context: Low serum T levels have been associated with type 2 diabetes (T2D) and cardiovascular disease. However, it is unresolved whether low T is a risk factor or rather a risk marker for these conditions. Objective: The objective of the study was to investigate serum levels of total T, SHBG, fr...

Arts Enrichment and Preschool Emotions for Low-Income Children at Risk

Science.gov (United States)

Brown, Eleanor D.; Sax, Kacey L.

2013-01-01

No studies to date examine the impact of arts-integrated preschool programming on the emotional functioning of low-income children at risk for school problems. The present study examines observed emotion expression and teacher-rated emotion regulation for low-income children attending Settlement Music School's Kaleidoscope Preschool Arts…

Stereotactic body radiation therapy for low- and low-intermediate risk prostate cancer: Is there a dose effect?

Directory of Open Access Journals (Sweden)

Alan Jay Katz

2011-12-01

Full Text Available This study examines the efficacy and toxicity of two stereotactic body radiation therapy (SBRT dose regimens for treatment of early prostate cancer. Forty-one patients treated with 35 Gy were matched with 41 patients treated with 36.25 Gy. Both patient groups received SBRT in 5 fractions over 5 consecutive days using the CyberKnife. Each group had 37 low-risk patients and 4 intermediate-risk patients. No statistically significant differences were present for age, prostate volume, PSA, Gleason score, stage, or risk between the groups. The dose was prescribed to the 83-87% isodose line to cover the prostate and a 5-mm margin all around, except 3 mm posteriorly. The overall median follow-up is 51 months (range, 45-58 months with a median 54 months and 48 months follow-up for the 35-Gy and 36.25-Gy dose groups, respectively. One biochemical failure occurred in each group yielding a 97.5% freedom from biochemical failure. The PSA response has been favorable for all patients with a mean PSA of 0.1 ng/ml at 4-years. Overall toxicity has been mild with 5% late grade 2 rectal toxicity in both dose groups. Late grade 1 urinary toxicity was equivalent between groups; grade 2 urinary toxicity was 5% (2/41 patients and 10% (4/41 patients in the 35-Gy and 36.25-Gy dose groups (p = 0.6969, respectively. Overall, the highly favorable PSA response, limited biochemical failures, limited toxicity, and limited impact on quality of life in these low- to low-intermediate-risk patients are supportive of excellent long-term results for CyberKnife delivered SBRT.

Mechanisms of Enhanced Cell Killing at Low Doses: Implications for Radiation Risk

International Nuclear Information System (INIS)

Johnston, Peter J.; Wilson, George D.

2003-01-01

We have shown that cell lethality actually measured after exposure to low-doses of low-LET radiation, is markedly enhanced relative to the cell lethality previously expected by extrapolation of the high-dose cell-killing response. Net cancer risk is a balance between cell transformation and cell kill and such enhanced lethality may more than compensate for transformation at low radiation doses over a least the first 10 cGy of low-LET exposure. This would lead to a non-linear, threshold, dose-risk relationship. Therefore our data imply the possibility that the adverse effects of small radiation doses (<10 cGy) could be overestimated in specific cases. It is now important to research the mechanisms underlying the phenomenon of low-dose hypersensitivity to cell killing, in order to determine whether this can be generalized to safely allow an increase in radiation exposure limits. This would have major cost-reduction implications for the whole EM program

Risk factors for frequent readmissions and barriers to transplantation in patients with cirrhosis.

Directory of Open Access Journals (Sweden)

Swaytha Ganesh

Full Text Available Hospital readmission rate is receiving increasing regulatory scrutiny. Patients with cirrhosis have high hospital readmissions rates but the relationship between frequent readmissions and barriers to transplantation remains unexplored. The goal of this study was to determine risk factors for frequent readmissions among patients with cirrhosis and identify barriers to transplantation in this population.We retrospectively reviewed medical records of 587 patients with a confirmed diagnosis of cirrhosis admitted to a large tertiary care center between May 1, 2008 and May 1, 2009. Demographics, clinical factors, and outcomes were recorded. Multivariate logistic regression was performed to identify risk factors for high readmission rates. Transplant-related factors were assessed for patients in the high readmission group.The 587 patients included in the study had 1557 admissions during the study period. A subset of 87 (15% patients with 5 or more admissions accounted for 672 (43% admissions. The factors associated with frequent admissions were non-white race (OR = 2.45, p = 0.01, diabetes (OR = 2.04, p = 0.01, higher Model for End-Stage Liver Disease (MELD score (OR = 35.10, p30 and younger age (OR = 0.98, p = 0.02. Among the 87 patients with ≥5 admissions, only 14 (16% underwent liver transplantation during the study period. Substance abuse, medical co-morbidities, and low (<15 MELD scores were barriers to transplantation in this group.A small group of patients with cirrhosis account for a disproportionately high number of hospital admissions. Interventions targeting this high-risk group may decrease frequent hospital readmissions and increase access to transplantation.

Risk factors associated with low birth weight of neonates among ...

African Journals Online (AJOL)

National Institute for Medical Research, Mwanza Research Centre, ... Abstract: According to the World Health Organization low birth weight (LBW) babies ... services in relation to safe motherhood at community level in order to reduce risk fac- .... Key : OR= Odds ratio; PAF= Population attributable risk; CI: 95% Confidence ...

Responses of epithelial cells to low and very low doses of low let radiation

International Nuclear Information System (INIS)

Mothersill, Carmel; Seymour, Colin

2003-01-01

Recent advances in our knowledge of the biological effects of low doses of ionizing radiation have shown unexpected phenomena. These vary in the endpoint used to detect them and in the dose range examined but all occur as high-frequency events in cell populations. They include: 1. a 'bystander effect' which can be demonstrated at low doses as a transferable.factor(s) causing radiobiological effects in unexposed cells, 2. an assortment of delayed effects' occurring in progeny of cells exposed to low doses, 3. Low-dose Hypersensitivity (HRS) and Increased radioresistance (IRR) which can collectively be demonstrated as a change in the dose-effect relationship, occurring around 0.5-1 Gy of low LET radiation and 4. adaptive responses where cells exposed to very low doses followed by higher doses, exhibit an induced relatively resistant response to the second dose. In all cases, the effect of very low doses is greater than would be predicted by extrapolation of high dose data and is inconsistent with conventional DNA break/repair-based radiobiology. In practical risk assessment terms, the relative importance of the effects are high at low doses where they dominate the response, and small at high doses. This paper reviews these assorted phenomena and in particular seeks to explore whether related or distinct mechanisms underlie these various effects Understanding the mechanistic basis of these phenomena may suggest new approaches to controlling death or survival sectoring at low radiation doses. The key question is whether these low dose phenomena necessitate a new approach to risk assessment. (author)

40 CFR 266.109 - Low risk waste exemption.

Science.gov (United States)

2010-07-01

... MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.109 Low risk waste exemption. (a) Waiver of DRE standard. The DRE standard of § 266.104(a) does not apply if the boiler or... 99.9 percent destruction and removal efficiency. That is, assume that 0.1 percent of the mass weight...

Why we need new approaches to low-dose risk modeling

International Nuclear Information System (INIS)

Alvarez, J.L.; Seiler, F.A.

1996-01-01

The linear no-threshold model for radiation effects was introduced as a conservative model for the design of radiation protection programs. The model has persisted not only as the basis for such programs, but has come to be treated as a dogma and is often confused with scientific fact. In this examination a number of serious problems with the linear no-threshold model of radiation carcinogenesis were demonstrated, many of them invalidating the hypothesis. It was shown that the relative risk formalism did not approach 1 as the dose approaches zero. When morality ratios were used instead, the data in the region below 0.3 Sv were systematically below the predictions of the linear model. It was also shown that the data above 0.3 Sv were of little use in formulating a model at low doses. In addition, these data are valid only for doses accumulated at high dose rates, and there is no scientific justification for using the model in low-dose, low-dose-rate extrapolations for purposes of radiation protection. Further examination of model fits to the Japanese survivor data were attempted. Several such models were fit to the data including an unconstrained linear, linear-square root, and Weibull, all of which fit the data better than the relative risk, linear no-threshold model. These fits were used to demonstrate that the linear model systematically over estimates the risk at low doses in the Japanese survivor data set. It is recommended here that an unbiased re-analysis of the data be undertaken and the results used to construct a new model, based on all pertinent data. This model could then form the basis for managing radiation risks in the appropriate regions of dose and dose rate

Allergy Testing in Children With Low-Risk Penicillin Allergy Symptoms.

Science.gov (United States)

Vyles, David; Adams, Juan; Chiu, Asriani; Simpson, Pippa; Nimmer, Mark; Brousseau, David C

2017-08-01

Penicillin allergy is commonly reported in the pediatric emergency department (ED). True penicillin allergy is rare, yet the diagnosis results from the denial of first-line antibiotics. We hypothesize that all children presenting to the pediatric ED with symptoms deemed to be low-risk for immunoglobulin E-mediated hypersensitivity will return negative results for true penicillin allergy. Parents of children aged 4 to 18 years old presenting to the pediatric ED with a history of parent-reported penicillin allergy completed an allergy questionnaire. A prespecified 100 children categorized as low-risk on the basis of reported symptoms completed penicillin allergy testing by using a standard 3-tier testing process. The percent of children with negative allergy testing results was calculated with a 95% confidence interval. Five hundred ninety-seven parents completed the questionnaire describing their child's reported allergy symptoms. Three hundred two (51%) children had low-risk symptoms and were eligible for testing. Of those, 100 children were tested for penicillin allergy. The median (interquartile range) age at testing was 9 years (5-12). The median (interquartile range) age at allergy diagnosis was 1 year (9 months-3 years). Rash (97 [97%]) and itching (63 [63%]) were the most commonly reported allergy symptoms. Overall, 100 children (100%; 95% confidence interval 96.4%-100%) were found to have negative results for penicillin allergy and had their labeled penicillin allergy removed from their medical record. All children categorized as low-risk by our penicillin allergy questionnaire were found to have negative results for true penicillin allergy. The utilization of this questionnaire in the pediatric ED may facilitate increased use of first-line penicillin antibiotics. Copyright © 2017 by the American Academy of Pediatrics.

Predictive value of late decelerations for fetal acidemia in unselective low-risk pregnancies.

Science.gov (United States)

Sameshima, Hiroshi; Ikenoue, Tsuyomu

2005-01-01

We evaluated the clinical significance of late decelerations (LD) of intrapartum fetal heart rate (FHR) monitoring to detect low pH (LD (occasional, 50%; recurrent, > or = 50%) and severity (reduced baseline FHR accelerations and variability) of LD, and low pH (test, and one-way analysis of variance with the Bonferroni/Dunn test. In the 5522 low-risk pregnancies, 301 showed occasional LD and 99 showed recurrent LD. Blood gases and pH values deteriorated as the incidence of LD increased and as baseline accelerations or variability was decreased. Positive predictive value for low pH (LD, and > 50% in recurrent LD with no baseline FHR accelerations and reduced variability. In low-risk pregnancies, information on LD combined with acceleration and baseline variability enables us to predict the potential incidence of fetal acidemia.

Biomarkers and low risk in heart failure. Data from COACH and TRIUMPH.

Science.gov (United States)

Meijers, Wouter C; de Boer, Rudolf A; van Veldhuisen, Dirk J; Jaarsma, Tiny; Hillege, Hans L; Maisel, Alan S; Di Somma, Salvatore; Voors, Adriaan A; Peacock, W Frank

2015-12-01

Traditionally, risk stratification in heart failure (HF) emphasizes assessment of high risk. We aimed to determine if biomarkers could identify patients with HF at low risk for death or HF rehospitalization. This analysis was a substudy of The Coordinating Study Evaluating Outcomes of Advising and Counselling in Heart Failure (COACH) trial. Enrolment of HF patients occurred before discharge. We defined low risk as the absence of death and/or HF rehospitalizations at 180 days. We tested a diverse group of 29 biomarkers on top of a clinical risk model, with and without N-terminal pro-B-type natriuretic peptide (NT-proBNP), and defined the low risk biomarker cut-off at the 10th percentile associated with high positive predictive value. The best performing biomarkers together with NT-proBNP and cardiac troponin I (cTnI) were re-evaluated in a validation cohort of 285 HF patients. Of 592 eligible COACH patients, the mean (± SD) age was 71 (± 11) years and median (IQR) NT-proBNP was 2521 (1301-5634) pg/mL. Logistic regression analysis showed that only galectin-3, fully adjusted, was significantly associated with the absence of events at 180 days (OR 8.1, 95% confidence interval 1.06-50.0, P = 0.039). Galectin-3, showed incremental value when added to the clinical risk model without NT-proBNP (increase in area under the curve from 0.712 to 0.745, P = 0.04). However, no biomarker showed significant improvement by net reclassification improvement on top of the clinical risk model, with or without NT-proBNP. We confirmed our results regarding galectin-3, NT-proBNP, and cTnI in the independent validation cohort. We describe the value of various biomarkers to define low risk, and demonstrate that galectin-3 identifies HF patients at (very) low risk for 30-day and 180-day mortality and HF rehospitalizations after an episode of acute HF. Such patients might be safely discharged. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of

Relationship between polycythemia and in-hospital mortality in chronic obstructive pulmonary disease patients with low-risk pulmonary embolism

Science.gov (United States)

Guo, Lu; Chughtai, Aamer Rasheed; Jiang, Hongli; Gao, Lingyun; Yang, Yan; Yang, Yang; Liu, Yuejian

2016-01-01

Backgrounds Pulmonary embolism (PE) is frequent in subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality. This multi-center retrospective study was performed to investigate if secondary polycythemia is associated with in-hospital mortality in COPD patients with low-risk PE. Methods We identified COPD patients with proven PE between October, 2005 and October, 2015. Patients in risk classes III–V on the basis of the PESI score were excluded. We extracted demographic, clinical and laboratory information at the time of admission from medical records. All subjects were followed until hospital discharge to identify all-cause mortality. Results We enrolled 629 consecutive patients with COPD and PE at low risk: 132 of them (21.0%) with and 497 (79.0%) without secondary polycythemia. Compared with those without polycythemia, the polycythemia group had significantly lower forced expiratory volume in one second (FEV1) level (0.9±0.3 vs. 1.4±0.5, P=0.000), lower PaO2 and SpO2 as well as higher PaCO2 (P=0.03, P=0.03 and P=0.000, respectively). COPD patients with polycythemia had a higher proportion of arrhythmia in electrocardiogram (ECG) (49.5% vs. 35.7%, P=0.02), a longer hospital duration time (15.3±10.1 vs. 9.7±9.1, P=0.001), a higher mechanical ventilation rate (noninvasive and invasive, 51.7% vs. 30.3%, P=0.04 and 31.0% vs. 7.9%, P=0.04, respectively), and a higher in-hospital mortality (12.1% vs. 6.6%, P=0.04). Multivariate logistic regression analysis revealed that polycythemia was associated with mortality in COPD patients with low-risk PE (adjusted OR 1.11; 95% CI, 1.04–1.66). Conclusions Polycythemia is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. PMID:28066591

Mental health, life functioning and risk factors among people exposed to frequent natural disasters and chronic poverty in Vietnam

OpenAIRE

Pollack, Amie Alley; Weiss, Bahr; Trung, Lam Tu

2016-01-01

Background People living in low- and middle-income countries (LMIC) are at increased risk for exposure to major natural disasters, which places them at increased risk for mental health problems. Evidence is less clear, however, regarding the effects of less severe but more frequent natural disasters, which are likely to increase due to global climate change. Aims To examine the mental health and life functioning, and their predictors, of people living in central coastal Vietnam ? an area char...

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

DEFF Research Database (Denmark)

Tofte, N; Lindhardt, M; Adamova, K

2018-01-01

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

Philosophical and ethical perspectives on cardiovascular disease risk in low-wage workers.

Science.gov (United States)

Hwang, Won Ju

2011-01-01

One of the overriding goals of Healthy People 2010 is to reduce the health disparities observed among Americans. Because workers in small businesses tend to have little or no access to health screening or preventive health education programs, they may be unaware of their unique risk factors and are thus more at risk of cardiovascular disease (CVD). Furthermore, occupational health nurses are more likely to be available in health programs to employees in large rather than small businesses. The purpose of this paper is to illustrate how nursing values and philosophy might influence public health nurses' thinking about nursing science and ethical issues relating to the risk of CVD among low-wage workers. The following questions will guide the exploration of health disparities among low-wage workers: (a) What are the health disparities observed among low-wage workers with CVD risk? (b) What are the philosophical and ethical perspectives on the issues presented? (c) Based on these findings, how should limited resources be allocated? and (d) How does this affect nursing? These approaches will provide the foundation for developing a culturally sensitive ethical and philosophical perspective to prevent CVD and promote cardiovascular health among low-wage workers. © 2011 Wiley Periodicals, Inc.

A genetic risk factor for low serum ferritin levels in Danish blood donors

DEFF Research Database (Denmark)

Sørensen, Erik; Grau, Katrine; Berg, Trine

2012-01-01

BACKGROUND: Iron deficiency is a frequent side effect of blood donation. In recent years, several studies have described genetic variants associated with iron concentrations. However, the impact of these variants on iron levels is unknown in blood donors. Knowledge of genetic variants....../or restless leg syndrome (RLS) were investigated in two groups of female blood donors. The first group had low iron stores (serum ferritin ≤ 12 µg/L, n = 657), and the second group had normal to high iron stores (serum ferritin > 30 µg/L, n = 645). Genotype distribution for each of the SNPs was compared......: A frequent polymorphism in BTBD9 was significantly associated with serum ferritin. This polymorphism has previously been associated with RLS, but not low iron stores in blood donors....

Risk assessment and late effects of radiation in low-earth orbits

International Nuclear Information System (INIS)

Fry, R.J.M.

1989-01-01

The radiation dose rates in low-earth orbits are dependent on the altitude and orbital inclination. The doses to which the crews of space vehicles are exposed is governed by the duration of the mission and the shielding, and in low-earth orbit missions protons are the dominant particles encountered. The risk of concern with the low dose rates and the relatively low total doses of radiation that will be incurred on the space station is excess cancer. The National Council on Radiation Protection and Measurements has recently recommended career dose-equivalent limits that take into account sex and age. The new recommendations for career limits range from 1.0 Sv to 4 Sv, depending on sex and on the age at the time of their first space mission, compared to a single career limit of 4.0 Sv previously used by NASA. Risk estimates for radiated-induced cancer are evolving and changes in the current guidance may be required in the next few years. 10 refs., 1 fig., 3 tabs

Bleeding Risk with Long-Term Low-Dose Aspirin: A Systematic Review of Observational Studies

Science.gov (United States)

García Rodríguez, Luis A.; Martín-Pérez, Mar; Hennekens, Charles H.; Rothwell, Peter M.; Lanas, Angel

2016-01-01

Background Low-dose aspirin has proven effectiveness in secondary and primary prevention of cardiovascular events, but is also associated with an increased risk of major bleeding events. For primary prevention, this absolute risk must be carefully weighed against the benefits of aspirin; such assessments are currently limited by a lack of data from general populations. Methods Systematic searches of Medline and Embase were conducted to identify observational studies published between 1946 and 4 March 2015 that reported the risks of gastrointestinal (GI) bleeding or intracranial hemorrhage (ICH) with long-term, low-dose aspirin (75–325 mg/day). Pooled estimates of the relative risk (RR) for bleeding events with aspirin versus non-use were calculated using random-effects models, based on reported estimates of RR (including odds ratios, hazard ratios, incidence rate ratios and standardized incidence ratios) in 39 articles. Findings The incidence of GI bleeding with low-dose aspirin was 0.48–3.64 cases per 1000 person-years, and the overall pooled estimate of the RR with low-dose aspirin was 1.4 (95% confidence interval [CI]: 1.2–1.7). For upper and lower GI bleeding, the RRs with low-dose aspirin were 2.3 (2.0–2.6) and 1.8 (1.1–3.0), respectively. Neither aspirin dose nor duration of use had consistent effects on RRs for upper GI bleeding. The estimated RR for ICH with low-dose aspirin was 1.4 (1.2–1.7) overall. Aspirin was associated with increased bleeding risks when combined with non-steroidal anti-inflammatory drugs, clopidogrel and selective serotonin reuptake inhibitors compared with monotherapy. By contrast, concomitant use of proton pump inhibitors decreased upper GI bleeding risks relative to aspirin monotherapy. Conclusions The risks of major bleeding with low-dose aspirin in real-world settings are of a similar magnitude to those reported in randomized trials. These data will help inform clinical judgements regarding the use of low-dose aspirin

Low dose diagnostic radiation does not increase cancer risk in cancer prone mice

Energy Technology Data Exchange (ETDEWEB)

Boreham, D., E-mail: dboreham@nosm.ca [Northern Ontario School of Medicine, ON (Canada); Phan, N., E-mail: nghiphan13@yahoo.com [Univ. of Ottawa, Ottawa, ON (Canada); Lemon, J., E-mail: lemonja@mcmaster.ca [McMaster Univ., Hamilton, ON (Canada)

2014-07-01

The increased exposure of patients to low dose diagnostic ionizing radiation has created concern that these procedures will result in greater risk of carcinogenesis. However, there is substantial evidence that shows in many cases that low dose exposure has the opposite effect. We have investigated whether CT scans can modify mechanisms associated with carcinogenesis in cancer-prone mice. Cancer was induced in Trp53+/- mice with an acute high dose whole-body 4 Gy γ-radiation exposure. Four weeks following the cancer-inducing dose, weekly whole-body CT scans (10 mGy/scan, 75 kVp X-rays) were given for ten consecutive weeks adding an additional radiation burden of 0.1 Gy. Short-term biological responses and subsequent lifetime cancer risk were investigated. Five days following the last CT scan, there were no detectable differences in the spontaneous levels of DNA damage in blood cells (reticulocytes). In fact, CT scanned mice had significantly lower constitutive levels of oxidative DNA damage and cell death (apoptosis), compared to non-CT scanned mice. This shows that multiple low dose radiation exposures modified the radio response and indicates protective processes were induced in mice. In mice treated with the multiple CT scans following the high cancer-inducing 4 Gy dose, tumour latency was increased, significantly prolonging lifespan. We conclude that repeated CT scans can reduce the cancer risk of a prior high-dose radiation exposure, and delay the progression of specific types of radiation-induced cancers in Trp53+/-mice. This research shows for the first time that low dose exposure long after cancer initiation events alter risk and reduce cancer morbidity. Cancer induction following low doses does not follow a linear non-threshold model of risk and this model should not be used to extrapolate risk to humans following low dose exposure to ionizing radiation. (author)

Low serum zinc is associated with elevated risk of cadmium nephrotoxicity

Energy Technology Data Exchange (ETDEWEB)

Lin, Yu-Sheng, E-mail: Lin.Yu-Sheng@epa.gov [National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC (United States); Ho, Wen-Chao [Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan (China); Caffrey, James L. [Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX (United States); Sonawane, Babasaheb [National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC (United States)

2014-10-15

Background: Despite animal evidence suggests that zinc modulates cadmium nephrotoxicity, limited human data are available. Objective: To test the hypothesis that low serum zinc concentrations may increase the risk of cadmium-mediated renal dysfunction in humans. Methods: Data from 1545 subjects aged 20 or older in the National Health and Nutrition Examination Survey (NHANES), 2011–2012 were analyzed. Renal function was defined as impaired when estimated glomerular filtration rate (eGFR) fell below 60 ml/min/1.73 m{sup 2} and/or the urinary albumin-to-creatinine ratio surpassed 2.5 in men and 3.5 mg/mmol in women. Results: Within the study cohort, 117 subjects had reduced eGFR and 214 had elevated urinary albumin. After adjusting for potential confounders, subjects with elevated blood cadmium (>0.53 μg/L) were more likely to have a reduced eGFR (odds ratio [OR]=2.21, 95% confidence interval [CI]: 1.09–4.50) and a higher urinary albumin (OR=2.04, 95% CI: 1.13–3.69) than their low cadmium (<0.18 μg/L) peers. In addition, for any given cadmium exposure, low serum zinc is associated with elevated risk of reduced eGFR (OR=3.38, 95% CI: 1.39–8.28). A similar increase in the odds ratio was observed between declining serum zinc and albuminuria but failed to reach statistical significance. Those with lower serum zinc/blood cadmium ratios were likewise at a greater risk of renal dysfunction (p<0.01). Conclusions: This study results suggest that low serum zinc concentrations are associated with an increased risk of cadmium nephrotoxicity. Elevated cadmium exposure is global public health issue and the assessment of zinc nutritional status may be an important covariate in determining its effective renal toxicity. - Highlights: • Blood cadmium was associated with increased risk of nephrotoxicity. • Low serum zinc may exacerbate risk of cadmium-mediated renal dysfunction. • Both zinc deficiency and elevated cadmium exposure are global public health issues. �

Low central venous pressure with milrinone during living donor hepatectomy.

Science.gov (United States)

Ryu, H-G; Nahm, F S; Sohn, H-M; Jeong, E-J; Jung, C-W

2010-04-01

Maintaining a low central venous pressure (CVP) has been frequently used in liver resections to reduce blood loss. However, decreased preload carries potential risks such as hemodynamic instability. We hypothesized that a low CVP with milrinone would provide a better surgical environment and hemodynamic stability during living donor hepatectomy. Thirty-eight healthy adult liver donors were randomized to receive either milrinone (milrinone group, n = 19) or normal saline (control group, n = 19) infusion during liver resection. The surgical field was assessed using a four-point scale. Intraoperative vital signs, blood loss, the use of vasopressors and diuretics and postoperative laboratory data were compared between groups. The milrinone group showed a superior surgical field (p milrinone group required smaller amounts of vasopressors and less-frequent diuretics to maintain a low CVP. The milrinone group also showed a more rapid recovery pattern after surgery. Milrinone-induced low CVP improves the surgical field with less blood loss during living donor hepatectomy and also has favorable effects on intraoperative hemodynamics and postoperative recovery.

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

International Nuclear Information System (INIS)

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

2016-01-01

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

Hypofractionated stereotactic body radiotherapy in low- and intermediate-risk prostate carcinoma

Energy Technology Data Exchange (ETDEWEB)

Kim, Hun Jung; Phak, Jeong Hoon; Kim, Woo Chul [Dept. of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon (Korea, Republic of)

2016-12-15

Stereotactic body radiotherapy (SBRT) takes advantage of low α/β ratio of prostate cancer to deliver a large dose in few fractions. We examined clinical outcomes of SBRT using CyberKnife for the treatment of low- and intermediate-risk prostate cancer. This study was based on a retrospective analysis of the 33 patients treated with SBRT using CyberKnife for localized prostate cancer (27.3% in low-risk and 72.7% in intermediate-risk). Total dose of 36.25 Gy in 5 fractions of 7.25 Gy were administered. The acute and late toxicities were recorded using the Radiation Therapy Oncology Group scale. Prostate-specific antigen (PSA) response was monitored. Thirty-three patients with a median 51 months (range, 6 to 71 months) follow-up were analyzed. There was no biochemical failure. Median PSA nadir was 0.27 ng/mL at median 33 months and PSA bounce occurred in 30.3% (n = 10) of patients at median at median 10.5 months after SBRT. No grade 3 acute toxicity was noted. The 18.2% of the patients had acute grade 2 genitourinary (GU) toxicities and 21.2% had acute grade 2 gastrointestinal (GI) toxicities. After follow-up of 2 months, most complications had returned to baseline. There was no grade 3 late GU and GI toxicity. Our experience with SBRT using CyberKnife in low- and intermediate-risk prostate cancer demonstrates favorable efficacy and toxicity. Further studies with more patients and longer follow-up duration are required.

The risk of low doses of ionising radiation and the linear no threshold relationship debate

International Nuclear Information System (INIS)

Tubiana, M.; Masse, R.; Vathaire, F. de; Averbeck, D.; Aurengo, A.

2007-01-01

The ICRP and the B.E.I.R. VII reports recommend a linear no threshold (L.N.T.) relationship for the estimation of cancer excess risk induced by ionising radiations (IR), but the 2005 report of Medicine and Science French Academies concludes that it leads to overestimate of risk for low and very low doses. The bases of L.N.T. are challenged by recent biological and animal experimental studies which show that the defence against IR involves the cell microenvironment and the immunologic system. The defence mechanisms against low doses are different and comparatively more effective than for high doses. Cell death is predominant against low doses. DNA repairing is activated against high doses, in order to preserve tissue functions. These mechanisms provide for multicellular organisms an effective and low cost defence system. The differences between low and high doses defence mechanisms are obvious for alpha emitters which show several greys threshold effects. These differences result in an impairment of epidemiological studies which, for statistical power purpose, amalgamate high and low doses exposure data, since it would imply that cancer IR induction and defence mechanisms are similar in both cases. Low IR dose risk estimates should rely on specific epidemiological studies restricted to low dose exposures and taking precisely into account potential confounding factors. The preliminary synthesis of cohort studies for which low dose data (< 100 mSv) were available show no significant risk excess, neither for solid cancer nor for leukemias. (authors)

Determinants of attaining and maintaining a low cardiovascular risk profile-the Doetinchem Cohort Study

NARCIS (Netherlands)

Hulsegge, Gerben; van der Schouw, Yvonne T; Daviglus, Martha L; Smit, Henriëtte A; Verschuren, W M Monique

2016-01-01

BACKGROUND: While maintenance of a low cardiovascular risk profile is essential for cardiovascular disease (CVD) prevention, few people maintain a low CVD risk profile throughout their life. We studied the association of demographic, lifestyle, psychological factors and family history of CVD with

Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice.

Science.gov (United States)

Kelly, Christopher J; Walker, Robert W M

2015-01-01

Recent studies have reported perioperative pulmonary aspiration in pediatric practice to be an uncommon problem associated with low morbidity and mortality. This paper examines the recent publications in both the adult and pediatric literature and looks at some of the potential risk factors involved, both patient and anesthetic, in the development of aspiration of gastric contents. We also look at the risk of severe morbidity following pulmonary aspiration and speculate on possible reasons behind the assertion that pulmonary aspiration in pediatric anesthetic practice is rare and a low-risk event. © 2014 John Wiley & Sons Ltd.

Development and validation of a tool for identifying women with low bone mineral density and low-impact fractures: the São Paulo Osteoporosis Risk Index (SAPORI).

Science.gov (United States)

Pinheiro, M M; Reis Neto, E T; Machado, F S; Omura, F; Szejnfeld, J; Szejnfeld, V L

2012-04-01

The performance of the São Paulo Osteoporosis Risk Index (SAPORI) was tested in 1,915 women from the original cohort, São Paulo Osteoporosis Study (SAPOS) (N = 4332). This new tool was able to identify women with low bone density (spine and hip) and low-impact fracture, with an area under the receiving operator curve (ROC) of 0.831, 0.724, and 0.689, respectively. A number of studies have demonstrated the clinical relevance of risk factors for identifying individuals at risk of fracture (Fx) and osteoporosis (OP). The SAPOS is an epidemiological study for the assessment of risk factors for Fx and low bone density in women from the community of the metropolitan area of São Paulo, Brazil. The aim of the present study was to develop and validate a tool for identifying women at higher risk for OP and low-impact Fx. A total of 4,332 pre-, peri-, and postmenopausal women were analyzed through a questionnaire addressing risk factors for OP and Fx. All of them performed bone densitometry at the lumbar spine and proximal femur (DPX NT, GE-Lunar). Following the identification of the main risk factors for OP and Fx through multivariate and logistic regression, respectively, the SAPORI was designed and subsequently validated on a second cohort of 1,915 women from the metropolitan community of São Paulo. The performance of this tool was assessed through ROC analysis. The main and significant risk factors associated with low bone density and low-impact Fx were low body weight, advanced age, Caucasian ethnicity, family history of hip Fx, current smoking, and chronic use of glucocorticosteroids. Hormonal replacement therapy and regular physical activity in the previous year played a protective role (p < 0.05). After the statistical adjustments, the SAPORI was able to identify women with low bone density (T-score ≤ -2 standard deviations) in the femur, with 91.4% sensitivity, 52% specificity, and an area under the ROC of 0.831 (p < 0.001). At the lumbar spine

First-line chemotherapy in low-risk gestational trophoblastic neoplasia.

LENUS (Irish Health Repository)

Alazzam, Mo'iad

2012-01-01

This is an update of a Cochrane review that was first published in Issue 1, 2009. Gestational trophoblastic neoplasia (GTN) is a rare but curable disease arising in the fetal chorion during pregnancy. Most women with low-risk GTN will be cured by evacuation of the uterus with or without single-agent chemotherapy. However, chemotherapy regimens vary between treatment centres worldwide and the comparable benefits and risks of these different regimens are unclear.

Low-level effects

International Nuclear Information System (INIS)

Devine, R.T.; Chaput, R.L.

1987-01-01

Risk assignments can be made to given practices involving exposure to radiation, because sufficient data are available for the effects of high-dose, low-LET radiation and because sufficient exists in the methods of extrapolation to low doses and low dose rates. The confidence in the extrapolations is based on the fact that the risk is not expected to be overestimated, using the assumptions made (as opposed to the possibility that the extrapolations represent an accurate estimate of the risk). These risk estimates have been applied to the selection of permissible exposure levels, to show that various amounts of radiation involve no greater risk to the worker than the risk expected in another industry that is generally considered safe. The setting of standards for protection from exposure to low levels of ionizing radiation is made by expert committees at the national and international levels who weigh social factors as well as scientific factors. Data on low-level effects may be applied when assigning a ''probability of causation'' to a certain exposure of radiation. This has become a prominent method for arriving at an equitable award for damages caused by such exposure. The generation of these tables requires as many (if not more) social and political considerations as does the setting up of protection criteria. It is impossible to extract a purely scientific conclusion solely from the protection standards and other legal decisions. Sufficient information exists on low-LET radiation that safety standards for exposure can be rationally (if not scientifically) agreed upon

Towards a comprehensive assessment and framework for low and high flow water risks

Science.gov (United States)

Motschmann, Alina; Huggel, Christian; Drenkhan, Fabian; León, Christian

2017-04-01

Driven by international organizations such as the Intergovernmental Panel on Climate Change (IPCC) the past years have seen a move from a vulnerability concept of climate change impacts towards a risk framework. Risk is now conceived at the intersection of climate-driven hazard and socioeconomic-driven vulnerability and exposure. The concept of risk so far has been mainly adopted for sudden-onset events. However, for slow-onset and cumulative climate change impacts such as changing water resources there is missing clarity and experience how to apply a risk framework. Research has hardly dealt with the challenge of how to integrate both low and high flow risks in a common framework. Comprehensive analyses of risks related to water resources considering climate change within multi-dimensional drivers across different scales are complex and often missing in climate-sensitive mountain regions where data scarcity and inconsistencies represent important limitations. Here we review existing vulnerability and risk assessments of low and high flow water conditions and identify critical conceptual and practical gaps. Based on this, we develop an integrated framework for low and high flow water risks which is applicable to both past and future conditions. The framework explicitly considers a water balance model simulating both water supply and demand on a daily basis. We test and apply this new framework in the highly glacierized Santa River catchment (SRC, Cordillera Blanca, Peru), representative for many developing mountain regions with both low and high flow water risks and poor data availability. In fact, in the SRC, both low and high flow hazards, such as droughts and floods, play a central role especially for agricultural, hydropower, domestic and mining use. During the dry season (austral winter) people are increasingly affected by water scarcity due to shrinking glaciers supplying melt water. On the other hand during the wet season (austral summer) high flow water

Low-cost risk reduction strategy for small workplaces: how can we spread good practices?

Science.gov (United States)

Kogi, K

2006-01-01

Recent advances in health risk reduction approaches are examined based on inter-country networking experiences. A noteworthy progress is the wider application of low-cost improvements to risk reduction particularly in small enterprises and agriculture in both industrially developing and developed countries. This is helped by the readiness of managers and workers to implement these improvements despite many constraints. Typical improvements include mobile racks, simple workstation changes, screening hazards, better welfare facilities and teamwork arrangements. In view of the complex circumstances of work-related health risks, it is important to know whether a low-cost strategy can advance risk reduction practices effectively and what support measures are necessary. It is confirmed that the strategy can overcome related constraints through its advantages. Main advantages lie in (a) the facilitation of improved practices in multiple technical areas, (b) the strengthening of realistic stepwise risk reduction, and (c) the enhanced multiplier effects through training of local trainers. Action-oriented risk assessment tools, such as action checklists and low-cost improvement guides, can encourage risk-reducing measures adjusted to each local situation. It is suggested to spread the low-cost risk reduction strategy for improving small workplaces in diversified settings with the support of these locally tailored tools.

Risk of Fracture in Women with Sarcopenia, Low Bone Mass, or Both.

Science.gov (United States)

Harris, Rebekah; Chang, Yuefang; Beavers, Kristen; Laddu-Patel, Deepika; Bea, Jennifer; Johnson, Karen; LeBoff, Meryl; Womack, Catherine; Wallace, Robert; Li, Wenjun; Crandall, Carolyn; Cauley, Jane

2017-12-01

To determine whether women with sarcopenia and low bone mineral density (BMD) are at greater risk of clinical fractures than those with sarcopenia or low BMD alone. Women's Health Initiative (WHI) Observational and Clinical trials. Three U.S. clinical centers (Pittsburgh, PA; Birmingham, AL; Phoenix/Tucson, AZ). Women (mean age 63.3 ± 0.07) with BMD measurements (N = 10,937). Sarcopenia was defined as appendicular lean mass values corrected for height and fat mass. Low BMD was defined as a femoral neck T-score less than -1.0 based on the Third National Health and Nutrition Examination Survey reference database for white women. Cox proportional hazards analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). We followed women for incident fractures over a median of 15.9 years. Participants were classified into mutually exclusive groups based on BMD and sarcopenia status: normal BMD and no sarcopenia (n = 3,857, 35%), sarcopenia alone (n = 774, 7%), low BMD alone (n = 4,907, 45%), and low BMD and sarcopenia (n = 1,399, 13%). Women with low BMD, with (HR = 1.72, 95% CI = 1.44-2.06) or without sarcopenia (HR = 1.58, 95% CI = 1.37-1.83), had greater risk of fracture than women with normal BMD; the difference remained statistically significant after adjustment for important covariates. Women with low BMD, with (HR = 2.78, 95% CI = 1.78-4.30 and without (HR = 2.42, 95% CI = 1.63-3.59) sarcopenia had higher risk of hip fractures. Women with sarcopenia alone had similar HRs to women with normal BMD. Compared to women with normal BMD. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Concern for another’s distress in toddlers at high and low genetic risk for Autism Spectrum Disorder

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Campbell, Susan B.; Leezenbaum, Nina B.; Schmidt, Emily N.; Day, Taylor N.; Brownell, Celia A.

2016-01-01

We examined concern for others in 22-month-old toddlers with an older sibling with autism spectrum disorder (ASD) and low risk typically-developing toddlers with older siblings. Responses to a crying infant and an adult social partner who pretended to hurt her finger were coded. Children with a later diagnosis of ASD showed limited empathic concern in either context compared to low risk toddlers. High risk toddlers without a later diagnosis fell between the ASD and low risk groups. During the crying baby probe the low risk and high risk toddlers without a diagnosis engaged their parent more often than the toddlers with ASD. Low levels of empathic concern and engagement with parents may signal emerging ASD in toddlerhood. PMID:26093390

Awareness of Measures for Reducing Health Risk of Using Low-Quality Irrigation Water in Morogoro, Tanzania

DEFF Research Database (Denmark)

Mayilla, Winfrida; Magayane, Flavianus; Konradsen, Flemming

2016-01-01

The study examined the awareness of farmers, vegetable traders, and consumers on the health risk reduction measures when using low-quality water in irrigated agriculture, and identifies farmers’ perceptions of the effectiveness of the health risk reduction measures. Data collection methods includ...... that health education targeting at specific exposed group and their social-demographic characteristics is the potential measure in raising awareness of the potential health risk reduction measures when using low-quality irrigation water in irrigated agriculture.......The study examined the awareness of farmers, vegetable traders, and consumers on the health risk reduction measures when using low-quality water in irrigated agriculture, and identifies farmers’ perceptions of the effectiveness of the health risk reduction measures. Data collection methods included...... a questionnaire survey with 60 farmers, 60 vegetable traders, and 70 consumers and four focus group discussions. General results show a low level of awareness of the health risk reduction measures in using low-quality irrigation water in all respondents’ categories. However, health protection measures...

Is obesity a risk factor for impaired cognition in young adults with low birth weight?

Science.gov (United States)

Lundgren, M; Morgården, E; Gustafsson, J

2014-10-01

Overweight and obesity are risk factors for cardiovascular disease. There is also an association between body mass index (BMI) and cognitive ability. Since low birth weight is associated with adult metabolic disease, particularly in obese subjects, the question emerges whether obesity has an additional negative effect on cognitive function in subjects with low birth weight. The aim was to analyse whether overweight or obesity influence intellectual performance in young adults with particular focus on those with a low birth weight. Data were collected from the Swedish Medical Birth Register on 620,834 males born between 1973 and 1988 and matched to results on intellectual performance and BMI at conscription. The risk for low intellectual performance was higher for those with high BMI compared to those with normal. The highest risk was found among subjects with low birth weight and overweight or obesity in young adulthood (odds ratios, 1.98 [1.73-2.22] and 2.59 [2.00-3.34], respectively). However, subjects with further high birth weight and a high BMI at conscription had no further increased risk. Overweight and obesity are associated with an increased risk of subnormal intellectual performance in young adult males. Subjects with low birth weight and adolescent overweight/obesity are at particular risk of subnormal performance. A high birth weight increases the risk for obesity, but a high adult BMI does not further increase the risk for subnormal performance. © 2013 The Authors. Pediatric Obesity © 2013 International Association for the Study of Obesity.

Recurrence risk of low Apgar score among term singletons: a population-based cohort study

NARCIS (Netherlands)

Ensing, Sabine; Schaaf, Jelle M.; Abu-Hanna, Ameen; Mol, Ben W. J.; Ravelli, Anita C. J.

