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Elevated Risk (elevated + risk)
Selected AbstractsYoung Adults Who Lack Continuous Health Insurance Coverage Have an Elevated Risk of Chlamydia InfectionPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 4 2006-D. Hollander No abstract is available for this article. [source] Women Aged 40 and Older Have Greatest Likelihood Of Stillbirth; Teenagers Also Have an Elevated RiskPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 3 2006D. Hollander No abstract is available for this article. [source] Skin sensitizing properties of the ethanolamines mono-, di-, and triethanolamine.CONTACT DERMATITIS, Issue 5 2009Data analysis of a multicentre surveillance network (IVDK, review of the literature Numerous publications address the skin sensitizing potential of the short chain alkanolamines triethanolamine (TEA), diethanolamine (DEA), monoethanolamine (MEA), which are not skin sensitizing according to animal studies. Regarding TEA, we analysed patch test data of 85 098 patients who had been tested with TEA 2.5% petrolatum by Information Network of Departments of Dermatology (IVDK) to identify particular exposures possibly associated with an elevated risk of sensitization. Altogether, 323 patients (0.4%) tested positive. The profile of patch test reactions indicates a slightly irritant potential rather than a true allergic response in many cases. Although used widely, no exposure associated with an increased risk of TEA sensitization was identified. Therefore, the risk of sensitization to TEA seems to be very low. MEA and DEA were patch tested in a much more aimed fashion in 9602 and 8791 patients, respectively when prevalence of contact allergy was 3.8% and 1.8%. MEA is the prominent allergen in metalworkers with exposure to water-based metalworking fluids (wbMWFs); DEA is probably used in cutting fluids less frequently nowadays. Chronic damage to the skin barrier resulting from wbMWF, the alkalinity of ethanolamines (increasing from TEA to MEA), and other cofactors may contribute to a notable sensitization risk. [source] Skin-sensitizing and irritant properties of propylene glycolCONTACT DERMATITIS, Issue 5 2005Data analysis of a multicentre surveillance network (IVDK, review of the literature In the several publications reviewed in this article, propylene glycol (PG; 1,2-propylene glycol) is described as a very weak contact sensitizer, if at all. However, particular exposures to PG-containing products might be associated with an elevated risk of sensitization. To identify such exposures, we analysed patch test data of 45 138 patients who have been tested with 20% PG in water between 1992 and 2002. Out of these, 1044 patients (2.3%) tested positively, 1083 showed a doubtful, follicular or erythematous reaction (2.4%) and 271 explicit irritant reactions (0.6%). This profile of patch test reactions is indicative of a slightly irritant preparation, and thus, many of the ,weak positive' reactions must probably be interpreted as false positive. No private or occupational exposures associated with an increased risk of PG sensitization were identified, except for lower leg dermatitis. Therefore, according to our patch test data, PG seems to exhibit very low sensitization potential, and the risk for sensitization to PG on uncompromised skin seems to be very low. [source] Prevalence and correlates of traumatic brain injury among delinquent youthsCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2008Brian E. Perron Background,Delinquent youth frequently exhibit high-risk behaviours that can result in serious injury. However, little is known about traumatic brain injuries (TBIs) and their correlates in this population. Aims,To examine the period prevalence and correlates of TBIs in delinquent youths. Method,Interviews were conducted with 720 (97.3%) residents of 27 Missouri Division of Youth Services rehabilitation facilities between March 1 and May 31, 2003. Participants [mean age (Mage) = 15.5, standard deviation (SD) = 1.2, 87% male] completed measures assessing TBI, substance use, psychiatric symptoms, and antisocial traits/behaviours. TBI was defined as ever having sustained a head injury causing unconsciousness for more than 20 minutes. Results,Nearly one-in-five youths (18.3%) reported a lifetime TBI. Youths with TBIs were significantly more likely than youths without to be male, have received a psychiatric diagnosis, report an earlier onset of criminal behaviour/substance use and more lifetime substance use problems and past-year criminal acts, evidence psychiatric symptoms, report lifetime suicidality, be impulsive, fearless, and external in locus of control and criminally victimized in the year preceding incarceration. Male gender and frequency of own criminal victimization were important predictors of TBI in multivariate analyses. Regression analyses adjusted for demographic factors, indicated that youths with TBIs were at significantly elevated risk for current depressive/anxious symptoms, antisocial behaviour, and substance abuse problems. Conclusions,TBI is common among delinquent youth and associated with wide ranging psychiatric dysfunction; however, the causal role of TBIs in the pathogenesis of co-morbid conditions remains unclear. Copyright © 2008 John Wiley & Sons, Ltd. [source] Depression and the metabolic syndrome: gender-dependent associationsDEPRESSION AND ANXIETY, Issue 8 2008Sharon Toker Ph.D. Abstract This