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Same Risk (same + risk)
Terms modified by Same Risk Selected AbstractsNeurological complications of psychiatric drugs: clinical features and management,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue S1 2008Peter M. Haddad Abstract This paper reviews the main neurological complications of psychiatric drugs, in particular antipsychotics and antidepressants. Extrapyramidal syndromes include acute dystonia, parkinsonism, akathisia, tardive dyskinesia and tardive dystonia. Extrapyramidal symptoms (EPS) are less frequent with atypical than with conventional antipsychotics but remain common in clinical practice partly due to lack of screening by health professionals. Neuroleptic malignant syndrome (NMS) consists of severe muscle rigidity, pyrexia, change in conscious level and autonomic disturbance but partial forms also occur. NMS is particularly associated with the initiation and rapid increase in dose of high-potency antipsychotics but it has been reported with all the atypical antipsychotics and rarely with other drugs including antidepressants. Serotonin toxicity comprises altered mental state (agitation, excitement, confusion), neuromuscular hyperactivity (tremor, clonus, myoclonus, hyper-reflexia) and autonomic hyperactivity and occurs on a spectrum. Severe cases, termed serotonin syndrome, usually follow the co-prescription of drugs that increase serotonergic transmission by different pathways, for example a monoamine oxidase inhibitor (MAOI) and a selective serotonin reuptake inhibitor (SSRI). Most antipsychotics and antidepressants lower the seizure threshold and can cause seizures; the risk is greater with clozapine than with other atypical antipsychotics and greater with tricyclic antidepressants (TCAs) than with SSRIs. In randomised controlled trials in elderly patients with dementia atypical antipsychotics are associated with a higher risk of stroke and death than placebo. Cohort studies suggest that conventional drugs carry at least the same risk. Cessation of treatment with antipsychotics and antidepressants can lead to a wide range of discontinuation symptoms which include movement disorders and other neurological symptoms. Clinicians need to be familiar with strategies to reduce the risk of these adverse events and to manage them when they arise. Their occurrence needs to be balanced against the benefits of psychiatric drugs in terms of efficacy and improved quality of life in a range of disorders. Copyright © 2007 John Wiley & Sons, Ltd. [source] Smoking and venous thromboembolism: a Danish follow-up studyJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2009M. T. SEVERINSEN Summary.,Background: Large-scale prospective studies are needed to assess whether smoking is associated with venous thromboembolism (VTE) (i.e. deep venous thrombosis and pulmonary embolism) independently of established risk factors. Objective: To investigate the association between smoking and the risk of VTE among middle-aged men and women. Methods: From 1993 to 1997, 27 178 men and 29 875 women, aged 50,64 years and born in Denmark, were recruited into the Danish prospective study ,Diet, Cancer and Health'. During follow-up, VTE cases were identified in the Danish National Patient Registry. Medical records were reviewed and only verified VTE cases were included in the study. Baseline data on smoking and potential confounders were included in gender stratified Cox proportional hazard models to asses the association between smoking and the risk of VTE. The analyses were adjusted for alcohol intake, body mass index, physical activity, and in women also for use of hormone replacement therapy. Results: During follow-up, 641 incident cases of VTE were verified. We found a positive association between current smoking and VTE, with a hazard ratio of 1.52 (95% CI, 1.15,2.00) for smoking women and 1.32 (95% CI, 1.00,1.74) for smoking men, and a positive dose-response relationship. Former smokers had the same hazard as never smokers. Conclusions: Smoking was an independent risk factor for VTE among middle-aged men and women. Former smokers have the same risk of VTE as never smokers, indicating acute effects of smoking, and underscoring the potential benefits of smoking cessation. [source] Mortality in epilepsy in the first 11 to 14 years after diagnosis: Multivariate analysis of a long-term, prospective, population-based cohortANNALS OF NEUROLOGY, Issue 3 2001Samden D. Lhatoo MRCP The United Kingdom National General Practice Study of Epilepsy is a prospective, population-based study of newly diagnosed epilepsy. A cohort of 792 patients has now been followed for up to 14 years (median follow-up [25th, 75th percentiles] 11.8 years, range 10.6,11.7 years), a total of 11,400 person-years. These data are sufficient for a detailed analysis of mortality in this early phase of epilepsy. Over 70% of patients in this cohort have developed lasting remission from seizures, although the mortality rate in the long term was still twice that of the general population. The standardized