2014-01-01

To examine the risk of recurrence of low Apgar score in a subsequent term singleton pregnancy. Population-based cohort study. The Netherlands. A total of 190,725 women with two subsequent singleton term live births between 1999 and 2007. We calculated the recurrence risk of low Apgar score after

Nonfasting Triglycerides, Low-Density Lipoprotein Cholesterol, and Heart Failure Risk

DEFF Research Database (Denmark)

Varbo, Anette; Nordestgaard, Børge G

2018-01-01

OBJECTIVE: The prevalence of heart failure is increasing in the aging population, and heart failure is a disease with large morbidity and mortality. There is, therefore, a need for identifying modifiable risk factors for prevention. We tested the hypothesis that high concentrations of nonfasting...... triglycerides and low-density lipoprotein cholesterol are associated with higher risk of heart failure in the general population. APPROACH AND RESULTS: We included 103 860 individuals from the Copenhagen General Population Study and 9694 from the Copenhagen City Heart Study in 2 prospective observational...... association studies. Nonfasting triglycerides and low-density lipoprotein cholesterol were measured at baseline. Individuals were followed for ≤23 years, during which time 3593 were diagnosed with heart failure. Hazard ratios were estimated using Cox proportional hazard regression models. In the Copenhagen...

Doses of low level ionizing radiation; a misunderstood risk, however unavoidable

International Nuclear Information System (INIS)

Nicolli, D.

1988-01-01

The treatment given by international organizations and associations to the problems of radiation exposures, and the recommendations and norms for calculating risks of low level radiation are analysed. It is shown that there are not zero risks for nuclear energy, and emphasis is given to the risks of natural radiation from environment. (M.C.K.) [pt

Comfrey: assessing the low-dose health risk.

Science.gov (United States)

Abbott, P J

The regular use of comfrey as part of the diet or for medicinal purposes may be a potential health risk as a result of the presence of naturally-occurring pyrrolizidine alkaloids. The majority of these alkaloids are hepatotoxic in both animals and humans, and some have been shown to induce tumours in experimental animals. In this article, the toxic properties of pyrrolizidine alkaloids are reviewed briefly, with particular reference to their presence in comfrey. The acute and long-term health risks at the normally-low levels of comfrey consumption are evaluated and discussed. On the basis of the data that are available currently, the small but significant long-term risk that is associated with the consumption of comfrey justifies the need to limit its intake. This is being achieved by controls under various state Poisons Acts, but also requires further education on the potential dangers of naturally-occurring chemicals of plant origin.

Determinants for hospitalization in " low-risk" community acquired pneumonia

Directory of Open Access Journals (Sweden)

Aliyu Muktar H

2003-06-01

Full Text Available Abstract Background A variable decision in managing community acquired pneumonia (CAP is the initial site of care; in-patient versus outpatient. These variations persist despite comprehensive practice guidelines. Patients with a Pneumonia Severity Index (PSI score lower than seventy have low risk for complications and outpatient antibiotic management is recommended in this group. These patients are generally below the age of fifty years, non-nursing home residents, HIV negative and have no major cardiac, hepatic, renal or malignant diseases. Methods A retrospective analysis of 296 low-risk CAP patients evaluated within a year one period at St. Agnes Hospital, Baltimore, Maryland was undertaken. All patients were assigned a PSI score. 208 (70% were evaluated and discharged from the emergency department (E.D. to complete outpatient antibiotic therapy, while 88 (30% were hospitalized. Patients were sub-stratified into classes I-V according to PSI. A comparison of demographic, clinical, social and financial parameters was made between the E.D. discharged and hospitalized groups. Results Statistically significant differences in favor of the hospitalized group were noted for female gender (CI: 1.46-5.89, p= 0.0018, African Americans (CI: 0.31-0.73, p= 0.004, insurance coverage (CI: 0.19-0.63, p= 0.0034, temperature (CI: 0.04-0.09, p= 0.0001 and pulse rate (CI: 0.03-0.14, p= 0.0001. No statistically significant differences were observed between the two groups for altered mental status, hypotension, tachypnea, laboratory/radiological parameters and social indicators (p>0.05. The average length of stay for in-patients was 3.5 days at about eight time's higher cost than outpatient management. There was no difference in mortality or treatment failures between the two groups. The documentation rate and justifications for hospitalizing low risk CAP patients by admitting physicians was less than optimal. Conclusions High fever, tachycardia, female gender

Rejection Sensitivity, Perceived Power, and HIV Risk in the Relationships of Low-Income Urban Women.

Science.gov (United States)

Berenson, Kathy R; Paprocki, Christine; Thomas Fishman, Marget; Bhushan, Devika; El-Bassel, Nabila; Downey, Geraldine

2015-01-01

The psychological processes associated with HIV infection in long-term relationships differ from those operative in casual sexual encounters, and relatively little research has considered the aspects of personality applicable in the ongoing heterosexual relationships in which women are at greatest risk. Sensitivity to rejection has been linked with efforts to prevent rejection at a cost to the self and, therefore, may be relevant to the health risks that many women incur in relationships. We examined the association of rejection sensitivity with women's sexual risk behavior in a sample of women at heightened risk for HIV exposure. Women in long-term heterosexual relationships (N = 159) were recruited for study participation in the hospital emergency room serving a low-income neighborhood in New York City, in 2001-2003. Rejection sensitivity and known HIV risk factors were assessed using verbally administered questionnaires. Rejection sensitivity was associated with lower perceived relationship power and, in turn, more frequent unprotected sex with a partner perceived to be at risk for HIV. These results held when controlling for other HIV risk factors including partner violence, economic dependence, and substance use. Understanding the association of rejection concerns with lower perceived personal power in relationships may be important for HIV prevention.

Migration from low- to high-risk countries:

DEFF Research Database (Denmark)

Kristiansen, M; Lue-Kessing, Linnea; Mygind, A

2013-01-01

to be caused by multiple factors, including genetics, health behaviour, stress, fertility and breastfeeding. Some women perceived breast cancer to be more prevalent in Denmark as compared with their country of birth, and perceived their risk of developing breast cancer to increase with length of stay......Migrants are less likely to participate in mammography screening programmes compared with local-born populations in Europe. We explored perceptions of breast cancer risk and the influence on participation in mammography screening programmes among migrant women born in countries with low incidence...... rates of breast cancer. We conducted eight individual interviews and six group interviews including a total of 29 women aged 50-69 years living in Copenhagen, Denmark. Women were migrants born in Somalia, Turkey, Pakistan or Arab countries. Phenomenological analysis was used. Breast cancer was perceived...

Multifactorial assessment of the risk of falls in low bone density older women

Directory of Open Access Journals (Sweden)

Patrícia Azevedo Garcia

Full Text Available Abstract Introduction: Identifying effective assessment instruments for predicting falls, specifically in older women with low bone mineral density (BMD that are more susceptible to fractures remains a challenge. Objective: To evaluate risk factors for falls at baseline, to identify the falls occurrence over six months of follow-up and to investigate the predictive validity of the Quickscreen Clinical Falls Risk Assessment for predicting multiple falls among low BMD older women. Methods: A methodological study with 110 older women with diagnosis of osteoporosis or osteopenia (70.26 ± 6.24 years. The presence of two or more of the eight risk factors assessed by the QuickScreen characterized the risk of falling (baseline and monthly phone calls identified the occurrence of falls during the six months of follow-up. Results: The most prevalent falls risk factors were self-reported previous falls, polypharmacy and impairment in shifting weight and lateral instability. Most of the older women (67.3% had two or more risk factors, 24.5% reported a single fall and 13.6% reported multiple falls over the six months. The QuickScreen (cutoff ≥ 2 risk factors showed good sensitivity (73.3% and high negative predictive value (88.89% for predicting multiple falls among low BMD older women. Conclusions: The results indicated a high frequency of falls among low BMD older women. Additionally, the results highlighted that the QuickScreen instrument was able to predict multiple falls in the six months of follow-up among these older women.

Low birth weights and risk of neonatal mortality in Indonesia

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Suparmi Suparmi

2016-12-01

mortality. This study aims to examine contribution of low birth weight on neonatal mortality in Indonesia. Methods: Data from the Indonesia Demographic and Health Survey (IDHS conducted in 2012 were used in the analysis. A total of 18021 live births in the last five years preceding the survey were reported from the mothers. Completed information of their children (14837 children were taken for this analysis. The adjusted relative risk with cox proportional hazard regression analysis were used to assess the strength of association to neonatal mortality. Results: Children born in low birth weight were 9.89-fold higher risk of neonatal mortality compared to children born in normal weight [adjusted relative risk (aRR = 9.89; 95% confidence interval (CI: 7.41 – 13.19; P = < 0.0001]. Children delivered from younger mothers (aged 15 - 19 years had 94% higher risk of neonatal mortality compared to children delivered from mothers aged 20-35 years. Working mothers had 81% higher risk of neonatal mortality compared to unemployed mothers. Conclusion: Children born in a low birth weight and born from younger mothers had higher risk of neonatal mortality. Appropriate care and treatment for children born in low birth weight is needed to prolonged survival rates of the children. (Health Science Journal of Indonesia 2016;7(2:113-117 Keywords: Low birth weight, neonatal mortality, Indonesia   

Improved Methods for Fire Risk Assessment in Low-Income and Informal Settlements

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John Twigg

2017-02-01

Full Text Available Fires cause over 300,000 deaths annually worldwide and leave millions more with permanent injuries: some 95% of these deaths are in low- and middle-income countries. Burn injury risk is strongly associated with low-income and informal (or slum settlements, which are growing rapidly in an urbanising world. Fire policy and mitigation strategies in poorer countries are constrained by inadequate data on incidence, impacts, and causes, which is mainly due to a lack of capacity and resources for data collection, analysis, and modelling. As a first step towards overcoming such challenges, this project reviewed the literature on the subject to assess the potential of a range of methods and tools for identifying, assessing, and addressing fire risk in low-income and informal settlements; the process was supported by an expert workshop at University College London in May 2016. We suggest that community-based risk and vulnerability assessment methods, which are widely used in disaster risk reduction, could be adapted to urban fire risk assessment, and could be enhanced by advances in crowdsourcing and citizen science for geospatial data creation and collection. To assist urban planners, emergency managers, and community organisations who are working in resource-constrained settings to identify and assess relevant fire risk factors, we also suggest an improved analytical framework based on the Haddon Matrix.

Improved Methods for Fire Risk Assessment in Low-Income and Informal Settlements.

Science.gov (United States)

Twigg, John; Christie, Nicola; Haworth, James; Osuteye, Emmanuel; Skarlatidou, Artemis

2017-02-01

Fires cause over 300,000 deaths annually worldwide and leave millions more with permanent injuries: some 95% of these deaths are in low- and middle-income countries. Burn injury risk is strongly associated with low-income and informal (or slum) settlements, which are growing rapidly in an urbanising world. Fire policy and mitigation strategies in poorer countries are constrained by inadequate data on incidence, impacts, and causes, which is mainly due to a lack of capacity and resources for data collection, analysis, and modelling. As a first step towards overcoming such challenges, this project reviewed the literature on the subject to assess the potential of a range of methods and tools for identifying, assessing, and addressing fire risk in low-income and informal settlements; the process was supported by an expert workshop at University College London in May 2016. We suggest that community-based risk and vulnerability assessment methods, which are widely used in disaster risk reduction, could be adapted to urban fire risk assessment, and could be enhanced by advances in crowdsourcing and citizen science for geospatial data creation and collection. To assist urban planners, emergency managers, and community organisations who are working in resource-constrained settings to identify and assess relevant fire risk factors, we also suggest an improved analytical framework based on the Haddon Matrix.

Foot length measurements of newborns of high and low risk pregnancies

Directory of Open Access Journals (Sweden)

Ana Karina Marques Salge

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

Burden of upper gastrointestinal symptoms in patients receiving low-dose acetylsalicylic acid for cardiovascular risk management

DEFF Research Database (Denmark)

Bytzer, Peter; Pratt, Stephen; Elkin, Eric

2013-01-01

Continuous low-dose acetylsalicylic acid (aspirin; ASA) is a mainstay of cardiovascular (CV) risk management. It is well established, however, that troublesome upper gastrointestinal (GI) symptoms are commonly experienced among low-dose ASA users.......Continuous low-dose acetylsalicylic acid (aspirin; ASA) is a mainstay of cardiovascular (CV) risk management. It is well established, however, that troublesome upper gastrointestinal (GI) symptoms are commonly experienced among low-dose ASA users....

Biomarkers and low risk in heart failure. Data from COACH and TRIUMPH

NARCIS (Netherlands)

Meijers, Wouter C.; de Boer, Rudolf A.; van Veldhuisen, Dirk J.; Jaarsma, Tiny; Hillege, Hans L.; Maisel, Alan S.; Di Somma, Salvatore; Voors, Adriaan A.; Peacock, W. Frank

2015-01-01

AimTraditionally, risk stratification in heart failure (HF) emphasizes assessment of high risk. We aimed to determine if biomarkers could identify patients with HF at low risk for death or HF rehospitalization. Methods and resultsThis analysis was a substudy of The Coordinating Study Evaluating

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

Science.gov (United States)

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

2018-02-01

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

Adolescents with Low Intelligence Are at Risk of Functional Somatic Symptoms : The TRAILS Study

NARCIS (Netherlands)

Kingma, Eva M.; Janssens, Karin A. M.; Venema, Manon; Ormel, Johan; de Jonge, Peter; Rosmalen, Judith G. M.

2011-01-01

Purpose: Low intelligence is a risk factor for functional somatic symptoms (FSSs) in adults, but it is unknown whether a similar association exists in adolescents. We hypothesized that low intelligence may lead to FSS, and that this association is mediated by low school performance. In addition, we

Mental Health in Low-to-Moderate Risk Preterm, Low Birth Weight, and Small for Gestational Age Children at 4 to 5 Years: The Role of Early Maternal Parenting

Science.gov (United States)

Westrupp, Elizabeth M.; Mensah, Fiona K.; Giallo, Rebecca; Cooklin, Amanda; Nicholson, Jan M.

2012-01-01

Objectives: The majority of children born preterm, with low birth weight, or small for gestational age are born with low-to-moderate risk (LTM), yet most research focuses on the high-risk group. Little is known about whether children with LTM perinatal risk are at greater risk for mental health problems, or what the role of early maternal…

Selection of low-risk design guidelines for energetic events

International Nuclear Information System (INIS)

Ferguson, D.; Marchaterre, J.; Graham, J.

1982-01-01

This paper recommends the establishment of specific design guidelines for protection against potential, but low-probability, energetic events. These guidelines recognize the plant protective features incorporated to prevent such events, as well as the inherent capability of the plant to accommodate a certain level of energy release. Further, their application is recommended within the context of necessary standardized and agreed-upon acceptance criteria which are less restrictive than ASME code requirements. The paper provides the background upon which the selection of the design is made, including the characterization of energetic events dependent on various core-design parameters, and including the necessity of a low-risk design balanced between prevention of accidents and the mitigation of consequences

Risk Factors for Neonatal Mortality Among Very Low Birth Weight Neonates

Directory of Open Access Journals (Sweden)

Fatemeh Nayeri

2013-05-01

Full Text Available The objective of this study is to determine risk factors causing increase in very low birth way (VLBW neonatal mortality. The medical files of all neonates weighing ≤1500 g, born in Vali-e-Asr hospital (2001-2004 were studied. Two groups of neonates (living and dead were compared up to the time of hospital discharge or death. A total of 317 neonates were enrolled. A meaningful relationship existed between occurrence of death and low gestational age (P=0.02, low birth weight, lower than 1000 g (P=0.001, Apgar score <6 at 5th minutes (P=0.001, resuscitation at birth (P=0.001, respiratory distress syndrome (P=0.001 need for mechanical ventilation (P=0.001, neurological complications (P=0.001 and intraventricular hemorrhage (P=0.001. Regression analysis indicated that each 250 g weight increase up to 1250 g had protective effect, and reduced mortality rate. The causes of death of those neonates weighting over 1250 g should be sought in factors other than weight. Survival rate was calculated to be 80.4% for neonates weighing more than 1000 g. The most important high risk factors affecting mortality of neonates are: low birth weight, need for resuscitation at birth, need for ventilator use and intraventricular hemorrhage.

Low birth weight: risk factors in irbid, jordan

International Nuclear Information System (INIS)

Tal, Y.S.A.; Bataineh, H.A.

2006-01-01

The aim of this study was to estimate the birth weight distribution and prevalence of low birth weights (LBW) in Irbid, Jordan, and to determine some of the contributing risk factors. A cross-sectional design was used to study women who delivered in Prince Rashed Hospital (PRH). Respondents were 2256 mothers ranging in age from 15-45 years. Anthropometric measurements and interviews were used to determine the risk factors. The birth weights and anthropometric measurements of all babies born alive in PRH during the period were collected. Post-delivery weight and other measurements of respondents were also collected. The mean birth weight of the newborns in the study was 2812 g. Twenty-two percent of the newborns weighed between 700 and 2499 g. About 39% of respondents had urinary tract infection while 29% suffered from anemia, and 10% had bleeding during pregnancy. All anthropometric measurements were significantly associated with LBW. Mothers who were younger in age at their first delivery, had low post-delivery weight, and bled during pregnancy, were more likely to have LBW babies. There is also a need to discourage early pregnancies and to encourage utilization of mother and child health services, and treat concomitant illnesses during pregnancy. (author)

Low back pain during pregnancy

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Maria Emília Coelho Costa Carvalho

2017-05-01

Full Text Available Objective: Low back pain is a common complaint among pregnant women. It is estimated that about 50% of pregnant women complain of some form of back pain at some point in pregnancy or during the postpartum period. The aim of this study was to evaluate the frequency of low back pain during pregnancy and its characteristics. Methods: Cross-sectional study with low-risk pregnant women. After approval by the Human Research Ethics Committee and receiving written informed consent, we included pregnant women over 18 years of age and excluded those with psychiatric disorders, previous lumbar pathologies, and receiving treatment for low back pain. Results: We interviewed 97 pregnant women. The frequency of low back pain was 68%. The mean age was 26.2 years and the median gestational age was 30 weeks. Fifty-eight pregnant women declared themselves as brown (58%. Most (88.6% were married or living in common-law marriage, 56 (57.7% worked outside the home, and 71 (73.2% had completed high school. Low back pain was more frequent during the second trimester of pregnancy (43.9%, referred to as a “burning” sensation in 37.8% of patients, with intermittent frequency in 96.9% of the women. The symptoms got worse at night (71.2%. Resting reduced low back pain in 43.9% of pregnant women, while the standing position for a long time worsened it in 27.2% of patients. Conclusion: Low back pain is common in pregnant women, has specific characteristics, and is more frequent in the second trimester of pregnancy. This indicates the need for prevention strategies that enable better quality of life for pregnant women. Resumo: Objetivo: A lombalgia é uma queixa comum entre grávidas. Estima-se que cerca de 50% das gestantes queixam-se de algum tipo de dor lombar em algum momento da gravidez ou durante o puerpério. O objetivo deste estudo foi avaliar a frequência da lombalgia na gestação e suas características. Método: Estudo de corte transversal com gestantes de

Deployment-related risk factors of low back pain

DEFF Research Database (Denmark)

Nissen, Lars Ravnborg; Marott, Jacob Louis; Gyntelberg, Finn

2014-01-01

Where much is known about the consequences of spinal and low back pain (LBP) during military deployments, there is lesser knowledge of risk factors for LBP among the deployed forces. The objective of this study was to identify deployment-related exposures associated with LBP. The study was a ques...... their subordinates and involve medical personnel, especially deployed physiotherapists, by giving advice to soldiers of different military occupational specialties on how to optimize ergonomics at work....

The assessment of risks from exposure to low-levels of ionizing radiation

International Nuclear Information System (INIS)

Gilbert, E.S.

1992-06-01

This report is concerned with risk assessments for human populations receiving low level radiation doses; workers routinely exposed to radiation, Japanese victims of nuclear bombs, and the general public are all considered. Topics covered include risk estimates for cancer, mortality rates, risk estimates for nuclear site workers, and dosimetry

Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Nordmann, Alain J; Nordmann, Abigail; Briel, Matthias; Keller, Ulrich; Yancy, William S; Brehm, Bonnie J; Bucher, Heiner C

2006-02-13

Low-carbohydrate diets have become increasingly popular for weight loss. However, evidence from individual trials about benefits and risks of these diets to achieve weight loss and modify cardiovascular risk factors is preliminary. We used the Cochrane Collaboration search strategy to identify trials comparing the effects of low-carbohydrate diets without restriction of energy intake vs low-fat diets in individuals with a body mass index (calculated as weight in kilograms divided by the square of height in meters) of at least 25. Included trials had to report changes in body weight in intention-to-treat analysis and to have a follow-up of at least 6 months. Two reviewers independently assessed trial eligibility and quality of randomized controlled trials. Five trials including a total of 447 individuals fulfilled our inclusion criteria. After 6 months, individuals assigned to low-carbohydrate diets had lost more weight than individuals randomized to low-fat diets (weighted mean difference, -3.3 kg; 95% confidence interval [CI], -5.3 to -1.4 kg). This difference was no longer obvious after 12 months (weighted mean difference, -1.0 kg; 95% CI, -3.5 to 1.5 kg). There were no differences in blood pressure. Triglyceride and high-density lipoprotein cholesterol values changed more favorably in individuals assigned to low-carbohydrate diets (after 6 months, for triglycerides, weighted mean difference, -22.1 mg/dL [-0.25 mmol/L]; 95% CI, -38.1 to -5.3 mg/dL [-0.43 to -0.06 mmol/L]; and for high-density lipoprotein cholesterol, weighted mean difference, 4.6 mg/dL [0.12 mmol/L]; 95% CI, 1.5-8.1 mg/dL [0.04-0.21 mmol/L]), but total cholesterol and low-density lipoprotein cholesterol values changed more favorably in individuals assigned to low-fat diets (weighted mean difference in low-density lipoprotein cholesterol after 6 months, 5.4 mg/dL [0.14 mmol/L]; 95% CI, 1.2-10.1 mg/dL [0.03-0.26 mmol/L]). Low-carbohydrate, non-energy-restricted diets appear to be at least as

Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study.

Science.gov (United States)

Carroccio, Antonio; Soresi, Maurizio; D'Alcamo, Alberto; Sciumè, Carmelo; Iacono, Giuseppe; Geraci, Girolamo; Brusca, Ignazio; Seidita, Aurelio; Adragna, Floriana; Carta, Miriam; Mansueto, Pasquale

2014-11-28

Non-celiac gluten sensitivity (NCGS) or 'wheat sensitivity' (NCWS) is included in the spectrum of gluten-related disorders. No data are available on the prevalence of low bone mass density (BMD) in NCWS. Our study aims to evaluate the prevalence of low BMD in NCWS patients and search for correlations with other clinical characteristics. This prospective observation study included 75 NCWS patients (63 women; median age 36 years) with irritable bowel syndrome (IBS)-like symptoms, 65 IBS and 50 celiac controls. Patients were recruited at two Internal Medicine Departments. Elimination diet and double-blind placebo controlled (DBPC) wheat challenge proved the NCWS diagnosis. All subjects underwent BMD assessment by Dual Energy X-Ray Absorptiometry (DXA), duodenal histology, HLA DQ typing, body mass index (BMI) evaluation and assessment for daily calcium intake. DBPC cow's milk proteins challenge showed that 30 of the 75 NCWS patients suffered from multiple food sensitivity. Osteopenia and osteoporosis frequency increased from IBS to NCWS and to celiac disease (CD) (P <0.0001). Thirty-five NCWS patients (46.6%) showed osteopenia or osteoporosis. Low BMD was related to low BMI and multiple food sensitivity. Values of daily dietary calcium intake in NCWS patients were significantly lower than in IBS controls. An elevated frequency of bone mass loss in NCWS patients was found; this was related to low BMI and was more frequent in patients with NCWS associated with other food sensitivity. A low daily intake of dietary calcium was observed in patients with NCWS.

Extremely low-frequency magnetic fields and risk of childhood leukemia

DEFF Research Database (Denmark)

Schüz, Joachim; Dasenbrock, Clemens; Ravazzani, Paolo

2016-01-01

Exposure to extremely low-frequency magnetic fields (ELF-MF) was evaluated in an International Agency for Research on Cancer (IARC) Monographs as "possibly carcinogenic to humans" in 2001, based on increased childhood leukemia risk observed in epidemiological studies. We conducted a hazard assess...

Decision-making under risk and ambiguity in low-birth-weight pigs.

Science.gov (United States)

Murphy, Eimear; Kraak, Lynn; van den Broek, Jan; Nordquist, Rebecca E; van der Staay, Franz Josef

2015-03-01

Low birth weight (LBW) in humans is a risk factor for later cognitive, behavioural and emotional problems. In pigs, LBW is associated with higher mortality, but little is known about consequences for surviving piglets. Alteration in hypothalamic-pituitary-adrenal axis function in LBW pigs suggests altered emotionality, but no behavioural indicators have been studied. Decision-making under uncertain conditions, e.g., risk or ambiguity, is susceptible to emotional influences and may provide a means of assessing long-term effects of LBW in piglets. We tested LBW (N = 8) and normal-birth-weight (NBW; N = 8) male pigs in two decision-making tasks. For decision-making under risk, we developed a simple two-choice probabilistic task, the Pig Gambling Task (PGT), where an 'advantageous' option offered small but frequent rewards and a 'disadvantageous' option offered large but infrequent rewards. The advantageous option offered greater overall gain. For decision-making under ambiguity, we used a Judgement Bias Task (JBT) where pigs were trained to make an active response to 'positive' and 'negative' tone cues (signalling large and small rewards, respectively). Responses to ambiguous tone cues were rated as more or less optimistic. LBW pigs chose the advantageous option more often in later blocks of the PGT, and were scored as less optimistic in the JBT, than NBW pigs. Our findings demonstrate that LBW pigs have developed different behavioural strategies with respect to decision-making. We propose that this is guided by changes in emotionality in LBW piglets, and we provide behavioural evidence of increased negative affect in LBW piglets.

76 FR 16234 - Prompt Corrective Action; Amended Definition of Low-Risk Assets

Science.gov (United States)

2011-03-23

...; Amended Definition of Low-Risk Assets AGENCY: National Credit Union Administration (NCUA). ACTION: Final... to reflect the absence of credit risk. Having considered the public comments addressing the Interim...), (f) and (g); 12 CFR 702.204(a)-(b). For a credit union that is subject to an additional Risk-Based...

Techniques for detecting and determining risks from low-level radiation

International Nuclear Information System (INIS)

Boice, J.D.

1980-01-01

Epidemiology is the study of disease in man. In evaluating radiation hazards, analytic studies have utilized the cohort type of investigation (where persons exposed and not exposed to radiation are followed forward in time for determination of disease experience) or case-control approaches (where persons with and without a specific disease are evaluated for previous exposure to radiation). Most radiation studies have evaluated cohorts (e.g., radiologists), although important case-control studies have been conducted (e.g., childhood leukemia as related to prenatal x ray). At its best, epidemiology is capable fo evaluating relative risks (RR) on the order of 1.4 (i.e., a 40% relative excess). However, the RRs of interest following low doses of radiation (1 rad) are on the order of 1.02-1.002. Thus, not much should be anticipated from direct observations at 1 rad, and indirect approaches must be taken to estimate low-dose effects. Such indirect approaches include evaluating 1) populations exposed to a range of doses, both low and high, where interpolation models can be reasonably applied to estimate low-dose effects; and 2) populations exposed to fractionated doses over a long period of time where the resulting dose-effect relationship theoretically should be linear and the estimation of low-level health effects facilitated

Quantification of lung cancer risk after low radon exposure and low exposure rate: synthesis from epidemiological and experimental data

International Nuclear Information System (INIS)

Timarche, M.

2004-03-01

Radon is a radioactive gas produced during the decay of uranium 238 that is present in soil. It was classified as a human lung carcinogen in 1988, based on evidence both from animal studies and from human studies of miners with high levels of radon exposure. Radon is present everywhere; therefore the quantification of the risk associated with exposure to it is a key public health issue. The project aimed to analyse the risk associated with radon inhalation at low doses and at low rates of exposure. It involved researchers from three different fields: epidemiology, animal experiments and mechanistic modelling and provided a unique opportunity to study the influence of dose rate, mainly in the range of low daily exposures over long periods, by analysing in parallel results from both animal and epidemiological studies. The project comprised 6 work packages (W.P.). Firstly, the partners involved in epidemiology and animal experiments worked on the validation and the analysis of the data. Secondly, the data from W.P.1 and W.P.4 were transferred to the partners involved in W.P.5 for the application of mechanistic models. In the final step a synthesis of the results was prepared. (N.C)

Quantification of lung cancer risk after low radon exposure and low exposure rate: synthesis from epidemiological and experimental data

Energy Technology Data Exchange (ETDEWEB)

Timarche, M

2004-03-15

Radon is a radioactive gas produced during the decay of uranium 238 that is present in soil. It was classified as a human lung carcinogen in 1988, based on evidence both from animal studies and from human studies of miners with high levels of radon exposure. Radon is present everywhere; therefore the quantification of the risk associated with exposure to it is a key public health issue. The project aimed to analyse the risk associated with radon inhalation at low doses and at low rates of exposure. It involved researchers from three different fields: epidemiology, animal experiments and mechanistic modelling and provided a unique opportunity to study the influence of dose rate, mainly in the range of low daily exposures over long periods, by analysing in parallel results from both animal and epidemiological studies. The project comprised 6 work packages (W.P.). Firstly, the partners involved in epidemiology and animal experiments worked on the validation and the analysis of the data. Secondly, the data from W.P.1 and W.P.4 were transferred to the partners involved in W.P.5 for the application of mechanistic models. In the final step a synthesis of the results was prepared. (N.C)

Perceptions of risk in adults with a low or high risk profile of developing type 2 diabetes; a cross sectional population-bases study.

NARCIS (Netherlands)

Adriaanse, M.C.; Twisk, J.W.R.; Dekker, J.M.; Spijkerman, A.M.W.; Nijpels, G.; Heine, R.J.; Snoek, F.J.

2008-01-01

Objective: To compare the perceived seriousness and risk of type 2 diabetes among low risk with high risk profile non-diabetic subjects and examine the relationship of perceived risk with multiple self-reported risk indicators. Methods: A cross-sectional population-based study among 4435 low risk

Computed tomography coronary angiography accuracy in women and men at low to intermediate risk of coronary artery disease

International Nuclear Information System (INIS)

Dharampal, Anoeshka S.; Papadopoulou, Stella L.; Rossi, Alexia; Weustink, Annick C.; Mollet, Nico R.A.; Meijboom, W. Bob; Neefjes, Lisan A.; Nieman, Koen; Feijter, Pim J. de; Boersma, Eric; Krestin, Gabriel P.

2012-01-01

To investigate the diagnostic accuracy of CT coronary angiography (CTCA) in women at low to intermediate pre-test probability of coronary artery disease (CAD) compared with men. In this retrospective study we included symptomatic patients with low to intermediate risk who underwent both invasive coronary angiography and CTCA. Exclusion criteria were previous revascularisation or myocardial infarction. The pre-test probability of CAD was estimated using the Duke risk score. Thresholds of less than 30 % and 30-90 % were used for determining low and intermediate risk, respectively. The diagnostic accuracy of CTCA in detecting obstructive CAD (≥50 % lumen diameter narrowing) was calculated on patient level. P < 0.05 was considered significant. A total of 570 patients (46 % women [262/570]) were included and stratified as low (women 73 % [80/109]) and intermediate risk (women 39 % [182/461]). Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk. For women vs. men at low risk they were 97 % vs. 100 %, 79 % vs. 90 %, 80 % vs. 80 % and 97 % vs. 100 %, respectively. For intermediate risk they were 99 % vs. 99 %, 72 % vs. 83 %, 88 % vs. 93 % and 98 % vs. 99 %, respectively. CTCA has similar diagnostic accuracy in women and men at low and intermediate risk. (orig.)

Darbepoetin alpha for the treatment of anaemia in low-intermediate risk myelodysplastic syndromes

DEFF Research Database (Denmark)

Musto, Pellegrino; Lanza, Francesco; Balleari, Enrico

2005-01-01

Thirty-seven anaemic subjects with low-to-intermediate risk myelodysplastic syndrome (MDS) received the highly glycosylated, long-acting erythropoiesis-stimulating molecule darbepoetin-alpha (DPO) at the single, weekly dose of 150 microg s.c. for at least 12 weeks. Fifteen patients (40.5%) achieved......, no excess of blasts and hypoplastic bone marrow. This study suggests that DPO, at the dose and schedule used, can be safely given in low-intermediate risk MDS and may be effective in a significant proportion of these patients....

Using a familiar risk comparison within a risk ladder to improve risk understanding by low numerates: a study of visual attention.

Science.gov (United States)

Keller, Carmen

2011-07-01

Previous experimental research provides evidence that a familiar risk comparison within a risk ladder is understood by low- and high-numerate individuals. It especially helps low numerates to better evaluate risk. In the present study, an eye tracker was used to capture individuals' visual attention to a familiar risk comparison, such as the risk associated with smoking. Two parameters of information processing-efficiency and level-were derived from visual attention. A random sample of participants from the general population (N= 68) interpreted a given risk level with the help of the risk ladder. Numeracy was negatively correlated with overall visual attention on the risk ladder (r(s) =-0.28, p= 0.01), indicating that the lower the numeracy, the more the time spent looking at the whole risk ladder. Numeracy was positively correlated with the efficiency of processing relevant frequency (r(s) = 0.34, p improving risk communication formats. © 2011 Society for Risk Analysis.

Management of low (favourable)-risk prostate cancer.

Science.gov (United States)

Carter, H Ballentine

2011-12-01

What's known on the subject? and What does the study add? Most men who are diagnosed with favourable-risk prostate cancer undergo some form of active intervention, despite evidence that treatment will not improve health outcomes for many. The decision to undergo treatment after diagnosis is, in part, related to the inability to precisely determine the long-term risk of harm without treatment. Nevertheless, physicians should consider patient age, overall health, and preferences for living with cancer and the potential side effects of curative treatments, before recommending a management option. This is especially important for older men, given the high level of evidence that those with low-risk disease are unlikely to accrue any benefit from curative intervention. What is known on the subject: Over treatment of favourable-risk prostate cancer is common, especially among older men. What does the study add: A review of the natural history of favourable-risk prostate cancer in the context of choices for management of the disease. • The management of favourable-risk prostate cancer is controversial, and in the absence of controlled trials to inform best practice, choices are driven by personal beliefs with resultant wide variation in practice patterns. • Men with favourable-risk prostate cancer diagnosed today often undergo treatments that will not improve overall health outcomes. • A shared-decision approach for selecting optimal management of favourable-risk disease should account for patient age, overall health, and preferences for living with cancer and the potential side effects of curative treatments. © 2011 THE AUTHOR. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Epidemiological studies on the effects of low-level ionizing radiation on cancer risk

International Nuclear Information System (INIS)

Akiba, Suminori

2010-01-01

The health effects of low-level ionizing radiation are yet unclear. As pointed out by Upton in his review (Upton, 1989), low-level ionizing radiation seems to have different biological effects from what high-level radiation has. If so, the hazard identification of ionizing radiation should he conducted separately for low- and high-level ionizing radiation; the hazard identification of low-level radiation is yet to be completed. What makes hazard identification of ionizing radiation difficult, particularly in the case of carcinogenic effect, is the difficulty in distinguishing radiation-induced cancer from other cancers with respect to clinicopathological features and molecular biological characteristics. Actually, it is suspected that radiation-induced carcinogenesis involves mechanisms not specific for radiation, such as oxidative stress. Excess risk per dose in medium-high dose ranges can be extrapolated to a low-dose range if dose-response can be described by the linear-non-threshold model. The cancer risk data of atomic-bomb survivors describes leukemia risk with a linear-quadratic (LQ) model and solid-cancer risk with linear non-threshold (LNT) model. The LQ model for leukemia and the LNT model for solid cancer correspond to the two-hit model and the one-hit model, respectively. Although the one-hit model is an unlikely dose-response for carcinogenesis, there is no convincing epidemiological evidence supporting the LQ model or non-threshold model for solid cancer. It should be pointed out, however, even if the true dose response is non-linear various noises involved in epidemiological data may mask the truth. In this paper, the potential contribution of epidemiological studies on nuclear workers and residents in high background radiation areas will be discussed. (author)

Low 25-hydroxyvitamin d and risk of type 2 diabetes

DEFF Research Database (Denmark)

Afzal, Shoaib; Bojesen, Stig E; Nordestgaard, Børge G

2013-01-01

Vitamin D deficiency has been implicated in decreased insulin secretion and increased insulin resistance, hallmarks of type 2 diabetes mellitus. We tested the hypothesis that low plasma 25-hydroxyvitamin D [25(OH)D] is associated with increased risk of type 2 diabetes in the general population....

Low-dose aspirin use and the risk of ovarian cancer in Denmark

DEFF Research Database (Denmark)

Baandrup, Lone; Kjaer, S K; Olsen, J H

2015-01-01

BACKGROUND: A comprehensive body of evidence has shown that aspirin has cancer-preventive effects, particularly against gastrointestinal cancer, but its effects on the risk of ovarian cancer are less well established. This nationwide case-control study examined the association between low......-dose aspirin and the risk of ovarian cancer. PATIENTS AND METHODS: We identified all patients in the Danish Cancer Registry aged 30-84 years old with a histologically verified first diagnosis of epithelial ovarian cancer during 2000-2011. Each patient was sex- and age-matched to 15 population controls using...... risk-set sampling. Prescription use, comorbidity, reproductive history, and demographic characteristics data were obtained from nationwide registries. The use of low-dose (75-150 mg) aspirin was defined according to the dose as well as the duration and consistency of use. Conditional logistic...

Comparison between visual and computerized cardiotocography in low risk pregnancy

International Nuclear Information System (INIS)

Mirghani, Hisham M.; Khair, Howaida

2005-01-01

To compare between visual and computerized cardiotocography (cCTG) in low-risk pregnant women in predicting pregnancy outcome. One hundred and fifty-three consecutive computerized fetal heart tracings were recorded from non-laboring pregnant women at >/- 30 weeks gestation. All traces were reviewed by 2 experienced obstetricians. The study was carried out at Al-Ain Medical District, United Arab Emirates, between August 2004 and December 2004. Of the 153 pregnant women, 11 (7.2%) were delivered by cesarean section. The interobserver agreement was 0.60. The observers cCTG agreement were 0.48 and 0.45. The difference in cesarean section rate was not statistically significant. Observers interpretation and cCTG did not correlate well with Apgar score at 5 minutes and admission to special care baby unit. Computerized CTG has little advantage over conventional CTG in the prediction of Apgar score and need for neonatal intensive care unit admission in a low-risk population. (author)

Second International MELODI Workshop on Low Dose Risk Research - Slides of the presentations

International Nuclear Information System (INIS)

Repussard, J.; Weiss, W.; Quintana Trias, O.; Rosario Perez, M. del; Andersen, M.; Rudiger Trott, K.; Ottolenghi, A.; Smyth, V.; Graw, J.; Little, M.P.; Yonai, S.; Barcellos-Hoff, M.H.; Bouffler, S.; Chevillard, S.; Jeggo, P.; Sabatier, L.; Baatout, S.; Niwa, O.; Oesch, F.; Atkinson, M.; Averbeck, D.; Lloyd, D.; O'Neill, P.

2011-01-01

The MELODI (Multidisciplinary European Low Dose Initiative) mission is to impulse low dose risk research in Europe through a strategic research agenda (SRA) and road-map of priorities. The last presentation is dedicated to the SRA and its preference research programs. The other presentations deal principally with the low-dose exposure in medical uses of ionizing radiations, radiosensitivity, radiation-induced cataracts, or epidemiology and radiobiology of cardiovascular disease. This document is composed of the slides of the presentations

A long-term risk-benefit analysis of low-dose aspirin in primary prevention.

Science.gov (United States)

Wu, I-Chen; Hsieh, Hui-Min; Yu, Fang-Jung; Wu, Meng-Chieh; Wu, Tzung-Shiun; Wu, Ming-Tsang

2016-02-01

The long-term risk-benefit effect of occasional and regular use of low-dose aspirin (≤ 100 mg per day) in primary prevention of vascular diseases and cancers was calculated. One representative database of 1 000 000 participants from Taiwan's National Health Insurance scheme in 1997-2000 was used. The potential study subjects were those aged 30-95 years, were found not to have been prescribed aspirin before 1 January 2000, but to have first been prescribed low-dose aspirin (≤ 100 mg per day) after that date and were followed up to 31 December 2009. Participants prescribed low-dose aspirin risk. A total of 1720 pairs were analysed. During the study period, haemorrhage and ischaemia occurred in 25 (1·45%) and 67 participants (3·90%) in occasional users and 69 (4·01%) and 100 participants (5·81%) in regular users, whereas cancer occurred in 32 participants (1·86%) in occasional users and 26 participants (1·51%) in regular users. The crude and adjusted net clinical risks of low-dose aspirin use between the two frequency of users (≥ 80% vs. prevention against major vascular diseases and cancer. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

Implications of effects ''adaptive response'', ''low-dose hypersensitivity'' und ''bystander effect'' for cancer risk at low doses and low dose rates

International Nuclear Information System (INIS)

Jacob, P

2006-01-01

A model for carcinogenesis (the TSCE model) was applied in order to examine the effects of ''Low-dose hypersensitivity (LDH)'' and the ''Bystander effect (BE)'' on the derivation of radiation related cancer mortality risks. LDH has been discovered to occur in the inactivation of cells after acute exposure to low LET radiation. A corresponding version of the TSCE model was applied to the mortality data on the Abomb survivors from Hiroshima and Nagasaki. The BE has been mainly observed in cells after exposure to high LET radiation. A Version of the TSCE model which included the BE was applied to the data on lung cancer mortality from the workers at the Mayak nuclear facilities who were exposed to Plutonium. In general an equally good description of the A-bomb survivor mortality data (for all solid, stomach and lung tumours) was found for the TSCE model and the (conventional) empirical models but fewer parameters were necessary for the TSCE model. The TSCE model which included the effects of radiation induced cell killing resulted in non-linear dose response curves with excess relative risks after exposure at young ages that were generally lower than in the models without cell killing. The main results from TSCE models which included cell killing described by either conventional survival curves or LDH were very similar. A sub multiplicative effect from the interaction of smoking and exposure to plutonium was found to result from the analysis of the Mayak lung cancer mortality data. All models examined resulted in the predominant number of Mayak lung cancer deaths being ascribed to smoking. The interaction between smoking and plutonium exposures was found to be the second largest effect. The TSCE model resulted in lower estimates for the lung cancer excess relative risk per unit plutonium dose than the empirical risk model, but this difference was not found to be statistically significant. The excess relative risk dose responses were linear in the empirical model and

Health effect of low dose/low dose rate radiation

International Nuclear Information System (INIS)

Kodama, Seiji

2012-01-01

The clarified and non-clarified scientific knowledge is discussed to consider the cause of confusion of explanation of the title subject. The low dose is defined roughly lower than 200 mGy and low dose rate, 0.05 mGy/min. The health effect is evaluated from 2 aspects of clinical symptom/radiation hazard protection. In the clinical aspect, the effect is classified in physical (early and late) and genetic ones, and is classified in stochastic (no threshold value, TV) and deterministic (with TV) ones from the radioprotection aspect. Although the absence of TV in the carcinogenic and genetic effects has not been proved, ICRP employs the stochastic standpoint from the safety aspect for radioprotection. The lowest human TV known now is 100 mGy, meaning that human deterministic effect would not be generated below this dose. Genetic deterministic effect can be observable only in animal experiments. These facts suggest that the practical risk of exposure to <100 mGy in human is the carcinogenesis. The relationship between carcinogenic risk in A-bomb survivors and their exposed dose are found fitted to the linear no TV model, but the epidemiologic data, because of restriction of subject number analyzed, do not always mean that the model is applicable even below the dose <100 mGy. This would be one of confusing causes in explanation: no carcinogenic risk at <100 mGy or risk linear to dose even at <100 mGy, neither of which is scientifically conclusive at present. Also mentioned is the scarce risk of cancer in residents living in the high background radiation regions in the world in comparison with that in the A-bomb survivors exposed to the chronic or acute low dose/dose rate. Molecular events are explained for the low-dose radiation-induced DNA damage and its repair, gene mutation and chromosome aberration, hypothesis of carcinogenesis by mutation, and non-targeting effect of radiation (bystander effect and gene instability). Further researches to elucidate the low dose

A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women.