study was designed to test the extent to which depressive symptoms are associated with the presence of the metabolic syndrome (MS) and each of its components, and whether these relationships are gender dependent. Participants were apparently healthy employed men (N=2,355) and women (N=1,525) who underwent a routine health check between the years 2003 and 2005. We used logistic regression analysis, predicting the MS by depressive symptoms, as assessed by the Patient Health Questionnaire, and the following control variables: age, education, smoking status, physical exercise, anxiety, and burnout. As hypothesized, we found that depression among women, but not men, was associated with a 1.94-fold risk of having the MS, and with an elevated risk of having two of its five components: elevated waist circumference (odds ratio, OR=2.23) and elevated glucose levels (OR=2.44). In addition, a positive trend was observed toward an association with the other three components: low high-density lipoprotein, hypertension, and elevated triglycerides. Among men depression was associated with elevated waist circumference only (OR=1.77). These findings suggest that especially among women, the association between depression and cardiovascular diseases might be linked to metabolic processes. If replicated in longitudinal studies, these findings may have important health-care policy implications with regard to depression management interventions. Depression and Anxiety 0:1,9, 2007. © 2007 Wiley-Liss, Inc. [source] Differing aspects of insulin resistance in diabetes complications: the shape of things to come.DIABETIC MEDICINE, Issue 12 2002RD Lawrence lecture 2000 Abstract The anticipated global epidemic of diabetes, largely as a consequence of increased rates of obesity, will particularly impact on people of South Asian and African Caribbean descent, two populations at elevated risk of insulin resistance. This article contrasts the consequent heightened risk of heart disease on the one hand in South Asians, and the paradoxical protection from heart disease in African Caribbeans on the other. Protection from the hypertriglyceridaemic effects of insulin resistance is likely to account for much of the African Caribbean paradox, although the mechanisms remain unclear. The growing evidence that insulin resistance is commonly observed in people with Type 1 diabetes, as well as those with Type 2 diabetes, and that features of insulin resistance may play a crucial role in the development of microvascular, as well as macrovascular complications, is also discussed. This indicates novel targets for the prevention and treatment of diabetes complications. Diabet. Med. 19, 973,977 (2002) [source] The familial aggregation of cannabis use disordersADDICTION, Issue 4 2009Kathleen R. Merikangas ABSTRACT Aims The aim of this paper is to examine the familial aggregation of cannabis use disorders and other psychiatric conditions among first-degree relatives and spouses of probands with a cannabis use disorder. Design Controlled family study methods. Setting Out-patient psychiatric clinics and the local community (same geographic area). Participants Two hundred and sixty-two probands with a life-time history of cannabis use disorder, alcohol dependence, anxiety disorders or no history of any disorder, and their first-degree relatives and spouses. Measurements Cannabis use disorders and other DSM-III-R disorders in the relatives and spouses using the Schedule for Affective Disorders and Schizophrenia. Findings Results reveal an elevated risk of life-time history of cannabis use disorders among siblings [odds ratio (OR: 3.6), adult offspring (OR): 6.9], and spouses (OR: 4.4) of probands with cannabis use disorders. There is a latent familial factor underlying cannabis use disorders that was shared partially with alcohol abuse/dependence. Comorbid mood and anxiety disorders aggregated independently from cannabis use disorders in families. Equal elevation in the magnitude of the association among the first-degree adult relatives and spouses of probands with a cannabis use disorder suggests the probable contribution of both environmental and genetic factors. Conclusions These findings support a family-based approach to drug abuse intervention and the importance of future research concerning environmental mediators of familial transmission of drug abuse. [source] Valproate teratogenicity and epilepsy syndromeEPILEPSIA, Issue 12 2008Edward B. Bromfield Summary Maternal valproate (VPA) use is associated with a significant risk for congenital malformations in the exposed fetus. Since VPA is commonly used in epilepsy syndromes with a presumed genetic cause (idiopathic epilepsies), it is possible that maternal genetic background contributes to this outcome. We reviewed responses to telephone questionnaires and medical records, when available, of enrollees in the North American Antiepileptic Drug Pregnancy Registry, classifying reason for treatment as idiopathic generalized epilepsy (IGE), partial epilepsy (PE), nonclassifiable epilepsy (NCE), or not epilepsy (NE). Of 284 VPA-exposed pregnancies, 30 (11.0%) were associated with malformations: IGE = 15/126 (12%), PE = 4/28 (14%), NCE = 9/105 (9%), NE = 2/25 (8%) (p > 0.7 for all comparisons). There was a trend toward increased malformation risk with higher VPA doses (p = 0.07). VPA, and not the underlying genetic syndrome, seems to be associated with the elevated risk for malformations