mortality ratio (SMR), the number of observed deaths per number of expected deaths, was 2.1 (95% confidence interval [CI] = 1.8, 2.4). Patients with acute symptomatic epilepsy (SMR 3.0; 95% CI = 2.0, 4.3), remote symptomatic epilepsy (SMR 3.7; 95% CI = 2.9, 4.6), and epilepsy due to congenital neurological deficits (SMR 25; 95% CI = 5.1, 73.1) had significantly increased long-term mortality rates, whereas patients with idiopathic epilepsy did not (SMR 1.3; 95% CI = 0.9, 1.9). This increase in mortality rate was noted particularly in the first few years after diagnosis. Multivariate Cox regression and time-dependent co-variate analyses were utilized for the first time in a prospective study of mortality in epilepsy. The former showed that patients with generalized tonic-clonic seizures had an increased risk of mortality. The hazard ratio (HR), or risk of mortality in a particular group with a particular risk factor compared to another group without that particular risk factor, was 6.2 (95% CI = 1.4, 27.7; p = 0.049). Cerebrovascular disease (HR 2.4; 95% CI = 1.7, 3.4; p < 0.0001), central nervous system tumor (HR 12.0; 95% CI = 7.9, 18.2; p < 0.0001), alcohol (HR 2.9; 95% CI = 1.5, 5.7; p = 0.004), and congenital neurological deficits (HR 10.9; 95% CI = 3.2, 36.1; p = 0.003) as causes for epilepsy and older age at index seizure (HR 1.9; 95% CI = 1.7,2.0; p < 0.0001) were also associated with significantly increased mortality rates. These hazard ratios suggest that epilepsy due to congenital neurological deficits may carry almost the same risk of mortality as epilepsy due to central nervous system tumors and that epileptic seizures subsequent to alcohol abuse may carry almost the same risk of mortality as epilepsy due to cerebrovascular disease. The occurrence of one or more seizures before the index seizure (the seizure that led to the diagnosis of epilepsy and enrolment in the study) was associated with a significantly reduced mortality rate (HR 0.57; 95% CI = 0.42, 0.76; p = 0.00001). Time-dependent co-variate analysis was used to examine the influence of ongoing factors, such as seizure recurrence, remission, and antiepileptic drug use, on mortality rates in the cohort. Seizure recurrence (HR 1.30; 95% CI = 0.84, 2.01) and antiepileptic drug treatment (HR 0.97; 95% CI = 0.67, 1.38) did not influence mortality rate. There were only 5 epilepsy-related deaths (1 each of sudden unexpected death in epilepsy, status epilepticus, burns, drowning, and cervical fracture), suggesting that death directly due to epileptic seizures is uncommon in a population-based cohort with epilepsy. Ann Neurol 2001;49:336,344 [source] Differences between Ventricular Repolarization in Men and Women: Description, Mechanism and ImplicationsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2003Borys Surawicz M.D., M.A.C.C. The purpose of this review article is to discuss the differences between ventricular repolarization in males and females in terms of morphology, possible mechanism, and practical significance. The interest in the subject increased when it became known that in comparison to men, women have a higher incidence of torsade de pointes (tdp) and a greater lengthening of QT-interval after administration of class III antiarrhythmic drugs. Before puberty, the QT intervals and the patterns of ventricular repolarization in boys and girls are similar. At puberty, in boys the QT interval shortens, and a typical male pattern of ventricular repolarization develops. This pattern is characterized by a higher amplitude of the J-point, a shorter and steeper ST segment course, a steeper ascent, and a higher amplitude of the T wave. This pattern is prevalent in >90% of young males. With increasing age the prevalence of the male pattern in males declines gradually and drops to 14% in the oldest age group. The rise and fall of the prevalence of the male pattern appears to parallel the rise and decline of testosterone in males. The female pattern of ventricular repolarization is prevalent in about 80% of females in all age groups. The hormonal effects on ventricular repolarization have been studied in normal and castrated rabbits of both sexes. The available evidence indicates that the females have greater divergence of L calcium current among different layers of the myocardium and a lower density of the repolarizing Kr and Ks currents. The clinical significance of the repolarization differences among genders remains to be determined. Of particular interest is the question whether the males with female pattern are at the same risk of tdp as the females or whether the females with male pattern are at lower risk of tdp than the females with female pattern. [source] Deterministic and Probabilistic Estimation of Appropriate Distances: Motivation for Considering the Consequences for Industrial SitesCHEMICAL ENGINEERING & TECHNOLOGY (CET), Issue 2 2009M. Gawlowski Abstract Accidents and disruptions in chemical process installations can, in principle, lead to the rare events in which the release of flammable and/or toxic substances occurs, and which at