Science.gov (United States)

Brehm, Bonnie J; Seeley, Randy J; Daniels, Stephen R; D'Alessio, David A

2003-04-01

Untested alternative weight loss diets, such as very low carbohydrate diets, have unsubstantiated efficacy and the potential to adversely affect cardiovascular risk factors. Therefore, we designed a randomized, controlled trial to determine the effects of a very low carbohydrate diet on body composition and cardiovascular risk factors. Subjects were randomized to 6 months of either an ad libitum very low carbohydrate diet or a calorie-restricted diet with 30% of the calories as fat. Anthropometric and metabolic measures were assessed at baseline, 3 months, and 6 months. Fifty-three healthy, obese female volunteers (mean body mass index, 33.6 +/- 0.3 kg/m(2)) were randomized; 42 (79%) completed the trial. Women on both diets reduced calorie consumption by comparable amounts at 3 and 6 months. The very low carbohydrate diet group lost more weight (8.5 +/- 1.0 vs. 3.9 +/- 1.0 kg; P fat (4.8 +/- 0.67 vs. 2.0 +/- 0.75 kg; P low fat diet group. Mean levels of blood pressure, lipids, fasting glucose, and insulin were within normal ranges in both groups at baseline. Although all of these parameters improved over the course of the study, there were no differences observed between the two diet groups at 3 or 6 months. beta- Hydroxybutyrate increased significantly in the very low carbohydrate group at 3 months (P = 0.001). Based on these data, a very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.

Views of Low-Income Women of Color at Increased Risk for Breast Cancer.

Science.gov (United States)

E Anderson, Emily; Tejada, Silvia; B Warnecke, Richard; Hoskins, Kent

2018-01-01

Individual risk assessment (IRA) for breast cancer may increase adherence to risk-appropriate screening and prevention measures. However, knowledge gaps exist regarding how best to communicate IRA results and support women at increased risk in future health care decisions, in part because patients conceptualize and make meaning of risk differently from the medical community. Better understanding the views of low-income women of color identified as being at increased risk for breast cancer can inform efforts to conduct IRA in an ethical and respectful manner. We conducted in-depth interviews with 13 low-income African American and Latina women who receive care at a federally qualified health center (FQHC) and had recently learned of their increased risk for breast cancer. These interviews explored their experience of the IRA process, their interpretation of what being at increased risk means, and their reactions to provider recommendations. Eight key themes were identified. We conclude with recommendations for the implementation of IRA for breast cancer in underserved primary care settings.

Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

Science.gov (United States)

Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Bulgiba, Awang; Majid, Hazreen Abdul

2015-01-01

We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

Prediction of Cardiovascular Disease Risk among Low-Income Urban Dwellers in Metropolitan Kuala Lumpur, Malaysia

Directory of Open Access Journals (Sweden)

Tin Tin Su

2015-01-01

Full Text Available We aimed to predict the ten-year cardiovascular disease (CVD risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM. Altogether 882 adults (≥30 years old with no CVD history were randomly selected. The classic FRS model (figures in parentheses are from the modified model revealed that 20.5% (21.8% and 38.46% (38.9% of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

Time to improve statin prescription guidelines in low-risk patients?

NARCIS (Netherlands)

Balder, Jan W.; de Vries, Jeroen K.; Mulder, Douwe J.; Kamphuisen, Pieter W.

Background The challenge of the primary prevention of cardiovascular disease (CVD) is to identify patients who would benefit from treatment with statins. Statins are currently prescribed to many patients, even those at a low 10-year risk of CVD. These latter patients may not be eligible for statins

Low Molecular Weight Heparin Improves Endothelial Function in Pregnant Women at High Risk of Preeclampsia.

Science.gov (United States)

McLaughlin, Kelsey; Baczyk, Dora; Potts, Audrey; Hladunewich, Michelle; Parker, John D; Kingdom, John C P

2017-01-01

Low molecular weight heparin (LMWH) has been investigated for the prevention of severe preeclampsia, although the mechanisms of action are unknown. The objective of this study was to investigate the cardiovascular effects of LMWH in pregnant women at high risk of preeclampsia. Pregnant women at high risk of preeclampsia (n=25) and low-risk pregnant controls (n=20) at 22 to 26 weeks' gestation underwent baseline cardiovascular assessments. High-risk women were then randomized to LMWH or saline placebo (30 mg IV bolus and 1 mg/kg subcutaneous dose). Cardiovascular function was assessed 1 and 3 hours post randomization. The in vitro endothelial effects of patient serum and exogenous LMWH on human umbilical venous endothelial cells were determined. High-risk women demonstrated a reduced cardiac output, high resistance hemodynamic profile with impaired radial artery flow-mediated dilation compared with controls. LMWH increased flow-mediated dilation in high-risk women 3 hours after randomization compared with baseline and increased plasma levels of placental growth factor, soluble fms-like tyrosine kinase-1, and myeloperoxidase. Serum from high-risk women impaired endothelial cell angiogenesis and increased PlGF-1 and PlGF-2 transcription compared with serum from low-risk controls. Coexposure of high-risk serum with LMWH improved the in vitro angiogenic response such that it was equivalent to that of low-risk serum and promoted placental growth factor secretion. LMWH improves maternal endothelial function in pregnant women at high risk of developing preeclampsia, possibly mediated through increased placental growth factor bioavailability. © 2016 American Heart Association, Inc.

Home birth or short-stay hospital birth in a low risk population in The Netherlands.

NARCIS (Netherlands)

Wiegers, T.A.; Zee, J. van der; Kerssens, J.J.; Keirse, M.J.N.C.

1998-01-01

In the Netherlands women with low risk pregnancies can choose whether they want to give birth at home or in hospital, under the care of their own primary caregiver. The majority of these women prefer to give birth at home, but over the last few decades an increasing number of low risk women have

An investigation of low ergonomics risk awareness, among staffs at early product development phase in Malaysia automotive industries

Science.gov (United States)

Aziz, Fazilah Abdul; Razali, Noraini; Najmiyah Jaafar, Nur

2016-02-01

Currently there are many automotive companies still unable to effectively prevent consequences of poor ergonomics in their manufacturing processes. This study purpose is to determine the surrounding factors that influence low ergonomics risk awareness among staffs at early product development phase in Malaysia automotive industry. In this study there are four variables, low ergonomic risk awareness, inappropriate method and tools, tight development schedule and lack of management support. The survey data were gathered from 245 respondents of local automotive companies in Malaysia. The data was analysed through multiple regression and moderated regression using the IBM SPSS software. Study results revealed that low ergonomic risk awareness has influenced by inappropriate method and tool, and tight development schedule. There were positive linear relationships between low ergonomic risk awareness and inappropriate method and tools, and tight development schedule. The more inappropriate method and tools applied; the lower their ergonomic risk awareness. The more tight development schedule is the lower ergonomic risk awareness. The relationship between low ergonomic risk awareness and inappropriate method and tools depends on staff's age, and education level. Furthermore the relationship between low ergonomic risk awareness and tight development schedule depends on staff's working experience and number of project involvement. The main contribution of this paper was identified the number of factors of low ergonomics risk awareness and offers better understanding on ergonomics among researchers and automotive manufacturer's employees during product development process.

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

Science.gov (United States)

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

2017-07-18

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

Low physical activity work-related and other risk factors increased the risk of poor physical fitness in cement workers

Directory of Open Access Journals (Sweden)

Ditha Diana

2009-09-01

Full Text Available Aim Low physical activity causes poor physical fitness, which leads to low productivity. The objective of this study was to determine the effects of low work-related physical activity and other risk factors on physical fitness.Methods This study was done in February 2008. Subjects were workers from 15 departments in PT Semen Padang, West Sumatera (Indonesia. Data on physical activities were collected using the questionnaire from the Student Field Work I Guidebook and Hypertension – Geriatric Integrated Program of the Faculty of Medicine, Universitas Indonesia2003. Physical fitness was measured using the Harvard Step Test.Results A number of 937 male workers aged 18 – 56 years participated in this study. Poor physical fitness was found in 15.9% of the subjects. Low work-related physical activity, smoking, lack of exercise, hypertension, diabetes mellitus, and asthma were dominant risk factors related to poor physical fi tness. Subjects with low compared to high work-related activity had a ten-fold risk of poor physical fitness [adjusted odds ratio (ORa = 10.71; 95% confidence interval (CI = 4.71–24.33]. In term of physical exercise, subjects who had no compared to those who had physical exercise had a six-fold risk of poor physical fitness (ORa = 6.30; 95%CI = 3.69-10.75.Conclusion Low work-related physical activities, smoking, lack of exercise, hypertension, diabetes mellitus, and sthma were correlated to poor physical fi tness. It is, among others, therefore necessary to implement exercises for workers with poor physical fitness. (Med J Indones. 2009;18:201-5Key words: exercise test, occupational healths, physical fitness

CANCER RISKS ATTRIBUTABLE TO LOW DOSES OF IONIZING RADIATION - ASSESSING WHAT WE REALLY KNOW?

Science.gov (United States)

Cancer Risks Attributable to Low Doses of Ionizing Radiation - What Do We Really Know?AbstractHigh doses of ionizing radiation clearly produce deleterious consequences in humans including, but not exclusively, cancer induction. At very low radiation doses the situatio...

Mother-child interactions in depressed children and children at high risk and low risk for future depression.

Science.gov (United States)

Dietz, Laura J; Birmaher, Boris; Williamson, Douglas E; Silk, Jennifer S; Dahl, Ronald E; Axelson, David A; Ehmann, Mary; Ryan, Neal D

2008-05-01

To compare mother-child interactions and parenting styles in families of children with major depressive disorder, youths at high risk for depression, and healthy controls. Currently depressed (n = 43), high-risk (n = 28), and healthy control (n = 41) youths and their mothers engaged in a standardized videotaped problem-solving interaction. Measures of affect and behavior for both mothers and children were obtained, in addition to global measures of parenting. Depressed children demonstrated more negativity and less positivity in dyadic interactions than did children at high risk and control children. Mothers of depressed children were more disengaged than control mothers. Exploratory repeated-measures analyses in a subgroup of depressed children (n = 16) suggested mother-child interactions do not significantly change when children recover from depression. Children at high risk demonstrated less positivity in dyadic interactions than did controls. Mothers with a history of major depressive disorder and mothers with higher current depressive symptoms demonstrated patterns of disengagement and low control in interactions with children. Mother-child interactions in depressed youths are marked by maternal disengagement and low child positivity that may not improve when children recover. The bidirectional effects of maternal disengagement and low levels of child positivity may precede onset of major depressive disorder in children and serve as risk factors for recurrent depression in youths.

Low fitness is associated with abdominal adiposity and low-grade inflammation independent of BMI

DEFF Research Database (Denmark)

Wedell-Neergaard, Anne-Sophie; Eriksen, Louise; Grønbæk, Morten

2018-01-01

OBJECTIVE: Up to 30% of obese individuals are metabolically healthy. Metabolically healthy obese (MHO) individuals are characterized by having low abdominal adiposity, low inflammation level and low risk of developing metabolic comorbidity. In this study, we hypothesize that cardiorespiratory fit...... to be inversely associated with both abdominal adiposity and low-grade inflammation independent of BMI. These data suggest that, in spite of BMI, high fitness levels lead to a reduction in abdominal fat mass and low-grade inflammation.......OBJECTIVE: Up to 30% of obese individuals are metabolically healthy. Metabolically healthy obese (MHO) individuals are characterized by having low abdominal adiposity, low inflammation level and low risk of developing metabolic comorbidity. In this study, we hypothesize that cardiorespiratory...... fitness (fitness) is a determinant factor for the MHO individuals and aim to investigate the associations between fitness, abdominal adiposity and low-grade inflammation within different BMI categories. METHOD: Data from 10,976 individuals from the general population, DANHES 2007-2008, on waist...

New low back pain in nurses: work activities, work stress and sedentary lifestyle.

Science.gov (United States)

Yip, Vera Yin Bing

2004-05-01

Low back pain is common among nurses. Previous studies have shown that the risk of low back pain increases rapidly with greater amounts of physical work and psychological stress, but is inversely related to leisure activities. However, these previous studies were predominantly retrospective in design and not many took account of three factors simultaneously. This 12-month prospective study examined the relationships between work activities, work stress, sedentary lifestyle and new low back pain. A total of 144 nurses from six Hong Kong district hospitals completed a face-to-face baseline interview, which was followed-up by a telephone interview. The main study measures were demographic characteristics, work activities, work stress, physical leisure activities and the nature of new low back pain during the 12-month follow-up period. Level of work stress, quality of relationships at work, level of enjoyment experienced at work, and work satisfaction were self-reported. Fifty-six (38.9%) nurses reported experiencing new low back pain. Sedentary leisure time activity was not associated with new low back pain. Being comparatively new on a ward (adjusted relative risk 2.90), working in bending postures (adjusted relative risk 2.76) and poor work relationships with colleagues (adjusted relative risk 2.52) were independent predictors of new low back pain. The findings of this study suggest that low back pain is a common problem in the population of nurses in Hong Kong. Being comparatively new on a ward, bending frequently during work and having poor work relationships with colleagues are independent predictors of new low back pain. Training for high-risk work activities and ergonomic assessment of awkward work postures are essential. Moreover, relaxation and team-building workshops for nurses, especially those who are less experienced in the type of work on their current ward, are recommended.

Risk comparisons relevant to sea disposal of low level radioactive waste

International Nuclear Information System (INIS)

1993-11-01

This document contains estimates of, and comparisons among, risks to human health posed by exposures to radionuclides, including those associated with low level radioactive wastes dumping at sea, and organic chemical contaminants resulting from seafood consumption. This study was conducted at the request of the Contracting Parties to the Convention on the Prevention of Marine Pollution by Dumping of Wastes and Other Matter (the London Convention 1972, formerly referred to as the London Dumping Convention) as a component of a review of the wider political, legal, economic and social aspects of sea dumping of radioactive wastes. The highest potential risks associated with seafood consumption are generally those resulting from exposures to naturally occurring radionuclides. In some representations, the potential risks associated with polychlorinated biphenyls (ΣPCB) and dieldrin in seafood are of the same order as those arising from naturally occurring radionuclides. The peak annual risks resulting from low level radioactive waste dumping at sea, assessed on any rational basis, are at least two orders of magnitude lower than those associated with the ingestion of common organic chemical contaminants in seafood. 47 refs, 4 figs, 13 tabs

Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures.

Science.gov (United States)

Armstrong, Joanne C; Kozhimannil, Katy B; McDermott, Patricia; Saade, George R; Srinivas, Sindhu K

2016-02-01

This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use. Copyright © 2016 Elsevier Inc. All rights reserved.

Low-beta investment strategies

OpenAIRE

Korn, Olaf; Kuntz, Laura-Chloé

2015-01-01

This paper investigates investment strategies that exploit the low-beta anomaly. Although the notion of buying low-beta stocks and selling high-beta stocks is natural, a choice is necessary with respect to the relative weighting of high-beta stocks and low-beta stocks in the investment portfolio. Our empirical results for US large-cap stocks show that this choice is very important for the risk-return characteristics of the resulting portfolios and their sensitivities to common risk factors. W...

High- and Low-Risk Characteristics of Youth: The Five Cs of Competency.

Science.gov (United States)

McWhirter, J. Jeffries; And Others

1994-01-01

Identifies and discusses five basic skill strengths or skill deficits that mark critical difference between low-risk and high-risk youth. The "Five Cs of Competency" described include critical school competencies, concept of self and self-esteem, communication skills, coping ability, and control. Contends that these characteristics discriminate…

Risk of lung cancer in animals following low exposures to Radon-222 progeny

International Nuclear Information System (INIS)

Duport, P.; Monchaux, G.; Morlier, J.P.

1997-01-01

Owing to the facts that a) large uncertainties affect the epidemiology of radon progeny-induced lung cancer in humans (especially at low exposures), and b) the rat is a good model for studying the carcinogenicity of radon progeny in humans, the risk of lung cancer following low exposures to low concentrations of radon progeny can be estimated from data obtained in the laboratory on rats exposed under controlled conditions. From the limited set of laboratory data on the induction of lung cancer in laboratory rats it appears that, at low exposures, the risk of lung cancer decreases with decreasing concentration, and that exposures of the order of 25 WLM, at an exposure rate of 2 WL do not produce any excess lung cancers. Since 20 WLM is a lifetime exposure comparable to those expected in occupational or indoors conditions and 2 WL is an exposure rate about 20 times higher dm current occupational exposures rates and 100 times higher than indoor ones, these observations may be indicative of threshold conditions for the induction of lung cancer by radon progeny. (author)

Low-risk diet for colorectal cancer in Italy.

Science.gov (United States)

Calza, S; Ferraroni, M; La Vecchia, C; Franceschi, S; Decarli, A

2001-12-01

An innovative approach was used to define a low-risk diet for colorectal cancer from a multicentric case-control study of 1953 incident cases and 4154 hospital controls from Italy. A logistic regression model was fitted on the reported intake of five macronutrients, and the estimated coefficients were used to compute a diet-related logistic risk score (LRS). The mean of LRS within risk decile ranged from 0.89 to 1.86. Total energy intake and absolute consumption of each macronutrient increased with increasing LRS. In relative terms, however, starch intake showed an almost threefold increase across subsequent score levels, while a decline was observed for unsaturated fat, sugar and protein. Saturated fat consumption remained fairly stable in relative terms. When food groups were considered, bread and cereals dishes, cakes and desserts and refined sugar were positively associated, while the consumption of vegetables, fruit, fish, poultry and olive oils was inversely associated with LRS.

7 CFR 3052.530 - Criteria for a low-risk auditee.

Science.gov (United States)

2010-01-01

... management of Federal awards and provide a waiver. (c) There were no deficiencies in internal control which... periods) in which they were classified as Type A programs: (1) Internal control deficiencies which were... 7 Agriculture 15 2010-01-01 2010-01-01 false Criteria for a low-risk auditee. 3052.530 Section...

Use of advanced treatment technologies among men at low risk of dying from prostate cancer.

Science.gov (United States)

Jacobs, Bruce L; Zhang, Yun; Schroeck, Florian R; Skolarus, Ted A; Wei, John T; Montie, James E; Gilbert, Scott M; Strope, Seth A; Dunn, Rodney L; Miller, David C; Hollenbeck, Brent K

2013-06-26

The use of advanced treatment technologies (ie, intensity-modulated radiotherapy [IMRT] and robotic prostatectomy) for prostate cancer is increasing. The extent to which these advanced treatment technologies have disseminated among patients at low risk of dying from prostate cancer is uncertain. To assess the use of advanced treatment technologies, compared with prior standards (ie, traditional external beam radiation treatment [EBRT] and open radical prostatectomy) and observation, among men with a low risk of dying from prostate cancer. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified a retrospective cohort of men diagnosed with prostate cancer between 2004 and 2009 who underwent IMRT (n = 23,633), EBRT (n = 3926), robotic prostatectomy (n = 5881), open radical prostatectomy (n = 6123), or observation (n = 16,384). Follow-up data were available through December 31, 2010. The use of advanced treatment technologies among men unlikely to die from prostate cancer, as assessed by low-risk disease (clinical stage ≤T2a, biopsy Gleason score ≤6, and prostate-specific antigen level ≤10 ng/mL), high risk of noncancer mortality (based on the predicted probability of death within 10 years in the absence of a cancer diagnosis), or both. In our cohort, the use of advanced treatment technologies increased from 32% (95% CI, 30%-33%) to 44% (95% CI, 43%-46%) among men with low-risk disease (P risk of noncancer mortality (P use of these advanced treatment technologies among men with both low-risk disease and high risk of noncancer mortality increased from 25% (95% CI, 23%-28%) to 34% (95% CI, 31%-37%) (P use of advanced treatment technologies for men unlikely to die from prostate cancer increased from 13% (95% CI, 12%-14%), or 129.2 per 1000 patients diagnosed with prostate cancer, to 24% (95% CI, 24%-25%), or 244.2 per 1000 patients diagnosed with prostate cancer (P risk disease, high risk of noncancer mortality, or both, the use of

CAREM-25: a low-risk nuclear option

International Nuclear Information System (INIS)

Baron, Jorge H.; Nunez Mac Leod, J.E.; Rivera, S.S.

2000-01-01

The future use of nuclear energy for electricity production is assumed as a viable alternative at present, mainly taking into account the high environmental impact of the fossil fuel alternatives (greenhouse effect, acid rain). In the worldwide context, however, it is desirable that the next generation of nuclear power stations to be safer than the present ones. To demonstrate the safety level of a particular nuclear installation, the Risk Analysis (or Probabilistic Safety Assessment) is the most appropriate tool. Quantitative risk estimations can be performed with PSA. The risk can be split as the product of two factors: the first one takes into account the occurrence probability of accidental sequences that involve the release of radioactive material, and the second takes into account the magnitude and consequences of such a release. In the present work, the reduction of both factors is analyzed. The probability is reduced by the use of simpler and more reliable systems to perform the safety functions, and the consequence by the use of small power production units, provided with passive mitigation systems and long response times. The work is illustrated with a risk comparison for electricity production with CAREM-25 units, towards classic production units (Atucha II). The results are based on PSAs performed for both plants. The conclusions show an effective risk reduction (both in probability and in consequence) for the innovative CAREM-25 plant, coming to doses so low as to prevent any acute effect in the nearby population. (author)

The selection of low-risk design guidelines for energetic events

International Nuclear Information System (INIS)

Fergusson, Donald; Marchaterre, John; Graham, John

1982-01-01

This paper recommends the establishment of specific design guidelines for protection against potential, but low probability, energetic events. These guidelines recognize the plant protective features incorporated to prevents such events, as well as the inherent capability of the plant to accommodate a certain level of energy release. Further, their application is recommended within the context of necessary standardized and agreed upon acceptance criteria which are less restrictive than ASME code requirements. The paper provides the background upon which the selection of the design is made, including the characterization of energetic events dependent on various core-design parameters, and including the necessity of a low-risk design balanced between prevention of accidents and the mitigation of consequences

Understanding and characterisation of the risks to human health from exposure to low levels of radiation

International Nuclear Information System (INIS)

Goodhead, D. T.

2009-01-01

Exposure to ionising radiation can lead to a wide variety of health effects. Cancer is judged to be the main risk from radiation at low doses and low dose rates, and controlling this risk has been the main factor in developing radiation protection practice. Conventional paradigms of radiobiology and radiation carcinogenesis have served to guide extrapolations of epidemiological data on exposed human populations, so as to estimate risks at low doses and low dose rates, to other types of ionising radiation and to non-uniform exposures. These paradigms are founded on a century of experimental and theoretical studies, but nevertheless there remain many uncertainties. Major assumptions and simplifications have been introduced to achieve a practical system of additive doses (and implied risks) for radiation protection. Advancing epidemiological studies and experimental research continue to reduce uncertainties in some areas while, in others, they raise new challenges to the generality and applicability of the conventional paradigms. (authors)

Decentralized substations for low-temperature district heating with no Legionella risk, and low return temperatures

International Nuclear Information System (INIS)

Yang, Xiaochen; Li, Hongwei; Svendsen, Svend

2016-01-01

To improve energy efficiency and give more access to renewable energy sources, low-temperature district heating (LTDH) is a promising concept to be realized in the future. However, concern about Legionella proliferation restricts applying low-temperature district heating in conventional systems with domestic hot water (DHW) circulation. In this study, a system with decentralized substations was analysed as a solution to this problem. Furthermore, a modification for the decentralized substation system were proposed in order to reduce the average return temperature. Models of conventional system with medium-temperature district heating, decentralized substation system with LTDH, and innovative decentralized substation system with LTDH were built based on the information of a case building. The annual distribution heat loss and the operating costs of the three scenarios were calculated and compared. From the results, realizing LTDH by the decentralized substation unit, 30% of the annual distribution heat loss inside the building can be saved compared to a conventional system with medium-temperature district heating. Replacing the bypass pipe with an in-line supply pipe and a heat pump, the innovative decentralized substation system can reduce distribution heat loss by 39% compared to the conventional system and by 12% compared to the normal decentralized substation system with bypass. - Highlights: • The system of decentralized substations can realize low-temperature district heating without running the risk of Legionella. • Decentralized substations help reduce the distribution heat loss inside the building compared to conventional system. • A new concept that can reduce the return temperature for district heating is proposed and analysed.

Willingness to pay for a cure of low-risk melanoma patients in Germany.

Science.gov (United States)

Augustin, Matthias; Blome, Christine; Forschner, Andrea; Gutzmer, Ralf; Hauschild, Axel; Heinzerling, Lucie; Livingstone, Elisabeth; Loquai, Carmen; Schadendorf, Dirk; Utikal, Jochen; Wagner, Tobias; Wilden, Sophia; Kähler, Katharina C

2018-01-01

Malignant melanoma is potentially life-threatening but in most cases curable if detected early. Willingness to pay (WTP) is a preference-based construct that reflects burden of disease by assessment of the monetary value for a hypothetical cure from disease. Since WTP (directly as total amount of money) has not been assessed so far in patients with low risk melanoma, it was interesting to gain insights in this patient population and then, in a second step, compare it directly with the WTP of their treating dermato-oncologists. WTP was assessed in 125 patients with low-risk melanoma and additionally in 105 treating physicians, asking for the one-time and continuous payments they would be willing to make for a sustainable cure, both as absolute sums and as percentages of monthly income. The median WTP based on one-time payment was €10,000 for patients and €100,000 for physicians; relative numbers were 100% versus 300% of monthly income. For continuous monthly payments, WTP was €500 for patients and €1000 for physicians, relative numbers 25% and 50% of income, respectively. Even after controlling for income differences, there was a significantly higher WTP in physicians for all four questions. Compared to patients with chronic skin diseases such as vitiligo, rosacea, atopic eczema and psoriasis, patients with low-risk melanoma showed a significantly higher WTP. Our data suggest that there is a relevant burden of disease even in patients with low-risk tumors. Higher WTP of physicians underlines the prevalence of differences in disease perception.

RISK FACTORS FOR THE EARLY NEONATAL MORTALITY IN NEWBORNS WITH VERY LOW AND EXTREMELY LOW BIRTH WEIGHT

Directory of Open Access Journals (Sweden)

О. V. Lebedeva

2014-01-01

Full Text Available Objective: Our aim was to assess the association of perinatal factors with the early neonatal mortality in newborns with very low (VLBW and extremely low birth weight (ELBW.Methods: The statistical data was carried out, that is analysis of 17 perinatal factors of 28 newborns with an ELBW with gestation of 23–27 weeks and 18 newborns with a VLBW with gestation of 28–32 weeks, who died in the first 7 days of life. The comparison group consisted of 25 newborns with an ELBW and 56 children with a VLBW with gestation of 25–27 and 28–32 weeks, respectively, who survived the early neonatal period. The association of risk factors with the early neonatal mortality was assessed by means of a multiple-factor logistic regression analysis. A critical p error level was set equal to 0.05. Results: In newborns with a VLBW the increased risk of the early neonatal mortality depended on a gestation term (OR 4.40, 95% CI 1.56–11.71; р = 0.002 and emergency Caesarean section (OR 7.48, 95% CI 1.28–43.74; р = 0.008. A vaginal birth increased the survival chance (OR 0.12, 95% CI 0.01–0.86; р = 0.032. Newborns with an ELBW had the following factors of the increased risk of the early neonatal mortality: gestational age (OR 2.86, 95% CI 1.06–7.73; р = 0.038, Apgar score at the 5th minute (OR 1.91, 95% CI 0.99–3.69; р = 0.050 and presence of chorioamnionitis (OR 5.45, 95% CI 1.0–29.53; p = 0.048. An elective Caesarean section increased the survival chance (OR 0.02, 95% CI 0.001–0.44; p = 0.048. Conclusion: Summarizing the obtained data, we can conclude that besides a gestational age the risk of early neonatal mortality in newborns with a VLBW may be increased due to the emergency Caesarean section, with an ELBW — due to a low Apgar score at the 5th minute and the presence of mother's chorioamnionitis. A vaginal birth in newborns with a VLBW and an elective Caesarean section in children with an ELBW increase survival chances.

Investigation of HOXA9 promoter methylation as a biomarker to distinguish oral cancer patients at low risk of neck metastasis

International Nuclear Information System (INIS)

Uchida, Kenichiro; Veeramachaneni, Ratna; Huey, Bing; Bhattacharya, Aditi; Schmidt, Brian L; Albertson, Donna G

2014-01-01

Metastasis to the cervical (neck) lymph nodes is one of the most significant clinical factors responsible for death from oral squamous cell carcinoma (SCC). Therefore, the lymph nodes are frequently removed when the tumor is excised (neck dissection), even though the majority of patients will not benefit from the extra surgery. Two subtypes of oral SCC distinguished by the presence of tumor genomic aberrations +3q, -8p, +8q and/or +20 differ in risk for metastasis – high for the 3q8pq20 subtype, harboring one or more of the aberrations and low for the non-3q8pq20 subtype, lacking these alterations. A prior analysis of the literature suggested genes differentially methylated in the two subtypes. Therefore, the goal of this study was to further investigate the methylation status of candidate biomarkers of the non-3q8pq20 subtype, and evaluate their utility for identifying patients at low risk for metastasis. Methylation status of genes in a cohort of 52 oral SCC patients with at least five year follow up was determined by pyrosequencing. Gene expression levels were determined by quantitative RT-PCR. Growth following re-expression of HOXA9 in cultured oral SCC cells was assessed by proliferation and colony formation assays. A pilot study evaluating methylation levels of HOXA9, MT1A and HOXA11 promoters in DNA from 12 tumors (six each of the 3q8pq20 and non-3q8pq20 subtypes) revealed that only HOXA9 was differentially methylated. Significant differences in methylation levels of HOXA9 were observed amongst the 52 oral SCCs with respect to genomic subtype and nodal status (p = 0.014, and p = 0.024, respectively, Wilcoxon rank sum test). High levels of HOXA9 methylation and low levels of expression in oral SCC cell lines were observed compared to HaCaT, a non-tumorigenic keratinocyte cell line. Re-expression of HOXA9 in the SCC4 oral cancer cell line resulted in diminished proliferation and colony formation. HOXA9 methylation is frequent in oral cancers and levels are

High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study.

Science.gov (United States)

Hoogendoorn, W E; Bongers, P M; de Vet, H C W; Ariëns, G A M; van Mechelen, W; Bouter, L M

2002-05-01

To determine whether physical and psychosocial load at work influence sickness absence due to low back pain. The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for musculoskeletal disorders. Workers from 21 companies located throughout The Netherlands participated in the part of this study on sickness absence due to low back pain. The study population consisted of 732 workers with no sickness absences of 3 days or longer due to low back pain in the 3 months before the baseline survey and complete data on the reasons for absences during the follow up period. The mean (range) period of follow up in this group was 37 (7-44) months. Physical load at work was assessed by analyses of video recordings. Baseline information on psychosocial work characteristics was obtained by a questionnaire. Data on sickness absence were collected from company records. The main outcome measure was the rate of sickness absences of 3 days or longer due to low back pain during the follow up period. After adjustment of the work related physical and psychosocial factors for each other and for other potential determinants, significant rate ratios ranging from 2.0 to 3.2 were found for trunk flexion, trunk rotation, lifting, and low job satisfaction. A dose-response relation was found for trunk flexion, but not for trunk rotation or lifting. Non-significant rate ratios of about 1.4 were found for low supervisor support and low coworker support. Quantitative job demands, conflicting demands, decision authority, and skill discretion showed no relation with sickness absence due to low back pain. Flexion and rotation of the trunk, lifting, and low job satisfaction are risk factors for sickness absence due to low back pain. Some indications of a relation between low social support, either from supervisors or coworkers, and sickness absence due to low back pain are also present.

Predictors of low diabetes risk perception in a multi-ethnic cohort of women with gestational diabetes mellitus.

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Mukerji, G; Kainth, S; Pendrith, C; Lowe, J; Feig, D S; Banerjee, A T; Wu, W; Lipscombe, L L

2016-10-01

To determine what proportion of women with gestational diabetes underestimate their diabetes risk and identify factors associated with low diabetes risk perception. Participants included pregnant adult women with gestational diabetes between 2009 and 2012 across seven diabetes clinics in Ontario, Canada. Data were collected through chart review and a survey that included a diabetes risk perception question. Of the 614 of 902 women (68% response rate) with gestational diabetes, 89% correctly responded that gestational diabetes increases the risk for developing diabetes. However, 47.1% of women perceived themselves to be at low risk for developing diabetes within 10 years. On multivariable analysis, BMI gestational diabetes history, absent diabetes family history and absent insulin use were appropriately associated with low diabetes risk perception. However, compared with Caucasian ethnicity, high-risk ethnicity (Aboriginal, Latin American, West Indian, South Asian, Middle Eastern, Filipino, Black, Pacific Islander) [odds ratio (OR) 2.07; 95% CI 1.30-3.31] and East and South East Asian ethnicity (OR 2.01; 1.10-3.67) were associated with low diabetes risk perception. After further adjustment for immigration, only high-risk ethnicity remained a predictor of low diabetes risk perception (OR 1.86; 1.09-3.19), whereas East and South East Asian ethnicity did not (OR 1.67; 0.86-3.22). Although the majority of women recognized gestational diabetes as a risk factor for diabetes, almost half underestimated their personal high diabetes risk despite prenatal care. Furthermore, women from high-risk ethnic groups were more likely to underestimate their risk, even after adjusting for immigration. Interventions tailored to these groups are necessary to enhance perceived diabetes risk. © 2015 Diabetes UK.

Contextual risk factors for low birth weight: a multilevel analysis.

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Gbenga A Kayode

Full Text Available Low birth weight (LBW remains to be a leading cause of neonatal death and a major contributor to infant and under-five mortality. Its prevalence has not declined in the last decade in sub-Saharan Africa (SSA and Asia. Some individual level factors have been identified as risk factors for LBW but knowledge is limited on contextual risk factors for LBW especially in SSA.Contextual risk factors for LBW in Ghana were identified by performing multivariable multilevel logistic regression analysis of 6,900 mothers dwelling in 412 communities that participated in the 2003 and 2008 Demographic and Health Surveys in Ghana.Contextual-level factors were significantly associated with LBW: Being a rural dweller increased the likelihood of having a LBW infant by 43% (OR 1.43; 95% CI 1.01-2.01; P-value <0.05 while living in poverty-concentrated communities increased the risk of having a LBW infant twofold (OR 2.16; 95% CI 1.29-3.61; P-value <0.01. In neighbourhoods with a high coverage of safe water supply the odds of having a LBW infant reduced by 28% (OR 0.74; 95% CI 0.57-0.96; P-value <0.05.This study showed contextual risk factors to have independent effects on the prevalence of LBW infants. Being a rural dweller, living in a community with a high concentration of poverty and a low coverage of safe water supply were found to increase the prevalence of LBW infants. Implementing appropriate community-based intervention programmes will likely reduce the occurrence of LBW infants.

Risk factors for low bone density in pediatric nephrotic syndrome

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Corina Lisa

2011-04-01

Full Text Available Background Disturbances in bone mineral metabolism and side effects of corticosteroid treatment may cause decreased bone density in patients v.ith nephrotic syndrome (NS. Objectives To compare the prevalence oflow bone mineral density (BMD in children with and 'Without NS and to assess the effect of corticosteroid treatment on bone density in NS patients.  Methods We conducted a retrospective, cohort study in children aged 5-18 years diagnosed 'With NS for more than 2 months prior to data collection, and in children v.ithout NS as a control. BMD was assessed on calcaneal bone wlith ultrasound bone densitometry. Serum calcium, albumin, creatinine and phosphate levels were also assessed. Results The prevalence of low BMD was significantly higher in NS patients than nonNS subjects, 73.3% (22 in 30 vs. 33% (11 in 33, respectively. The prevalence ratio was 6.3 (95% CI 2.1 to 18.9. NS patients had lower serum calcium levels, With mean difference of -0.17 (95% CI -0.27 to -0.07 mMollL, P<0.009, and lower serum albumin, with mean difference of  -0.88 (95% CI -1.27 to -0.49 gIL; Prisk factors, we found NS to be an independent risk factor for low BMD. Steroid-resistant and steroid-dependent patients had lower BMD than steroid-sensitive subjects (P=0.02. There was also a significant correlation between the onset of corticosteroid treatment and BMD (r=O.3; P=0.02. Conclusions NS patients had higher risk for low BMD compared to normal subjects. Response to steroid treatment influences the severity of impaired bone density.

29 CFR 99.530 - Criteria for a low-risk auditee.

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2010-07-01

... management of Federal awards and provide a waiver. (c) There were no deficiencies in internal control which... periods) in which they were classified as Type A programs: (1) Internal control deficiencies which were... 29 Labor 1 2010-07-01 2010-07-01 true Criteria for a low-risk auditee. 99.530 Section 99.530 Labor...

Toxicity risk of non-target organs at risk receiving low-dose radiation: case report

International Nuclear Information System (INIS)

Shueng, Pei-Wei; Lin, Shih-Chiang; Chang, Hou-Tai; Chong, Ngot-Swan; Chen, Yu-Jen; Wang, Li-Ying; Hsieh, Yen-Ping; Hsieh, Chen-Hsi

2009-01-01

The spine is the most common site for bone metastases. Radiation therapy is a common treatment for palliation of pain and for prevention or treatment of spinal cord compression. Helical tomotherapy (HT), a new image-guided intensity modulated radiotherapy (IMRT), delivers highly conformal dose distributions and provides an impressive ability to spare adjacent organs at risk, thus increasing the local control of spinal column metastases and decreasing the potential risk of critical organs under treatment. However, there are a lot of non-target organs at risk (OARs) occupied by low dose with underestimate in this modern rotational IMRT treatment. Herein, we report a case of a pathologic compression fracture of the T9 vertebra in a 55-year-old patient with cholangiocarcinoma. The patient underwent HT at a dose of 30 Gy/10 fractions delivered to T8-T10 for symptom relief. Two weeks after the radiotherapy had been completed, the first course of chemotherapy comprising gemcitabine, fluorouracil, and leucovorin was administered. After two weeks of chemotherapy, however, the patient developed progressive dyspnea. A computed tomography scan of the chest revealed an interstitial pattern with traction bronchiectasis, diffuse ground-glass opacities, and cystic change with fibrosis. Acute radiation pneumonitis was diagnosed. Oncologists should be alert to the potential risk of radiation toxicities caused by low dose off-targets and abscopal effects even with highly conformal radiotherapy

Consumption of Yogurt, Low-Fat Milk, and Other Low-Fat Dairy Products Is Associated with Lower Risk of Metabolic Syndrome Incidence in an Elderly Mediterranean Population.

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Babio, Nancy; Becerra-Tomás, Nerea; Martínez-González, Miguel Ángel; Corella, Dolores; Estruch, Ramon; Ros, Emilio; Sayón-Orea, Carmen; Fitó, Montserrat; Serra-Majem, Lluís; Arós, Fernando; Lamuela-Raventós, Rosa M; Lapetra, José; Gómez-Gracia, Enrique; Fiol, Miguel; Díaz-López, Andrés; Sorlí, José V; Martínez, J Alfredo; Salas-Salvadó, Jordi

2015-10-01

The association between consumption of dairy products and the risk of developing metabolic syndrome (MetS) is unclear. The purpose of this study was to evaluate the associations between consumption of dairy products (total and different subtypes) and incident MetS in a Mediterranean population at high cardiovascular disease risk. We prospectively analyzed 1868 men and women (55-80 y old) without MetS at baseline, recruited from different PREDIMED (Prevención con Dieta Mediterránea) centers between October 2003 and June 2009 and followed up until December 2010. MetS was defined according to updated, harmonized criteria. At baseline and yearly thereafter, we determined anthropometric variables, dietary habits by a 137-item validated food-frequency questionnaire, and blood biochemistry. Multivariable-adjusted HRs of MetS or its components were estimated for each of the 2 upper tertiles (vs. the lowest one) of mean consumption of dairy products during the follow-up. During a median follow-up of 3.2 y, we documented 930 incident MetS cases. In the multivariable-adjusted model, HRs (95% CIs) of MetS for the comparison of extreme tertiles of dairy product consumption were 0.72 (0.61, 0.86) for low-fat dairy, 0.73 (0.62, 0.86) for low-fat yogurt, 0.78 (0.66, 0.92) for whole-fat yogurt, and 0.80 (0.67, 0.95) for low-fat milk. The respective HR for cheese was 1.31 (1.10, 1.56). Higher consumption of low-fat dairy products, yogurt (total, low-fat, and whole-fat yogurt) and low-fat milk was associated with a reduced risk of MetS in individuals at high cardiovascular disease risk from a Mediterranean population. Conversely, higher consumption of cheese was related to a higher risk of MetS. This trial was registered at controlled-trials.com as ISRCTN35739639. © 2015 American Society for Nutrition.