in the drug-exposed fetus. [source] The Effect of Within-Flock Spatial Position on the Use of Social Foraging Tactics in Free-Living Tree SparrowsETHOLOGY, Issue 3 2008Ferenc Mónus The benefit of producer (searches for own food) or scrounger (exploits the others' food discoveries) foraging tactic in a group of socially feeding animals may depend on where the individual searches for food within the group. Scrounging may be more advantageous in the centre of the group, having more individuals around to join, while producing may be more beneficial at the edges, where more unexplored food patches may be found. This study shows within-flock position correlates with foraging tactic use of feeding birds in socially foraging tree sparrows, Passer montanus. Sparrows staying closer to the centre of the flock found their food patches more frequently by joining (i.e. use more frequently the scrounging tactic) than those staying toward the edges. To our knowledge this is the first field study demonstrating the relationship between spatial position and foraging tactic use. We investigated this relationship under different perceived predation hazard, and found that under elevated risk of predation, central individuals may increase their use of joining more than individuals on the periphery of the flock. Moreover, we show that extremely specialized use of searching tactics may be very infrequent in tree sparrows. As both within-flock position and search tactic use can be altered very quickly and without leaving the flock, individuals may easily alter them in order to adjust their behaviour. [source] A case-control study on hormone therapy as a risk factor for breast cancer in Finland: Intrauterine system carries a risk as wellINTERNATIONAL JOURNAL OF CANCER, Issue 2 2010Heli K. Lyytinen Abstract The purpose of this study was to evaluate the association between postmenopausal hormone therapy (HT) and the risk for breast cancer in recently postmenopausal Finnish women. All Finnish women with first invasive breast cancer diagnosed between the ages of 50 and 62 years during 1995,2007 (n = 9,956) were identified from the Finnish Cancer Registry. For each case, 3 controls of the same age were retrieved from the Finnish Population Register. The cases and controls were linked to the national medical reimbursement register to assess the use of HT. The odds ratios (ORs) and 95% confidence intervals (CIs) for breast cancer were calculated with conditional logistic regression analysis, adjusting for parity, age at the first birth and health care district. Estradiol-only therapy (991 users with breast cancer, n) or oral progestagen (n = 138) was not accompanied by an increased risk. Estradiol-progestagen therapy (EPT) (n = 1,731) was associated with an elevated risk in the whole series (OR 1.36; 95% CI 1.27,1.46). The risk became detectable in less than 3 years of use. Continuous EPT use tended to be associated with a higher risk for breast cancer than the sequential EPT use. The use of tibolone (n = 80) (1.36; 1.15,1.96), a levonorgestrel-releasing intrauterine system (LNG,IUS) alone (n = 154) (1.45; 1.97,1.77) or as a complement to estradiol (n = 137) (2.15; 1.72,2.68) was also associated with an increased risk. The association between HT use and the risk for breast cancer shows a large variation between various forms of HT, and also the use of LNG-IUS may carry a risk. [source] Cigarette smoking, alcohol drinking and the risk of gallbladder cancer death: A prospective cohort study in JapanINTERNATIONAL JOURNAL OF CANCER, Issue 4 2008Kiyoko Yagyu Abstract Gallbladder cancer is a rare cancer with a poor prognosis, and few risk factors have been identified to date. This prospective study was conducted to evaluate the association of cigarette smoking and alcohol consumption with the risk of gallbladder cancer death. A baseline survey in 45 areas throughout Japan was conducted from 1988 to 1990 using a self-administered questionnaire, and a total of 113,496 participants (65,740 women) aged 40,89 years at entry were followed for 15 years. During the follow-up period, 165 gallbladder cancer deaths (95 women) were observed. Among women, the hazard ratio (HR) [95 percent confidence interval: 95% CI] of current smoker was 2.00 [0.91,4.42], when adjusted for age and drinking. There was no clear association between alcohol consumption and the risk. Among men, HR of current smoker was 2.27 [1.05,4.90]. HRs of those who smoked 21 cigarettes or more per day and those with 801,1,000 cigarette-years were 3.18 [1.18,8.53] and 3.44 [1.40,8.45], respectively, and positive linear associations were observed between that risk and the number of cigarettes per day (p for trend = 0.007) or "cigarette-years" (p for trend = 0.012). The alcohol dose was linearly associated with risk (p for trend = 0.004), where the HR among those who consumed 72.0 g or more of alcohol per day was 3.60 [1.29,9.85]. Among both men and women, cigarette smoking may elevate the risk of death from gallbladder cancer. Drinking may pose an elevated risk among men, but that seems to be less true among women. © 2007 Wiley-Liss, Inc. [source] Molecular margin analysis predicts local recurrence after sublobar resection of lung cancerINTERNATIONAL JOURNAL OF CANCER, Issue 6 2005Brett G. Masasyesva Abstract Sublobar resection for early-stage lung cancer has been used for patients who are not candidates for lobar resection. However, sublobar resection is associated