particular distances from the installation can result in a hazard potential due to thermal radiation, blast wave effects or the concentration of toxic substances. The possibilities and limits of deterministic and probabilistic estimation methods for appropriate distances from hazardous installations, based on the example of an ammonia release and a large surface fire, are shown. In this, it is demonstrated that the deterministic and probabilistic approaches are in no way conflicting or unnecessary, but rather that they are complementary. The use of a deterministic estimation method leads to a maximum set radius of effects which only take account of the damage impact. Depending on the selection of the appropriate and suitable consequence models, critical distances are calculated which are in some cases much larger than the current standardised distances, as is shown by the example of large-scale fires. The use of a probabilistic estimation method leads to a range of distances for which the individual risk can be given in addition. In principle, iso-contours joining points of same risk or areas of same risk may be defined through the use of such estimations. [source] Tree species range shifts at a continental scale: new predictive insights from a process-based modelJOURNAL OF ECOLOGY, Issue 4 2008Xavier Morin Summary 1Climate change has already caused distribution shifts in many species, and climate predictions strongly suggest that these will accelerate in the future. Obtaining reliable predictions of species range shifts under climate change is thus currently one of the most crucial challenges for both ecologists and stakeholders. 2Here we simulate the distributions of 16 North American tree species at a continental scale for the 21st century according to two IPCC storylines, using a process-based species distribution model that for the first time allows identification of the possible causes of distribution change. 3Our projections show local extinctions in the south of species ranges (21% of the present distribution, on average), and colonizations of new habitats in the north, though these are limited by dispersal ability for most species. Areas undergoing local extinctions are slightly larger under climate scenario A2 (+3.2 C, +22% on average) than B2 (+1.0 C, +19% on average). This small difference is caused by nonlinear responses of processes (leaves and flowers phenological processes in particular) to temperature. We also show that local extinction may proceed at a slower rate than forecasted so far. 4Although predicted distribution shifts are very species-specific, we show that the loss of habitats southward will be mostly due to increased drought mortality and decreased reproductive success, while northward colonizations will be primarily promoted by increased probability of fruit ripening and flower frost survival. 5Synthesis. Our results show that different species will not face the same risks due to climate change, because their responses to climate differ as well as their dispersal rate. Focusing on processes, our study therefore tempers the alarming conclusions of widely used niche-based models about biodiversity loss, mainly because our predictions take into account the local adaptation and trait plasticity to climate of the species. [source] Sex differentials in frailty in medieval EnglandAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 2 2010Sharon N. DeWitte Abstract In most modern populations, there are sex differentials in morbidity and mortality that favor women. This study addresses whether such female advantages existed to any appreciable degree in medieval Europe. The analyses presented here examine whether men and women with osteological stress markers faced the same risks of death in medieval London. The sample used for this study comes from the East Smithfield Black Death cemetery in London. The benefit of using this cemetery is that most, if not all, individuals interred in East Smithfield died from the same cause within a very short period of time. This allows for the analysis of the differences between men and women in the risks of mortality associated with osteological stress markers without the potential confounding effects of different causes of death. A sample of 299 adults (173 males, 126 females) from the East Smithfield cemetery was analyzed. The results indicate that the excess mortality associated with several osteological stress markers was higher for men than for women. This suggests that in this medieval population, previous physiological stress increased the risk of death for men during the Black Death to a greater extent than was true for women. Alternatively, the results might indicate that the Black Death discriminated less strongly between women with and without pre-existing health conditions than was true for men. These results are examined in light of previous analyses of East Smithfield and what is known about diet and sexually mediated access to resources in medieval England. Am J Phys Anthropol 143:285,297, 2010. © 2010 Wiley-Liss, Inc. [source] | |||||||||||||