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

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Gisselsson David

2007-09-01

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

Advanced Computational Approaches for Characterizing Stochastic Cellular Responses to Low Dose, Low Dose Rate Exposures

Energy Technology Data Exchange (ETDEWEB)

Scott, Bobby, R., Ph.D.

2003-06-27

OAK - B135 This project final report summarizes modeling research conducted in the U.S. Department of Energy (DOE), Low Dose Radiation Research Program at the Lovelace Respiratory Research Institute from October 1998 through June 2003. The modeling research described involves critically evaluating the validity of the linear nonthreshold (LNT) risk model as it relates to stochastic effects induced in cells by low doses of ionizing radiation and genotoxic chemicals. The LNT model plays a central role in low-dose risk assessment for humans. With the LNT model, any radiation (or genotoxic chemical) exposure is assumed to increase one¡¯s risk of cancer. Based on the LNT model, others have predicted tens of thousands of cancer deaths related to environmental exposure to radioactive material from nuclear accidents (e.g., Chernobyl) and fallout from nuclear weapons testing. Our research has focused on developing biologically based models that explain the shape of dose-response curves for low-dose radiation and genotoxic chemical-induced stochastic effects in cells. Understanding the shape of the dose-response curve for radiation and genotoxic chemical-induced stochastic effects in cells helps to better understand the shape of the dose-response curve for cancer induction in humans. We have used a modeling approach that facilitated model revisions over time, allowing for timely incorporation of new knowledge gained related to the biological basis for low-dose-induced stochastic effects in cells. Both deleterious (e.g., genomic instability, mutations, and neoplastic transformation) and protective (e.g., DNA repair and apoptosis) effects have been included in our modeling. Our most advanced model, NEOTRANS2, involves differing levels of genomic instability. Persistent genomic instability is presumed to be associated with nonspecific, nonlethal mutations and to increase both the risk for neoplastic transformation and for cancer occurrence. Our research results, based on

Assessing a risk tailored intervention to prevent disabling low back pain - protocol of a cluster randomized controlled trial

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Marnitz Ulf

2010-01-01

Full Text Available Abstract Background Although most patients with low back pain (LBP recover within a few weeks a significant proportion has recurrent episodes or will develop chronic low back pain. Several mainly psychosocial risk factors for developing chronic LBP have been identified. However, effects of preventive interventions aiming at behavioural risk factors and unfavourable cognitions have yielded inconsistent results. Risk tailored interventions may provide a cost efficient and effective means to take systematic account of the individual risk factors but evidence is lacking. Methods/Design This study will be a cluster-randomised controlled trial comparing screening and a subsequent risk tailored intervention for patients with low back pain to prevent chronic low back pain compared to treatment as usual in primary care. A total of 600 patients from 20 practices in each study arm will be recruited in Berlin and Goettingen. The intervention comprises the following elements: Patients will be assigned to one of four risk groups based on a screening questionnaire. Subsequently they receive an educational intervention including information and counselling tailored to the risk group. A telephone/email consulting service for back pain related problems are offered independent of risk group assignment. The primary outcomes will be functional capacity and sick leave. Discussion This trial will evaluate the effectiveness of screening for risk factors for chronic low back pain followed by a risk tailored intervention to prevent chronic low back pain. This trial will contribute new evidence regarding the flexible use of individual physical and psychosocial risk factors in general practice. Trial registration ISRCTN 68205910

Low bone mass prevalence and osteoporosis risk factor assessment in African American Wisconsin women.

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Kidambi, Srividya; Partington, Susan; Binkley, Neil

2005-11-01

Post-menopausal osteoporosis is seen in all racial groups. With the increasing population and longevity of minority groups, osteoporosis is becoming an important health concern. Data regarding risk factors for, and prevalence of, low bone mass and awareness of osteoporosis risk in African American (AA) women are limited. This article evaluates the risk factors for, and prevalence of, low bone mass in a population of urban AA women in Wisconsin and assesses this group's perceived risk for osteoporosis. One hundred fifty consecutive community-dwelling AA women > or = 45 years old from Milwaukee, Wis were asked to complete a questionnaire based on currently accepted osteoporosis risk factors. Additionally, their perception of osteoporosis risk was assessed using a Likert scale. All subjects underwent quantitative calcaneal ultrasound. Subject mean age was 54 +/- 7 years. Mean T- and Z-scores were 0.5 and 0.4, respectively. Applying World Health Organization criteria, osteopenia (bone mineral density T-score 2 children), postmenopausal state, and current smoking were associated with lower calcaneal bone mass. Higher education and presence of diabetes were associated with a higher bone mass. Only 25% of the women surveyed thought they were at moderate to high risk for osteoporosis. Low bone mass was present in 33% of these AA women despite their relative young age. Many AA women do not perceive osteoporosis as a health risk. It is necessary to develop strategies to educate AA women regarding osteoporosis risk.

A Potential Approach for Low Flow Selection in Water Resource Supply and Management

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Ying Ouyang

2012-01-01

Low flow selections are essential to water resource management, water supply planning, and watershed ecosystem restoration. In this study, a new approach, namely the frequent-low (FL) approach (or frequent-low index), was developed based on the minimum frequent-low flow or level used in minimum flows and/or levels program in northeast Florida, USA. This FL approach was...

The influence of previous low back trouble, general health, and working conditions on future sick-listing because of low back trouble. A 15-year follow-up study of risk indicators for self-reported sick-listing caused by low back trouble.

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Müller, C F; Monrad, T; Biering-Sørensen, F; Darre, E; Deis, A; Kryger, P

1999-08-01

A 15-year follow-up study. To find risk indicators for self-reported sick-listing because of low back trouble and to evaluate which variables were the most important indicators of work incapacity resulting from low back trouble during the follow-up period of 15 years. The initial data were obtained from a health survey conducted in a general population from the Municipality of Glostrup, Denmark. The follow-up data included information from the Central Person Register, the Early Retirement Pension Register, and a postal questionnaire regarding self-reported sick-listing because of low back trouble. An epidemiologic study, in which logistic regression analyses were used for evaluation of the data. The model used consisted of the variable in question, age, gender, and previous experience of low back trouble, along with interactions. It was found that 22 of 37 variables were risk indicators for later self-reported sick-listing because of low back trouble during the preceding year or the 7 years before the date of follow-up evaluation. In analyzing the most significant variables simultaneously, it was found that information from the initial investigation about sick-listing in general during the previous 10 years, sciatic pain, use of analgesics for low back trouble, previous sick-listing because of low back trouble, and occupation were the most important risk indicators for self-reported work incapacity resulting from low back trouble during the follow-up period of 15 years. Findings showed that the strongest prognostic indicators of later sick-listing because of low back trouble involve information from the person about previous sick-listing behavior in general and previous experience of low back trouble episodes, especially if these had been accompanied by sciatic pain, use of analgesics, or previous low back trouble sick-listing.

Patient perceptions of risky drinking: Knowledge of daily and weekly low-risk guidelines and standard drink sizes.

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Sprague, Debra J; Vinson, Daniel C

2017-01-01

Effective intervention for risky drinking requires that clinicians and patients know low-risk daily and weekly guidelines and what constitutes a "standard drink." The authors hypothesized that most patients lack this knowledge, and that education is required. Following primary care visits, patients completed anonymous exit questionnaires that included the 3 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions, "How many drinks (containing alcohol) can you safely have in one day?" and questions about size, in ounces, of a standard drink of wine, beer, and liquor. Descriptive analyses were done in Stata. Of 1,331 respondents (60% female, mean age: 49.6, SD = 17.5), 21% screened positive on the AUDIT-C for risky drinking. Only 10% of those accurately estimated daily low-risk limits, with 9% accurate on weekly limits, and half estimated low-risk limits at or below guidelines. Fewer than half who checked "Yes" to "Do you know what a 'standard drink' is?" provided accurate answers for beer, wine, or liquor. Patients with a positive screen were twice as likely to say they knew what a standard drink is, but only a third gave accurate estimates. When asked about plans in the next month regarding change in drinking behavior, 23% with a positive AUDIT-C indicated they were at least considering a change. Most patients in primary care don't know specifics of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Exploring patient perceptions of low-risk guidelines and current drinking behavior may reveal discrepancies worth discussing. For risky drinkers, most of whom don't know daily and weekly low-risk guidelines or standard drink sizes, education can be vital in intervening. Findings suggest the need for detailed and explicit social marketing and communication on exactly what low-risk drinking entails.

Maternal verbal responses to communication of infants at low and heightened risk of autism.

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Leezenbaum, Nina B; Campbell, Susan B; Butler, Derrecka; Iverson, Jana M

2014-08-01

This study investigates mothers' responses to infant communication among infants at heightened genetic risk (high risk) of autism spectrum disorder compared to infants with no such risk (low risk). A total of 26 infants, 12 of whom had an older sibling with autism spectrum disorder, were observed during naturalistic in-home interaction and semistructured play with their mothers at 13 and 18 months of age. Results indicate that overall, mothers of low-risk and high-risk infants were highly and similarly responsive to their infants' communicative behaviors. However, examination of infant vocal and gestural communication development together with maternal verbal responses and translations (i.e. verbally labeling a gesture referent) suggests that delays in early communication development observed among high-risk infants may alter the input that these infants receive; this in turn may have cascading effects on the subsequent development of communication and language. © The Author(s) 2013.

Health effects of low-level ionising radiation: biological basis for risk assessment

International Nuclear Information System (INIS)

Upton, A.C.

1987-01-01

The biological basis for risk assessment is discussed. The risks of carcinogenic effects, teratogenic effects, and genetic (heritable) effects are estimated to vary in proportion with the dose of radiation in the low-dose domain; however, the risks also appear to vary with the LET of the radiation, age at the time of irradiation, and other variables. Although the data suffice to place the risks in perspective with other hazards of modern life, further research to refine the reliability of the risk assessment is called for. (author)

Dietary Intake and Cardiovascular Risk Factors in Icelanders Following Voluntarily a Low Carbohydrate Diet.

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Anita S Elidottir

Full Text Available Most studies regarding low-carbohydrate diets (LCDs have been intervention studies. The aim of the current study was to investigate dietary intake and cardiovascular risk factors among individuals who voluntarily follow a LCD.A cross-sectional study was conducted (N = 54, 20-66yrs in Reykjavik, Iceland. Participants recorded food intake for three days. Blood samples were analyzed for cardiovascular risk factors.Nearly half of the participants were obese and around 60% had been on a LCD for ≥ 6 months. Fifty percent claimed they had lost weight during the past month. The median intake of carbohydrate, protein and fat were 8%, 22% and 68% E (hereof 25% saturated fatty acids, respectively. The consumption of bread and wholegrain cereals was very low (<5g/day, including the intake of dietary fiber (11g/day. Median fruit intake was 12 g/day. Intake of red meat and meat products was double that of the general population or ~900 g/week. Median intake of vitamins and minerals were mostly higher than the estimated average requirements. Cardiovascular risk factors were mostly within normal range. Mean blood lipids were slightly elevated although the high density lipoprotein/total cholesterol ratio was normal.Despite poor diet quality and high prevalence of obesity, individuals who voluntarily follow a LCD have cardiovascular risk factors mostly within reference range. These individuals consume very low amounts of carbohydrates and high amounts of fat and saturated fat acids. Intake of red meat and processed meat exceeds recommended intake. Very low intake of whole grain cereals and fruits results in low intake of fiber. Long term health implications need to be examined further in longitudinal studies.

Low skeletal muscle mass outperforms the Charlson Comorbidity Index in risk prediction in patients undergoing pancreatic resections.

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Wagner, D; Marsoner, K; Tomberger, A; Haybaeck, J; Haas, J; Werkgartner, G; Cerwenka, H; Bacher, H; Mischinger, H J; Kornprat, P

2018-05-01

Low skeletal muscle mass is a known predictor of morbidity and mortality in patients undergoing major pancreatic surgeries. We sought to combine low skeletal muscle mass with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity. As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define low skeletal muscle mass in 424 patients undergoing pancreatic resections for malignancies. Patients in the lowest sex-adjusted quartile for HUAC were defined as having low skeletal muscle mass (muscle wasting). Multivariable Cox regression analysis was utilized to identify preoperative risk factors associated with postoperative morbidity. Median patient age was 63 years (19-87), 47.9% patients were male, and half the cohort had multiple comorbidities (Charlson Comorbidity Index [CCI]>6, 63.2%), 30-day mortality was 5.8% (n = 25). Median HUAC was 19.78 HU (IQR: 15.94-23.54) with 145 patients (34.2%) having low skeletal muscle mass. Preoperative frailty defined by low skeletal muscle mass was associated with an increased risk for postoperative complications (OR 1.55, CI 95% 0.98-2.45, p = 0.014), and a higher 30-day mortality (HR 5.17, CI 95% 1.57-16.69, p = 0.004). With an AUC of 0.85 HUAC showed the highest predictability for 30-day mortality (CI 95% 0.78-0.91, p = 0.0001). Patients with CCI ≥6 and low skeletal muscle mass defined by the HUAC had a 9.78 higher risk of dying in the immediate postoperative phase (HR 9.78, CI 95% 2.98-12.2, p = 0.0001). Low skeletal muscle mass predicts postoperative mortality and complications best and it should be incorporated to conventional risk scores to identify high risk patients. Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights

Low-risk diet for breast cancer in Italy.

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Franceschi, S; La Vecchia, C; Russo, A; Negri, E; Favero, A; Decarli, A

1997-11-01

To define a low-risk diet for breast cancer in Italy, a multicentric case-control study of 2569 incident cases of breast cancer and 2588 controls from Italy was analyzed. A logistic regression model was applied to the estimated intake of five macronutrients and used to compute a diet-related risk score (RS). The pattern of macronutrient and food group intake across RS deciles was defined. The mean of diet-related RSs across subsequent risk deciles ranged from 0.83 to 1.44. Total energy intake first decreased slightly, from the first to the second decile, and then increased, mostly in the last three risk deciles. Intake of starch increased in absolute and relative terms, whereas saturated fat intake rose in absolute terms but remained stable as a proportion. A relative decline was observed for unsaturated fat and sugars, with a hint, however, of U-shape effect. From a food group viewpoint, there was a marked increase in the intake of bread and cereal dishes, cakes and desserts, and refined sugar across subsequent deciles, whereas the consumption of vegetables, olive and seed oils, and fruit decreased.

Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network.

Science.gov (United States)

Humberg, Alexander; Härtel, Christoph; Paul, Pia; Hanke, Kathrin; Bossung, Verena; Hartz, Annika; Fasel, Laura; Rausch, Tanja K; Rody, Achim; Herting, Egbert; Göpel, Wolfgang

2017-05-01

Very-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death. To assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN). A total cohort of 2203 singleton VLBWI with a birth weight 30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%). Our observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor. Copyright © 2017 Elsevier B.V. All rights reserved.

Decision-making under risk and ambiguity in low-birth-weight pigs

NARCIS (Netherlands)

Murphy, Eimear; Kraak, Lynn; van den Broek, Jan; Nordquist, Rebecca E; van der Staay, Franz Josef

2015-01-01

Low birth weight (LBW) in humans is a risk factor for later cognitive, behavioural and emotional problems. In pigs, LBW is associated with higher mortality, but little is known about consequences for surviving piglets. Alteration in hypothalamic-pituitary-adrenal axis function in LBW pigs suggests

Emotional reactions to alcohol-related words: Differences between low- and high-risk drinkers.

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Gantiva, Carlos; Delgado, Rafael; Romo-González, Tania

2015-11-01

Research that has examined responses to alcohol-related words in drinkers has mostly linked such responses to memory, attentional, and perceptual bias. However, studies of emotional processing in alcoholics have not received much attention. The main goal of the present study was to identify the features and differences of emotional responses to alcohol-related words in low- and high-risk drinkers. A total of 149 low-risk drinkers and 125 high-risk drinkers evaluated five alcohol-related words and 15 words from the Affective Norms for English Words in the dimensions of valence, arousal, and dominance using the Self-Assessment Manikin. The results indicated that high-risk drinkers evaluated alcohol-related words as more appetitive and arousing. These results, together with findings in the attention and memory research literature, suggest that alcohol-related words can serve as conditioned cues in alcohol consumption. Copyright © 2015 Elsevier Ltd. All rights reserved.

Low doses of ionizing radiation and risk of cardiovascular disease: A review of epidemiological studies

International Nuclear Information System (INIS)

Metz-Flamant, C.; Bonaventure, A.; Tirmarche, M.; Laurier, D.; Bernier, M.O.; Milliat, F.

2009-01-01

Background While cardiovascular risks associated with high level of ionizing radiation are well-established, long-term effects of low and medium levels of exposure, between 0 and 5 gray (Gy), on the cardiovascular system are debated. Methods Available literature was reviewed considering various populations, such as survivors of atomic bombs, nuclear workers, Chernobyl liquidators, radiologists and radiological technologists and patients exposed for medical reasons. Results A significant increased risk of cardiovascular diseases associated with low doses of ionizing radiation was observed in 13 studies among the 27 analyzed. The ischemic heart diseases risk was detailed in 16 studies and seven of them showed a significant increase. The cerebrovascular risk was significantly increased in five studies among the 12 considered. Conclusion Some epidemiological and experimental data are clearly in favour of an increased cardiovascular risk associated with exposure to low doses. However, given the multi-factorial origin of cardiovascular diseases and the lack of a clear pathophysiologic mechanism, epidemiological results have to be carefully interpreted. Further research should be conducted in this area. (authors)

[Clinical guideline for management of patients with low risk differentiated thyroid carcinoma].

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Díez, Juan José; Oleaga, Amelia; Álvarez-Escolá, Cristina; Martín, Tomás; Galofré, Juan Carlos

2015-01-01

Incidence of thyroid cancer is increasing in Spain and worldwide. Overall thyroid cancer survival is very high, and stratification systems to reliably identify patients with worse prognosis have been developed. However, marked differences exist between the different specialists in clinical management of low-risk patients with thyroid carcinoma. Almost half of all papillary thyroid carcinomas are microcarcinomas, and 90% are tumors < 2 cm that have a particularly good prognosis. However, they are usually treated more aggressively than needed, despite the lack of adequate scientific support. Surgery remains the gold standard treatment for these tumors. However, lobectomy may be adequate in most patients, without the need for total thyroidectomy. Similarly, prophylactic lymph node dissection of the central compartment is not required in most cases. This more conservative approach prevents postoperative complications such as hypoparathyroidism or recurrent laryngeal nerve injury. Postoperative radioiodine remnant ablation and strict suppression of serum thyrotropin, although effective for the more aggressive forms of thyroid cancer, have not been shown to be beneficial for the treatment of low risk patients, and may impair their quality of life. This guideline provides recommendations from the task force on thyroid cancer of the Spanish Society of Endocrinology and Nutrition for adequate management of patients with low-risk thyroid cancer. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Low Bone Mineral Density Risk Factors and Testing Patterns in Institutionalized Adults with Intellectual and Developmental Disabilities

Science.gov (United States)

Hess, Mailee; Campagna, Elizabeth J.; Jensen, Kristin M.

2018-01-01

Background: Adults with intellectual or developmental disability (ID/DD) have multiple risks for low bone mineral density (BMD) without formal guidelines to guide testing. We sought to identify risk factors and patterns of BMD testing among institutionalized adults with ID/DD. Methods: We evaluated risk factors for low BMD (Z-/T-score < -1) and…

Low amniotic fluid index in high risk pregnancy and poor apgar score at birth

International Nuclear Information System (INIS)

Sultana, S.; Akhtar, K.A.K.

2008-01-01

To determine the accuracy of antepartum Amniotic Fluid Index (AFI) of 5 cm was labeled as predictor of good outcome at birth. The subjects in both the groups were demographically matched and fulfilled the inclusion and exclusion criteria. The Apgar score was calculated at 5 minutes of birth. The newborns, with Apgar score 6 were labeled as healthy. AFI was compared with Apgar score, using Chi-square and a p-value was calculated to determine the statistical significance. Sensitivity, specificity, efficiency and the predictive values of AFI at a cut off point of < 5 cm as a predictor of adverse outcome at birth (Apgar score of < 6 at 5 minutes of birth) in high-risk pregnancy were calculated. Only 8 neonates of 50 women with low AFI had low Apgar score. Similarly, 6 neonates of 50 women with normal AFI had poor Apgar score. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency of AFI as test were 57.1%, 51.3%, 16%, 88% and 52% respectively. Low AFI is a poor predictor of adverse outcome for high-risk term patients. AFI is not a good screening test for high-risk pregnant women at term for birth of an infant with low Apgar score. (author)

Biological influence from low dose and low-dose rate radiation

International Nuclear Information System (INIS)

Magae, Junji

2007-01-01

Although living organisms have defense mechanisms for radioadaptive response, the influence is considered to vary qualitatively and quantitatively for low dose and high dose, as well as for low-dose rate and high-dose rate. This article describes the bioresponse to low dose and low-dose rate. Among various biomolecules, DNA is the most sensitive to radiation, and accurate replication of DNA is an essential requirement for the survival of living organisms. Also, the influence of active enzymes resulted from the effect of radiation on enzymes in the body is larger than the direct influence of radiation on the body. After this, the article describes the carcinogenic risk by low-dose radiation, and then so-called Hormesis effect to create cancer inhibition effect by stimulating active physiology. (S.K.)

Should we perform an echocardiogram in hypertensive patients classified as having low and medium risk?

Science.gov (United States)

Suárez, Carmen; Villar, José; Martel, Nieves; Extremera, Blas Gil; Suliman, Najaty; Campo, Carlos; Castellanos, Victoriano; Liébana, Antonio; Rodilla, Enrique; Nieto, Javier; Velasco, Olga; Ruilope, Luis M

2006-01-04

Left ventricular hypertrophy is an important predictor of cardiovascular risk and its detection contributes to risk stratification. However, echocardiography is not a routine procedure and electrocardiography (ECG) underestimates its prevalence. To evaluate the prevalence of echocardiographic left ventricular hypertrophy in low and medium risk non-treated hypertensive subjects, in order to find out the percentage of them who would be reclassified as high risk patients. Cross-sectional, multicenter study was performed in hospital located hypertension units. An echocardiogram was performed in 197 previously untreated hypertensive patients, > 18 years, classified as having low (61%) or medium (39%) risk, according to the OMS/ISH classification. The presence of left ventricular hypertrophy was considered if left ventricular mass index was > or = 134 or 110 g/m(2) in men and women, respectively (Devereux criteria). A logistic regression analysis was performed to identify factors associated to left ventricular hypertrophy. The prevalence of left ventricular hypertrophy was 23.9% (95% CI:17.9-29.9), 25.6% in men and 22.6% in women. In the low risk group its prevalence was 20.7% and in medium risk group 29.5%. Factors associated to left ventricular hypertrophy were: years since the diagnosis of hypertension, OR:1.1 (95% CI:1.003-1.227); systolic blood pressure, OR:1.08 (95% CI:1.029-1.138); diastolic blood pressure, OR:0.9 (95% CI:0.882-0.991); and family history of cardiovascular disease, OR:4.3 (95% CI:1.52-12.18). These findings underline the importance of performing an echocardiogram in low and high risk untreated hypertensive patients in which treatment would otherwise be delayed for even one year.

Low-dose aspirin or other nonsteroidal anti-inflammatory drug use and prostate cancer risk

DEFF Research Database (Denmark)

Skriver, Charlotte; Dehlendorff, Christian; Borre, Michael

2016-01-01

PURPOSE: Increasing evidence suggests that aspirin use may protect against prostate cancer. In a nationwide case-control study, using Danish high-quality registry data, we evaluated the association between the use of low-dose aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs......) and the risk of prostate cancer. METHODS: We identified 35,600 patients (cases) with histologically verified prostate cancer during 2000-2012. Cases were matched to 177,992 population controls on age and residence by risk-set sampling. Aspirin and nonaspirin NSAID exposure was defined by type, estimated dose......, duration, and consistency of use. We used conditional logistic regression to estimate odds ratios (ORs), with 95 % confidence intervals (CIs), for prostate cancer associated with low-dose aspirin (75-150 mg) or nonaspirin NSAID use, adjusted for potential confounders. RESULTS: Use of low-dose aspirin...

Work-related psychosocial stress and risk of preterm, low birthweight delivery.

Science.gov (United States)

Homer, C J; James, S A; Siegel, E

1990-02-01

We investigated whether work-related psychologic stress--defined as work characterized by both high psychologic demands and limited control over the response to these demands--increases a woman's risk of delivering a preterm, low birthweight infant. We studied 786 employed pregnant women included in the National Longitudinal Survey of Labor Market Experience, Youth Cohort (NLSY), a nationally representative sample of 12,686 young adults. Data concerning work status, job title, and other factors affecting pregnancy outcome were obtained from the NLSY. Assessment of job experience was based on job title, using an established catalogue of occupation characteristics. After accounting for the physical exertion entailed in a job, occupational psychologic stress as measured by job title was not associated with preterm, low birthweight delivery for the sample as a whole (Relative risk = 1.16, 95% confidence interval .45, 2.95). For those women who did not want to remain in the work force, work-related stress increased their risk of experiencing this outcome (RR = 8.1, 95% CI 1.5, 50.2). Personal motivation toward work, as well as the physical effort of work, should be considered in evaluating the impact of a job's psychologic characteristics on pregnancy outcome.

Ureteral diameter in low-risk vesicoureteral reflux in infancy and childhood

International Nuclear Information System (INIS)

Hellstroem, M.; Hjaelmaas, K.; Jacobsson, B.; Jodal, U.; Oestra Sjukhuset, Goeteborg; Oestra Sjukhuset, Goeteborg

1986-01-01

In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was defined as VUR not associated with infection, obstruction, calculi, duplication, malformations (except for hypospadia) or neurogenic bladder disturbances. Forty-six children (age 1 day - 14 years) were selected by examining the records of 12000 MCUG:s performed 1960-1983. Ureteral diameter was measured at the widest point of the ureter on the films from MCUG:s and urographies. Ureteral diameter was slightly larger at MCUG than at urography in the same individuals but the difference was not significant. The ureteral diameter at MCUG also correlated closely to normal values at urography in a previous study. It is proposed that the reference values obtained at MCUG in the present investigation can be used for the differentiation between dilatation and no dilatation in the grading of VUR. (orig.)

Active surveillance for low-risk prostate cancer in Austria: the online registry of the Qualitätspartnerschaft Urologie (QuapU).

Science.gov (United States)

Eredics, Klaus; Dorfinger, Karl; Kramer, Gero; Ponholzer, Anton; Madersbacher, Stephan

2017-06-01

Active surveillance (AS) is a well-recognized strategy to reduce the risk of overtreatment in men with low-risk prostate cancer. No data on this approach are available from Austria. The Qualitätspartnerschaft Urologie (QuapU) developed an online database for patients managed with AS in Austria. Principal inclusion/exclusion criteria corresponded to those of the S3 prostate cancer guideline of German urologists: prostate-specific antigen (PSA) 4-10 ng/ml: 85%). The prostate volume averaged 39 ml. The mean time under AS was 17.5 months (12 months: 40%). The AS adherence at 12 months was 85% and at 24 months 76%. To date, a total of 23 patients (17.6%) stopped AS. The most frequent reasons for discontinuing AS were patient wish for active treatment (43.5%) and PSA progression (30.4%). A histological progression was rarely seen (6.1%) and the control biopsy rate was low (19.8%). This study is the first description of AS in Austria and documents the feasibility of an online registry for AS. The data confirm the international experience with this approach with acceptable adherence rates.

Dose-response characteristics of low- and intermediate-risk prostate cancer treated with external beam radiotherapy

International Nuclear Information System (INIS)

Cheung, Rex; Tucker, Susan L.; Lee, Andrew K.; Crevoisier, Renaud de; Dong Lei; Kamat, Ashish; Pisters, Louis; Kuban, Deborah

2005-01-01

Purpose: In this era of dose escalation, the benefit of higher radiation doses for low-risk prostate cancer remains controversial. For intermediate-risk patients, the data suggest a benefit from higher doses. However, the quantitative characterization of the benefit for these patients is scarce. We investigated the radiation dose-response relation of tumor control probability in low-risk and intermediate-risk prostate cancer patients treated with radiotherapy alone. We also investigated the differences in the dose-response characteristics using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition vs. an alternative biochemical failure definition. Methods and materials: This study included 235 low-risk and 387 intermediate-risk prostate cancer patients treated with external beam radiotherapy without hormonal treatment between 1987 and 1998. The low-risk patients had 1992 American Joint Committee on Cancer Stage T2a or less disease as determined by digital rectal examination, prostate-specific antigen (PSA) levels of ≤10 ng/mL, and biopsy Gleason scores of ≤6. The intermediate-risk patients had one or more of the following: Stage T2b-c, PSA level of ≤20 ng/mL but >10 ng/mL, and/or Gleason score of 7, without any of the following high-risk features: Stage T3 or greater, PSA >20 ng/mL, or Gleason score ≥8. The logistic models were fitted to the data at varying points after treatment, and the dose-response parameters were estimated. We used two biochemical failure definitions. The ASTRO PSA failure was defined as three consecutive PSA rises, with the time to failure backdated to the mid-point between the nadir and the first rise. The second biochemical failure definition used was a PSA rise of ≥2 ng/mL above the current PSA nadir (CN + 2). The failure date was defined as the time at which the event occurred. Local, nodal, and distant relapses and the use of salvage hormonal therapy were also failures. Results: On the basis of the

Pattern recognition and functional neuroimaging help to discriminate healthy adolescents at risk for mood disorders from low risk adolescents.

Science.gov (United States)

Mourão-Miranda, Janaina; Oliveira, Leticia; Ladouceur, Cecile D; Marquand, Andre; Brammer, Michael; Birmaher, Boris; Axelson, David; Phillips, Mary L

2012-01-01

There are no known biological measures that accurately predict future development of psychiatric disorders in individual at-risk adolescents. We investigated whether machine learning and fMRI could help to: 1. differentiate healthy adolescents genetically at-risk for bipolar disorder and other Axis I psychiatric disorders from healthy adolescents at low risk of developing these disorders; 2. identify those healthy genetically at-risk adolescents who were most likely to develop future Axis I disorders. 16 healthy offspring genetically at risk for bipolar disorder and other Axis I disorders by virtue of having a parent with bipolar disorder and 16 healthy, age- and gender-matched low-risk offspring of healthy parents with no history of psychiatric disorders (12-17 year-olds) performed two emotional face gender-labeling tasks (happy/neutral; fearful/neutral) during fMRI. We used Gaussian Process Classifiers (GPC), a machine learning approach that assigns a predictive probability of group membership to an individual person, to differentiate groups and to identify those at-risk adolescents most likely to develop future Axis I disorders. Using GPC, activity to neutral faces presented during the happy experiment accurately and significantly differentiated groups, achieving 75% accuracy (sensitivity = 75%, specificity = 75%). Furthermore, predictive probabilities were significantly higher for those at-risk adolescents who subsequently developed an Axis I disorder than for those at-risk adolescents remaining healthy at follow-up. We show that a combination of two promising techniques, machine learning and neuroimaging, not only discriminates healthy low-risk from healthy adolescents genetically at-risk for Axis I disorders, but may ultimately help to predict which at-risk adolescents subsequently develop these disorders.

Low mortality rates after endovascular aortic repair expand use to high-risk patients.

Science.gov (United States)

Adkar, Shaunak S; Turner, Megan C; Leraas, Harold J; Gilmore, Brian F; Nag, Uttara; Turley, Ryan S; Shortell, Cynthia K; Mureebe, Leila

2018-02-01

The 2010 endovascular aneurysm repair (EVAR) trial 2 (EVAR 2) reported that patients with comorbidity profiles rendering them unfit for open aneurysm repair who underwent EVAR did not experience a survival advantage compared with those who did not undergo intervention. These patients experienced a 30-day mortality of 7.3%, whereas reports from similar cohorts reported far lower mortality rates. The primary objective of our study was to compare the incidence of 30-day mortality in low- and high-risk patients undergoing EVAR in a contemporary data set, using patient risk stratification criteria from EVAR 2. Secondarily, we sought to identify risk factors associated with a disproportionate contribution to 30-day mortality risk. Data were obtained from the 2005 to 2013 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data Files (N = 24,813). Patients were included in the high-risk cohort with the presence of renal, respiratory, or cardiac preoperative criteria alone or in combination. Renal impairment criteria were defined as dialysis and creatinine concentration >2.26 mg/dL. Respiratory impairment criteria included history of chronic obstructive pulmonary disease and preoperative ventilator support. Cardiac impairment criteria included history of myocardial infarction, congestive heart failure, angina, and prior coronary intervention. Patient and procedural characteristics and 30-day postoperative outcomes were compared using Pearson χ 2 tests for categorical variables and Wilcoxon rank sum tests for continuous variables. Among 24,813 patients undergoing EVAR, 12,043 (48%) patients were characterized as high risk (at least one impairment criterion); 12,770 (52%) patients were stratified as low risk. The 30-day mortality rate was 1.9% in the high-risk cohort compared with the 7.3% reported by EVAR 2, and it was higher in the high-risk cohort compared with the low-risk cohort (1.9% vs 0.9%; P < .001). Whereas the

Just-in-Time Training for High-Risk Low-Volume Therapies: An Approach to Ensure Patient Safety.

Science.gov (United States)

Helman, Stephanie; Lisanti, Amy Jo; Adams, Ann; Field, Cynthia; Davis, Katherine Finn

2016-01-01

High-risk low-volume therapies are those therapies that are practiced infrequently and yet carry an increased risk to patients because of their complexity. Staff nurses are required to competently manage these therapies to treat patients' unique needs and optimize outcomes; however, maintaining competence is challenging. This article describes implementation of Just-in-Time Training, which requires validation of minimum competency of bedside nurses managing high-risk low-volume therapies through direct observation of a return-demonstration competency checklist.

Low birth weight. A risk factor for development of diabetic nephropathy?

DEFF Research Database (Denmark)

Rossing, P; Tarnow, L; Nielsen, F S

1995-01-01

for expression of renal disease after exposure to potentially injurious renal stimuli. The aim of this study was to determine if low birth weight is a risk factor for development of diabetic nephropathy. In a case-control study, we investigated 184 (110 men) insulin-dependent diabetes mellitus (IDDM) patients...

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

Science.gov (United States)

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

2015-01-06

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

Sphincter-Preserving Surgery for Low Rectal Cancers: Incidence and Risk Factors for Permanent Stoma.

Science.gov (United States)

Mak, Joanna Chung Kiu; Foo, Dominic Chi Chung; Wei, Rockson; Law, Wai Lun

2017-11-01

Advances in surgical techniques and paradigm changes in rectal cancer treatment have led to a drastic decline in the abdominoperineal resection rate, and sphincter-preserving operation is possible in distal rectal cancer. The aim of this study is to evaluate the long-term incidence of permanent stoma after sphincter-preserving surgery for low rectal cancer and its corresponding risk factors. From 2000 to 2014, patients who underwent sphincter-preserving low anterior resection for low rectal cancer (within 5 cm from the anal verge) were included. The occurrence of permanent stoma over time and its risk factors were investigated by using a Cox proportional hazards regression model. This study included 194 patients who underwent ultra-low anterior resection for distal rectal cancer, and the median follow-up period was 77 months for the surviving patients. Forty-six (23.7%) patients required a permanent stoma eventfully. Anastomotic-related complications and disease progression were the main reasons for permanent stoma. Clinical anastomotic leakage (HR 5.72; 95% CI 2.31-14.12; p consideration when contemplating sphincter-preserving surgery.

Unilateral Prostate Cancer Cannot be Accurately Predicted in Low-Risk Patients

International Nuclear Information System (INIS)

Isbarn, Hendrik; Karakiewicz, Pierre I.; Vogel, Susanne

2010-01-01

Purpose: Hemiablative therapy (HAT) is increasing in popularity for treatment of patients with low-risk prostate cancer (PCa). The validity of this therapeutic modality, which exclusively treats PCa within a single prostate lobe, rests on accurate staging. We tested the accuracy of unilaterally unremarkable biopsy findings in cases of low-risk PCa patients who are potential candidates for HAT. Methods and Materials: The study population consisted of 243 men with clinical stage ≤T2a, a prostate-specific antigen (PSA) concentration of <10 ng/ml, a biopsy-proven Gleason sum of ≤6, and a maximum of 2 ipsilateral positive biopsy results out of 10 or more cores. All men underwent a radical prostatectomy, and pathology stage was used as the gold standard. Univariable and multivariable logistic regression models were tested for significant predictors of unilateral, organ-confined PCa. These predictors consisted of PSA, %fPSA (defined as the quotient of free [uncomplexed] PSA divided by the total PSA), clinical stage (T2a vs. T1c), gland volume, and number of positive biopsy cores (2 vs. 1). Results: Despite unilateral stage at biopsy, bilateral or even non-organ-confined PCa was reported in 64% of all patients. In multivariable analyses, no variable could clearly and independently predict the presence of unilateral PCa. This was reflected in an overall accuracy of 58% (95% confidence interval, 50.6-65.8%). Conclusions: Two-thirds of patients with unilateral low-risk PCa, confirmed by clinical stage and biopsy findings, have bilateral or non-organ-confined PCa at radical prostatectomy. This alarming finding questions the safety and validity of HAT.

Cardiovascular Risk and Serum Hyaluronic Acid: A Preliminary Study in a Healthy Population of Low/Intermediate Risk.

Science.gov (United States)

Papanastasopoulou, Chrysanthi; Papastamataki, Maria; Karampatsis, Petros; Anagnostopoulou, Eleni; Papassotiriou, Ioannis; Sitaras, Nikolaos

2017-01-01

Hyaluronic acid (HA) has been found to be an important trigger of atherosclerosis. In this study, we investigate the possible association of serum HA with cardiovascular disease risk in a population of low/intermediate risk for cardiovascular events. We enrolled 200 subjects with low/intermediate risk for developing cardiovascular disease. High specific C-reactive protein (hsCRP) was used as an indicator of preclinical atherosclerosis. The Framingham score was used to calculate the cardiovascular risk. Participants with dyslipidemia had significantly higher levels of serum HA than those without dyslipidemia (t-test, P = 0.05), higher levels of hsCRP (Kruskal-Wallis test, P = 0.04), and higher cardiovascular risk according to the Framingham score (Kruskal-Wallis test, P = 0.05). Serum HA concentration correlated significantly with the Framingham score for risk for coronary heart disease over the next 10 years (Spearman r = 0.152, P = 0.02). Diabetic volunteers had significantly higher HA than those without diabetes (t-test, P = 0.02). Participants with metabolic syndrome had higher serum HA levels and higher hsCRP (Kruskal-Wallis test, P = 0.01) compared to volunteers without metabolic syndrome (t-test, P = 0.03). Serum HA should be explored as an early marker of atheromatosis and cardiovascular risk. © 2016 Wiley Periodicals, Inc.

Low Adiponectin Levels and Increased Risk of Type 2 Diabetes in Patients With Myocardial Infarction

DEFF Research Database (Denmark)

Lindberg, Søren; Jensen, Jan S; Pedersen, Sune H

2014-01-01

OBJECTIVE: Patients with acute myocardial infarction (MI) have increased risk of developing type 2 diabetes mellitus (T2DM). Adiponectin is an insulin-sensitizing hormone produced in adipose tissue, directly suppressing hepatic gluconeogenesis, stimulating fatty acid oxidation and glucose uptake...... 5.3-6.1]) 6% (n = 38) developed T2DM. Risk of T2DM was analyzed using a competing risk analysis. RESULTS: Low adiponectin levels were associated with increased risk of T2DM (P age, sex, hypertension, hypercholesterolemia, current smoking.......001). Importantly, plasma adiponectin added to the predictive value of blood glucose, with the combination of high blood glucose and low plasma adiponectin, vastly increasing the risk of developing T2DM (HR 9.6 [3.7-25.3]; P

Risk-averse decision-making for civil infrastructure exposed to low-probability, high-consequence events

International Nuclear Information System (INIS)

Cha, Eun Jeong; Ellingwood, Bruce R.

2012-01-01

Quantitative analysis and assessment of risk to civil infrastructure has two components: probability of a potentially damaging event and consequence of damage, measured in terms of financial or human losses. Decision models that have been utilized during the past three decades take into account the probabilistic component rationally, but address decision-maker attitudes toward consequences and risk only to a limited degree. The application of models reflecting these attitudes to decisions involving low-probability, high-consequence events that may impact civil infrastructure requires a fundamental understanding of risk acceptance attitudes and how they affect individual and group choices. In particular, the phenomenon of risk aversion may be a significant factor in decisions for civil infrastructure exposed to low-probability events with severe consequences, such as earthquakes, hurricanes or floods. This paper utilizes cumulative prospect theory to investigate the role and characteristics of risk-aversion in assurance of structural safety.

Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities.

Science.gov (United States)

Hession, M; Rolland, C; Kulkarni, U; Wise, A; Broom, J

2009-01-01

There are few studies comparing the effects of low-carbohydrate/high-protein diets with low-fat/high-carbohydrate diets for obesity and cardiovascular disease risk. This systematic review focuses on randomized controlled trials of low-carbohydrate diets compared with low-fat/low-calorie diets. Studies conducted in adult populations with mean or median body mass index of > or =28 kg m(-2) were included. Thirteen electronic databases were searched and randomized controlled trials from January 2000 to March 2007 were evaluated. Trials were included if they lasted at least 6 months and assessed the weight-loss effects of low-carbohydrate diets against low-fat/low-calorie diets. For each study, data were abstracted and checked by two researchers prior to electronic data entry. The computer program Review Manager 4.2.2 was used for the data analysis. Thirteen articles met the inclusion criteria. There were significant differences between the groups for weight, high-density lipoprotein cholesterol, triacylglycerols and systolic blood pressure, favouring the low-carbohydrate diet. There was a higher attrition rate in the low-fat compared with the low-carbohydrate groups suggesting a patient preference for a low-carbohydrate/high-protein approach as opposed to the Public Health preference of a low-fat/high-carbohydrate diet. Evidence from this systematic review demonstrates that low-carbohydrate/high-protein diets are more effective at 6 months and are as effective, if not more, as low-fat diets in reducing weight and cardiovascular disease risk up to 1 year. More evidence and longer-term studies are needed to assess the long-term cardiovascular benefits from the weight loss achieved using these diets.