with high local recurrence rates in the context of tumor-free parenchymal margins. The mechanism underlying this high recurrence rate is not well understood. We hypothesized that this elevated risk of local recurrence is due to undetected tumor cells present at parenchymal margins thought to be negative by conventional light microscopy. Thirteen of 44 patients who underwent sublobar resection for lung cancer were found to have a k-ras mutation at codon 12.1. A novel fluorescence-based assay for detection of rare copies of mutant DNA in a background of wild-type DNA, fluorescent gap ligase chain reaction, was used to quantitate the mutant/wild-type DNA in a range of 1 to 1/10,000 in histologically normal margins from these resections. Nine of 13 patients had at least one margin with the number of mutant cells over or equal to a threshold of 1/5,000, and of these, 6/9 (67%) recurred locally. None of the remaining 4 patients without mutant DNA in any surgical margin had evidence of recurrence. The higher rate of local recurrence associated with sublobar resection of lung cancer is likely due to the occult presence of tumor cells at resection margins. These occult tumor cells can be quantitated using a novel fluorescence-based assay and define a group of patients at high risk for local recurrence who are candidates for adjuvant therapy or more extensive resection. This methodology may be adaptable to a real-time format for intraoperative use. © 2004 Wiley-Liss, Inc. [source] Sexual orientation as a risk factor for bulimic symptomsINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 6 2006Lars Wichstrøm PhD Abstract Objective: This study was carried out to examine whether sexual orientation predicts future bulimic symptoms and whether alleged risk factors associated with non-heterosexual sexual orientation explain the increased risk. Method: A nationally representative sample of Norwegian high school students (age 14,19; N = 2,924) completed self-reports about bulimic symptoms by means of the Bulimic Investigatory Test,Edinborough (BITE), same-sex sexual experience, degree of sexual attraction to the same sex, and alleged risk factors. They were reexamined 5 years later (T2). Results: Same-sex sexual experience before T1 increased the prevalence of bulimic symptoms at T2. Males who were attracted to the same sex at T1 had higher odds for bulimic symptoms compared with heterosexual males. These associations were still significant after controlling for initial bulimic symptoms and alleged risk factors. Conclusion: Same-sex sexual experience in both genders and non-heterosexual sexual attraction among males predict future bulimic symptoms. Commonly advocated explanations for this elevated risk were not supported. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [source] Personality disorder traits evident by early adulthood and risk for eating and weight problems during middle adulthoodINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 3 2006Jeffrey G. Johnson PhD Abstract Objective: The current article investigates the association of personality disorder (PD) with the subsequent development of eating and weight problems. Method: Psychiatric interviews were administered to a community-based sample of 658 individuals at mean ages 14, 16, 22, and 33 years. Results: Individuals with PD by age 22 were at an elevated risk for eating disorders at mean age 33 years. PDs were associated with risk for onset of binge eating, purging, daily dietary restriction, and obesity among individuals without a history of these problems. Borderline and histrionic PD symptoms were associated with recurrent binging and purging at mean age 33 years. Antisocial and schizotypal symptoms were associated with recurrent binging and obesity at mean age 33 years. Depressive PD symptoms were associated with recurrent binging and dietary restriction at mean age 33 years. Conclusion: PD symptoms, evident by early adulthood, may be associated with the risk for the development of eating and weight problems by middle adulthood. © 2006 Wiley Periodicals, Inc., Int J Eat Disord, 2006 [source] Suicide after hospitalization in the elderly: a population based study of suicides in Northern Finland between 1988,2003INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008Kaisa Karvonen Abstract Objective Elderly people commit suicide more often than people under the age of 65. An elevated risk is also attached to depression and other axis I psychiatric disorders. However, little is known about the preferred suicide method, effect of primary psychiatric diagnosis, and length of time between discharge from psychiatric hospitalization and suicide. The lack of information is most apparent in the oldest old (individuals over 75 years). Methods On the basis of forensic examinations, data on suicide rates were separately examined for the 50,64, 65,74 and over 75 year-olds (Total n,=,564) with regard to suicide method, history of psychiatric hospitalization and primary diagnoses gathered from the Finnish Hospital Discharge Register. Study population consisted of all suicides committed between 1988 and 2003 in the province of Oulu in Northern Finland. Results Of the oldest old, females had more frequent hospitalizations than males in connection with psychiatric disorders (61% vs 23%), of which depression was the most common (39% vs 14%). In this age group, 42% committed suicide within 3 months after being discharged from hospital and 83% used a violent method. Both elderly males and females were less often under the influence of alcohol, but used more often violent methods than middle-aged persons. Conclusions Suicide rates within the first 3 months following discharge from hospital in the 65,74 and the over 75 year olds were substantial and should influence post-hospitalization treatment strategies. To reduce the risk of suicides in elderly patients discharged from hospital, close post-hospitalization supervision combined with proper psychoactive medication and psychotherapy, are possible interventions. Copyright © 2007 John Wiley & Sons, Ltd. [source] Usefulness of PSA screening in outpatients with bladder cancer: Preliminary resultsINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2002Kohei Kurokawa Abstract Background: We performed prostate-specific antigen (PSA) screening and evaluated its usefulness in outpatients with bladder cancer who may have an elevated risk for prostate cancer. Methods: Sixty-one new or followed-up outpatients with bladder cancer were examined between September 1999 and December 2000 in the Department of Urology, Gunma University Hospital, Japan. PSA was measured after informed consent was obtained, and patients in whom the PSA level was 4.1 ng/mL or higher were selected for thorough examination. In the examination, one examiner performed DRE (digital rectal examination) and, based on DRE and TRUS (transrectal ultrasonography) findings, determined whether prostate biopsy was indicated. Results: The average age of the 61 cases was 69.1 ± 8.6 years, and the average PSA level was 3.5 ± 5.8 ng/mL. The PSA level was 4.1 ng/mL or higher in 11 (18.0%) patients, nine of whom underwent six-sextant biopsy under TRUS guidance. Of these nine cases, four (6.6%) were diagnosed as having prostate cancer. The Gleason score was 7 in three cases and 9 in one case. The clinical stage was T2N0M0 in three cases and T3N0M0 in one case. Conclusions: On PSA screening in patients with bladder cancer and patients with a history of transurethral resection of the bladder tumor (TUR-BT), prostate cancer was found in 6.6%. This rate is higher than in the general population. These cancers were classified into intermediate to high-risk groups, and the prognosis of prostate cancers could be more important than those of the bladder cancers in two cases (50%). We conclude that PSA screening for inpatients with bladder cancer may be useful. [source] Nest predators affect spatial dynamics of breeding red-backed shrikes (Lanius collurio)JOURNAL OF ANIMAL ECOLOGY, Issue 1 2004Staffan Roos Summary 1Predation may be a strong selective factor affecting individual behaviour and life histories. However, few studies have investigated whether predators affect breeding habitat selection of prey species. 2We tested whether breeding habitat selection and reproduction of a tropical migrant, the red-backed shrike (Lanius collurio L.), was related to the presence of breeding pairs of its potential nest predators, magpie (Pica pica L.), hooded crow (Corvus corone cornix L.) and jackdaw (C. monedula L.). 3Only magpie and hooded crow territories were associated with an elevated risk of predation based on an artificial nest experiment with nests mimicking red-backed shrike nests. Predation risk on real red-backed shrike nests was also higher close to nests of hooded crow and magpie than elsewhere in the landscape. 4Occupation frequency of known red-backed shrike territory sites during 3 years of study increased with increasing mean distance to the nearest magpie nest. 5Changes in spatial distribution of corvids affected the spatial distribution of red-backed shrikes. Vacant red-backed shrike territory sites were more likely to become occupied in the next year when magpie and hooded crows had moved away from the site, while occupied sites were more likely to be abandoned in the next year when at least hooded crows had moved closer. 6Our results suggest that breeding territories of nest predators may affect breeding habitat selection of prey species. Thus, a large part of an observed spatial dynamics of prey species may be caused by a corresponding spatial dynamics of predators. Because sink territories are occupied more irregularly than source territories, we suggest that the dynamics in predator sinks may be the driving force of the spatial dynamics of prey species. [source] Biochemical Markers of Bone Turnover, Hip Bone Loss, and Fracture in Older Men: The MrOS Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2009Douglas C Bauer Abstract We used data from the Osteoporotic Fractures in Men (MrOS) study to test the hypothesis that men with higher levels of bone turnover would have accelerated bone loss and an elevated risk of fracture. MrOS enrolled 5995 subjects >65 yr; hip BMD was measured at baseline and after a mean follow-up of 4.6 yr. Nonspine fractures were documented during a mean follow-up of 5.0 yr. Using fasting serum collected at baseline and stored at ,190°C, bone turnover measurements (type I collagen N-propeptide [PINP]; , C-terminal cross-linked telopeptide of type I collagen [,CTX]; and TRACP5b) were obtained on 384 men with nonspine fracture (including 72 hip fractures) and 947 men selected at random. Among randomly selected men, total hip bone loss was 0.5%/yr among those in the highest quartile of PINP (>44.3 ng/ml) and 0.3%/yr among those in the lower three quartiles (p = 0.01). Fracture risk