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

International Nuclear Information System (INIS)

Li Xiaojuan; Sun Quanfu

2006-01-01

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

Human Papillomavirus - Prevalence of High-Risk and Low-Risk Types among Females Aged 14-59 Years, National Health and ...

Science.gov (United States)

... Archive Data & Statistics Sexually Transmitted Diseases Figure 45. Human Papillomavirus — Prevalence of High-risk and Low-risk ... on the STD Data and Statistics page . * HPV = human papillomavirus. NOTE: Error bars indicate 95% confidence interval. ...

Patterns of Violence Exposure and Sexual Risk in Low-Income, Urban African American Girls

Science.gov (United States)

Wilson, Helen W.; Woods, Briana A.; Emerson, Erin; Donenberg, Geri R.

2013-01-01

Objective This study examined the relationship between violence exposure and sexual risk-taking among low-income, urban African American (AA) adolescent girls, considering overlap among different types and characteristics of violence. Methods AA adolescent girls were originally recruited from outpatient mental health clinics serving urban, mostly low-SES communities in Chicago, IL as part of a two-year longitudinal investigation of HIV-risk behavior. A subsequent follow-up was completed to assess lifetime history of trauma and violence exposure. The current study (N=177) included violence exposure and sexual risk behavior reported at the most recent interview (ages 14-22). Multiple regression was used to examine combined and unique contributions of different types, ages, settings, and perpetrators or victims of violence to variance in sexual risk. Results More extensive violence exposure and cumulative exposure to different kinds of violence were associated with overall unsafe sex, more partners, and inconsistent condom use. The most significant unique predictors, accounting for overlap among different forms of violence, were physical victimization, adolescent exposure, neighborhood violence, and violence involving dating partners. Conclusions These findings put sexual risk in the context of broad traumatic experiences but also suggest that the type and characteristics of violence exposure matter in terms of sexual health outcomes. Violence exposure should be addressed in efforts to reduce STIs among low-income, urban African American girls. PMID:24563808

Factors Associated With Mortality in Low-Risk Pediatric Critical Care Patients in The Netherlands.

Science.gov (United States)

Verlaat, Carin W; Visser, Idse H; Wubben, Nina; Hazelzet, Jan A; Lemson, Joris; van Waardenburg, Dick; van der Heide, Douwe; van Dam, Nicolette A; Jansen, Nicolaas J; van Heerde, Mark; van der Starre, Cynthia; van Asperen, Roelie; Kneyber, Martin; van Woensel, Job B; van den Boogaard, Mark; van der Hoeven, Johannes

2017-04-01

To determine differences between survivors and nonsurvivors and factors associated with mortality in pediatric intensive care patients with low risk of mortality. Retrospective cohort study. Patients were selected from a national database including all admissions to the PICUs in The Netherlands between 2006 and 2012. Patients less than 18 years old admitted to the PICU with a predicted mortality risk lower than 1% according to either the recalibrated Pediatric Risk of Mortality or the Pediatric Index of Mortality 2 were included. None. In total, 16,874 low-risk admissions were included of which 86 patients (0.5%) died. Nonsurvivors had more unplanned admissions (74.4% vs 38.5%; p < 0.001), had more complex chronic conditions (76.7% vs 58.8%; p = 0.001), were more often mechanically ventilated (88.1% vs 34.9%; p < 0.001), and had a longer length of stay (median, 11 [interquartile range, 5-32] d vs median, 3 [interquartile range, 2-5] d; p < 0.001) when compared with survivors. Factors significantly associated with mortality were complex chronic conditions (odds ratio, 3.29; 95% CI, 1.97-5.50), unplanned admissions (odds ratio, 5.78; 95% CI, 3.40-9.81), and admissions in spring/summer (odds ratio, 1.67; 95% CI, 1.08-2.58). Nonsurvivors in the PICU with a low predicted mortality risk have recognizable risk factors including complex chronic condition and unplanned admissions.

Pneumonia Risk Stratification Scores for Children in Low-Resource Settings: A Systematic Literature Review.

Science.gov (United States)

Deardorff, Katrina V; McCollum, Eric D; Ginsburg, Amy Sarah

2017-12-22

Pneumonia is the leading infectious cause of death among children less than five years of age. Predictive tools, commonly referred to as risk scores, can be employed to identify high-risk children early for targeted management to prevent adverse outcomes. This systematic review was conducted to identify pediatric pneumonia risk scores developed, validated, and implemented in low-resource settings. We searched CAB Direct, Cochrane Reviews, Embase, PubMed, Scopus, and Web of Science for studies that developed formal risk scores to predict treatment failure or mortality among children less than five years of age diagnosed with a respiratory infection or pneumonia in low-resource settings. Data abstracted from articles included location and study design, sample size, age, diagnosis, score features and model discrimination. Three pediatric pneumonia risk scores predicted mortality specifically, and two treatment failure. Scores developed using World Health Organization recommended variables for pneumonia assessment demonstrated better predictive fit than scores developed using alternative features. Scores developed using routinely collected healthcare data performed similarly well as those developed using clinical trial data. No score has been implemented in low-resource settings. While pediatric pneumonia-specific risk scores have been developed and validated, it is yet unclear if implementation is feasible, what impact, if any, implemented scores may have on child outcomes, or how broadly scores may be generalized. To increase the feasibility of implementation, future research should focus on developing scores based on routinely collected data.

Oxytocin and dystocia as risk factors for adverse birth outcomes: a cohort of low-risk nulliparous women.

Science.gov (United States)

Bernitz, Stine; Øian, Pål; Rolland, Rune; Sandvik, Leiv; Blix, Ellen

2014-03-01

augmented and not augmented women without dystocia were compared to investigate associations between oxytocin and adverse birth outcomes. Augmented women with and without dystocia were compared, to investigate associations between dystocia and adverse birth outcomes. a cohort of low-risk nulliparous women originally included in a randomised controlled trial. the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway. the study population consists of 747 well defined low-risk women. incidence of oxytocin augmentation, and associations between dystocia and augmentation, and mode of delivery, transfer of newborns to the intensive care unit, episiotomy and postpartum haemorrhage. of all participants 327 (43.8%) were augmented with oxytocin of which 139 (42.5%) did not fulfil the criteria for dystocia. Analyses adjusted for possible confounders found that women without dystocia had an increased risk of instrumental vaginal birth (OR 3.73, CI 1.93-7.21) and episiotomy (OR 2.47, CI 1.38-4.39) if augmented with oxytocin. Augmented women had longer active phase if vaginally delivered and longer labours if delivered by caesarean section if having dystocia. Among women without dystocia, those augmented had higher body mass index, gave birth to heavier babies, had longer labours if vaginally delivered and had epidural analgesia more often compared to women not augmented. in low-risk nulliparous without dystocia, we found an association between the use of oxytocin and an increased risk of instrumental vaginal birth and episiotomy. careful attention should be paid to criteria for labour progression and guidelines for oxytocin augmentation to avoid unnecessary use. Copyright © 2013 Elsevier Ltd. All rights reserved.

Morbidity in early adulthood among low-risk very low birth weight children in Turkey: a preliminary study.

Science.gov (United States)

Can, Gülay; Bilgin, Leyla; Tatli, Burak; Saydam, Reyhan; Coban, Asuman; Ince, Zeynep

2012-01-01

The objective of this study was to assess low-risk very low birth weight (VLBW) children, before the era of modern neonatal intensive care in Turkey, during adolescence. Forty-one VLBW adolescents were compared with 40 adolescents who had normal birth weight. The physical and neuromotor development, educational achievement and psychosocial status were assessed at a mean age of 17 +/- 1.6 years. VLBW adolescents were shorter than normal birth weight adolescents (p = 0.01). A major neurological abnormality (cerebral palsy) was seen in 12% and a minor neurological abnormality (tremor, coordination, behavioral and speech disorders) in 17%. VLBW adolescents had higher rates of visual problems (56% vs. 5%). School failure was present in 27%. There were no differences in behavioral problems or quality of life between the two groups, but VLBW adolescents did have a lower self-esteem score. Neurodevelopment and growth sequelae were a significant problem in VLBW adolescents. As early intervention might help to prevent or ameliorate potential problems, long-term follow-up is essential.

Estimating population health risk from low-level environmental radon

International Nuclear Information System (INIS)

Fisher, D.R.

1980-01-01

Although incidence of respiratory cancer is directly related to inhalation of radon and radon daughters, the magnitude of the actual risk is uncertain for members of the general population exposed for long periods to low-level concentrations. Currently, any such estimate of the risk must rely on data obtained through previous studies of underground-miner populations. Several methods of risk analysis have resulted from these studies. Since the breathing atmospheres, smoking patterns, and physiology are different between miners and the general public, overestimates of lung cancer risk to the latter may have resulted. Strong evidence exists to support the theory of synergistic action between alpha radiation and other agents, and therefore a modified relative risk model was developed to predict lung cancer risks to the general public. The model considers latent period, observation period, age dependency, and inherent risks from smoking or geographical location. A test of the model showed excellent agreement with results of the study of Czechoslovakian uranium miners, for which the necessary time factors were available. The risk model was also used to predict lung cancer incidence among residents of homes on reclaimed Florida phosphate lands, and results of this analysis indicate that over the space of many years, the increased incidence of lung cancer due to elevated radon levels may be indisgtinguishable from those due to other causes

Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.

Science.gov (United States)

Shai, Iris; Schwarzfuchs, Dan; Henkin, Yaakov; Shahar, Danit R; Witkow, Shula; Greenberg, Ilana; Golan, Rachel; Fraser, Drora; Bolotin, Arkady; Vardi, Hilel; Tangi-Rozental, Osnat; Zuk-Ramot, Rachel; Sarusi, Benjamin; Brickner, Dov; Schwartz, Ziva; Sheiner, Einat; Marko, Rachel; Katorza, Esther; Thiery, Joachim; Fiedler, Georg Martin; Blüher, Matthias; Stumvoll, Michael; Stampfer, Meir J

2008-07-17

Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates. In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie. The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (Pcarbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (Ploss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (Plosses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (Pcarbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions. (ClinicalTrials.gov number, NCT00160108.) 2008 Massachusetts Medical Society

The neglected sociobehavioral risk factors of low birth weight

Directory of Open Access Journals (Sweden)

Mohsen Momeni

2016-08-01

Full Text Available Background: Low Birth Weight (LBW is one of the most important health indicators in the world. It has certain known and unknown causes. The present study was designed to evaluate the role of socio-behavioral factors on neonatal birth weight.Methods: The current case-control study was conducted on 300 eligible neonates (150 LBW infants as cases and 150 normal body weight infants as controls in 2015. The national pregnancy care forms of the neonates kept in heath care centers in Kerman were used. The data was analyzed running Independent samples t-test, Chi square test, and Fisher’s Exact test in SPSS. The significance level was set as 0.05.Results: Preterm birth (P<0.001, number of primary care during pregnancy (P=0.001, mother’s age (P=0.049, consumption of supplements during pregnancy (P=0.03, and history of substance abuse in mothers (P=0.03 were found to have significant roles in having LBW neonate.Conclusion: Identifying the sociobehavioral risk factors of Preterm labor and modifying them to prevent preterm birth are essential approaches to prevent LBW. Governments should pay special attention to nutritional status of teenage and young girls to have healthy mothers and babies in the future. Women of childbearing age should be screened and educated about risky behaviors. Pregnancy care and support should be delivered to all pregnant women according to the standard methods.Keywords: Low Birth Weight; Risk Factors; Behavior; Preterm Labor

Thyrotropin Suppressive Therapy for Low-Risk Small Thyroid Cancer: A Propensity Score-Matched Cohort Study.

Science.gov (United States)

Park, Suyeon; Kim, Won Gu; Han, Minkyu; Jeon, Min Ji; Kwon, Hyemi; Kim, Mijin; Sung, Tae-Yon; Kim, Tae Yong; Kim, Won Bae; Hong, Suck Joon; Shong, Young Kee

2017-09-01

Thyrotropin (TSH) suppression has improved the clinical outcomes of patients with differentiated thyroid cancer (DTC). However, the efficacy of TSH suppressive therapy (TST) is unclear in patients with low-risk DTC. This study aimed to evaluate the efficacy of TST and optimal TSH levels of patients with low-risk DTC. This retrospective propensity score-matched cohort study included DTC patients (n = 446) who underwent lobectomy from 2002 to 2008 with or without TST (TST group and No-TST group). Disease-free survival (DFS) and dynamic risk stratification were compared between both groups using serum TSH levels. Approximately 74% of TST patients and 11% of No-TST patients had suppressed serum TSH levels (<2 mIU/L). The median follow-up period was 8.6 years. During follow-up, the disease recurred in 10 (2.7%) patients, with no significant difference in DFS between the groups (p = 0.63). The proportion of patients with excellent treatment response was similar between the TST (65.2%) and No-TST (64.4%) groups. Incomplete biochemical response was noted in 17.2% of the TST group patients and 9.4% of the No-TST group patients. No significant difference was observed in the DFS between both groups by comparing serum TSH level (p = 0.57). TST did not improve clinical outcomes, and serum TSH levels were not associated with recurrence in patients with low-risk small DTC. No clinical benefits were shown for TSH suppression in low-risk patients who underwent lobectomy. Thus, levothyroxine is not necessary for patients without evidence of hypothyroidism.

A risk assessment tool for contaminated sites in low-permeability fractured media

DEFF Research Database (Denmark)

Chambon, Julie Claire Claudia; Binning, Philip John; Jørgensen, Peter R.

2011-01-01

A risk assessment tool for contaminated sites in low-permeability fractured media is developed, based on simple transient and steady-state analytical solutions. The discrete fracture (DF) tool, which explicitly accounts for the transport along fractures, covers different source geometries...... and history (including secondary sources) and can be applied to a wide range of compounds. The tool successfully simulates published data from short duration column and field experiments. The use for risk assessment is illustrated by three typical risk assessment case studies, involving pesticides...

Carcinogenesis induced by low-dose radiation

Directory of Open Access Journals (Sweden)

Piotrowski Igor

2017-11-01

Full Text Available Although the effects of high dose radiation on human cells and tissues are relatively well defined, there is no consensus regarding the effects of low and very low radiation doses on the organism. Ionizing radiation has been shown to induce gene mutations and chromosome aberrations which are known to be involved in the process of carcinogenesis. The induction of secondary cancers is a challenging long-term side effect in oncologic patients treated with radiation. Medical sources of radiation like intensity modulated radiotherapy used in cancer treatment and computed tomography used in diagnostics, deliver very low doses of radiation to large volumes of healthy tissue, which might contribute to increased cancer rates in long surviving patients and in the general population. Research shows that because of the phenomena characteristic for low dose radiation the risk of cancer induction from exposure of healthy tissues to low dose radiation can be greater than the risk calculated from linear no-threshold model. Epidemiological data collected from radiation workers and atomic bomb survivors confirms that exposure to low dose radiation can contribute to increased cancer risk and also that the risk might correlate with the age at exposure.

Frequent hospital admissions in Singapore: clinical risk factors and impact of socioeconomic status.

Science.gov (United States)

Low, Lian Leng; Tay, Wei Yi; Ng, Matthew Joo Ming; Tan, Shu Yun; Liu, Nan; Lee, Kheng Hock

2018-01-01

Frequent admitters to hospitals are high-cost patients who strain finite healthcare resources. However, the exact risk factors for frequent admissions, which can be used to guide risk stratification and design effective interventions locally, remain unknown. Our study aimed to identify the clinical and sociodemographic risk factors associated with frequent hospital admissions in Singapore. An observational study was conducted using retrospective 2014 data from the administrative database at Singapore General Hospital, Singapore. Variables were identified a priori and included patient demographics, comorbidities, prior healthcare utilisation, and clinical and laboratory variables during the index admission. Multivariate logistic regression analysis was used to identify independent risk factors for frequent admissions. A total of 16,306 unique patients were analysed and 1,640 (10.1%) patients were classified as frequent admitters. On multivariate logistic regression, 16 variables were independently associated with frequent hospital admissions, including age, cerebrovascular disease, history of malignancy, haemoglobin, serum creatinine, serum albumin, and number of specialist outpatient clinic visits, emergency department visits, admissions preceding index admission and medications dispensed at discharge. Patients staying in public rental housing had a 30% higher risk of being a frequent admitter after adjusting for demographics and clinical conditions. Our study, the first in our knowledge to examine the clinical risk factors for frequent admissions in Singapore, validated the use of public rental housing as a sensitive indicator of area-level socioeconomic status in Singapore. These risk factors can be used to identify high-risk patients in the hospital so that they can receive interventions that reduce readmission risk. Copyright: © Singapore Medical Association

Active surveillance can reduce overtreatment in patients with low-risk prostate cancer

DEFF Research Database (Denmark)

Thomsen, Frederik Birkebæk; Røder, Martin Andreas; Hvarness, Helle

2013-01-01

The incidence of prostate cancer in Denmark rose approximately 50% from 2000 to 2009 in parallel with the introduction of prostate-specific antigen (PSA)-testing. Available evidence indicates a significant overtreatment of patients with low-risk prostate cancer. Active surveillance has been...

Combination of isocitrate dehydrogenase 1 (IDH1) mutation and podoplanin expression in brain tumors identifies patients at high or low risk of venous thromboembolism.

Science.gov (United States)

Mir Seyed Nazari, Pegah; Riedl, Julia; Preusser, Matthias; Posch, Florian; Thaler, Johannes; Marosi, Christine; Birner, Peter; Ricken, Gerda; Hainfellner, Johannes A; Pabinger, Ingrid; Ay, Cihan

2018-04-19

Venous thromboembolism (VTE) is a frequent complication in primary brain tumor patients. Independent studies revealed that podoplanin expression in brain tumors is associated with increased VTE risk, while the isocitrate dehydrogenase 1 (IDH1) mutation is associated with very low VTE risk. To investigate the interrelation between intratumoral podoplanin expression and IDH1 mutation, and their mutual impact on VTE development. In a prospective cohort study, intratumoral IDH1 R132H mutation and podoplanin were determined in brain tumor specimens (mainly glioma) by immunohistochemistry. Primary endpoint of the study was symptomatic VTE during a 2-year follow-up. All brain tumors that expressed podoplanin to a medium-high extent showed also an IDH1 wildtype status. A score based on IDH1 status and podoplanin expression levels allowed predicting risk of VTE. Patients with wildtype IDH1 brain tumors and high podoplanin expression had a significantly increased VTE risk compared to those with mutant IDH1 tumors and no podoplanin expression (6-month risk 18.2% vs. 0%). IDH1 mutation and podoplanin overexpression seem to be exclusive. While brain tumor patients with IDH1 mutation are at very low VTE risk, the risk of VTE in patients with IDH1 wildtype tumors is strongly linked to podoplanin expression levels. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Risk of low birthweight in social districts of Copenhagen

DEFF Research Database (Denmark)

Lund, R; Modvig, J; Hilden, J

1999-01-01

The purpose of this survey was to investigate the small-area variations in low birthweight within social services districts in Copenhagen and the relation of such variations to the socioeconomic characteristics of the district. The study was based on register data and included all live-born single...... on births to women living in the city of Copenhagen from 1987-90. We found a statistically significant association between district and risk of newborns being small-for-gestational age (SGA). This association was independent of adjustment for maternal age and parity. Only part of the association...

Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus

DEFF Research Database (Denmark)

Stolzenburg Oxlund, Christina; Henriksen, J. E.; Tarnow, L.

2013-01-01

frequent adverse event leading to dose reduction in three cases and discontinuation in one, whereas gynaecomastia was not reported.Conclusion:Low dose spironolactone exerts significant BP and urinary albumin creatinine ratio lowering effects in high-risk patients with resistant hypertension and type 2...

National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer

Energy Technology Data Exchange (ETDEWEB)

Yang, David D. [Harvard Medical School, Boston, Massachusetts (United States); Muralidhar, Vinayak [Department of Medicine, Harvard Medical School, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Mahal, Brandon A. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Labe, Shelby A.; Nezolosky, Michelle D.; Vastola, Marie E.; King, Martin T.; Martin, Neil E.; Orio, Peter F. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Choueiri, Toni K. [Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Trinh, Quoc-Dien [Division of Urological Surgery, Harvard Medical School, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Spratt, Daniel E. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); University of Michigan, Ann Arbor, Michigan (United States); Hoffman, Karen E. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Feng, Felix Y. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Departments of Urology & Medicine and Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California (United States); and others

2017-06-01

Purpose: Androgen deprivation therapy (ADT) is not recommended for low-risk prostate cancer because of its lack of benefit and potential for harm. We evaluated the incidence and predictors of ADT use in low-risk disease. Methods and Materials: Using the National Cancer Database, we identified 197,957 patients with low-risk prostate cancer (Gleason score of 3 + 3 = 6, prostate-specific antigen level <10 ng/mL, and cT1-T2a) diagnosed from 2004 to 2012 with complete demographic and treatment information. We used multiple logistic regression to evaluate predictors of ADT use and Cox regression to examine its association with all-cause mortality. Results: Overall ADT use decreased from 17.6% in 2004 to 3.5% in 2012. In 2012, 11.5% of low-risk brachytherapy patients and 7.6% of external beam radiation therapy patients received ADT. Among 82,352 irradiation-managed patients, predictors of ADT use included treatment in a community versus academic cancer program (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.50-1.71; P<.001; incidence, 14.0% vs 6.0% in 2012); treatment in the South (AOR, 1.51), Midwest (AOR, 1.81), or Northeast (AOR, 1.90) versus West (P<.001); and brachytherapy use versus external beam radiation therapy (AOR, 1.32; 95% CI, 1.27-1.37; P<.001). Among 25,196 patients who did not receive local therapy, predictors of primary ADT use included a Charlson-Deyo comorbidity score of ≥2 versus 0 (AOR, 1.42; 95% CI, 1.06-1.91; P=.018); treatment in a community versus academic cancer program (AOR, 1.61; 95% CI, 1.37-1.90; P<.001); and treatment in the South (AOR, 1.26), Midwest (AOR, 1.52), or Northeast (AOR, 1.28) versus West (P≤.008). Primary ADT use was associated with increased all-cause mortality in patients who did not receive local therapy (adjusted hazard ratio, 1.28; 95% CI, 1.14-1.43; P<.001) after adjustment for age and comorbidity. Conclusions: ADT use in low-risk prostate cancer has declined nationally but may remain an issue

Cancer and non-cancer risk at low doses of radiation: biological basis of radiation-environment interplay

International Nuclear Information System (INIS)

Sasaki, Masao S.

2013-01-01

Cancer and non-cancer risk at low doses of ionizing radiation remains poorly defined due to ambiguity at low doses caused by limitations in statistical power and information available on interplay with environment. To deal with these problems, a novel non-parametric statistics was developed based on artificial neural networks theorem and applied to cancer and non-cancer risk in A-bomb survivors. The analysis revealed several unique features at low doses that could not be accounted for by nominal radiation dose alone. They include (1) threshold that varies with organ, gender and age, including cardiovascular diseases, (2) prevalence of infectious diseases, and (3) suppression of pathogenesis of HTLV1. The threshold is unique as it is manifested as negative excess relative risk, a reduction of spontaneous rate at low doses. The response is consistent with currently emerging laboratory data on DNA double-strand break (DSB) repair pathway choice and its sustainability as epigenetic memory in accordance with histone code theory. In response to DSB, of radiation or DNA replication arrest origin, distinct and competitively operating repair pathways are instigated. Activation by low doses of restitution-directed canonical non-homologous end-joining (C-NHEJ) suppresses both error-prone alternative end-joining (Alt-NHEJ) and homologous recombination (HR). The latter two present major pathways to mutagenesis at stalled replication folk associated with endogenous and exogenous genotoxin such as tobacco smoke metabolites and AID-associated somatic hypermutation and class switch recombination in Ig gene. Suppression of these error-prone pathways by low doses of low LET radiation is consistent with the reduction of cancer occurrence by environmental genotoxin, immunodiversity and stable integration of retrovirus DNA, providing a significant modulator of dose linearity at low doses. Whole picture may bring about a new landscape of cancer and non-cancer molecular epidemiology which

Frequency and interrelations of risk factors for chronic low back pain in a primary care setting.

Directory of Open Access Journals (Sweden)

Marie-Martine Lefevre-Colau

Full Text Available INTRODUCTION: Many risk factors have been identified for chronic low back pain (cLBP, but only one study evaluated their interrelations. We aimed to investigate the frequency of cLBP risk factors and their interrelations in patients consulting their general practitioners (GPs for cLBP. METHODS: A cross-sectional, descriptive, national survey was performed. 3000 GPs randomly selected were asked to include at least one patient consulting for cLBP. Demographic, clinical characteristics and the presence of cLBP risk factors were recorded. The frequency of each cLBP risk factor was calculated and multiple correspondence analysis (MCA was performed to study their interrelations. RESULTS: A total of 2068 GPs (68.9% included at least 1 patient, for 4522 questionnaires analyzed. In the whole sample of patients, the 2 risk factors most commonly observed were history of recurrent LBP (72.1% and initial limitation of activities of daily living (66.4%. For working patients, common professional risk factors were beliefs, that LBP was due to maintaining a specific posture at work (79.0% and frequent heavy lifting at work (65.5%. On MCA, we identified 3 risk-factor dimensions (axes for working and nonworking patients. The main dimension for working patients involved professional risk factors and among these factors, patients' job satisfaction and job recognition largely contribute to this dimension. DISCUSSION: Our results shed in light for the first time the interrelation and the respective contribution of several previously identified cLBP risk factors. They suggest that risk factors representing a "work-related" dimension are the most important cLBP risk factors in the working population.

Incidence of low risk human papillomavirus in oral cancer: a real time PCR study on 278 patients.

Science.gov (United States)

Palmieri, A; Scapoli, L; Martinelli, M; Pezzetti, F; Girardi, A; Spinelli, G; Lucchese, A; Carinci, F

2011-01-01

Squamous cell carcinoma is the most frequent malignant tumour of the oral cavity. It is widely known that tobacco and alcohol consumption are the major causes of the development of oral squamous cell carcinoma (OSCC). The human papilloma virus infection has also been postulated as a risk factor for squamous cell carcinoma, although conflicting results have been reported. The aim of this study is to evaluate the presence of high-risk and low-risk type human papillomavirus in a large sample of squamous cell carcinoma limited to the oral cavity by means of quantitative real-time polymerase chain reaction. Data were obtained from 278 squamous cell carcinoma limited to oral cavity proper. Sequencing revealed that 5 samples were positive for HPV type 16, 5 for HPV type 11, and 1 for HPV type 6. Human papillomavirus 11 was detected in 5 tumours out of the 278 examined. The prevalence rate for Human papillomavirus 11 was 1.8% (C.I. 0.7-3.9). The matched case-controls analysis indicated that the prevalence among controls did not significantly differ with respect to cases and that Human papillomavirus 11 alone did not correlate with squamous cell carcinoma.

Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births

NARCIS (Netherlands)

de jonge, A.; van der Goes, B. Y.; Ravelli, A. C. J.; Amelink-Verburg, M. P.; Mol, B. W.; Nijhuis, J. G.; Bennebroek Gravenhorst, J.; Buitendijk, S. E.

2009-01-01

OBJECTIVE: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. DESIGN: A nationwide cohort study. SETTING: The entire Netherlands. POPULATION: A total of 529,688 low-risk women

Low-level waste management

International Nuclear Information System (INIS)

Levin, G.B.

1980-01-01

An overview of the current situation in the United States and a look to the future of low-level waste management are presented. Current problems and challenges are discussed, such as: the need of additional disposal sites in the future; risks and costs involved in transport of low-level wastes; reduction of low-level waste volume through smelting, incineration, and storage for wastes containing nuclides with short half lives; development of a national policy for the management of low-level waste, and its implementation through a sensible system of regulations. Establishing a success with low-level waste management should provide the momentum and public confidence needed to continue on and to resolve the technical and politically more difficult low-level waste problems

Milk intake is not associated with low risk of diabetes or overweight-obesity

DEFF Research Database (Denmark)

Bergholdt, Helle K M; Nordestgaard, Børge G; Ellervik, Christina

2015-01-01

BACKGROUND: High dairy/milk intake has been associated with a low risk of type 2 diabetes observationally, but whether this represents a causal association is unknown. OBJECTIVE: We tested the hypothesis that high milk intake is associated with a low risk of type 2 diabetes and of overweight-obesity......, observationally and genetically. DESIGN: In 97,811 individuals from the Danish general population, we examined the risk of incident type 2 diabetes and of overweight-obesity by milk intake observationally and by LCT-13910 C/T genotype [polymorphism (rs4988235) upstream from the lactase (LCT) gene], where TT...... and TC genotypes are associated with lactase persistence and CC with nonpersistence. RESULTS: Observationally for any compared with no milk intake, the HR for type 2 diabetes was 1.10 (95% CI: 0.98, 1.24; P = 0.11), whereas the OR for overweight-obesity was 1.06 (1.02, 1.09; P = 0.002). Median milk...

Driving under the influence among frequent ecstasy consumers in Australia: trends over time and the role of risk perceptions.

Science.gov (United States)

Matthews, Allison Jane; Bruno, Raimondo; Dietze, Paul; Butler, Kerryn; Burns, Lucy

2014-11-01

Driving under the influence (DUI) of alcohol and illicit drugs is a serious road safety concern. This research aimed to examine trends in DUI across time and changes in attitudes towards the risks (crash and legal) associated with DUI among regular ecstasy users (REU) interviewed in Australia. Participants were regular (at least monthly) ecstasy users surveyed in 2007 (n=573) or 2011 (n=429) who had driven a car in the last six months. Face to face interviews comprised questions about recent engagement of DUI and roadside breath (alcohol) and saliva (drug) testing. Participants also reported the risk of crash and of being apprehended by police if DUI of alcohol, cannabis, ecstasy, and methamphetamine. There were significant reductions in DUI of psychostimulants (ecstasy, methamphetamine, cocaine, LSD) but not alcohol or cannabis between 2007 and 2011. This was accompanied by increased experience of roadside saliva testing and increases in crash and legal risk perceptions for ecstasy and methamphetamine, but not alcohol or cannabis. When the relationship between DUI and risk variables was examined, low crash risk perceptions were associated with DUI of all substances and low legal risk perceptions were associated with DUI of ecstasy. The observed reduction in DUI of psychostimulants among frequent ecstasy consumers may be related to increased risk awareness stemming from educational campaigns and the introduction of saliva testing on Australian roads. Such countermeasures may be less effective in relation to deterring or changing attitudes towards DUI of cannabis and alcohol among this group. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults athospital admission.

Science.gov (United States)

Chatindiara, Idah; Allen, Jacqueline; Popman, Amy; Patel, Darshan; Richter, Marilize; Kruger, Marlena; Wham, Carol

2018-03-21

Malnutrition in patients admitted to hospital may have detrimental effects on recovery and healing. Malnutrition is preceded by a state of malnutrition risk, yet malnutrition risk is often not detected during admission. The aim of the current study was to investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission. A cross-sectional was study conducted in 234 older adults (age ≥ 65 or ≥ 55 for Māori or Pacific ethnicity) at admission to hospital in Auckland, New Zealand. Assessment of malnutrition risk status was performed using the Mini Nutritional Assessment Short-Form (MNA®-SF), dysphagia risk by the Eating Assessment Tool (EAT-10), muscle strength by hand grip strength and cognitive status by the Montreal Cognitive Assessment (MoCA) tool. Among 234 participants, mean age 83.6 ± 7.6 years, 46.6% were identified as at malnutrition risk and 26.9% malnourished. After adjusting for age, gender and ethnicity, the study identified [prevalence ratio (95% confidence interval)] high dysphagia risk [EAT-10 score: 0.98 (0.97-0.99)], low body mass index [kg/m 2 : 1.02 (1.02-1.03)], low muscle strength [hand grip strength, kg: 1.01 (1.00-1.02)] and decline in cognition [MoCA score: 1.01 (1.00-1.02)] as significant predictors of malnutrition risk in older adults at hospital admission. Among older adults recently admitted to the hospital, almost three-quarters were malnourished or at malnutrition risk. As the majority (88%) of participants were admitted from the community, this illustrates the need for routine nutrition screening both at hospital admission and in community-dwelling older adults. Factors such as dysphagia, unintentional weight loss, decline in muscle strength, and poor cognition may indicate increased risk of malnutrition.

Mammography-oncogenecity at low doses

International Nuclear Information System (INIS)

Heyes, G J; Mill, A J; Charles, M W

2009-01-01

Controversy exists regarding the biological effectiveness of low energy x-rays used for mammography breast screening. Recent radiobiology studies have provided compelling evidence that these low energy x-rays may be 4.42 ± 2.02 times more effective in causing mutational damage than higher energy x-rays. These data include a study involving in vitro irradiation of a human cell line using a mammography x-ray source and a high energy source which matches the spectrum of radiation observed in survivors from the Hiroshima atomic bomb. Current radiation risk estimates rely heavily on data from the atomic bomb survivors, and a direct comparison between the diagnostic energies used in the UK breast screening programme and those used for risk estimates can now be made. Evidence highlighting the increase in relative biological effectiveness (RBE) of mammography x-rays to a range of x-ray energies implies that the risks of radiation-induced breast cancers for mammography x-rays are potentially underestimated by a factor of four. A pooled analysis of three measurements gives a maximal RBE (for malignant transformation of human cells in vitro) of 4.02 ± 0.72 for 29 kVp (peak accelerating voltage) x-rays compared to high energy electrons and higher energy x-rays. For the majority of women in the UK NHS breast screening programme, it is shown that the benefit safely exceeds the risk of possible cancer induction even when this higher biological effectiveness factor is applied. The risk/benefit analysis, however, implies the need for caution for women screened under the age of 50, and particularly for those with a family history (and therefore a likely genetic susceptibility) of breast cancer. In vitro radiobiological data are generally acquired at high doses, and there are different extrapolation mechanisms to the low doses seen clinically. Recent low dose in vitro data have indicated a potential suppressive effect at very low dose rates and doses. Whilst mammography is a low

Risk factors for major antenatal depression among low-income African American women.

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Luke, Sabrina; Salihu, Hamisu M; Alio, Amina P; Mbah, Alfred K; Jeffers, Dee; Berry, Estrellita Lo; Mishkit, Vanessa R

2009-11-01

Data on risk factors for major antenatal depression among African American women are scant. In this study, we seek to determine the prevalence and risk factors for major antenatal depression among low-income African American women receiving prenatal services through the Central Hillsborough Healthy Start (CHHS). Women were screened using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff of > or =13 as positive for risk of major antenatal depression. In total, 546 African American women were included in the analysis. We used logistic regression to identify risk factors for major antenatal depression. The prevalence of depressive symptomatology consistent with major antenatal depression was 25%. Maternal age was identified as the main risk factor for major antenatal depression. The association between maternal age and risk for major antenatal depression was biphasic, with a linear trend component lasting until age 30, at which point the slope changed markedly tracing a more pronounced likelihood for major depression with advancing age. Women aged > or =30 were about 5 times as likely to suffer from symptoms of major antenatal depression as teen mothers (OR = 4.62, 95% CI 2.23-9.95). The risk for major antenatal depression increases about 5-fold among low-income African American women from age 30 as compared to teen mothers. The results are consistent with the weathering effect resulting from years of cumulative stress burden due to socioeconomic marginalization and discrimination. Older African American mothers may benefit from routine antenatal depression screening for early diagnosis and intervention.

The Folate-Vitamin B12 Interaction, Low Hemoglobin, and the Mortality Risk from Alzheimer's Disease.

Science.gov (United States)

Min, Jin-Young; Min, Kyoung-Bok

2016-03-21

Abnormal hemoglobin levels are a risk factor for Alzheimer's disease (AD). Although the mechanism underlying these associations is elusive, inadequate micronutrients, particularly folate and vitamin B12, may increase the risk for anemia, cognitive impairment, and AD. In this study, we investigated whether the nutritional status of folate and vitamin B12 is involved in the association between low hemoglobin levels and the risk of AD mortality. Data were obtained from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) and the NHANES (1999-2006) Linked Mortality File. A total of 4,688 participants aged ≥60 years with available baseline data were included in this study. We categorized three groups based on the quartiles of folate and vitamin B12 as follows: Group I (low folate and vitamin B12); Group II (high folate and low vitamin B12 or low folate and high vitamin B12); and Group III (high folate and vitamin B12). Of 4,688 participants, 49 subjects died due to AD. After adjusting for age, sex, ethnicity, education, smoking history, body mass index, the presence of diabetes or hypertension, and dietary intake of iron, significant increases in the AD mortality were observed in Quartile1 for hemoglobin (HR: 8.4, 95% CI: 1.4-50.8), and the overall risk of AD mortality was significantly reduced with increases in the quartile of hemoglobin (p for trend = 0.0200), in subjects with low levels of both folate and vitamin B12 at baseline. This association did not exist in subjects with at least one high level of folate and vitamin B12. Our finding shows the relationship between folate and vitamin B12 levels with respect to the association between hemoglobin levels and AD mortality.

Thymic epithelial tumors: Comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas

International Nuclear Information System (INIS)

Sadohara, Junko; Fujimoto, Kiminori; Mueller, Nestor L.; Kato, Seiya; Takamori, Shinzo; Ohkuma, Kazuaki; Terasaki, Hiroshi; Hayabuchi, Naofumi

2006-01-01

Objective: To assess the CT and magnetic resonance (MR) imaging findings of thymic epithelial tumors classified according to the current World Health Organization (WHO) histologic classification and to determine useful findings in differentiating the main subtypes. Materials and methods: Sixty patients with thymic epithelial tumor who underwent both CT and MR imaging were reviewed retrospectively. All cases were classified according to the 2004 WHO classification. The following findings were assessed in each case on both CT and MRI: size of tumor, contour, perimeter of capsule; homogeneity, presence of septum, hemorrhage, necrotic or cystic component within tumor; presence of mediastinal lymphadenopathy, pleural effusion, and great vessel invasion. These imaging characteristics of 30 low-risk thymomas (4 type A, 12 type AB, and 14 type B1), 18 high-risk thymomas (11 type B2 and seven type B3), and 12 thymic carcinomas on CT and MR imaging were compared using the chi-square test. Comparison between CT and MR findings was performed by using McNemar test. Results: On both CT and MR imaging, thymic carcinomas were more likely to have irregular contours (P < .001), necrotic or cystic component (P < .05), heterogeneous contrast-enhancement (P < .05), lymphadenopathy (P < .0001), and great vessel invasion (P < .001) than low-risk and high-risk thymomas. On MR imaging, the findings of almost complete capsule, septum, and homogenous enhancement were more commonly seen in low-risk thymomas than high-risk thymomas and thymic carcinomas (P < .05). MR imaging was superior to CT in the depiction of capsule, septum, or hemorrhage within tumor (all comparison, P < .05). Conclusion: The presence of irregular contour, necrotic or cystic component, heterogeneous enhancement, lymphadenopathy, and great vessel invasion on CT or MR imaging are strongly suggestive of thymic carcinomas. On MR imaging, the findings of contour, capsule, septum, and homogenous enhancement are helpful in

Setting up low-risk bone marrow transplantation for children with thalassemia may facilitate pediatric cancer care

Directory of Open Access Journals (Sweden)

Lawrence B Faulkner

2013-01-01

Full Text Available Background: In many South Asian countries there is shortage of centers providing care for pediatric malignancies. This report describes the experience of the Cure2Children Foundation (C2C in supporting, both financially and professionally, the startup of two bone marrow transplant (BMT centers, one in Pakistan and one in India, for the cure of transfusion-dependent thalassemia. Even though transplantation is generally considered as a more complex and advanced step relatively to basic pediatric cancer care, the authors argue that BMT for low-risk thalassemia patients with a matched sibling is a relatively simple procedure amenable to focused training. Materials and Methods: Since 2008 the C2C, an Italian Nongovernmental Organization (NGO, has supported a BMT network in Pakistan. The primary aim of this project was to assess feasibility, outcomes, and costs of matched-related BMT for thalassemia in young low-risk children employing a well established and quite tolerable strategy employed in Italy. This initiative relied primarily on focused training and task-shift strategies within a structured cooperation program. The initial success of that strategy led to its replication in India with 100 total BMTs performed over the past 4 years, 91 of which were for thalassemia major. Results: Low-risk matched-related BMT in children younger than 5 years could deliver a 92% thalassemia-free survival with 100% performance score and no extensive chronic graft versus host disease (GVHD, for an average cost of 10,000 USD per BMT. Within an existing hospital facility, 50,000 USD were sufficient to renovate and fully equip a 2-3 bedded start up BMT unit capable of performing safe low-risk compatible marrow transplantation. Conclusions: In low resource settings matched-related low-risk BMT for thalassemia can be performed with outcomes comparable to richer countries and with a fraction of the costs. Within structured and intensive cooperation, good outcomes can be

Low-dose aspirin and risk of intracranial bleeds: An observational study in UK general practice.