was elevated among men in the highest quartile of PINP (hip fracture relative hazard = 2.13; 95% CI: 1.23, 3.68; nonspine relative hazard = 1.57, 95% CI: 1.21, 2.05) or ,CTX (hip fracture relative hazard = 1.76, 95 CI: 1.04, 2.98; nonspine relative hazard = 1.29, 95% CI: 0.99, 1.69) but not TRACP5b. Further adjustment for baseline hip BMD eliminated all associations between bone turnover and fracture. We conclude that higher levels of bone turnover are associated with greater hip bone loss in older men, but increased turnover is not independently associated with the risk of hip or nonspine fracture. [source] Introduction: Role of the hospitalist in secondary stroke prevention care,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2008David J. Likosky MD Abstract Stroke is a prevalent and often devastating condition that is likely to affect a growing proportion of the United States population in the coming decades. Individuals who have experienced a stroke or transient ischemic attack are at elevated risk for recurrent events, which are frequently more severe. Therefore, secondary prevention has become the focus of much clinical research and widespread initiatives to deliver evidence-based care. Hospitalists are in a unique position to contribute substantially to these efforts. The 4 articles in this supplement are a call to action for hospital-based physicians. They are based on the conclusions of a panel of hospitalists, neurohospitalists, vascular neurologists, and neurointensivists who met for a roundtable discussion in March 2007. This, the first of the 4 articles, discusses the opportunity for hospitalists to take a leadership role in creating stroke systems of care that integrate secondary stroke prevention with inpatient treatment of acute stroke. The articles that follow will summarize the consensus of roundtable participants on stroke care best practices and their implementation. Journal of Hospital Medicine 2008;3(4 Suppl):S1,S5. © 2008 Society of Hospital Medicine. [source] Factors predicting mortality in midlife adults with and without Down syndrome living with familyJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 12 2007A. J. Esbensen Abstract Background Little is known about the mortality of individuals with Down syndrome who have lived at home with their families throughout their lives. The current study evaluates the predictors, causes and patterns of mortality among co-residing individuals in midlife with Down syndrome as compared with co-residing individuals with ID owing to other causes. Method This paper examines mortality in 169 individuals with and 292 individuals without Down syndrome from 1988 to 2007. Dates and causes of death were obtained from maternal report, the Social Security Death Index and the National Death Index. Risk factors predicting mortality, including demographic variables, transition variables, and initial and change measures of health, functional abilities and behaviour problems, were obtained from maternal report. Results Having Down syndrome is a risk factor of mortality, net of other risk factors including older age, poorer functional abilities, worsening behaviour problems, residential relocation and parental death. The causes of death among individuals with and without Down syndrome who are in midlife and co-residing with their families are similar, and are most commonly due to cardiovascular or respiratory problems. Conclusions The findings indicate that midlife adults with Down syndrome who co-reside with their families generally exhibit similar causes of mortality as do midlife adults with intellectual disability owing to other causes, but show an elevated risk of mortality in midlife net of other variables, such as age and changes in functional abilities and behaviour problems. [source] Poverty, socio-economic position, social capital and the health of children and adolescents with intellectual disabilities in Britain: a replicationJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2007E. Emerson Abstract Background When compared with their nonintellectually disabled peers, people with intellectual disabilities (IDs) have poorer health and are more likely to be exposed to poverty during childhood. Given that exposure to child poverty has been linked to poorer health outcomes, we attempted to estimate the extent to which the health inequalities faced by children and adolescents with IDs may be accounted for by their more disadvantaged socio-economic position. Methods Secondary analysis of data on a nationally representative sample of 12 160 British children aged under 17 years extracted from the Department of Work and Pensions' Families and Children Study. Results After controlling for age and sex, children with IDs were significantly more likely (corrected odds ratio = 2.49) to be reported to have less than good health than their nonintellectually disabled peers. However, 31% of the elevated risk for poorer health was accounted for by between-group differences in socio-economic position and social capital. Conclusions A socially and statistically significant proportion of the increased risk of poorer health among children and adolescents with IDs may be attributed to their increased risk of socio-economic disadvantage. [source] Socio-economic position, household composition, health status and indicators of the well-being of mothers of children with and without intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 12 2006E. Emerson Abstract Background Many previous studies have reported that mothers of children with intellectual disabilities (IDs) are more likely to show signs of psychological distress and have lower well-being than mothers of ,typically developing' children. Our aim was to estimate the extent to which these differences may be accounted for by between-group differences in socio-economic position. Methods This study involved secondary analysis of happiness, self-esteem and self-efficacy variables in a nationally representative sample of 6954 British mothers with dependent children under the age of 17 years, 514 of whom were supporting a child with an ID. Results Mothers of children with IDs reported lower levels of happiness, self-esteem and self-efficacy than mothers of children without IDs. Statistically controlling for differences in socio-economic position, household composition and maternal characteristics fully accounted for the between-group differences in maternal happiness, and accounted for over 50% of the elevated risk for poorer self-esteem and self-efficacy. Conclusions A socially and statistically significant proportion of the increased risk of poorer well-being among mothers of children with IDs may be attributed to their increased risk of socio-economic disadvantage. [source] The Risk of Partner Violence Among Low-Income Hispanic SubgroupsJOURNAL OF MARRIAGE AND FAMILY, Issue 3 2005Sonia M. Frias Women with few social resources are at elevated risk of partner abuse. Certain evidence suggests that African American and Hispanic women, who are overrepresented in the lower socioeconomic strata, are at particularly high risk. We compare women's risk of partner violence, defined as moderate and severe, among 2,400 low-income African American, Hispanic, and non-Hispanic Whites from "Welfare, Children and Families: A Three City Study" and find that these groups differ in their risk of degrees of violence. Specific nation-of-origin Hispanic subgroups also manifest important differences in their violence risk profiles. We argue that a better understanding of victimization requires more detailed ethnic categorization and a more refined understanding of the meaning of domestic violence for different groups. [source] Premarital Sex, Premarital Cohabitation, and the Risk of Subsequent Marital Dissolution Among WomenJOURNAL OF MARRIAGE AND FAMILY, Issue 2 2003Jay Teachman Using nationally representative data from the 1995 National Survey of Family Growth, I estimate the association between intimate premarital relationships (premarital sex and premarital cohabitation) and subsequent marital dissolution. I extend previous research by considering relationship histories pertaining to both premarital sex and premarital cohabitation. I find that premarital sex or premarital cohabitation that is limited to a woman's husband is not associated with an elevated risk of marital disruption. However, women who have more than one intimate premarital relationship have an increased risk of marital dissolution. These results suggest that neither premarital sex nor premarital cohabitation by itself indicate either preexisting characteristics or subsequent relationship environments that weaken marriages. Indeed, the findings are consistent with the notion that premarital sex and cohabitation limited to one's future spouse has become part of the normal courtship process for marriage. [source] Disordered eating and job stress among nursesJOURNAL OF NURSING MANAGEMENT, Issue 7 2009CHES, KEITH A. KING PhD Aim, The purpose of this study was to examine disordered eating behaviours among nurses in the state of Ohio. Background, Individuals involved in disordered eating tend to report more frequent and higher levels of perceived stress than their counterparts. As nurses regularly perform stressful roles and responsibilities within a high-stress environment, this group may be at elevated risk of disordered eating. Method, A 65-item survey was mailed to a random sample of 1000 nurses in the state of Ohio. Results, A total of 435 nurses (47%) returned completed surveys. Most (93%) were registered nurses (RNs) and 87% were over 31 years old. Results indicated that disordered eating differed significantly based on perceived job stress and perceived body satisfaction. Nurses with high levels of perceived job stress and low levels of body satisfaction had higher disordered eating involvement. Conclusions, Nurses reporting high levels of job stress are at increased risk of disordered eating behaviours. Recommendations for future research are offered. Implications for nursing management, Employee wellness programmes should be developed that educate and support nurses to make healthy lifestyle choices. [source] Validation of a Simple Approach to Caries Risk AssessmentJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2005James D. Bader DDS Abstract Objective: This study examined the predictive validity of a simple subjective method promoted to dentists for assessing their patients' caries risk. Methods: Data from two large group practices that have used guideline-assisted caries risk assessment (CRA) for several years were analyzed retrospectively to determine the receipt of caries-related treatment following a CRA. Patient age and receipt of caries preventive treatment subsequent to the CRA were control variables in logistic regressions to determine the likelihood of caries-related treatment for