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Cea Soriano, Lucía; Gaist, David; Soriano-Gabarró, Montse; Bromley, Susan; García Rodríguez, Luis A

2017-11-28

To quantify the risk of intracranial bleeds (ICBs) associated with new use of prophylactic low-dose aspirin using a population-based primary care database in the United Kingdom. A cohort of new users of low-dose aspirin (75-300 mg; n = 199,079) aged 40-84 years and a 1:1 matched cohort of nonusers of low-dose aspirin at baseline were followed (maximum 14 years, median 5.4 years) to identify incident cases of ICB, with validation by manual review of patient records or linkage to hospitalization data. Using 10,000 frequency-matched controls, adjusted rate ratios (RRs) with 95% confidence intervals (CIs) were calculated for current low-dose aspirin use (0-7 days before the index date [ICB date for cases, random date for controls]); reference group was never used. There were 1,611 cases of ICB (n = 743 for intracerebral hemorrhage [ICH], n = 483 for subdural hematoma [SDH], and n = 385 for subarachnoid hemorrhage [SAH]). RRs (95% CI) were 0.98 (0.84-1.13) for all ICB, 0.98 (0.80-1.20) for ICH, 1.23 (0.95-1.59) for SDH, and 0.77 (0.58-1.01) for SAH. No duration of use or dose-response association was apparent. RRs (95% CI) for ≥1 year of low-dose aspirin use were 0.90 (0.72-1.13) for ICH, 1.20 (0.91-1.57) for SDH, and 0.69 (0.50-0.94) for SAH. Low-dose aspirin is not associated with an increased risk of any type of ICB and is associated with a significantly decreased risk of SAH when used for ≥1 year. © 2017 American Academy of Neurology.

Prenatal Care Initiation in Low-Income Hispanic Women: Risk and Protective Factors

Science.gov (United States)

Luecken, Linda J.; Purdom, Catherine L.; Howe, Rose

2009-01-01

Objectives: To examine the psychosocial risk (distress, stress, unintended pregnancy) and protective factors (social support, mastery, familism) associated with entry into prenatal care among low-income Hispanic women. Methods: Between April and September 2005, 483 postpartum Medicaid-eligible Hispanic women completed a survey at the hospital.…

Do Ontarians drink in moderation? a baseline assessment against Canadian low risk drinking guidelines.

Science.gov (United States)

Bondy, S J; Ashley, M J; Rehm, J T; Walsh, G

1999-01-01

We used the 1997 Ontario Drug Monitor, a population-based, random-digit dialing survey of 2,776 adults, to obtain a baseline assessment of alcohol drinking by Ontarians against the 1997 low-risk drinking guidelines of the Addiction Research Foundation and the Canadian Centre on Substance Abuse. Average weekly alcohol consumption and the frequency of exceeding the daily limit, estimated using the graduated frequency scale, were determined for the population overall, and by sex and age group (18-44 and 45+ years). Most Ontarians drank alcohol in a pattern associated with a low risk of health consequences. About 10% of women and 25% of men drank in a style associated with some increase in acute or long-term risk. Younger men were most likely to drink in a risky pattern. Most drinkers of middle age or older, for whom cardiovascular disease is a significant health risk, consumed alcohol in a pattern associated with cardiovascular benefit.

Quantifying the benefits of achieving or maintaining long-term low risk profile for cardiovascular disease: The Doetinchem Cohort Study.

Science.gov (United States)

Hulsegge, Gerben; Smit, Henriëtte A; van der Schouw, Yvonne T; Daviglus, Martha L; Verschuren, W M Monique

2015-10-01

Studies investigating the relation between risk profiles and cardiovascular disease have measured risk at baseline only. We investigated maintenance and changes of risk profiles over time and their potential impact on incident cardiovascular disease. Population-based cohort study. Risk factors were measured at baseline (1987-1991) among 5574 cardiovascular disease-free adults aged 20-59 years. They were classified into four risk categories according to smoking status, presence of diabetes and widely accepted cut-off values for blood pressure, total cholesterol/HDL-ratio and body mass index. Categories were subdivided (maintenance, deterioration, improvement) based on risk factor levels at six and 11 years of follow-up. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cardiovascular disease incidence 5-10 years following the risk-change period were fitted using Cox proportional hazards models. Only 12% of participants were low risk at baseline, and only 7% maintained it. Participants who maintained a low risk profile over 11 years had seven times lower risk of cardiovascular disease (HR: 0.14, 95% CI: 0.05-0.41) than participants with long-term high risk profile, whereas those low risk at baseline whose profile deteriorated had three times lower risk (HR: 0.36, 95% CI: 0.18-0.71). Our results suggest that, within each baseline risk profile group, compared with a stable profile, improving profiles may be associated with up to two-fold lower HRs, and deteriorating profiles with about two-fold higher HRs. Our study, using long-term risk profiles, demonstrates the full benefits of low risk profile. These findings underscore the importance of achieving and maintaining low risk from young adulthood onwards. © The European Society of Cardiology 2014.

Low- and high-testosterone individuals exhibit decreased aversion to economic risk.

Science.gov (United States)

Stanton, Steven J; Mullette-Gillman, O'Dhaniel A; McLaurin, R Edward; Kuhn, Cynthia M; LaBar, Kevin S; Platt, Michael L; Huettel, Scott A

2011-04-01

Testosterone is positively associated with risk-taking behavior in social domains (e.g., crime, physical aggression). However, the scant research linking testosterone to economic risk preferences presents inconsistent findings. We examined the relationship between endogenous testosterone and individuals' economic preferences (i.e., risk preference, ambiguity preference, and loss aversion) in a large sample (N = 298) of men and women. We found that endogenous testosterone levels have a significant U-shaped association with individuals' risk and ambiguity preferences, but not loss aversion. Specifically, individuals with low or high levels of testosterone (more than 1.5 SD from the mean for their gender) were risk and ambiguity neutral, whereas individuals with intermediate levels of testosterone were risk and ambiguity averse. This relationship was highly similar in men and women. In contrast to received wisdom regarding testosterone and risk, the present data provide the first robust evidence for a nonlinear association between economic preferences and levels of endogenous testosterone.

Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study.

Science.gov (United States)

Sundström, Johan; Hedberg, Jakob; Thuresson, Marcus; Aarskog, Pernilla; Johannesen, Kasper Munk; Oldgren, Jonas

2017-09-26

There are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events. We performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk. During a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34-1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time. In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal. © 2017 American Heart Association, Inc.

An Assessment of Technical and Production Risks of Candidate Low-Cost Attitude/Heading Reference Systems(AHRS)

Science.gov (United States)

Yuchnovicz, Daniel; Burgess, Malcolm; Hammers, William

1999-01-01

This report provides an assessment of technical and production risks of candidate low-cost attitude/heading reference systems (AHRS) for use in the Advanced General Aviation Transport Experiments (AGATE) airplanes. A low-cost AHRS is a key component of modem "glass cockpit" flight displays for General Aviation (GA) aircraft. The technical capabilities of several candidate low-cost AHRS were examined and described along with the technical issues involved with using all solid-state components for attitude measurement. An economic model was developed which describes the expected profit, rate of return, and volume requirements for the manufacture of low-cost AHRS for GA aircraft in the 2000 to 2020 time frame. The model is the result of interviews with GA airframe manufacturers, avionics manufacturers and historical analysis of avionics of similar complexity. The model shows that a manufacturer will break even after three years of AHRS production, realizing an 18 percent rate of return (23 percent profit) on an investment of $3.5M over the 20 year period. A start-up production estimate showed costs of $6-12M for a new company to build and certify an AHRS from scratch, considered to be a high-risk proposition, versus $0.25-0.75M for an experienced avionics manufacturer to manufacture a design under license, a low-risk proposition.

Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors.

Science.gov (United States)

Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( [Formula: see text] ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years ( P fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76-19.49; P falls (OR =2.55; 95% CI =1.05-6.19; P =0.039), age (OR =1.14; 95% CI =1.05-1.23; P =0.001), and BMI (OR =0.91; 95% CI =0.83-0.99; P =0.034). Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.

Low back pain in school-age children: risk factors, clinical features and diagnostic managment.

Science.gov (United States)

Boćkowski, L; Sobaniec, W; Kułak, W; Smigielska-Kuzia, J; Sendrowski, K; Roszkowska, M

2007-01-01

Low back pain (LBP) is common in adult population, and it is becoming a serious health concern in adolescents. On surveys, about every fifth child in the school-age reports LBP. The study objective was to analysis the natural history, risk factors, clinical symptoms, causes and diagnostic management in school-age children hospitalized with LBP. The study group consisted of 36 patients at the age between 10 and 18 years, 22 girls and 14 boys suffering from LBP hospitalized in our Department of Pediatric Neurology and Rehabilitation in years 2000-2004. The mean age of clinical onset of LBP in our group was 14.7 years, earlier in girls, later in boys. We find the family history of LBP in 50% children. Most frequent factors associated with LBP were: spina bifida (16.7%) and incorrect posture (13.9%). Half of patients pointed the factor initialising LBP: rapid, incoordinated move (39%) or heavy load rise (11%). 58% of patients present the symptoms of ischialgia. Diagnostic imaging showed disc protrusion in 11 children (31%) 6 in computed tomography, 4 in magnetic resonance imaging and 1 in X-Ray examination only. Other causes of LBP included: spondylolysis in 2 patients, Scheuermann disease in one case and juvenile reumatoid arthritis in one case. Some school-age children suffering on low back pain, particulary with sciatic neuralgia symptoms seek medical care in hospital. Althought the main causes are mechanical, associated with lack of physical activity or strenous exercise, serious diagnostic managment is strongly recommended.

Focus Group Study Exploring Factors Related to Frequent Sickness Absence.

Directory of Open Access Journals (Sweden)

Annette Notenbomer

Full Text Available Research investigating frequent sickness absence (3 or more episodes per year is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves.We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD-R model as theoretical framework.Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills were regarded as solutions to reduce frequent sickness absence.The JD-R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance.

Focus Group Study Exploring Factors Related to Frequent Sickness Absence.

Science.gov (United States)

Notenbomer, Annette; Roelen, Corné A M; van Rhenen, Willem; Groothoff, Johan W

2016-01-01

Research investigating frequent sickness absence (3 or more episodes per year) is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves. We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD-R) model as theoretical framework. Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills) were regarded as solutions to reduce frequent sickness absence. The JD-R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance.

[Chronic low-grade inflammation, lipid risk factors and mortality in functionally dependent elderly].

Science.gov (United States)

Vasović, Olga; Trifunović, Danijela; Despotovié, Nebojsa; Milosević, Dragoslav P

2010-07-01

It has been proved that a highly sensitive C-reactive protein (hsCRP) can be used as an established marker of chronic inflammation for cardiovascular risk assessment. Since mean values of both low-density cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) decrease during aging, the knowledge that increased hsCRP concentration predicts mortality (Mt) would influence therapy and treatment outcome. The aim of this study was to examine importance of chronic low grade inflammation and its association with lipid risk factors for all-cause Mt in functionally dependent elderly. The participants of this longitudinal prospective study were 257 functionally dependent elderly aged 65-99 years. Baseline measurements: anthropometric measurements, blood pressure, fasting plasma total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C, non-HDL-C, hemoglobin Alc (HbA1c) were recorded and different lipid ratios were calculated. Inflammation was assessed by the levels of white blood cells, fibrinogen and hsCRP. The participants with hsCRP grater than 10 mg/L were excluded from the study. The residual participants (77.4% women) were divided into three groups according to their hsCRP levels: a low (agressive lipid lowering treatment.

Total sitting time, leisure time physical activity and risk of hospitalization due to low back pain

DEFF Research Database (Denmark)

Balling, Mie; Holmberg, Teresa; Petersen, Christina B

2018-01-01

AIMS: This study aimed to test the hypotheses that a high total sitting time and vigorous physical activity in leisure time increase the risk of low back pain and herniated lumbar disc disease. METHODS: A total of 76,438 adults answered questions regarding their total sitting time and physical...... activity during leisure time in the Danish Health Examination Survey 2007-2008. Information on low back pain diagnoses up to 10 September 2015 was obtained from The National Patient Register. The mean follow-up time was 7.4 years. Data were analysed using Cox regression analysis with adjustment...... disc disease. However, moderate or vigorous physical activity, as compared to light physical activity, was associated with increased risk of low back pain (HR = 1.16, 95% CI: 1.03-1.30 and HR = 1.45, 95% CI: 1.15-1.83). Moderate, but not vigorous physical activity was associated with increased risk...

Housing conditions as a social determinant of low birthweight and preterm low birthweight

Directory of Open Access Journals (Sweden)

Mario Vianna Vettore

2010-12-01

Full Text Available OBJECTIVE: To assess the relationship between housing conditions and low birthweight and preterm low birthweight among low-income women. METHODS: A case-control study was conducted with post-partum women living in the city of Rio de Janeiro, Southeast Brazil, in 2003-2005. Two groups of cases, low birthweight (n=96 and preterm low birthweight infants (n=68, were compared against normal weight term controls (n=393. Housing conditions were categorized into three levels: adequate, inadequate, and highly inadequate. Covariates included sociodemographic and anthropometric characteristics, risk behaviors, violence, anxiety, satisfaction during pregnancy, obstetric history and prenatal care. RESULTS: Poor housing conditions was independently associated with low birthweight (inadequate - OR 2.3 [1.1;4.6]; highly inadequate - OR 7.6 [2.1;27.6] and preterm low birthweight (inadequate - OR 2.2 [1.1;4.3]; highly inadequate - OR 7.6 [2.4;23.9] and factors associated with outcomes were inadequate prenatal care and previous preterm birth. Low income and low maternal body mass index remained associated with low birthweight. CONCLUSIONS: Poor housing conditions were associated with low birthweight and preterm low birthweight.

Blood microRNAs in Low or No Risk Ischemic Stroke Patients

Directory of Open Access Journals (Sweden)

Jun Rong Tan

2013-01-01

Full Text Available Ischemic stroke is a multi-factorial disease where some patients present themselves with little or no risk factors. Blood microRNA expression profiles are becoming useful in the diagnosis and prognosis of human diseases. We therefore investigated the blood microRNA profiles in young stroke patients who presented with minimal or absence of risk factors for stroke such as type 2 diabetes, dyslipidemia and hypertension. Blood microRNA profiles from these patients varied with stroke subtypes as well as different functional outcomes (based on modified Rankin Score. These microRNAs have been shown to target genes that are involved in stroke pathogenesis. The findings from our study suggest that molecular mechanisms in stroke pathogenesis involving low or no risk ischemic stroke patients could differ substantially from those with pre-existing risk factors.

Risk charts to identify low and excessive responders among first-cycle IVF/ICSI standard patients

DEFF Research Database (Denmark)

la Cour Freiesleben, N; Gerds, Thomas Alexander; Forman, Julie Lyng

2011-01-01

Ovarian stimulation carries a risk of either low or excessive ovarian response. The aim was to develop prognostic models for identification of standard (ovulatory and normal basal FSH) patients’ risks of low and excessive response to conventional stimulation for IVF/intracytoplasmic sperm injection....... Prospectively collected data on 276 first-cycle patients treated with 150 IU recombinant FSH (rFSH)/day in a long agonist protocol were analysed. Logistic regression analysis was applied to the outcome variables:low (seven or less follicles) and excessive (20 or more follicles) response. Variables were woman......’s age, menstrual cycle length, weight or body mass index, ovarian volume, antral follicle count (AFC) and basal FSH. The predictive performance of the models was evaluated from the prediction error (Brier score, %) where zero corresponds to a perfect prediction. Model stability was assessed using 1000...

Monotherapy of aspirin or warfarin for prevention of ischemic stroke in low-risk atrial fibrillation: A Easter Asian population-based study.

Science.gov (United States)

Liu, Chieh-Yu; Chen, Hui-Chun

2018-05-02

This study aimed to investigate the effectiveness of monotherapy aspirin and warfarin for stroke prevention in low-risk atrial fibrillation (AF) by using a population-based cohort study in Taiwan. A newly diagnosed low-risk AF patient cohort were identified by using National Health Insurance Research Database (NHIRD) in Taiwan in 2008. The study cohort was observed with a follow-up of 2 years to examine the onset of ischemic stroke (IS) (to 2010). The longitudinal data were analyzed by using generalized estimation equations (GEE). A total of 8,065 newly-diagnosed low-risk AF patients were identified in 2008. 7.4% were prescribed with aspirin and 4.6% were prescribed with warfarin. The GEE results showed that low-risk AF patients with hypertension who received warfarin were associated with a statistically significant 58.4% reduction of IS risk (OR = 0.416, p = 0.024, 95% CI 0.194-0.891). Additionally, low-risk AF patients with hyperlipidemia who received warfarin were associated with a 69.3% reduction of IS risk (OR = 0.307, p = 0.044, 95% CI 0.097-0.969). Warfarin is suggested to be prescribed in preventing ischemic stroke for low-stroke-risk atrial fibrillation patients with hypertension and hyperlipidemia.

Low level radiation: how low can you get?

International Nuclear Information System (INIS)

Townsley, M.

1990-01-01

Information stored on the world's largest data bank concerning the health of nuclear industry workers is to be handed over to researchers at Birmingham University by the US Department of Energy. The data bank contains detailed information on 300,000 nuclear employees, going back to the 1940s. Such a large sample size will allow the results of a previous study conducted on workers in the US nuclear industry to be verified. That study was concluded in 1978 and showed that the risk estimates set by the International Commission on Radiological Protection (ICRP) were between 10 and 30 times too low. The current ICRP estimate allows workers up to 50mSv of exposure to low level radiation per year. Risk estimates have been derived from data relating to the atomic bombings of Hiroshima and Nagasaki. However in those cases the radiation doses were relatively high but over a short period. In the nuclear industry the doses are lower but are long term and this may account for the apparent anomalies such as the incidence of leukaemia amongst children whose fathers have worked in the nuclear industry compared with that for the children whose fathers received radiation doses from the atomic bombings. It is expected the study will show that low-level radiation is more damaging than has previously been thought. (author)

Vaginal flora alterations and clinical symptoms in low-risk pregnant women.

Science.gov (United States)

Gondo, Fausto; da Silva, Márcia G; Polettini, Jossimara; Tristao, Andréa da R; Peracoli, José C; Witkin, Steven S; Rudge, Marilza V C

2011-01-01

To evaluate associations between alterations in vaginal flora and clinical symptoms in low-risk pregnant women. Vaginal specimens from 245 pregnant women were analyzed by microscopy for vaginal flora. Signs and symptoms of vaginal infection were determined by patient interviews and gynecologic examinations. Abnormal vaginal flora was identified in 45.7% of the subjects. The final clinical diagnoses were bacterial vaginosis (21.6%), vaginal candidosis (10.2%), intermediate vaginal flora (5.2%), aerobic vaginitis (2.9%), mixed flora (2.9%) and other abnormal findings (2.9%). The percentage of women with or without clinical signs or symptoms was not significantly different between these categories. The presence of vaginal odor or vaginal discharge characteristics was not diagnostic of any specific flora alteration; pruritus was highly associated with candidosis (p vaginal odor was associated with bacterial vaginosis (p = 0.0026). The prevalence of atypical vaginal flora is common in our low-risk pregnant population and is not always associated with pathology. The occurrence of specific signs or symptoms does not always discriminate between women with different types of atypical vaginal flora or between those with abnormal and normal vaginal flora. Copyright © 2010 S. Karger AG, Basel.

Dietary Intervention for Overweight and Obese Adults: Comparison of Low-Carbohydrate and Low-Fat Diets. A Meta-Analysis.

Directory of Open Access Journals (Sweden)

Jonathan Sackner-Bernstein

Full Text Available Reduced calorie, low fat diet is currently recommended diet for overweight and obese adults. Prior data suggest that low carbohydrate diets may also be a viable option for those who are overweight and obese.Compare the effects of low carbohydrate versus low fats diet on weight and atherosclerotic cardiovascular disease risk in overweight and obese patients.Systematic literature review via PubMed (1966-2014.Randomized controlled trials with ≥8 weeks follow up, comparing low carbohydrate (≤120gm carbohydrates/day and low fat diet (≤30% energy from fat/day.Data were extracted and prepared for analysis using double data entry. Prior to identification of candidate publications, the outcomes of change in weight and metabolic factors were selected as defined by Cochrane Collaboration. Assessment of the effects of diets on predicted risk of atherosclerotic cardiovascular disease risk was added during the data collection phase.1797 patients were included from 17 trials with 99% while the reduction in predicted risk favoring low carbohydrate was >98%.Lack of patient-level data and heterogeneity in dropout rates and outcomes reported.This trial-level meta-analysis of randomized controlled trials comparing LoCHO diets with LoFAT diets in strictly adherent populations demonstrates that each diet was associated with significant weight loss and reduction in predicted risk of ASCVD events. However, LoCHO diet was associated with modest but significantly greater improvements in weight loss and predicted ASCVD risk in studies from 8 weeks to 24 months in duration. These results suggest that future evaluations of dietary guidelines should consider low carbohydrate diets as effective and safe intervention for weight management in the overweight and obese, although long-term effects require further investigation.

Are low wages risk factors for hypertension?

Science.gov (United States)

Leigh, J Paul; Du, Juan

2012-12-01

Socio-economic status (SES) is strongly correlated with hypertension. But SES has several components, including income and correlations in cross-sectional data need not imply SES is a risk factor. This study investigates whether wages-the largest category within income-are risk factors. We analysed longitudinal, nationally representative US data from four waves (1999, 2001, 2003 and 2005) of the Panel Study of Income Dynamics. The overall sample was restricted to employed persons age 25-65 years, n = 17 295. Separate subsamples were constructed of persons within two age groups (25-44 and 45-65 years) and genders. Hypertension incidence was self-reported based on physician diagnosis. Our study was prospective since data from three base years (1999, 2001, 2003) were used to predict newly diagnosed hypertension for three subsequent years (2001, 2003, 2005). In separate analyses, data from the first base year were used to predict time-to-reporting hypertension. Logistic regressions with random effects and Cox proportional hazards regressions were run. Negative and strongly statistically significant correlations between wages and hypertension were found both in logistic and Cox regressions, especially for subsamples containing the younger age group (25-44 years) and women. Correlations were stronger when three health variables-obesity, subjective measures of health and number of co-morbidities-were excluded from regressions. Doubling the wage was associated with 25-30% lower chances of hypertension for persons aged 25-44 years. The strongest evidence for low wages being risk factors for hypertension among working people were for women and persons aged 25-44 years.

Overweight and obesity among children at risk of intellectual disability in 20 low and middle income countries.

Science.gov (United States)

Savage, A; Emerson, E

2016-11-01

Children with intellectual disability (ID) in high income countries are at significantly greater risk of obesity than their non-disabled peers. We aimed to estimate the prevalence of overweight and obesity in 3 to 4-year-old children who are/are not at risk of ID in low and middle income countries. Secondary analysis of Round 4 and 5 UNICEF Multiple Indicator Cluster Surveys (MICS) from 20 low and middle income countries that included a total of 83 597 3 to 4-year-old children. Few differences in risk of overweight or obesity were apparent between 3 and 4-year-old children identified as being at risk/not at risk of ID in 20 low and middle income countries. In the two countries where statistically significant differences were observed, prevalence of overweight/obesity was lower among children at risk of ID. These results stand in stark contrast to evidence from high income countries which suggest that children with ID are at significantly increased risk of obesity when compared to their non-intellectually disabled peers. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Low serum insulin-like growth factor I is associated with increased risk of ischemic heart disease

DEFF Research Database (Denmark)

Juul, Anders; Scheike, Thomas Harder; Davidsen, Michael

2002-01-01

Insulin-like growth factor I (IGF-I) has been suggested to be involved in the pathogenesis of atherosclerosis. We hypothesize that low IGF-I and high IGFBP-3 levels might be associated with increased risk of ischemic heart disease (IHD).......Insulin-like growth factor I (IGF-I) has been suggested to be involved in the pathogenesis of atherosclerosis. We hypothesize that low IGF-I and high IGFBP-3 levels might be associated with increased risk of ischemic heart disease (IHD)....

Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries.

Science.gov (United States)

Kalinowski, Agnieszka; Humphreys, Keith

2016-07-01

One of the challenges of international alcohol research and policy is the variability in and lack of knowledge of how governments in different nations define a standard drink and low-risk drinking. This study gathered such information from governmental agencies in 37 countries. A pool of 75 countries that might have definitions was created using World Health Organization (WHO) information and the authors' own judgement. Structured internet searches of relevant terms for each country were supplemented by efforts to contact government agencies directly and to consult with alcohol experts in the country. Most of the 75 national governments examined were not identified as having adopted a standard drink definition. Among the 37 that were so identified, the modal standard drink size was 10 g pure ethanol, but variation was wide (8-20 g). Significant variability was also evident for low-risk drinking guidelines, ranging from 10-42 g per day for women and 10-56 g per day for men to 98-140 g per week for women and 150-280 g per week for men. Researchers working and communicating across national boundaries should be sensitive to the substantial variability in 'standard' drink definitions and low-risk drinking guidelines. The potential impact of guidelines, both in general and in specific national cases, remains an important question for public health research. © 2016 Society for the Study of Addiction.

Risk Factors Associated with Crash Severity on Low-Volume Rural Roads in Denmark

DEFF Research Database (Denmark)

Prato, Carlo Giacomo; Rasmussen, Thomas Kjær; Kaplan, Sigal

2014-01-01

Safety on low-volume rural roads is drawing attention due to the high fatality and severe injury rates in comparison with high-volume roads and the increasing awareness of sustainable rural development among policy makers. This study analyzes the risk factors associated with crash severity on low......-volume rural roads, including crash characteristics, driver attributes and behavior, vehicle type, road features, environmental conditions, distance from the nearest hospital, and zone rurality degree. The data consist of a set of crashes occurred on low-volume rural roads in Denmark between 2007 and 2011...... advantage in accommodating the ordered-response nature of severity while relaxing the proportional odds assumption. Model estimates and pseudoelasticities show that aggravated crash injury severity is significantly associated with (1) alcohol and failure to wear seatbelts, (2) involvement of vulnerable road...

Spirituality and low-risk consumption of alcohol in young adults

OpenAIRE

Díaz Heredia, Luz Patricia; Muñoz Sánchez, Alba Idaly

2013-01-01

The relationship between spirituality and health, as well as it effect on adopting healthy behaviors, is a topic of interest for nursing and, in general, for social and life sciences. Spirituality, as a human realm, is a relevant research theme that is often related to the promotion of health in individuals. Studies indicate that spirituality is related to mental and physical health, being a protective and promoting factor of healthy behaviors, among them low-risk consumption of alcohol in yo...

Assessing risk from low energy radionuclide aerosol dispersal

International Nuclear Information System (INIS)

Waller, Edward; Perera, Sharman; Erhardt, Lorne; Cousins, Tom; Desrosiers, Marc

2008-01-01

Full text: When considering the potential dispersal of radionuclides into the environment, there are two broad classifications: explosive and non-explosive dispersal. An explosive dispersal relies on a violent and sudden release of energy, which may disrupt or vapourised any source containment. As such, the explosion provides the energy to both convert the source into a dispersable physical form and provides initial kinetic energy to transport the source away from the initiation point. This would be the case for sources of radiation in proximity to a steam or chemical explosion of high energy density. A low energy dispersal, on the other hand, may involve a lower energy initiator event (such as a fire or water spray) that transports particles into the near release zone, to be spread via wind or mechanical fields. For this type of dispersion to take place, the source must be in physical form ready for dispersal. In broad terms, this suggests either an ab initio powder form, or soluble/insoluble particulate form in a liquid matrix. This may be the case for radioactive material released from pressurized piping systems, material released through ventilation systems, or deliberate dispersals. To study aerosol dispersion of radionuclides and risk from low energy density initiators, there are a number of important parameters to consider. For example, particle size distribution, physicochemical form, atmospheric effects, charge effects, coagulation and agglomeration. At the University of Ontario Institute of Technology (UOIT) a unique small scale aerosol test chamber has been developed to study the low energy dispersal properties of a number of radioactive source simulant. Principle emphasis has been given to salts (CsCl and CoCl 2 ) and oxides (SrTiO 3 , CeO 2 and EuO 2 ). A planetary ball mill has been utilized to reduce particle size distributions when required. Particle sizing has been performed using Malvern Spraytec spray particle analyzers, cascade impactors, and

Use of low-dose aspirin and non-aspirin nonsteroidal anti-inflammatory drugs and risk of glioma

DEFF Research Database (Denmark)

Gaist, David; García-Rodríguez, L A; Sørensen, H T

2013-01-01

Background:Few studies have examined the association between use of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) and risk of glioma and the results have been equivocal. We therefore investigated the influence of NSAID use on glioma risk in a nationwide setting.Methods:We used...... exposure to low-dose aspirin or non-aspirin (NA) NSAIDs into ever use or long-term use, defined as continuous use for 5 years. Conditional logistic regression was used to compute odds ratios (ORs), with 95% confidence intervals (CIs), for glioma associated with NSAID use, adjusted for potential...... confounders.Results:A total of 2688 glioma cases and 18 848 population controls were included in the study. Ever use of low-dose aspirin (OR=0.90; 95% CI: 0.77-1.04) or NA-NSAIDs (OR=1.05; 95% CI: 0.96-1.14) was not associated with glioma risk. Compared with never use, long-term use of low-dose aspirin...

Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed

Directory of Open Access Journals (Sweden)

Crivera C

2016-05-01

Full Text Available Concetta Crivera,1 Winnie W Nelson,1 Jeff R Schein,1 Edward A Witt2 1Janssen Scientific Affairs, LLC, Raritan, 2Kantar Health, Princeton, NJ, USA Background: Atrial fibrillation (AF is associated with an increased risk of stroke. Anticoagulant (AC therapies are effective at treating AF, but carry with them an increased risk of bleed. Research suggests that a large proportion of AF patients who have high risk of stroke and low risk of bleeding are not currently receiving AC treatment. The goal of this study was to understand the reasons why these patients do not engage in this potentially life-saving treatment.Method: Through a self-report online survey, using validated instruments, 1,184 US adults who self-reported a diagnosis of AF were screened for the risk of stroke and bleed. Of these patients, 230 (19.4% were at high risk of stroke, low risk of bleed, and not currently using an AC treatment, and were asked follow-up questions to assess their reasons for nontreatment, attitudes toward treatment, and attitudes toward dosing regimens.Results: The most common reasons patients stopped AC treatment were concerns regarding bleeding (27.8% and other medical concerns (26.6%, whereas the most common reason cited for not being prescribed an AC in the first place was the use of antiplatelet therapy as an alternative (57.1%. In both cases, potentially erroneous decisions regarding perceived stoke and/or bleeding risk were also a factor. Finally, the largest factors regarding attitudes toward treatment and dosing regimen were instructions from an authority figure (eg, physician, pharmacist and ease of use, respectively.Conclusion: Results suggest that many AF patients who are at high risk of stroke but at low risk of bleed may not be receiving AC due to potentially inaccurate beliefs about risk. This study also found that AF patients place trust in physicians above other factors such as cost when making treatment decisions. Increased education of

Risk of Low Dose/Low Dose Rate Ionizing Radiation to Humans Symposium Annual Meeting of the Environmental Mutagen Society: Agenda and Abstracts

Energy Technology Data Exchange (ETDEWEB)

Veigl, Martina L. [Environmental Mutagen Society (EMS), Reston, VA (United States); Case Western Reserve Univ., Cleveland, OH (United States). Case Comprehensive Cancer Center; Morgan, William F. [Univ. of Maryland, College Park, MD (United States); Schwartz, Jeffrey L. [Univ. of Washington, Seattle, WA (United States)

2009-11-11

The low dose symposium thoughtfully addressed controversy of risk from low dose radiation exposure, hormesis and radon therapy. The stem cell symposium cogently considered the role of DNA damage and repair in hematopoietic stem cells underlying aging and malignancy and provocatively presented evidence that stem cells may have distinct morphologies and replicative properties, as well as special roles in cancer initiation. In the epigenetics symposium, studies illustrated the long range interaction of epigenetic mechanisms, the roles of CTCF and BORIS in region/specific regulation of epigenetic processes, the impact of DNA damage on epigenetic processes as well as links between epigenetic mechanisms and early nutrition and bystander effects. This report shows the agenda and abstracts for this symposium.

[Draft of the best medical treatment in patients with low-risk thyroid cancer].

Science.gov (United States)

Vlček, Petr; Nováková, Dagmar; Vejvalka, Jan; Zimák, Jaroslav; Křenek, Martin; Vošmiková, Květuše; Smutný, Svatopluk; Bavor, Petr; Astl, Jaromír; Lukáš, Jindřich

2015-09-01

The incidence of well-differentiated low-risk thyroid cancer have increased globally over the last three decades. Thyroid cancer treatment relates to a suitable surgical procedure and the use of adjuvant radio-iodine therapy in selected patients. Evaluation of prognostic factors and risk stratification are critical for determining appropriate treatment. Survival of patients with low-risk thyroid cancer is excellent. Appropriate choice of medical treatment resulted in full recovery in most patients. Relapse risk increases with the size of the primary tumor, along with the findings of the risk factors in men. Our study included a total of 1 980 patients in whom were diagnosed T1a and T1b tumors between the years 2003 to 2012. The population included 1 675 women (84.6 %) of average age of 45.22 years and 305 men (15.4 %) of average age of 50.0 years. The bulk of the file represented papillary carcinomas (1 868; 94.4 %), and smaller group of follicular carcinomas (112; 5.6 %). Patients were divided into four groups according to tumor size. Patients were evaluated according to risk factors: unifocality no other risk factors, multifocality - more bearings in thyroid tumor, metastases in regional lymph nodes, distant metastases or combination of risk factors. Group A: In the monitored set of 678 patients with papillary and follicular microcarcinoma up to 5 mm, during histological input, the findings revealed one bearing (unifocal type of cancer) in 566 patients. Multifocality was found in 112 patients, local nodal metastasis were demonstrated in 24 cases and pulmonary metastasis was discove-red in 1 case. Group B: In this group there were 576 study patients with papillary and follicular microcarcinoma size of 5-10 mm. Histological findings were captured input one bearing carcinoma in 434 patients, 142 patients with multifocality, in 53 cases of local nodal metastasis, and 1 case of bone metastases. Group C: In this group there were 467 study patients with papillary

Risk of low Apgar score and socioeconomic position: a study of Swedish male births.

Science.gov (United States)

Odd, David E; Doyle, Pat; Gunnell, David; Lewis, Glyn; Whitelaw, Andrew; Rasmussen, Finn

2008-09-01

The aim of this study was to investigate the association between maternal socioeconomic position and a persistent low Apgar score (a score of manual (Odds ratio (OR) 0.83 (0.72-0.97)) and self-employed (OR 0.64 (0.44-0.93)) occupations were less likely to have an infant with a low Apgar score, compared to manual workers. There was evidence that the risk of a low Apgar score decreased as the mother's level of education increased, if the infant was born by instrumental (OR 0.86 (0.74-0.99)) or caesarean section (OR 0.80 (0.68-0.93)) delivery, but not by unassisted vaginal delivery (OR 1.01 (0.92-1.10)). There was a lower risk of poor birth condition in male infants born to more educated and non-manual/self-employed mothers. These differences may contribute to our understanding of socioeconomic differences in infant health and development although the results may not be applicable due to changes over the last 30 years.

Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents.

Directory of Open Access Journals (Sweden)

Soffia M Hrafnkelsdottir

Full Text Available Few studies have explored the potential interrelated associations of screen time and physical activity with mental health in youth, particularly using objective methods. We examined cross-sectional associations of these variables among Icelandic adolescents, using objective and subjective measurements of physical activity.Data were collected in the spring of 2015 from 315 tenth grade students (mean age 15.8 years in six elementary schools in metropolitan Reykjavík, Iceland. Participants reported, via questionnaire, on demographics, weekly frequency of vigorous physical activity, daily hours of screen time and mental health status (symptoms of depression, anxiety and somatic complaints, self-esteem and life satisfaction. Total physical activity was measured over one week with wrist-worn accelerometers. Body composition was determined by DXA-scanning. Poisson regression analysis was used to explore independent and interactive associations of screen time and physical activity with mental health variables, adjusting for gender, body fat percentage and maternal education.Less screen time (below the group median of 5.3 h/day and more frequent vigorous physical activity (≥4x/week were each associated with reporting fewer symptoms of depression, anxiety, low self-esteem, and life dissatisfaction. No significant associations were observed between objectively measured physical activity and mental health outcomes. Interactive regression analysis showed that the group reporting both less screen time and more frequent vigorous physical activity had the lowest risk of reporting symptoms of depression, anxiety, low self-esteem, and life dissatisfaction.Reports of less screen time and more frequent vigorous physical activity were associated with lower risk of reporting mental health problems among Icelandic adolescents. Those who reported a combination of engaging in less screen time and more frequent vigorous physical activity had the lowest risk

Risk factors for low receptive vocabulary abilities in the preschool and early school years in the longitudinal study of Australian children.

Directory of Open Access Journals (Sweden)

Daniel Christensen

Full Text Available Receptive vocabulary development is a component of the human language system that emerges in the first year of life and is characterised by onward expansion throughout life. Beginning in infancy, children's receptive vocabulary knowledge builds the foundation for oral language and reading skills. The foundations for success at school are built early, hence the public health policy focus on reducing developmental inequalities before children start formal school. The underlying assumption is that children's development is stable, and therefore predictable, over time. This study investigated this assumption in relation to children's receptive vocabulary ability. We investigated the extent to which low receptive vocabulary ability at 4 years was associated with low receptive vocabulary ability at 8 years, and the predictive utility of a multivariate model that included child, maternal and family risk factors measured at 4 years. The study sample comprised 3,847 children from the first nationally representative Longitudinal Study of Australian Children (LSAC. Multivariate logistic regression was used to investigate risks for low receptive vocabulary ability from 4-8 years and sensitivity-specificity analysis was used to examine the predictive utility of the multivariate model. In the multivariate model, substantial risk factors for receptive vocabulary delay from 4-8 years, in order of descending magnitude, were low receptive vocabulary ability at 4 years, low maternal education, and low school readiness. Moderate risk factors, in order of descending magnitude, were low maternal parenting consistency, socio-economic area disadvantage, low temperamental persistence, and NESB status. The following risk factors were not significant: One or more siblings, low family income, not reading to the child, high maternal work hours, and Aboriginal or Torres Strait Islander ethnicity. The results of the sensitivity-specificity analysis showed that a well

Cardiovascular risks associated with low dose ionizing particle radiation.

Directory of Open Access Journals (Sweden)

Xinhua Yan

Full Text Available Previous epidemiologic data demonstrate that cardiovascular (CV morbidity and mortality may occur decades after ionizing radiation exposure. With increased use of proton and carbon ion radiotherapy and concerns about space radiation exposures to astronauts on future long-duration exploration-type missions, the long-term effects and risks of low-dose charged particle irradiation on the CV system must be better appreciated. Here we report on the long-term effects of whole-body proton ((1H; 0.5 Gy, 1 GeV and iron ion ((56Fe; 0.15 Gy, 1GeV/nucleon irradiation with and without an acute myocardial ischemia (AMI event in mice. We show that cardiac function of proton-irradiated mice initially improves at 1 month but declines by 10 months post-irradiation. In AMI-induced mice, prior proton irradiation improved cardiac function restoration and enhanced cardiac remodeling. This was associated with increased pro-survival gene expression in cardiac tissues. In contrast, cardiac function was significantly declined in (56Fe ion-irradiated mice at 1 and 3 months but recovered at 10 months. In addition, (56Fe ion-irradiation led to poorer cardiac function and more adverse remodeling in AMI-induced mice, and was associated with decreased angiogenesis and pro-survival factors in cardiac tissues at any time point examined up to 10 months. This is the first study reporting CV effects following low dose proton and iron ion irradiation during normal aging and post-AMI. Understanding the biological effects of charged particle radiation qualities on the CV system is necessary both for the mitigation of space exploration CV risks and for understanding of long-term CV effects following charged particle radiotherapy.

Low- and high-dose radioiodine therapy for low-/intermediate-risk differentiated thyroid cancer. A preliminary clinical trial

International Nuclear Information System (INIS)

Qu Yuan; Huang Rui; Li Lin

2017-01-01

To compare the ablation results, therapeutic responses and adverse reactions between a low dose (1.1 GBq) or high dose (3.7 GBq) of 131 I in low-/intermediate-risk differentiated thyroid cancer (DTC) patients. The factors influencing the ablation result and therapeutic response were also analyzed. The researchers used a random number table to randomly assign the enrolled patients to the low-dose group or high-dose group at a 1:1 ratio, and assessment of ablation result, therapeutic response, and adverse reactions evaluated 6 ± 3 months after therapy. A total of 140 patients were enrolled in the study through October 2014-June 2015. Until February 2016, 132 patients completed the trial. 99 patients were re-examined under thyroid-stimulating hormone (TSH) stimulation 3-9 months after 131 I therapy. For the low-dose and high-dose groups, the success rates of ablation were 52.7% (29/55) and 59.1% (26/44), respectively. The ablation results did not differ significantly between the two groups (P = 0.548). One hundred and thirty two patients were re-examined 2-9 months after 131 I therapy. The low-dose group had an excellent response rate of ∼80% (53/66), an indeterminate response rate of ∼ 20% (13/66), and no cases with a biochemical incomplete response. The high-dose group had an excellent response rate of ∼85% (36/66), an indeterminate response rate of ∼11% (7/66), and a biochemical incomplete response rate of ∼4% (3/66). No significant differences in the therapeutic response were observed between the two groups (P = 0.087). Patients in stage N1b had a significantly lower success rate of ablation than those in stage N0 (P = 0.000). The success rate of ablation increased significantly with lower thyroglobulin (Tg) levels (P = 0.000). A pre-treatment Tg level was significantly associated with a higher excellent response rate (P = 0.002). Pre-treatment-stimulated Tg of 0.47 and 3.09 μg/L were identified as cut-off values for predicting the ablation result and

Cancer risk at low doses of ionizing radiation. Artificial neural networks inference from atomic bomb survivors

International Nuclear Information System (INIS)

Sasaki, Masao S.; Tachibana, Akira; Takeda, Shunichi

2014-01-01

Cancer risk at low doses of ionizing radiation remains poorly defined because of ambiguity in the quantitative link to doses below 0.2 Sv in atomic bomb survivors in Hiroshima and Nagasaki arising from limitations in the statistical power and information available on overall radiation dose. To deal with these difficulties, a novel nonparametric statistics based on the ‘integrate-and-fire’ algorithm of artificial neural networks was developed and tested in cancer databases established by the Radiation Effects Research Foundation. The analysis revealed unique features at low doses that could not be accounted for by nominal exposure dose, including (1) the presence of a threshold that varied with organ, gender and age at exposure, and (2) a small but significant bumping increase in cancer risk at low doses in Nagasaki that probably reflects internal exposure to 239 Pu. The threshold was distinct from the canonical definition of zero effect in that it was manifested as negative excess relative risk, or suppression of background cancer rates. Such a unique tissue response at low doses of radiation exposure has been implicated in the context of the molecular basis of radiation–environment interplay in favor of recently emerging experimental evidence on DNA double-strand break repair pathway choice and its epigenetic memory by histone marking. (author)

Low pressure pain thresholds are associated with, but does not predispose for, low back pain

DEFF Research Database (Denmark)

O'Neill, Søren; Kjær, Per; Graven-Nielsen, Thomas

2011-01-01

Chronic pain is often associated with hyperalgesia in cross-sectional studies. In the present study, a random cohort of 40-year-old individuals (n = 264) from the general population was assessed for low back pain (LBP) status and pressure pain threshold (PPT), with follow-up assessment 4 and 8......-lasting LBP, those with a low PPT at baseline (lower 10% percentile) had no increased risk of developing LBP (p > 0.05). The findings indicate that PPT decreases as a consequence of long-lasting pain, whereas a low PPT seems not to constitute a separate risk factor for the development of LBP....