low, moderate, and high risk groups. Results: Among 45,693 individuals in the two plans, those categorized as being at high caries risk were approximately four times as likely to receive any caries-related treatment as those categorized as being at low caries risk. Those categorized as at moderate risk were approximately twice as likely to receive any treatment. In addition, for those at elevated risk who required any treatment, the number of teeth requiring treatment was larger. Conclusion: The results of this study provide the first large-scale, generalizable evidence for the validity of dentists' subjective assessment of caries risk. [source] Current status of biomarkers in head and neck cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 8 2008Steven S. Chang MD Abstract As our understanding of HNSCC increases so has biomarker development. HPV16 integration is a significant marker of favorable prognosis and response to therapy for HNSCC. EGFR-amplification and overexpression is a poor-prognostic indicator. For premalignant lesions, LOH of 3p&9p21 loci confers an elevated risk of malignant transformation. As molecular targets are identified, these will be candidates for biomarkers for detection, diagnosis, prognosis, and therapy. Validation of these biomarkers requires demonstration of independence of significance beyond known biomarkers. J. Surg. Oncol. 2008;97:640,643. © 2008 Wiley-Liss, Inc. [source] Alcohol-Related Problems, Drug Use, and Male Intimate Partner Violence Severity Among US CouplesALCOHOLISM, Issue 4 2002Carol B. Cunradi Background: Particularly for women, level of intimate partner violence (IPV) severity is associated with risk of injury. Previous research suggests that male drinking problems and drug use are key risk factors. Few studies, however, have examined the associations between male and female alcohol problems and drug use and risk of moderate and severe male IPV in general household population samples. Methods: A multiethnic sample of 1615 married and cohabiting couples was obtained from the 1995 National Study of Couples, a cross-sectional study on alcohol and IPV. We assessed the contribution of past year male and female alcohol-related problems (i.e., drinking consequences and alcohol-dependence symptoms) and illicit drug use to the risk of moderate and severe male IPV. A series of generalized multinomial logit models, with adjustment for sociodemographic and psychosocial covariates, was constructed to assess these associations. Results: Female and male alcohol-related problems and female drug use, were associated with increased risk of moderate and severe male IPV. Contrary to our expectation, male drug use was not associated with elevated risk for either type of male IPV. Compared with couples residing in low-unemployment neighborhoods, couples residing in high-unemployment neighborhoods were at greater risk for severe, but not moderate, male IPV. Conclusions: Alcohol-related problems among men and women and drug use among women, appear to be important correlates of male IPV severity among couples in the general population. These findings can aid in IPV screening efforts, the formulation of prevention strategies, and help inform batterer and victim treatment programs. [source] Injury Risk Among Medically Identified Alcohol and Drug AbusersALCOHOLISM, Issue 1 2001Ted R. Miller Background: Although nonfatal injury prevalence is higher among substance abusers than in the general population, few studies have estimated the injury risk for clinically recognized substance abusers. The extant studies, moreover, analyze rates of visits for injury treatment rather than rates of injury events. This study estimates the excess risk of medically treated and hospitalized nonoccupational injury for people under age 65 with medically identified substance abuse problems and private health care coverage. Method: We conducted a retrospective cohort study by using medical claims data from Medstat Systems, Inc., with a longitudinal database of health care claims for 1.5 million people with health care coverage from 70 large corporations. Claims histories for anyone who had an alcohol-related or drug-related primary or secondary diagnosis during 1987 to 1989 were analyzed. A random sample was selected from the remaining people without a substance abuse diagnosis in their medical records. Injury rates were compared among groups. We used logistic regression to estimate odds of medically treated and hospitalized injury, controlling for demographics. Results: Medically identified substance abusers had an elevated risk of injury in a 3-year period; alcohol and drug abusers had the highest risk (58%), followed by drug-only abusers (49%), alcohol-only abusers (46%), and controls (38%). Alcohol and drug abusers were almost four times as likely to be hospitalized for an injury in a 3-year period when compared with controls. Injury risks were elevated substantially more for female then male substance abusers. Conclusions: This study greatly improves on available information about the risk of injury for drug and multiple-substance abusers. Medically identified substance abusers, especially adult women, have a higher probability of injury, more hospitalized injuries, and more injury episodes per person injured than nonabusers. More aggressive identification and subsequent treatment of female substance abusers appear warranted. [source] | |||||||||||||||||||||||||||||||||||||