Are low back pain and low physical capacity risk indicators for dropout among recently qualified eldercare workers?

DEFF Research Database (Denmark)

Faber, Anne; Giver, Hanne; Strøyer, Jesper

2010-01-01

BACKGROUND: A high job turnover and dropout among eldercare workers has led to a significant shortage of qualified manpower in the Danish eldercare sector. OBJECTIVES: The predictive effect of some non-work-related causes for leaving the eldercare sector 2 years after qualification, physical...... either in the eldercare sector, in other health- and welfare sectors, in all other sectors, under education, or outside labour market, 2 years after qualification. RESULTS: Disability due to and duration of low back pain were significant predictors for dropout from the eldercare sector 2 years after...... qualification. Low physical capacity was not. Data on duration of low back pain suggest a trend towards a dose-response relationship: The longer the duration of low back pain, the higher odds for dropout. CONCLUSIONS: Low back pain and disability due to low back pain during the last year of education were...

Communicating about risk: strategies for situations where public concern is high but the risk is low

Directory of Open Access Journals (Sweden)

Claire Hooker

2017-02-01

Full Text Available In this article, we summarise research that identifies best practice for communicating about hazards where the risk is low but public concern is high. We apply Peter Sandman’s ‘risk = hazard + outrage’ formulation to these risks, and review factors associated with the amplification of risk signals. We discuss the structures that determine the success of risk communication strategies, such as the capacity for early communication to ‘capture’ the dominant representation of risk issues, the importance of communicating uncertainty, and the usefulness of engaging with communities. We argue that, when facing trade-offs in probable outcomes from communication, it is always best to choose strategies that maintain or build trust, even at the cost of initial overreactions. We discuss these features of successful risk communication in relation to a range of specific examples, particularly opposition to community water fluoridation, Ebola, and routine childhood immunisation.

Risk for low pathogenicity avian influenza virus on poultry farms, The Netherlands, 2007–2013

NARCIS (Netherlands)

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

2017-01-01

Using annual serologic surveillance data from all poultry farms in the Netherlands during 2007–2013, we quantified the risk for the introduction of low pathogenicity avian influenza virus (LPAIV) in different types of poultry production farms and putative spatial-environmental risk factors:

Total Risk Management for Low Dose Radiation Exposures

International Nuclear Information System (INIS)

Simic, Z.; Mikulicic, V.; Sterc, D.

2012-01-01

Our civilization is witnessing about century of nuclear age mixed with enormous promises and cataclysmic threats. Nuclear energy seems to encapsulate both potential for pure good and evil or at least we humans are able to perceive that. These images are continuously with us and they are both helping and distracting from making best of nuclear potentials for civilization. Today with nuclear use significantly present and with huge potential to further improve our life with energy and medical use it is of enormous importance to try to have calmed, rational, and objective view on potential risks and certain benefits. Because all use of nuclear energy proved that their immediate risks are negligible (i.e., Three Mile Island and Fukushima) or much smaller than from the other alternatives (i.e., Chernobyl) it seems that the most important issue is the amount of risk from the long term effects to people from exposure to small doses of radiation. A similar issue is present in the increased use of modern computational tomography and other radiation sources use in medicine for examination and therapy. Finally, extreme natural exposures are third such potential risk sources. Definition of low doses varies depending on the way of delivery (i.e., single, multiple or continuous exposures), and for this paper usual dose of 100 mSv is selected as yearly upper amount. There are three very different scientifically supported views on the potential risks from the low doses exposure. The most conservative theory is that all radiation is harmful, and even small increments from background levels (i.e., 2-3 mSv) present additional risk. This view is called linear no threshold theory (LNT) and it is accepted as a regulatory conservative simple approach which guarantees safety. Risk is derived from the extrapolation of the measured effects of high levels of radiation. Opposite theory to LNT is hormesis which assumes that in fact small doses of radiation are helpful and they are improving our

Visual performance in preterm infants with brain injuries compared with low-risk preterm infants.

Science.gov (United States)

Leonhardt, Merçè; Forns, Maria; Calderón, Caterina; Reinoso, Marta; Gargallo, Estrella

2012-08-01

Neonatal brain injuries are the main cause of visual deficit produced by damage to posterior visual pathways. While there are several studies of visual function in low-risk preterm infants or older children with brain injuries, research in children of early age is lacking. To assess several aspects of visual function in preterm infants with brain injuries and to compare them with another group of low-risk preterm infants of the same age. Forty-eight preterm infants with brain injuries and 56 low-risk preterm infants. The ML Leonhardt Battery of Optotypes was used to assess visual functions. This test was previously validated at a post-menstrual age of 40 weeks in newborns and at 30-plus weeks in preterm infants. The group of preterm infants with brain lesions showed a delayed pattern of visual functions in alertness, fixation, visual attention and tracking behavior compared to infants in the healthy preterm group. The differences between both groups, in the visual behaviors analyzed were around 30%. These visual functions could be identified from the first weeks of life. Our results confirm the importance of using a straightforward screening test with preterm infants in order to assess altered visual function, especially in infants with brain injuries. The findings also highlight the need to provide visual stimulation very early on in life. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The greatest risk for low-back pain among newly educated female health care workers; body weight or physical work load?

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Jensen Jette

2012-06-01

Full Text Available Abstract Background Low back pain (LBP represents a major socioeconomic burden for the Western societies. Both life-style and work-related factors may cause low back pain. Prospective cohort studies assessing risk factors among individuals without prior history of low back pain are lacking. This aim of this study was to determine risk factors for developing low back pain (LBP among health care workers. Methods Prospective cohort study with 2,235 newly educated female health care workers without prior history of LBP. Risk factors and incidence of LBP were assessed at one and two years after graduation. Results Multinomial logistic regression analyses adjusted for age, smoking, and psychosocial factors showed that workers with high physical work load had higher risk for developing LBP than workers with low physical work load (OR 1.8; 95% CI 1.1–2.8. In contrast, workers with high BMI were not at a higher risk for developing LBP than workers with a normal BMI. Conclusion Preventive initiatives for LBP among health care workers ought to focus on reducing high physical work loads rather than lowering excessive body weight.

Pathological differences in radical prostatectomy specimens between low- and intermediate-risk prostate cancer patients. Indications for permanent seed implantation monotherapy

International Nuclear Information System (INIS)

Sakamoto, Naotaka; Monji, Keisuke; Yuuki, Kohei; Yoshikawa, Masahiro; Iguchi, Atsushi

2010-01-01

To clarify the indications for permanent seed implantation monotherapy in patients with intermediate-risk prostate cancer, pathological differences in radical prostatectomy specimens between low- and intermediate-risk prostate cancer were assessed. Fifty-three cases in the low-risk group and 96 cases in the intermediate-risk group had their radical prostatectomy specimens pathologically evaluated between April 2000 and January 2009. Patients with radical prostatectomy specimens of pT2 and Gleason score ≤3+4 were defined as the favorable group, while those with ≥pT3a and/or Gleason score ≥4+3 were defined as the unfavorable group. The favorable group was made up of 67.9%, 81.2%, 73.9%, 73.3%, 23.5% and 24.0% low-risk group cases, ≤T2a, GS 3+3 and 10< prostatic specific antigen (PSA)≤20 ng/ml cases, ≤T2a, GS 3+4 and PSA ≤10 ng/ml cases, ≤T2a, GS 3+4 and 10< PSA≤20 ng/ml cases, ≤T2a, GS 4+3 and PSA ≤20 ng/ml cases and T2b, GS ≤4+3 and PSA ≤20 ng/ml cases, respectively. The rate of unfavorable group in cases with ≤T2a, GS 4+3 and PSA ≤20 ng/ml, and cases with T2b, GS ≤4+3 and PSA ≤20 ng/ml was statistically higher than that in the low-risk group. Accordingly, cancer volume in cases with T2b, GS ≤4+3 and PSA ≤ 20 ng/ml was statistically larger than that in the low-risk group. Cancer volume in intermediate-risk groups other than ≤T2a, GS 3+4 and PSA ≤10 ng/ml tended to be larger than that in the low-risk group. As for radical prostatectomy specimens, the pathological findings of cases with ≤T2a, GS 3+4 and PSA ≤10 ng/ml were similar to those of cases in the low-risk group. The outcome for permanent seed implantation monotherapy with a conventional dose in cases with ≤T2a, GS 3+4 and PSA ≤10 ng/ml may be similar to that of cases in the low-risk group from a pathological aspect. (author)

Potential risk factors of persistent low back pain developing from mild low back pain in urban Japanese workers.

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Ko Matsudaira

Full Text Available STUDY DESIGN: Two-year, prospective cohort data from the Japan epidemiological research of occupation-related back pain study in urban settings were used for this analysis. OBJECTIVE: To examine the association between aggravated low back pain and psychosocial factors among Japanese workers with mild low back pain. SUMMARY OF BACKGROUND DATA: Although psychosocial factors are strongly indicated as yellow flags of low back pain (LBP leading to disability, the association between aggravated LBP and psychosocial factors has not been well assessed in Japanese workers. METHODS: At baseline, 5,310 participants responded to a self-administered questionnaire including questions about individual characteristics, ergonomic work demands, and work-related psychosocial factors (response rate: 86.5%, with 3,811 respondents completing the 1-year follow-up questionnaire. The target outcome was aggravation of mild LBP into persistent LBP during the follow-up period. Incidence was calculated for the participants with mild LBP during the past year at baseline. Logistic regression was used to explore risk factors associated with persistent LBP. RESULTS: Of 1,675 participants who had mild LBP during the preceding year, 43 (2.6% developed persistent LBP during the follow-up year. Multivariate analyses adjusted for individual factors and an ergonomic factor found statistically significant or almost significant associations of the following psychosocial factors with persistent LBP: interpersonal stress at work [adjusted odds ratio (OR: 1.96 and 95% confidence interval (95%CI: 1.00-3.82], job satisfaction (OR: 2.34, 95%CI: 1.21-4.54, depression (OR: 1.92, 95%CI: 1.00-3.69, somatic symptoms (OR: 2.78, 95%CI: 1.44-5.40, support from supervisors (OR: 2.01, 95%CI: 1.05-3.85, previous sick-leave due to LBP (OR: 1.94, 95%CI: 0.98-3.86 and family history of LBP with disability (OR: 1.98, 95%CI: 1.04-3.78. CONCLUSIONS: Psychosocial factors are important risk factors for

Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes

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King Christopher R

2011-01-01

Full Text Available Abstract Purpose Hypofractionated, stereotactic body radiotherapy (SBRT is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT. Method and Materials Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35-36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method and RTOG toxicity outcomes were assessed. Results At a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%. Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation. Conclusion Five-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach.

PPARγ2 C1431T genotype increases metabolic syndrome risk in young men with low cardiorespiratory fitness.

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Sanada, Kiyoshi; Iemitsu, Motoyuki; Murakami, Haruka; Tabata, Izumi; Yamamoto, Kenta; Gando, Yuko; Suzuki, Katsuhiko; Higuchi, Mitsuru; Miyachi, Motohiko

2011-02-11

The peroxisome proliferator-activated receptor gamma 2 (PPARγ2) genotypes are related to obesity and the metabolic syndrome (MetS). A low level of cardiorespiratory fitness is also a strong determining factor in the development of MetS. This cross-sectional study was performed to investigate the influence of the interaction between the PPARγ2 genotype and cardiorespiratory fitness on the risk of MetS. Healthy Japanese men (n = 211) and women (n = 505) participated in this study. All subjects were divided into 8 groups according to sex, fitness level (high and low fitness groups), and age (younger, age interacted to produce a significant effect on MetS risk in younger men and that the risk of MetS in the CC genotype group with low cardiorespiratory fitness was significantly higher than that in the corresponding CT+TT genotypes or in the high fitness groups. There was no significant interaction between fitness and genotype in determining MetS risk in middle-aged/older men or in women in any group. With regard to the Pro12Ala genotype of the PPARγ2 gene, there were no significant differences in fitness or genotype effects nor were there any interactions between measurement variables. We concluded that the CC genotype of C1431T in the PPARγ2 gene together with low cardiorespiratory fitness may increase the risk of MetS in younger men (age < 40 yr), even with adjustment for age.

Metabolic risk in schoolchildren is associated with low levels of cardiorespiratory fitness, obesity, and parents' nutritional profile.

Science.gov (United States)

Todendi, Pâmela Ferreira; Valim, Andréia Rosane de Moura; Reuter, Cézane Priscila; Mello, Elza Daniel de; Gaya, Anelise Reis; Burgos, Miria Suzana

2016-01-01

Verify the association between metabolic risk profile in students with different levels of cardiorespiratory fitness and body mass index, as well as the nutritional status of their parents. A cross-sectional study comprising 1.254 schoolchildren aged between seven and 17 years. The metabolic risk profile was calculated by summing the standardized values of high density lipoproteins and low density lipoproteins, triglycerides, glucose and systolic blood pressure. The parents' nutritional status was evaluated by self-reported weight and height data, for body mass index calculating. The body mass index of schoolchildren was classified as underweight/normal weight and overweight/obesity. The cardiorespiratory fitness was assessed by 9-minute running/walk test, being categorized as fit (good levels) and unfit (low levels). Data were analyzed using prevalence ratio values (PR). The data indicates a higher occurrence of developing metabolic risk in schoolchildren whose mother is obese (PR: 1.50; 95% CI: 1.01, 2.23), and even higher for those whose father and mother are obese (PR: 2, 79, 95% CI: 1.41; 5.51). Students who have low levels of cardiorespiratory fitness and overweight/obesity have higher occurrence of presenting metabolic risk profile (PR: 5.25; 95% CI: 3.31; 8.16). the occurrence of developing metabolic risk in schoolchildren increase when they have low levels of cardiorespiratory fitness and overweight/obesity, and the presence of parental obesity. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Low field-low cost: Can low-field magnetic resonance systems replace high-field magnetic resonance systems in the diagnostic assessment of multiple sclerosis patients?

International Nuclear Information System (INIS)

Ertl-Wagner, B.B.; Reith, W.; Sartor, K.

2001-01-01

As low-field MR imaging is becoming a widely used imaging technique, we aimed at a prospective assessment of differences in imaging quality between low- and high-field MR imaging in multiple sclerosis patients possibly interfering with diagnostic or therapeutic decision making. Twenty patients with clinically proven multiple sclerosis were examined with optimized imaging protocols in a 1.5- and a 0.23-T MR scanner within 48 h. Images were assessed independently by two neuroradiologists. No statistically significant interrater discrepancies were observed. A significantly lower number of white matter lesions could be identified in low-field MR imaging both on T1- and on T2-weighted images (T2: high field 700, low field 481; T1: high field 253, low field 177). A total of 114 enhancing lesions were discerned in the high-field MR imaging as opposed to 45 enhancing lesions in low-field MR imaging. Blood-brain barrier disruption was identified in 11 of 20 patients in the high-field MR imaging, but only in 4 of 20 patients in low-field MR imaging. Since a significantly lower lesion load is identified in low-field MR imaging than in high-field MR imaging, and blood-brain barrier disruption is frequently missed, caution must be exercised in interpreting a normal low-field MR imaging scan in a patient with clinical signs of multiple sclerosis and in interpreting a scan without enhancing lesions in a patient with known multiple sclerosis and clinical signs of exacerbation. (orig.)

Risk at Low Doses: Scientific knowledge, uncertainties and management

International Nuclear Information System (INIS)

Giusssani, A.; Ballarini, F.; Ottolenghi, A.

2002-01-01

Most of the applications of ionizing radiation in the medical field, for the exposed workers as well as the majority of patients undergoing diagnostic examinations, can be seen as low situations. Epidemiological information is however available for dose and dose rates higher than the values typical of most medical situation. Main source of information is the Life Span Study (LSS) of Japanese. A-bomb survivors, supplemented by studies of selected groups of exposed workers (uranium miners, radium painters) or radiotherapy patients with a detailed follow-up history. All of these group studies, however, suffer from one or more of the following limitations: - lack of adequate dosimetry - lack of a reliable control group for the necessary comparison - influence of concomitant factors (not always easy to find out) - influence of social conditions. In addition exposed study populations are different than the population of patients for which the risk estimates are needed in the medical situation. Recent studies aimed to evaluate the available data on the cohorts of the inhabitants of the Techa river settlements as well as of the workers of the Mayak nuclear facilities may provide in the future useful information on large populations chronically exposed to relatively low doses. (Author)

Plasma dimethylglycine, nicotine exposure and risk of low bone mineral density and hip fracture: the Hordaland Health Study.

Science.gov (United States)

Øyen, J; Svingen, G F T; Gjesdal, C G; Tell, G S; Ueland, P M; Lysne, V; Apalset, E M; Meyer, K; Vollset, S E; Nygård, O K

2015-05-01

In the large community-based Hordaland Health Study, low plasma dimethylglycine was associated with low bone mineral density in both middle-aged and elderly subjects and to an increased risk of subsequent hip fracture among the elderly. These associations seemed to be particularly strong among subjects exposed to nicotine. Dimethylglycine (DMG) is a product of the choline oxidation pathway and formed from betaine during the folate-independent remethylation of homocysteine (Hcy) to methionine. Elevated plasma DMG levels are associated with atherosclerotic cardiovascular disease and inflammation, which in turn are related to osteoporosis. High plasma total Hcy and low plasma choline are associated with low bone mineral density (BMD) and hip fractures, but the role of plasma DMG in bone health is unknown. We studied the associations of plasma DMG with BMD among 5315 participants (46-49 and 71-74 years old) and with hip fracture among 3310 participants (71-74 years old) enrolled in the Hordaland Health Study. In age and sex-adjusted logistic regression models, subjects in the lowest versus highest DMG tertile were more likely to have low BMD (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.43-1.99). The association was stronger in participants exposed compared to those unexposed to nicotine (OR 2.31, 95% CI 1.73-3.07 and OR 1.43, 95% CI 1.16-1.75, respectively, p interaction = 0.008). In the older cohort, Cox regression analyses adjusted for sex showed that low plasma DMG was associated with an increased risk of hip fracture (hazard ratio [HR] 1.70, 95% CI 1.28-2.26). A trend toward an even higher risk was found among women exposed to nicotine (HR 3.41, 95% CI 1.40-8.28). Low plasma DMG was associated with low BMD and increased risk of hip fractures. A potential effect modification by nicotine exposure merits particular attention.

Periodontal disease and some adverse perinatal outcomes in a cohort of low risk pregnant women

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Cecatti Jose G

2010-11-01

Full Text Available Abstract Objective To evaluate the association of periodontal disease (PD in pregnancy with some adverse perinatal outcomes. Method This cohort study included 327 pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. The rates of preterm birth (PTB, low birth weight (LBW, small for gestational age (SGA neonates and prelabor rupture of membranes (PROM were evaluated using Risk Ratios (95%CI and Population Attributable Risk Fractions. Results PD was associated with a higher risk of PTB (RRadj. 3.47 95%CI 1.62-7.43, LBW (RRadj. 2.93 95%CI 1.36-6.34 and PROM (RRadj. 2.48 95%CI 1.35-4.56, but not with SGA neonates (RR 2.38 95%CI 0.93 - 6.10. Conclusions PD was a risk factor for PT, LBW and PROM among Brazilian low risk pregnant women.

Risk of solid cancer in low dose-rate radiation epidemiological studies and the dose-rate effectiveness factor.

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Shore, Roy; Walsh, Linda; Azizova, Tamara; Rühm, Werner

2017-10-01

Estimated radiation risks used for radiation protection purposes have been based primarily on the Life Span Study (LSS) of atomic bomb survivors who received brief exposures at high dose rates, many with high doses. Information is needed regarding radiation risks from low dose-rate (LDR) exposures to low linear-energy-transfer (low-LET) radiation. We conducted a meta-analysis of LDR epidemiologic studies that provide dose-response estimates of total solid cancer risk in adulthood in comparison to corresponding LSS risks, in order to estimate a dose rate effectiveness factor (DREF). We identified 22 LDR studies with dose-response risk estimates for solid cancer after minimizing information overlap. For each study, a parallel risk estimate was derived from the LSS risk model using matching values for sex, mean ages at first exposure and attained age, targeted cancer types, and accounting for type of dosimetric assessment. For each LDR study, a ratio of the excess relative risk per Gy (ERR Gy -1 ) to the matching LSS ERR risk estimate (LDR/LSS) was calculated, and a meta-analysis of the risk ratios was conducted. The reciprocal of the resultant risk ratio provided an estimate of the DREF. The meta-analysis showed a LDR/LSS risk ratio of 0.36 (95% confidence interval [CI] 0.14, 0.57) for the 19 studies of solid cancer mortality and 0.33 (95% CI 0.13, 0.54) when three cohorts with only incidence data also were added, implying a DREF with values around 3, but statistically compatible with 2. However, the analyses were highly dominated by the Mayak worker study. When the Mayak study was excluded the LDR/LSS risk ratios increased: 1.12 (95% CI 0.40, 1.84) for mortality and 0.54 (95% CI 0.09, 0.99) for mortality + incidence, implying a lower DREF in the range of 1-2. Meta-analyses that included only cohorts in which the mean dose was LDR data provide direct evidence regarding risk from exposures at low dose rates as an important complement to the LSS risk estimates used

Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease

NARCIS (Netherlands)

M.M. van den Heuvel (Mieke); O. Sorop (Oana); P. Musters (Paul); R.T. van Domburg (Ron); T.W. Galema (Tjebbe); D.J.G.M. Duncker (Dirk); W.J. van der Giessen (Wim); K. Nieman (Koen)

2015-01-01

textabstractBackground Endothelial dysfunction precedes coronary artery disease (CAD) and can be measured by peripheral arterial tonometry (PAT). We examined the applicability of PAT to detect a low risk of CAD in a chest pain clinic. Methods In 93 patients, PAT was performed resulting in reactive

Understanding high traffic injury risks for children in low socioeconomic areas: a qualitative study of parents' views.

Science.gov (United States)

Christie, N; Ward, H; Kimberlee, R; Towner, E; Sleney, J

2007-12-01

To gain an in-depth qualitative understanding of parents' views about their children's exposure to road traffic injury risk in low socioeconomic areas. Focus groups facilitated by a moderator with content analysis of data. Focus groups were conducted in 10 low socioeconomic English districts that also have high rates of child pedestrian injury. Research was conducted in community venues within each area. Parents of children aged 9-14 years living in low socioeconomic areas. Parents believe that children play in their local streets for the following reasons: they like playing out with friends near home; there are few safe, secure, and well-maintained public spaces for children; children are excluded from affordable leisure venues because of their costs; insufficient parental responsibility. For children that play in the street, the key sources of risk identified by parents were: illegal riding and driving around estates and on the pavements; the speed and volume of traffic; illegal parking; drivers being poorly informed about where children play; children's risk-taking behavior. Intervention programs need to take into account multiple reasons why children in low socioeconomic areas become exposed to hazardous environments thereby increasing their risk of injury. Multi-agency partnerships involving the community are increasingly needed to implement traditional road safety approaches, such as education, engineering, and enforcement, and provide safe and accessible public space, affordable activities for children, and greater support for parents.

Financial risk and the transition to a low-carbon economy. Towards a carbon stress testing framework - Working Paper

International Nuclear Information System (INIS)

Chenet, Hugues; Thomae, Jakob; Janci, Didier; Dupre, Stan; Hubert, Romain; Robins, Nick; Cruickshank, Peter

2015-07-01

On July 27 at Moody's in New York, 2 deg. Investing Initiative launched the report 'Financial risk and the transition to a low-carbon economy' in partnership with UNEP Inquiry and I4CE. The report reviews the main approaches to assessing carbon risk along the investment chain and discusses barriers to its integration in decision making. The report identifies two categories of climate-related financial risks to financial institutions: risks arising from physical climate change and 'carbon risk' which arise from the transition to a low-carbon economy following one of the possible decarbonization pathways. The authors show that to date, risk factors resulting from climate change and the transition to a low-carbon economy are generally not taken into consideration by mainstream risk assessment and management frameworks; there are multiple reasons for this. The report reviews a number of 'climate and carbon stress test' initiatives that suggest the materiality of these risks along the investment chain. The materiality of these risks for financial institutions and the financial system remains unclear. Financial regulators and policy makers, notably in France, the United Kingdom, and at the G20 level have nevertheless started responding to the issue

The use of low-carbohydrate diet in type 2 diabetes – benefits and risks

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Łucja Czyżewska-Majchrzak

2014-06-01

Full Text Available The pharmacological treatment of type 2 diabetes is increasingly being supported by the recommendation of an appropriate diet. The purpose of this study is to identify the potential benefits and risks arising from the use of one of the modern models of low-carbohydrate diet in patients with type 2 diabetes. Research shows that diet can favourably affect the health of diabetic patients. It has been shown that diet affects positively the concentration of blood glucose, glycosylated haemoglobin, and also contributes to the reduction of insulin taken in the course of drug therapy. At the same time, short-term studies have demonstrated a positive relationship of nutrition with reduction in body weight, as well as favourable changes in lipid profile of HDL cholesterol and levels of triglyceride. Attention is also drawn to the negative health effects of a low-carbohydrate diet; these include an increased risk of mineral deficiency, hypovitaminosis and reduced intake of dietary fibres. This diet may be associated with very high levels of protein which, in turn, raises the risk of renal dysfunction and the appearance of irregularities in the water and electrolyte balance. The impact of changes in the skeletal system and the development of osteopenia and osteoporosis is also observed. Besides the positive impact of this model of diet on the lipid profile parameters, its use significantly increases the risk of adverse changes in other markers predisposing to atherosclerosis occurring in individuals with type 2 diabetes. In composing a nutrition model for diabetes patients, both the benefits and potential risks of a low-carbohydrate diet should therefore take into account. At the same time, it is important to individualize the diet used, based on the current state of health, used pharmacological treatments, as well as taking into account the individual characteristics of the patient.

Low-gradient aortic stenosis.

Science.gov (United States)

Clavel, Marie-Annick; Magne, Julien; Pibarot, Philippe

2016-09-07

An important proportion of patients with aortic stenosis (AS) have a 'low-gradient' AS, i.e. a small aortic valve area (AVA gradient (gradient discrepancy raises uncertainty about the actual stenosis severity and thus about the indication for aortic valve replacement (AVR) if the patient has symptoms and/or left ventricular (LV) systolic dysfunction. The most frequent cause of low-gradient (LG) AS is the presence of a low LV outflow state, which may occur with reduced left ventricular ejection fraction (LVEF), i.e. classical low-flow, low-gradient (LF-LG), or preserved LVEF, i.e. paradoxical LF-LG. Furthermore, a substantial proportion of patients with AS may have a normal-flow, low-gradient (NF-LG) AS: i.e. a small AVA-low-gradient combination but with a normal flow. One of the most important clinical challenges in these three categories of patients with LG AS (classical LF-LG, paradoxical LF-LG, and NF-LG) is to differentiate a true-severe AS that generally benefits from AVR vs. a pseudo-severe AS that should be managed conservatively. A low-dose dobutamine stress echocardiography may be used for this purpose in patients with classical LF-LG AS, whereas aortic valve calcium scoring by multi-detector computed tomography is the preferred modality in those with paradoxical LF-LG or NF-LG AS. Although patients with LF-LG severe AS have worse outcomes than those with high-gradient AS following AVR, they nonetheless display an important survival benefit with this intervention. Some studies suggest that transcatheter AVR may be superior to surgical AVR in patients with LF-LG AS. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Low Family Support and Risk of Obesity among Black Youth: Role of Gender and Ethnicity.

Science.gov (United States)

Assari, Shervin; Caldwell, Cleopatra Howard

2017-05-12

Most studies on the role of family environment in developing risk of obesity among youth have focused on parenting behaviors that are directly involved in energy balance in regional, non-representative White samples. Using a national sample of ethnically diverse Black youth, the current study tested the association between low family support and risk of obesity. We also tested the heterogeneity of this association based on gender, ethnicity, and their intersection. We used data from the National Survey of American Life-Adolescent Supplement (NSAL-A), a national survey of Black adolescents in the United States. The study enrolled 1170 African American and Caribbean Black 13-17 year old youth. Obesity was defined based on the cutoff points of body mass index (BMI) appropriate for age and gender of youth. Family support was measured using a five-item measure that captured emotional and tangible social support. Age, gender, and ethnicity were also measured. Logistic regressions were utilized in the pooled sample, and also based on gender, ethnicity, and their intersection, to test the link between low family support and risk for obesity. In the pooled sample, low family support was not associated with an increased risk of obesity (OR = 1.35, 95% Confidence Interval (CI) = 0.96-1.89). The association between low family support and risk of obesity was, however, significant among African American females (OR = 1.60, 95% CI = 1.01-2.55). There was no association for African American males (OR = 1.26, 95% CI = 0.82-1.92), Caribbean Black males (OR = 0.68, 95% CI = 0.01-54.85), and Caribbean Black females (OR = 0.78, 95% CI = 0.42-1.44). In conclusion, policies and programs that enable African American families to provide additional family support may prevent obesity among African American female youth. Future research should test the efficacy of promoting family support as a tool for preventing obesity among African American female youth.

Estimation of radiation risks at low dose

International Nuclear Information System (INIS)

1990-04-01

The report presents a review of the effects caused by radiation in low doses, or at low dose rates. For the inheritable (or ''genetic''), as well as for the cancer producing effects of radiation, present evidence is consistent with: (a) a non-linear relationship between the frequency of at least some forms of these effects, with comparing frequencies caused by doses many times those received annually from natural sources, with those caused by lower doses; (b) a probably linear relationship, however, between dose and frequency of effects for dose rates in the region of that received from natural sources, or at several times this rate; (c) no evidence to indicate the existence of a threshold dose below which such effects are not produced, and a strong inference from the mode of action of radiation on cells at low dose rates that no such thresholds are likely to apply to the detrimental, cancer-producing or inheritable, effects resulting from unrepaired damage to single cells. 19 refs

Childhood leukaemia and low-level radiation - are we underestimating the risk?

International Nuclear Information System (INIS)

Wakeford, R.

1996-01-01

The Seascale childhood leukaemia 'cluster' can be interpreted as indicating that the risk of childhood leukaemia arising from low-level exposure to ionising radiation has been underestimated. Indeed, several variants of such an interpretation have been advanced. These include exposure to particular radionuclides, an underestimation of the radiation risk coefficient for childhood leukaemia, and the existence of a previously unrecognized risk of childhood leukaemia from the preconceptional irradiation of fathers. However, the scientific assessment of epidemiological associations is a complex matter, and such associations must be interpreted with caution. It would now seem most likely that the Seascale 'cluster' does not represent an unanticipated effect of the exposure to ionising radiation, but rather the effect of unusual population mixing generated by the Sellafield site which has produced an increase in the infection-based risk of childhood leukaemia. This episode in the history of epidemiological research provides a timely reminder of the need for great care in the interpretation-of novel statistical associations. (author)

Different Risk Factors for Very Low Birth Weight, Term-Small-for-Gestational-Age, or Preterm Birth in Japan

Directory of Open Access Journals (Sweden)

Naomi Tamura

2018-02-01

Full Text Available From 1985 to 2013, the mean birth weight of infants in Japan decreased from 3120 g to 3000 g, and the low-birth-weight rate among live births increased from 6.3% to 9.6%. No prospective study has elucidated the risk factors for poor fetal growth and preterm birth in recent Japanese parents, such as increased parental age, maternal body figure, assisted reproductive technology (ART, and socioeconomic status. Participants were mother–infant pairs (n = 18,059 enrolled in a prospective birth cohort in Hokkaido, Japan from 2002 to 2013. Parental characteristics were obtained via self-reported questionnaires during pregnancy. Medical records helped identify very-low-birth-weight (VLBW; <1500g, term-small-for-gestational-age (term-SGA, and preterm-birth (PTB; <37 weeks infants. We calculated relative risks (RRs for PTB, VLBW, and term-SGA birth based on parental characteristics. The prevalence of PTB, VLBW, and term-SGA was 4.5%, 0.4%, and 6.5%, respectively. Aged parents and ART were risk factors for PTB and VLBW. Maternal alcohol drinking during pregnancy increased the risk; a parental educational level of ≥16 years reduced risk of term-SGA. Maternal pre-pregnancy BMI of <18.5 kg/m2 increased the risk of PTB and term-SGA. The RR for low BMI was highest among mothers who have low educational level. Among various factors, appropriate nutritional education to maintain normal BMI is important to prevent PTB and term-SGA in Japan.

Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey

Science.gov (United States)

Yang, Haiou; Haldeman, Scott; Lu, Ming-Lun; Baker, Dean

2017-01-01

Objectives The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors and to identify worker groups with an increased vulnerability for low back pain in the US. Methods The data used for this study came from the 2010 National Health Interview Survey (NHIS), which was designed to collect data on health conditions and related risk factors obtained from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% Confidence Interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment and job insecurity. Work hours, occupation and other work organizational factors (non-standard work arrangements and alternative shifts) were also examined. Results The prevalence rate of self-reported low back pain in previous three months among workers in the U.S. was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15–1.41), exposure to hostile work (OR 1.39, CI 1.25–1.55), and job insecurity (OR 1.44, CI 1.24–1.67), while controlling for demographic characteristics and other health related factors. Older workers who had non-standard work arrangements were more likely to report low back pain. Females who worked 41–45 hours per week and younger workers who worked over 60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including, male healthcare practitioners, female and younger healthcare support workers, and female farming, fishing and forestry workers had

Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey.

Science.gov (United States)

Yang, Haiou; Haldeman, Scott; Lu, Ming-Lun; Baker, Dean

2016-09-01

The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors, and to identify worker groups with an increased vulnerability for low back pain in the United States. The data used for this cross-sectional study came from the 2010 National Health Interview Survey, which was designed to collect data on health conditions and related risk factors from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% confidence interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment, and job insecurity. Work hours, occupation, and other work organizational factors (nonstandard work arrangements and alternative shifts) were also examined. The prevalence of self-reported low back pain in the previous 3 months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15-1.41), exposure to hostile work (OR 1.39, CI 1.25-1.55), and job insecurity (OR 1.44, CI 1.24-1.67), while controlling for demographic characteristics and other health-related factors. Older workers who had nonstandard work arrangements were more likely to report low back pain. Women who worked 41 to 45 hours per week and younger workers who worked >60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including male health care practitioners, female and younger health care support workers, and female farming, fishing, and forestry workers, had an increased risk of

Diclofenac Does Not Reduce the Risk of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in Low-Risk Units.

Science.gov (United States)

Rainio, Mia; Lindström, Outi; Udd, Marianne; Louhimo, Johanna; Kylänpää, Leena

2017-08-01

Nonsteroidal anti-inflammatory drugs have an inhibitory role in pathogenesis of pancreatitis. Guidelines from the European Society of Gastrointestinal Endoscopy recommend routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP for all patients without contraindications. Our aim was to evaluate the effect of diclofenac in preventing post-ERCP pancreatitis (PEP) in a high-volume, low-PEP-risk ERCP unit. The rate and severity of PEP were compared in groups of 1000 historical controls prior to the routine use of diclofenac and in 1000 patients receiving 100 mg diclofenac before ERCP. PEP occurred in 56 (2.8%) of the 2000 patients, and the rate of the pancreatitis was 2.8% in control group and 2.8% in diclofenac group (p = 1.000). The PEP rate among the native papilla patients was 3.9% in control group and 3.6% in diclofenac group (p = 0.803). In subgroup analysis of patients with a high risk of PEP, diclofenac neither prevented PEP nor made its course milder. In an unselected patient population in a center with a low incidence of PEP, diclofenac seems to have no beneficial effect.

Chronic low-grade inflammation, lipid risk factors and mortality in functionally dependent elderly

Directory of Open Access Journals (Sweden)

Vasović Olga

2010-01-01

Full Text Available Background/Aim. It has been proved that a highly sensitive C-reactive protein (hsCRP can be used as an established marker of chronic inflammation for cardiovascular risk assessment. Since mean values of both low-density cholesterol (LDL-C and high-density lipoprotein cholesterol (HDL-C decrease during aging, the knowledge that increased hsCRP concentration predicts mortality (Mt would influence therapy and treatment outcome. The aim of this study was to examine importance of chronic low grade inflammation and its association with lipid risk factors for all-cause Mt in functionally dependent elderly. Methods. The participants of this longitudinal prospective study were 257 functionally dependent elderly aged 65-99 years. Baseline measurements: anthropometric measurements, blood pressure, fasting plasma total cholesterol (TC, triglyceride (TG, HDL-C, LDL-C, non- HDL-C, hemoglobin A1c (HbA1c were recorded and different lipid ratios were calculated. Inflammation was assessed by the levels of white blood cells, fibrinogen and hsCRP. The participants with hsCRP grater than 10 mg/L were excluded from the study. The residual participants (77.4% women were divided into three groups according to their hsCRP levels: a low (< 1 mg/L, n = 70, average (1 to 3 mg/L, n = 69, and high (3-10 mg/L, n = 69 hsCRP group. Associations of all-cause Mt with different risk factors were examined using logistic regression analysis. Results. The hsCRP level showed a significant positive correlation with waist (r = 0.199, p = 0.004 and hip (r = 0.187, p = 0.007 circumferences, body mass index (r = 0.143, p = 0.040 and serum triglyceride level (r = 0.139, p = 0.045 and significant negative correlation with HDL-C (r = -0.164, p = 0.018. Ratios TC/HDL-C and TG/HDL-C were significantly smaller in the low hsCRP group compared to the average hsCRP group (p = 0.019, p = 0.045, respectively and without significant differences compared with the high hsCRP group. Two years after the

Risk estimation and decision making: the health effects on populations of exposure to low levels of ionizing radiation

International Nuclear Information System (INIS)

Fabrikant, J.I.

1982-01-01

Presented is a background for an understanding of the potential health effects in populations exposed to low-level radiation. Discussed is the knowledge about the health effects of low-level radiation. Comments on how the risks of radiation-induced cancer and genetically-related ill-health in man may be estimated, the sources of the scientific and epidemiological data, the dose-response models used, and the uncertainties which limit precise estimates of excess risks from radiation. Also discussed are the implications of numerical risk estimation for radiation protection and decision-making for public health policy

Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football

DEFF Research Database (Denmark)

Clausen, Mikkel Bek; Tang, L; Zebis, M K

2016-01-01

with low KOOS subscale scores (Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P time-loss knee...... questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (... as independent variables in the risk factor analyses. The study showed that self-reported previous knee injury significantly increased the risk of time-loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73-7.68; P time-loss knee injury was also significantly increased in players...

Is low self-esteem a risk factor for depression among adolescents? an analytical study with interventional component

Directory of Open Access Journals (Sweden)

Jayanthi P, Rajamanickam Rajkumar

2014-07-01

Full Text Available Background: Self – esteem is an important factor for helping persons deal with life stressors. It is an important determinant of psychological well-being that is particularly problematic during an adolescent life stage. Low self-esteem might contribute to depression through both interpersonal and intrapersonal pathways. Many theories of depression postulate that low self esteem is a defining feature of depression. Aims: Self-esteem in adolescents has been associated with a number of risk and protective factors in previous studies. This study examined the relationship between low self esteem and depression among adolescents. Methods: This study used a case control (retrospective design. Samples of 1120 adolescents, aged 14-17 years were selected for the study. Screening was done by using MINI-KID and the level of depression was assessed by using Beck depression inventory. Self esteem was measured by Rosenberg self esteem scale. Odds Ratio and Multivariate logistic regression were used to examine the relation between self-esteem and socio-demographic variables. Results: The odds ratio analysis revealed that adolescents who had low self esteem found to have 3.7 times (95% CI=1.9-6.9 and p- value 0.001 more risk of developing depression than the adolescents who had high self esteem. Conclusions: The findings implied that low self-esteem is a risk factor for depression among adolescents. Adolescents with low self esteem have to be identified earlier and prompt interventions will prevent future psychiatric illnesses. As an intervention towards the educational component pamphlet was distributed to the adolescents, parents and teachers. A concept programme called “Self Esteem Education & Development – SEED” programme, is planned for, from High school level.

Psychosocial Risk Factors for Low Back Pain and Absenteeism among Slovenian Professional Drivers.

Science.gov (United States)

Kresal, Friderika; Suklan, Jana; Roblek, Vasja; Jerman, Andrej; Meško, Maja

2017-06-01

The aim of this study was to determine the most common psychosocial risk factors for absenteeism and the extent to which low back pain occurs among Slovenian professional drivers as result of various psychosocial risk factors. The study involved 275 professional drivers, mostly men (mean age 41.6 years). Statistical data analysis was conducted using SPSS package version 21, MS Excel version 2007 and Pajek, version 3. The main method for data processing was regression analysis. The results of the quantitative survey showed that lower back pain is mostly caused by lifting and carrying heavy loads, inadequate working conditions, poor physical fitness, regular nights out, shift work, and stress. Dissatisfaction with work, shift work and unsuitable working conditions significantly affect the incidence of low back pain. Absenteeism is influenced by factors such as dissatisfaction at work, disrespectful attitude of managers, unsuitable working conditions, personal dissatisfaction, lack of understanding of the partner, and enjoying nightlife on a regular basis. The study clarifies the unexplained holistic psychosocial risk factors and treatment effects on health in the population of professional drivers. Such factors can lead to absenteeism. The study also provides initial demonstration research in the Slovenian practice. Furthermore, it provides solutions in a holistic approach to solve the problem of risk factors management. Copyright© by the National Institute of Public Health, Prague 2017

Development of risk assessment simulation tool for optimal control of a low probability-high consequence disaster

International Nuclear Information System (INIS)

Yotsumoto, Hiroki; Yoshida, Kikuo; Genchi, Hiroshi

2011-01-01

In order to control low probability-high consequence disaster which causes huge social and economic damage, it is necessary to develop simultaneous risk assessment simulation tool based on the scheme of disaster risk including diverse effects of primary disaster and secondary damages. We propose the scheme of this risk simulation tool. (author)

Low oocyte yield during IVF treatment and the risk of a trisomic pregnancy

DEFF Research Database (Denmark)

Honorato, Talita; Hoek, Annemieke; Henningsen, Anna-Karina

2017-01-01

A low number of antral follicles may result in the selection of suboptimal oocytes that are prone to meiotic errors. The aim of this case-control study was to evaluate women receiving IVF treatment with low oocyte yield (defined as three or fewer oocytes retrieved after ovarian stimulation) who...... are at an increased risk of a trisomic pregnancy. Data were obtained from Danish and Dutch medical registries between 1983 and 2011. Analyses were carried out in 105 cases and 442 controls matched by age and year of IVF treatment. Cases were women with a trisomic pregnancy (trisomies 13, 18 or 21) resulting from...... fresh IVF treatment and confirmed by karyotyping. Cases were included regardless of pregnancy outcome. Controls were women with a live born child without a trisomy, resulting from fresh IVF treatment. Low oocyte yield was observed in 6.6% (29/440) of the women, of which 8.4% (7/83) were cases and 6...

Consumption of low-fat dairy products and energy and protein intake in cancer patients at risk of malnutrition.

Science.gov (United States)

Vidal-Casariego, Alfonso; Pintor-de la Maza, Begoña; Calleja-Fernández, Alicia; Villar-Taibo, Rocío; Cano-Rodríguez, Isidoro; Ballesteros-Pomar, María D

2015-01-01

Current nutritional guidelines encourage the reduction of fat intake from animal sources like dairy products. The aim was to determine whether the consumption of low-fat dairy is related to poorer dietary intake and nutritional status in cancer patients at risk of malnutrition. This cross-sectional included patients with solid or hematological malignancies at risk of malnutrition. Nutritional status was studied using Subjective Global Assessment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall and dairy consumption with a structured questionnaire. Seventy-four patients were recruited; 71.6% males of 64.8 yr, most with gastrointestinal malignancies. Only 37.8% consumed whole milk, and 61.4% consumed whole yogurt. Reasons for consumption of low-fat dairies were healthy diet (58.0%), hypercholesterolemia (20.0%), and digestive intolerance (10.0%). There were similar rates of malnutrition according the type of dairy (whole 60.9% vs. low-fat 66.7%, P = 0.640). Low-fat dairies were related to a reduction in energy (whole 1980.1 kcal vs. low-fat 1480.9, P = 0.007) and protein intake (whole 86.0 g vs. low-fat 63.0 g, P = 0.030).

Prematurity and low birth weight as risk factors for the development of affective disorder, especially depression and schizophrenia: A register study

DEFF Research Database (Denmark)

JK, Larsen; Bendsen, BB; Foldager, Leslie

2010-01-01

Background: The present study examined whether low birth weight, prematurity or low birth weight adjusted for gestational age are risk factors for the subsequent development of affective disorder, especially depression. Methods: A population-based case-control design was applied to the Danish.......039) when correcting for gestational age (premature birth), but was lost in the group with both disorders. Premature birth per se was found to be associated with a significantly elevated risk of developing both affective disorder and schizophrenia (p = 0.00018), an effect that remained significant after...... adjustment for low birth weight. Conclusion: Prematurity and low birth weight were found to be risk factors for subsequent development of affective disorder (especially depression) and schizophrenia....

Nonvisible tumors on multiparametric magnetic resonance imaging does not predict low-risk prostate cancer

Directory of Open Access Journals (Sweden)

Seung Hwan Lee

2015-12-01

Conclusions: Even though cancer foci were not visualized by postbiopsy MRI, the pathological tumor volumes and extent of GS upgrading were relatively high. Therefore, nonvisible tumors by multiparametric MRI do not appear to be predictive of low-risk PCA.

Exposure to low-dose radiation and the risk of breast cancer among women with a familial or genetic predisposition: a meta-analysis

International Nuclear Information System (INIS)

Jansen-van der Weide, Marijke C.; Greuter, Marcel J.W.; Pijnappel, Ruud M.; Jansen, Liesbeth; Oosterwijk, Jan C.; Bock, Geertruida H. de

2010-01-01

Women with familial or genetic aggregation of breast cancer are offered screening outside the population screening programme. However, the possible benefit of mammography screening could be reduced due to the risk of radiation-induced tumours. A systematic search was conducted addressing the question of how low-dose radiation exposure affects breast cancer risk among high-risk women. A systematic search was conducted for articles addressing breast cancer, mammography screening, radiation and high-risk women. Effects of low-dose radiation on breast cancer risk were presented in terms of pooled odds ratios (OR). Of 127 articles found, 7 were selected for the meta-analysis. Pooled OR revealed an increased risk of breast cancer among high-risk women due to low-dose radiation exposure (OR = 1.3, 95% CI: 0.9- 1.8). Exposure before age 20 (OR = 2.0, 95% CI: 1.3-3.1) or a mean of ≥5 exposures (OR = 1.8, 95% CI: 1.1-3.0) was significantly associated with a higher radiation-induced breast cancer risk. Low-dose radiation increases breast cancer risk among high-risk women. When using low-dose radiation among high-risk women, a careful approach is needed, by means of reducing repeated exposure, avoidance of exposure at a younger age and using non-ionising screening techniques. (orig.)

Absence of survival benefit of radioactive iodine (RAI) after thyroidectomy in low risk differentiated thyroid cancer (DTC) patients

International Nuclear Information System (INIS)

Schwartz, C.; Fieffe, S.; Pochart, J.M.; Bonnetain, F.; Gauthier, M.; Cueff, A.; Crevisy, E.; Dygai-Cochet, I.; Toubeau, M.

2012-01-01

After thyroidectomy, the goal of the first dose of radioactive iodine (RAI) is remnant ablation to facilitate the initial staging with the post-therapy scan and to facilitate the early detection of recurrences. The purpose of this study is to the survival benefit of RAI in low-risk thyroid cancer patients. Using Cancer thyroid registry of Marne Ardennes (1041 patients) and hospital data base of centre Leclerc (257 patients), we included all differentiated thyroid cancer (DTC) patients at low risk from 1975 to 2005. Median follow-up was 10.3 years, during which 19 recurrences, 61 other malignant diseases and 105 deaths were registered. 387 patients (30%) received no RAI and 911 had RAI (70%). If we confirmed that some clinical characteristics were associated with RAI intake, the study failed to demonstrate any survival benefit of RAI in low risk DTC patients

Absence of survival benefit of radioactive iodine (RAI) after thyroidectomy in low risk differentiated thyroid cancer (DTC) patients

Energy Technology Data Exchange (ETDEWEB)

Schwartz, C.; Fieffe, S.; Pochart, J.M. [Endocrinology Nuclear Medicine, Institut Jean Godinot, Reims (France); Bonnetain, F.; Gauthier, M.; Cueff, A. [Statistics and Epidemiology, Centre Georges Francois Leclerc, Dijon (France); Crevisy, E.; Dygai-Cochet, I.; Toubeau, M. [Nuclear Medicine, Centre Georges Francois Leclerc, Dijon (France)

2012-07-01

After thyroidectomy, the goal of the first dose of radioactive iodine (RAI) is remnant ablation to facilitate the initial staging with the post-therapy scan and to facilitate the early detection of recurrences. The purpose of this study is to the survival benefit of RAI in low-risk thyroid cancer patients. Using Cancer thyroid registry of Marne Ardennes (1041 patients) and hospital data base of centre Leclerc (257 patients), we included all differentiated thyroid cancer (DTC) patients at low risk from 1975 to 2005. Median follow-up was 10.3 years, during which 19 recurrences, 61 other malignant diseases and 105 deaths were registered. 387 patients (30%) received no RAI and 911 had RAI (70%). If we confirmed that some clinical characteristics were associated with RAI intake, the study failed to demonstrate any survival benefit of RAI in low risk DTC patients

No survival difference after successful {sup 131}I ablation between patients with initially low-risk and high-risk differentiated thyroid cancer

Energy Technology Data Exchange (ETDEWEB)

Verburg, Frederik Anton [University of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht (Netherlands); Stokkel, Marcel P.M.; Verkooijen, Robbert B.T. [Leiden University Medical Center, Department of Radiology, Division of Nuclear Medicine, Leiden (Netherlands); Dueren, Christian; Reiners, Christoph [University of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Maeder, Uwe [University of Wuerzburg, Comprehensive Cancer Center, Wuerzburg (Germany); Isselt, Johannes W. van [University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht (Netherlands); Marlowe, Robert J. [Spencer-Fontayne Corporation, Jersey City, NJ (United States); Smit, Johannes W. [Leiden University Medical Center, Department of Endocrinology, Leiden (Netherlands); Luster, Markus [University of Ulm, Department of Nuclear Medicine, Ulm (Germany)

2010-02-15

To compare disease-specific survival and recurrence-free survival (RFS) after successful {sup 131}I ablation in patients with differentiated thyroid carcinoma (DTC) between those defined before ablation as low-risk and those defined as high-risk according to the European Thyroid Association 2006 consensus statement. Retrospective data from three university hospitals were pooled. Of 2009 consecutive patients receiving ablation, 509 were identified as successfully ablated based on both undetectable stimulated serum thyroglobulin in the absence of antithyroglobulin antibodies and a negative diagnostic whole-body scan in a follow-up examination conducted 8.1{+-}4.6 months after ablation. Of these 509 patients, 169 were defined as high-risk. After a mean follow-up of 81{+-}64 months (range 4-306 months), only three patients had died of DTC, rendering assessment of disease-specific survival differences impossible. Of the 509 patients, 12 (2.4%) developed a recurrence a mean 35 months (range 12-59 months) after ablation. RFS for the duration of follow-up was 96.6% according to the Kaplan-Meier method. RFS did not differ between high-risk and low-risk patients (p=0.68). RFS differed slightly but significantly between those with papillary and those with follicular thyroid carcinoma (p=0.03) and between those aged {<=}45 years those aged >45 years at diagnosis (p=0.018). After (near) total thyroidectomy and successful {sup 131}I ablation, RFS does not differ between patients classified as high-risk and those classified as low-risk based on TNM stage at diagnosis. Consequently, the follow-up protocol should be determined on the basis of the result of initial treatment rather than on the initial tumour classification. (orig.)

Outcomes of peptic ulcer bleeding following treatment with proton pump inhibitors in routine clinical practice: 935 patients with high- or low-risk stigmata.

Science.gov (United States)

Lanas, Angel; Carrera-Lasfuentes, Patricia; García-Rodríguez, Luis A; García, Santiago; Arroyo-Villarino, María Teresa; Ponce, Julio; Bujanda, Luis; Calleja, José L; Polo-Tomas, Mónica; Calvet, Xavier; Feu, Faust; Perez-Aisa, Angeles

2014-10-01

To assess rates of further bleeding, surgery and mortality in patients hospitalized owing to peptic ulcer bleeding. Consecutive patients hospitalized for peptic ulcer bleeding and treated with a proton pump inhibitor (PPI) (esomeprazole or pantoprazole) were identified retrospectively in 12 centers in Spain. Patients were included if they had high-risk stigmata (Forrest class Ia-IIb, underwent therapeutic endoscopy and received intravenous PPI ≥120 mg/day for ≥24 h) or low-risk stigmata (Forrest class IIc-III, underwent no therapeutic endoscopy and received intravenous or oral PPI [any dose]). Of 935 identified patients, 58.3% had high-risk stigmata and 41.7% had low-risk stigmata. After endoscopy, 88.3% of high-risk patients and 22.1% of low-risk patients received intravenous PPI therapy at doses of at least 160 mg/day. Further bleeding within 72 h occurred in 9.4% and 2.1% of high- and low-risk patients, respectively (p peptic ulcer bleeding and treated with PPIs, patients with high-risk stigmata have a higher risk of further bleeding and surgery, but not of death, than those with low-risk stigmata.

Contamination and cancers: low-dose risks and standards of radioprotection

International Nuclear Information System (INIS)

Vignes, S.

1980-01-01

Irradiation of the population due to the running of nuclear power stations represents less than 1% of the natural radioactivity today, and should amount to 3% at most by the year 2 000. The main effects of ionizing radiations are reviewed and their undetectability below 100 rems is underlined. Thus the evaluation of low-dose risks can only be speculative and the cautions hypothesis adopted is that of a linear relationship between dose and effect, together with the absence of threshold. According to calculations the worker, supposedly exposed to 500 mrem a year between ages 18 and 65, would run a 22.2% instead of the normal 22% risk of dying of cancer. As for the population, the risk would increase by only 1 per 10 000 in the year 2 000. This means that no other mutagenic and carcinogenic agent is as well regulated as radioactive pollution and efforts directed at a better control of harmful chemicals, for instance, are only taking an example from the ruling on radioprotection [fr

Carcinogenesis and low-level ionizing radiation with special reference to lung cancer and exposure to radon daughters

Energy Technology Data Exchange (ETDEWEB)

Fabrikant, J.I.

1982-04-01

Of the important health effects of ionizing radiation, three important late effects - carcinogenesis, teratogenesis and mutagenesis are of greatest concern. This is because any exposure, even at low levels, carries some risk of such deleterious effects. As the dose of radiation increases above very low levels, the risk of health effects increases. Cancer-induction is the most important late somatic effect of low-dose ionizing radiation. Solid cancers, rather than leukemia, are principal late effects in exposed individuals. Tissues vary greatly in their susceptibility to radiation carcinogenesis. The most frequently occurring radiation-induced cancers in man include, in decreasing order of susceptibility: the female breast, the thyroid gland, the blood-forming tissues, the lung, certain organs of the gastrointestinal tract, and the bones. A number of biological and physical factors affect the cancer risk, such as age, sex, life-style, LET, and RBE. Despite uncertainty about low-level radiation risks, regulatory and advisory bodies must set standards for exposure, and individuals need information to be able to make informed judgments for themselves. From the point of view of the policy maker, the overriding concern is the fact that small doses of radiation can cause people to have more cancers than would otherwise be expected. While concern for all radiation effects exists, our human experience is limited to cancer-induction in exposed populations. This discussion is limited to cancer risk estimation and decision-making in relation to the health effects on populations of exposure to low levels of ionizing radiation. Here, low-level radiation will refer to yearly whole-body doses up to 5 rems or 0.05 Sv, or to cumulative doses up to 50 rems or 0.5 Sv from low-LET radiation and from high-LET radiation. (ERB)

Carcinogenesis and low-level ionizing radiation with special reference to lung cancer and exposure to radon daughters

International Nuclear Information System (INIS)

Fabrikant, J.I.

1982-04-01

Of the important health effects of ionizing radiation, three important late effects - carcinogenesis, teratogenesis and mutagenesis are of greatest concern. This is because any exposure, even at low levels, carries some risk of such deleterious effects. As the dose of radiation increases above very low levels, the risk of health effects increases. Cancer-induction is the most important late somatic effect of low-dose ionizing radiation. Solid cancers, rather than leukemia, are principal late effects in exposed individuals. Tissues vary greatly in their susceptibility to radiation carcinogenesis. The most frequently occurring radiation-induced cancers in man include, in decreasing order of susceptibility: the female breast, the thyroid gland, the blood-forming tissues, the lung, certain organs of the gastrointestinal tract, and the bones. A number of biological and physical factors affect the cancer risk, such as age, sex, life-style, LET, and RBE. Despite uncertainty about low-level radiation risks, regulatory and advisory bodies must set standards for exposure, and individuals need information to be able to make informed judgments for themselves. From the point of view of the policy maker, the overriding concern is the fact that small doses of radiation can cause people to have more cancers than would otherwise be expected. While concern for all radiation effects exists, our human experience is limited to cancer-induction in exposed populations. This discussion is limited to cancer risk estimation and decision-making in relation to the health effects on populations of exposure to low levels of ionizing radiation. Here, low-level radiation will refer to yearly whole-body doses up to 5 rems or 0.05 Sv, or to cumulative doses up to 50 rems or 0.5 Sv from low-LET radiation and from high-LET radiation

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym

Directory of Open Access Journals (Sweden)

Giulia Catassi

2017-03-01

Full Text Available FODMAP, “Fermentable Oligo-, Di- and Mono-saccharides And Polyols”, is a heterogeneous group of highly fermentable but poorly absorbed short-chain carbohydrates and polyols. Dietary FODMAPs might exacerbate intestinal symptoms by increasing small intestinal water volume, colonic gas production, and intestinal motility. In recent years the low-FODMAP diet for treatment of irritable bowel syndrome (IBS has gained increasing popularity. In the present review we aim to summarize the physiological, clinical, and nutritional issues, suggesting caution in the prolonged use of this dietary treatment on the basis of the existing literature. The criteria for inclusion in the FODMAPs list are not fully defined. Although the low-FODMAP diet can have a positive impact on the symptoms of IBS, particularly bloating and diarrhea, the quality of the evidence is lower than optimal, due to frequent methodological flaws, particularly lack of a proper control group and/or lack of blinding. In particular, it remains to be proven whether this regimen is superior to conventional IBS diets. The drastic reduction of FODMAP intake has physiological consequences, e.g., on the intestinal microbiome and colonocyte metabolism, which are still poorly understood. A low-FODMAP diet imposes an important restriction of dietary choices due to the elimination of some staple foods, such as wheat derivatives, lactose-containing dairy products, many vegetables and pulses, and several types of fruits. For this reason, patients may be at risk of reduced intake of fiber, calcium, iron, zinc, folate, B and D vitamins, and natural antioxidants. The nutritional risk of the low-FODMAP diet may be higher in persons with limited access to the expensive, alternative dietary items included in the low-FODMAP diet.

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym.

Science.gov (United States)

Catassi, Giulia; Lionetti, Elena; Gatti, Simona; Catassi, Carlo

2017-03-16

FODMAP, "Fermentable Oligo-, Di- and Mono-saccharides And Polyols", is a heterogeneous group of highly fermentable but poorly absorbed short-chain carbohydrates and polyols. Dietary FODMAPs might exacerbate intestinal symptoms by increasing small intestinal water volume, colonic gas production, and intestinal motility. In recent years the low-FODMAP diet for treatment of irritable bowel syndrome (IBS) has gained increasing popularity. In the present review we aim to summarize the physiological, clinical, and nutritional issues, suggesting caution in the prolonged use of this dietary treatment on the basis of the existing literature. The criteria for inclusion in the FODMAPs list are not fully defined. Although the low-FODMAP diet can have a positive impact on the symptoms of IBS, particularly bloating and diarrhea, the quality of the evidence is lower than optimal, due to frequent methodological flaws, particularly lack of a proper control group and/or lack of blinding. In particular, it remains to be proven whether this regimen is superior to conventional IBS diets. The drastic reduction of FODMAP intake has physiological consequences, e.g., on the intestinal microbiome and colonocyte metabolism, which are still poorly understood. A low-FODMAP diet imposes an important restriction of dietary choices due to the elimination of some staple foods, such as wheat derivatives, lactose-containing dairy products, many vegetables and pulses, and several types of fruits. For this reason, patients may be at risk of reduced intake of fiber, calcium, iron, zinc, folate, B and D vitamins, and natural antioxidants. The nutritional risk of the low-FODMAP diet may be higher in persons with limited access to the expensive, alternative dietary items included in the low-FODMAP diet.

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

Science.gov (United States)

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

2015-07-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

1989-01-01

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

High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: Results of a prospective cohort study

NARCIS (Netherlands)

Hoogendoorn, W.E.; Bongers, P.M.; Vet, H.C.W. de; Ariëns, G.A.M.; Mechelen, W. van; Bouter, L.M.

2002-01-01

Objective: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain. Methods: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for

High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study

NARCIS (Netherlands)

Hoogendoorn, W.E.; Bongers, P.M.; de Vet, H.C.W.; Ariens, G.A.M.; van Mechelen, W.; Bouter, L.M.

2002-01-01

Objective: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain. Methods: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for

High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain : results of a prospective cohort study

NARCIS (Netherlands)

Hoogendoorn, W E; Bongers, P M; de Vet, H C W; Ariëns, G A M; van Mechelen, W; Bouter, L M

OBJECTIVE: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain. METHODS: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for

A potential approach for low flow selection in water resource supply and management

Science.gov (United States)

Ouyang, Ying

2012-08-01

SummaryLow flow selections are essential to water resource management, water supply planning, and watershed ecosystem restoration. In this study, a new approach, namely the frequent-low (FL) approach (or frequent-low index), was developed based on the minimum frequent-low flow or level used in minimum flows and/or levels program in northeast Florida, USA. This FL approach was then compared to the conventional 7Q10 approach for low flow selections prior to its applications, using the USGS flow data from the freshwater environment (Big Sunflower River, Mississippi) as well as from the estuarine environment (St. Johns River, Florida). Unlike the FL approach that is associated with the biological and ecological impacts, the 7Q10 approach could lead to the selections of extremely low flows (e.g., near-zero flows) that may hinder its use for establishing criteria to prevent streams from significant harm to biological and ecological communities. Additionally, the 7Q10 approach could not be used when the period of data records is less than 10 years by definition while this may not the case for the FL approach. Results from both approaches showed that the low flows from the Big Sunflower River and the St. Johns River decreased as time elapsed, demonstrating that these two rivers have become drier during the last several decades with a potential of salted water intrusion to the St. Johns River. Results from the FL approach further revealed that the recurrence probability of low flow increased while the recurrence interval of low flow decreased as time elapsed in both rivers, indicating that low flows occurred more frequent in these rivers as time elapsed. This report suggests that the FL approach, developed in this study, is a useful alternative for low flow selections in addition to the 7Q10 approach.

Natural History of Clinically Staged Low- and Intermediate-Risk Prostate Cancer Treated With Monotherapeutic Permanent Interstitial Brachytherapy

International Nuclear Information System (INIS)

Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Wallner, Kent E.; Butler, Wayne M.

2010-01-01

Purpose: To evaluate the natural history of clinically staged low- and intermediate-risk prostate cancer treated with permanent interstitial seed implants as monotherapy. Methods and Materials: Between April 1995 and May 2005, 463 patients with clinically localized prostate cancer underwent brachytherapy as the sole definitive treatment. Men who received supplemental external beam radiotherapy or androgen deprivation therapy were excluded. Dosimetric implant quality was determined based on the minimum dose that covered 90% of the target volume and the volume of the prostate gland receiving 100% of the prescribed dose. Multiple parameters were evaluated as predictors of treatment outcomes. Results: The 12-year biochemical progression-free survival (bPFS), cause-specific survival, and overall survival rates for the entire cohort were 97.1%, 99.7%, and 75.4%, respectively. Only pretreatment prostate-specific antigen level, percent positive biopsy cores, and minimum dose that covered 90% of the target volume were significant predictors of biochemical recurrence. The bPFS, cause-specific survival, and overall survival rates were 97.4%, 99.6%, and 76.2%, respectively, for low-risk patients and 96.4%, 100%, and 74.0%, respectively, for intermediate-risk patients. The bPFS rate was 98.8% for low-risk patients with high-quality implants versus 92.1% for those with less adequate implants (p < 0.01), and it was 98.3% for intermediate-risk patients with high-quality implants versus 86.4% for those with less adequate implants (p < 0.01). Conclusions: High-quality brachytherapy implants as monotherapy can provide excellent outcomes for men with clinically staged low- and intermediate-risk prostate cancer. For these men, a high-quality implant can achieve results comparable to high-quality surgery in the most favorable pathologically staged patient subgroups.

Periodontal infection as a risk factor for preterm low birth weight

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Gandhimadhi D

2010-01-01

Full Text Available Introduction: There is an overwhelming body of evidence strongly suggesting that periodontal infection may have a significant negative impact on pregnancy outcome in some women. The aim of this study was to determine the association, if any, between periodontal disease and preterm low birth weight. Materials and Methods : A total of 211 mothers between the ages of 17 and 35 were grouped into two categories based on the gestational age and weight of the baby as cases (< 37 weeks, < 2500 g and controls (>37 weeks, >2500 g. Relevant obstetric history and information on other primary risk factors for preterm low birth weight were obtained. Investigation reports on blood group, Rh factor and hemoglobin (Hb were also gathered. Oral assessments included: simplified oral hygiene index (OHI-S, gingival bleeding index, probing pocket depth and clinical attachment level (CAL. Results: Cases had significantly more attachment loss and probing pocket depth, poor oral hygiene, more percentage of sites with attachment loss (Extent and more mean attachment loss per site (Severity and less Hb than controls. The number of visits for prenatal care and the percentage of sites with CAL≥2mm (Extent 2 remained significant when compared to other variables. Conclusion: The study indicated that periodontal disease is a contributing factor for preterm low birth weight.

Systematic review with meta-analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low-risk adenomas.

Science.gov (United States)

Hassan, C; Gimeno-García, A; Kalager, M; Spada, C; Zullo, A; Costamagna, G; Senore, C; Rex, D K; Quintero, E

2014-05-01

Patients with one to two tubular adenomas advanced neoplasia as those with no neoplasia at baseline colonoscopy. To compare incidence of metachronous advanced neoplasia between patients in the low-risk adenoma group and those without neoplasia at index colonoscopy. Relevant publications were identified by MEDLINE/EMBASE and other databases for the period 1992-2013. Studies comparing the incidence of post-polypectomy advanced neoplasia (adenomas ≥10 mm/high-grade dysplasia/villous or cancer) between the low-risk group and patients without colorectal neoplasia at the first colonoscopy were included. Detection rates for advanced neoplasia at endoscopic surveillance were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random-effect models. Inter-study heterogeneity was assessed using the I(2) statistic. Seven studies provided data on 11 387 patients. Mean surveillance periods ranged between 2 and 5 years. Altogether, 267 patients with post-polypectomy advanced neoplasia were detected in the two groups. The incidence of advanced neoplasia was 1.6% (119/7308) in those without neoplasia and 3.6% (148/4079) in those with low-risk adenoma, respectively, corresponding to a relative risk of 1.8 (95% CI: 1.3-2.6). Inter-study heterogeneity was only moderate (I(2) : 37%). No publication bias was present. Patients with low-risk adenomas at baseline had a higher risk of metachronous advanced neoplasia than the group with no adenomas at baseline, though the absolute risk was low in both groups. © 2014 John Wiley & Sons Ltd.

Low-Dose Aspirin Reduces Breast Cancer Risk in Women with Diabetes: A Nationwide Retrospective Cohort Study in Taiwan.

Science.gov (United States)

Yang, Yi-Sun; Kornelius, Edy; Chiou, Jeng-Yuan; Lai, Yung-Rung; Lo, Shih-Chang; Peng, Chiung-Huei; Huang, Chien-Ning

2017-12-01

Low-dose aspirin is commonly used for preventing cardiovascular disease in people with diabetes, but its association with cancer remains controversial. This study used a nationwide population-based reimbursement database to investigate the relationship between low-dose aspirin use and breast cancer incidence in women with diabetes. This retrospective cohort study was conducted using data retrieved from the National Health Insurance Research Database in Taiwan from January 1, 1998 to December 31, 2011. Women diagnosed as having diabetes with low-dose aspirin use (75-165 mg daily) were identified as the study population, whereas those without low-dose aspirin use were selected as the comparison group. We analyzed 148,739 patients with diabetes. Their mean age (standard deviation) was 63.3 (12.8) years. A total of 27,378 patients were taking aspirin. Overall, the use of aspirin in patients with diabetes reduced the risk of breast cancer by 18% (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.71-0.94) after adjustment for potential confounders, namely age and comorbidities. Specifically, a cumulative dose of aspirin exceeding 88,900 mg was observed to reduce the risk of breast cancer by 47% (HR, 0.53, 95% CI, 0.43-0.67); however, low (aspirin did not reduce the risk of breast cancer. Our findings suggest that a cumulative aspirin dosage of more than 88,900 mg daily was associated with a reduced risk of breast cancer in women with diabetes. However, additional studies are necessary to confirm these findings.

Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

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Norhayati Moktar

2016-08-01

Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

Interpersonal Problem-Solving Skills, Executive Function and Learning Potential in Preadolescents with High/Low Family Risk.

Science.gov (United States)

Mata, Sara; Gómez-Pérez, M Mar; Molinero, Clara; Calero, M Dolores

2017-10-30

Situations generated by high family risk have a negative effect on personal development, especially during preadolescence. Growing up in the presence of risk factors can lead to negative consequences on mental health or on school performance. The objective of this study focuses on individual factors related to this phenomenon during preadolescence. Specifically, we seek to establish whether level of family risk (high vs. low risk) is related to interpersonal problem-solving skills, executive function and learning potential in a sample of preadolescents controlling age, sex, total IQ, verbal comprehension ability and the classroom influences. The participants were 40 children, 23 boys and 17 girls between the ages of 7 and 12, twenty of which had a record on file with the Social and Childhood Protection Services of Information deleted to maintain the integrity of the review process, and therefore, a high family risk situation. The other 20 participants had a low family risk situation. Results show that the preadolescents from high family risk performed worse on interpersonal solving-problem skills and executive function (p family risk. These results highlight the negative effects of high family risk situation in preadolescents and give value of taking into account protective factors such as learning potential when assessing preadolescents from high family risk.

Quantifying the Transition from Active Surveillance to Watchful Waiting Among Men with Very Low-risk Prostate Cancer.

Science.gov (United States)

Van Hemelrijck, Mieke; Garmo, Hans; Lindhagen, Lars; Bratt, Ola; Stattin, Pär; Adolfsson, Jan

2017-10-01

Active surveillance (AS) is commonly used for men with low-risk prostate cancer (PCa). When life expectancy becomes too short for curative treatment to be beneficial, a change from AS to watchful waiting (WW) follows. Little is known about this change since it is rarely documented in medical records. To model transition from AS to WW and how this is affected by age and comorbidity among men with very low-risk PCa. National population-based healthcare registers were used for analysis. Using data on PCa characteristics, age, and comorbidity, a state transition model was created to estimate the probability of changes between predefined treatments to estimate transition from AS to WW. Our estimates indicate that 48% of men with very low-risk PCa starting AS eventually changed to WW over a life course. This proportion increased with age at time of AS initiation. Within 10 yr from start of AS, 10% of men aged 55 yr and 50% of men aged 70 yr with no comorbidity at initiation changed to WW. Our prevalence simulation suggests that the number of men on WW who were previously on AS will eventually stabilise after 30 yr. A limitation is the limited information from clinical follow-up visits (eg, repeat biopsies). We estimated that changes from AS to WW become common among men with very low-risk PCa who are elderly. This potential change to WW should be discussed with men starting on AS. Moreover, our estimates may help in planning health care resources allocated to men on AS, as the transition to WW is associated with lower demands on outpatient resources. Changes from active surveillance to watchful waiting will become more common among men with very low-risk prostate cancer. These observations suggest that patients need to be informed about this potential change before they start on active surveillance. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Low dose irradiation and risk of leukaemia: A case-control study

International Nuclear Information System (INIS)

Chobanova, N.; Bayrakova, A.

1997-01-01

The effect of low dose irradiation (medical X-ray diagnostic) on the developing of leukaemias in adults is investigated. The influence of non-radiation agents (occupational exposure to chemical carcinogens, past viral infections, family aggregations) to leukaemias are considered also. During this retrospective study 228 patients have been examined with the following diagnosis: acute myeloid leukaemia, chronic myelogenous leukaemias, myelodisplastic syndrome and non-Hodgkin lymphoma (diagnosed between 1991-1993). Each case has been matched with two controls. Statistically significant increase has been found in the risk of developing leukaemias after X-ray diagnostic irradiation (OR = 1.98, 95% CI = 1.14 ./. 3.46). Exposure to chemical agents is also associated with significant increase in the risk (OR = 1.98, 95% CI = 1.25 ./. 2.86). (author)

Efficacy of Low-Dose Protocol in Follow-Up of Lymphoproliferative Disorders - Preliminary Results

International Nuclear Information System (INIS)

Popic-Ramac, J.; Brnic, Z.; Klasic, B.; Hebrang, A.; Knezevic, Z.

2011-01-01

Most medically-related radiation is caused by diagnostic examinations, in particular by computed tomography (CT). The purpose of this research is to reduce radiation doses faced by the population frequently exposed to such procedures-those with lymphoproliferative disorders. The research was conducted comparing radiation-exposition doses received by the radiosensitive organs (thyroid, lens, breast and gonad) using the standard thoracic CT protocol with the radiation received using the low-dose protocol, while maintaining display quality. The standard-dose thoracic protocol implies 120 kV and 150 mAs. The low-dose protocol was conducted on the same device using 120 kV and 30 mAs. We confirmed the hypothesis that the use of the low-dose thoracic CT protocol leads to a reduction in radiation dose without compromising display quality. It is further expected that a reduction in doses will reduce the risk of radiation-related mutations. (author)

Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trøndelag Health Study.

Science.gov (United States)

Heuch, Ingrid; Heuch, Ivar; Hagen, Knut; Zwart, John-Anker

2017-01-01

Physical activity in leisure time seems to reduce the risk of low back pain, but it is not known whether occupational activity, as recorded in a representative working population, produces a higher or lower risk. To study associations between physical activity level at work and risk of chronic low back pain. Associations were examined in a Norwegian prospective study using data from the HUNT2 and HUNT3 surveys carried out in the whole county of Nord-Trøndelag. Participants were 7580 women and 7335 men who supplied information about physical activity level at work. Levels considered were sedentary work, work involving walking but no heavy lifting, work involving walking and heavy lifting, and particularly strenuous physical work. Nobody in the cohort was affected by chronic low back pain at baseline. After 11 years, participants reported whether they suffered from chronic low back pain. Generalized linear modelling with adjustment for potential confounders was applied to assess associations with risk factors. In age-adjusted analyses both women and men showed statistically significant associations between physical activity at work and risk of chronic low back pain, suggesting positive relationships. For particularly strenuous physical work the relative risk of chronic low back pain was 1.30 (95% CI: 1.00-1.71) in women and 1.36 (95% CI 1.17-1.59) in men, compared to sedentary work. Women still showed a general association with activity level after adjustment for education, leisure time physical activity, BMI, smoking and occupational category. In men, the higher risk was only maintained for particularly strenuous work. In this cohort, women had a higher risk of chronic low back pain with work involving walking and heavy lifting or particularly strenuous work, compared to sedentary work. Men participating in particularly strenuous work also experienced a higher risk of chronic low back pain.

Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trøndelag Health Study.

Directory of Open Access Journals (Sweden)

Ingrid Heuch

Full Text Available Physical activity in leisure time seems to reduce the risk of low back pain, but it is not known whether occupational activity, as recorded in a representative working population, produces a higher or lower risk.To study associations between physical activity level at work and risk of chronic low back pain.Associations were examined in a Norwegian prospective study using data from the HUNT2 and HUNT3 surveys carried out in the whole county of Nord-Trøndelag. Participants were 7580 women and 7335 men who supplied information about physical activity level at work. Levels considered were sedentary work, work involving walking but no heavy lifting, work involving walking and heavy lifting, and particularly strenuous physical work. Nobody in the cohort was affected by chronic low back pain at baseline. After 11 years, participants reported whether they suffered from chronic low back pain. Generalized linear modelling with adjustment for potential confounders was applied to assess associations with risk factors.In age-adjusted analyses both women and men showed statistically significant associations between physical activity at work and risk of chronic low back pain, suggesting positive relationships. For particularly strenuous physical work the relative risk of chronic low back pain was 1.30 (95% CI: 1.00-1.71 in women and 1.36 (95% CI 1.17-1.59 in men, compared to sedentary work. Women still showed a general association with activity level after adjustment for education, leisure time physical activity, BMI, smoking and occupational category. In men, the higher risk was only maintained for particularly strenuous work.In this cohort, women had a higher risk of chronic low back pain with work involving walking and heavy lifting or particularly strenuous work, compared to sedentary work. Men participating in particularly strenuous work also experienced a higher risk of chronic low back pain.

WHO's health risk assessment of extremely low frequency electric fields

International Nuclear Information System (INIS)

Repacholi, M.H.

2003-01-01

The World Health Organization (WHO), the International Commission on Non-Ionizing Radiation Protection (ICNIRP), WHOs scientific collaborating centres (including the UKs National Radiological Protection Board (NRPB) and over 50 participating Member States are participants of WHOs International EMF Project. As part of WHOs health risk assessment process for extremely low frequency fields (ELFs), this workshop was convened by NRPB to assist WHO in evaluating potential health impacts of electrical currents and fields induced by ELF in molecules, cells, tissues and organs of the body. This paper describes the process by which WHO will conduct its health risk assessment. WHO is also trying to provide information on why exposure to ELF magnetic fields seems to be associated with an increased incidence of childhood leukaemia. Are there mechanisms that could lead to this health outcome or does the epidemiological evidence incorporate biases or other factors that need to be further explored? (author)

Research on low radiation doses - A better understanding of low doses

International Nuclear Information System (INIS)

2016-01-01

Radiation doses below 100 mSv are called low doses. Epidemiological research on the health hazards of low doses are difficult to do because numerous pathologies, particularly cancer, appear lifelong for genetical or environmental causes without any link with irradiation and it is very difficult to identify the real cause of a cancer. Another concern is that the impact on human health is weak and are observed only after a long period after irradiation. These features make epidemiological studies cumbersome to implement since they require vast cohorts and a very long-term follow-up. The extrapolation of the effects of higher doses to the domain of low doses does not meet reality and it is why the European Union takes part into the financing of such research. In order to gain efficiency, scientists work together through various European networks among them: HLEG (High Level Expert Group On European Low Dose Risk Research) or MELODI (Multidisciplinary European Low Dose Initiative). Several programs are underway or have been recently launched: -) the impact of Cesium contamination on children's health (Epice program), -) the study of the impact of medical imaging on children, -) the study of the health of children living near nuclear facilities, -) the relationship between radon and lung cancer, -) the effect of occupational low radiation doses, -) the effect of uranium dissolved in water on living organisms (Envirhom program). (A.C.)

U.S.Department of energy low dose radiation research program: potential impact on Human health risk from Chornobyl

International Nuclear Information System (INIS)

Brooks, A.

2002-01-01

Radiation risks from low levels of radiation exposure, cannot be predicted with epidemiological studies alone. Combining advances in technology with those in cell and molecular biology make it possible to detect biological changes after low doses and dose-rates of radiation exposure, such as Chornobyl. Understanding the role of these biological changes in cancer risk may or may not impact radiation protection standards. However, they will help ensure that the standards are both adequate and appropriate

Drinking patterns and adherence to "low-risk" guidelines among community-residing older adults.

Science.gov (United States)

Lewis, Ben; Garcia, Christian C; Nixon, Sara Jo

2018-06-01

Older adults constitute a rapidly expanding proportion of the U.S. Contemporary studies note the increasing prevalence of alcohol consumption in this group. Thus, understanding alcohol effects, consumption patterns, and associated risks in aging populations constitute critical areas of study with increasing public health relevance. Participants (n = 643; 292 women; ages 21-70) were community residing adult volunteers. Primary measures of interest included four patterns of alcohol consumption (average [oz./day]; typical quantity [oz./occasion]; frequency [% drinking days]; and maximal quantity [oz.]). Regression analyses explored associations between these measures, age, and relevant covariates. Subsequent between-group analyses investigated differences between two groups of older adults and a comparator group of younger adults, their adherance to "low-risk" guidelines, and whether alcohol-associated risks differed by age and adherence pattern. Average consumption did not vary by age or differ between age groups. In contrast, markedly higher frequencies and lower quantities of consumption were observed with increasing age. These differences persisted across adherence categories and were evident even in the oldest age group. Exceeding "low-risk" guidelines was associated with greater risk for alcohol-related problems among the older groups. These results emphasize the utility of considering underlying constituent patterns of consumption in older drinkers. Findings highlight difficulties in identifying problem drinking among older adults and contribute to the few characterizations of "risky" drinking patterns in this group. Taken together, our data contribute to literatures of import for the design and enhancement of screening, prevention, and education initiatives directed toward aging adults. Copyright © 2018. Published by Elsevier B.V.

Low bone mineral density and risk of incident fracture in HIV-infected adults.

Science.gov (United States)

Battalora, Linda; Buchacz, Kate; Armon, Carl; Overton, Edgar T; Hammer, John; Patel, Pragna; Chmiel, Joan S; Wood, Kathy; Bush, Timothy J; Spear, John R; Brooks, John T; Young, Benjamin

2016-01-01

Prevalence rates of low bone mineral density (BMD) and bone fractures are higher among HIV-infected adults compared with the general United States (US) population, but the relationship between BMD and incident fractures in HIV-infected persons has not been well described. Dual energy X-ray absorptiometry (DXA) results of the femoral neck of the hip and clinical data were obtained prospectively during 2004-2012 from participants in two HIV cohort studies. Low BMD was defined by a T-score in the interval >-2.5 to fractures, adjusted for sociodemographics, other risk factors and covariables, using multivariable proportional hazards regression. Among 1,006 participants analysed (median age 43 years [IQR 36-49], 83% male, 67% non-Hispanic white, median CD4(+) T-cell count 461 cells/mm(3) [IQR 311-658]), 36% (n=358) had osteopenia and 4% (n=37) osteoporosis; 67 had a prior fracture documented. During 4,068 person-years of observation after DXA scanning, 85 incident fractures occurred, predominantly rib/sternum (n=18), hand (n=14), foot (n=13) and wrist (n=11). In multivariable analyses, osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture. In this large sample of HIV-infected adults in the US, low baseline BMD was significantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population.

Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method.

Science.gov (United States)

Ueda, Kayo; Ohtera, Shosuke; Kaso, Misato; Nakayama, Takeo

2017-09-22

In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan. We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012. The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively. We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.