Attributable Risk Factors Research Articles

Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus

The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations. In a high-risk cohort with frequent protocol-directed follow-up, we evaluated the influence of race on cardiovascular (CV) outcomes and incidence of ESRD. TREAT was a randomized, double-blind, placebo-controlled study. This secondary analysis focused on role of race on outcomes. TREAT enrolled 4,038 patients with type 2 diabetes, chronic kidney disease (estimated glomerular filtration rate 20-60 mL/min per 1.73 m(2)), and anemia (hemoglobin level ≤11 g/dL) treated with either darbepoetin alfa or placebo. We compared self-described black and Hispanic patients to white patients with regard to baseline characteristics and outcomes, including mortality, CV outcomes (myocardial infarction, stroke, heart failure, resuscitated sudden death, and coronary revascularization), and incident ESRD. Multivariate adjusted Cox models were developed for these outcomes. Black and Hispanic patients were younger, more likely women, had less prior CV disease, and higher blood pressure. During a mean follow-up of 2.4 years with comparable access to care, blacks and Hispanics had a greater risk of ESRD but a significant lower risk of myocardial infarction and coronary revascularization than whites. After adjusting for confounders, blacks remained at significantly greater risk of ESRD than whites (hazard ratio 1.53, 95% CI 1.26-1.85, P < .001), whereas this ESRD risk did not persist among Hispanics. Despite similar access to care and lower CV event rates, the risk of ESRD was higher among blacks and Hispanics than whites. For blacks, but not Hispanics, this increase was independent of known attributable risk factors.

Burden of disease attributable to main behavioral risk factor of chronic disease inactivity in China, 1990 and 2010

To examine burden of disease (BOD) attributable to dietary risk factors, tobacco smoking, alcohol use, and physical inactivity in China in 1990 and 2010. The results of the Global Burden of Diseases Study 2010(GBD 2010) for China were extracted to examine BOD attributable to the four behavioral risk factors in terms of current status, time trend, age patterns, and their diseasecomposition. Measurements for attributable BOD were years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). In 1990, for both genders combined, BOD attributable to dietary risk factors, tobacco smoking, and alcohol use were 37.28 (32.88-42.12), 28.32 (22.50-35.73), and 13.02 (10.50-15.74) million DALYs, respectively; for men, attributable BOD were 21.17 (18.26-24.48), 17.87 (13.59-23.74), and 10.23 (8.22-12.38) million DALYs, respectively, more than those in women (16.11 (13.90-19.32), 10.45 (727-15.69), and 2.79 (1.81-392) million DALYs, respectively). In 2010, BOD attributable to dietary risk factors, tobacco smoking, alcohol use, and physical inactivity were 51.70 (46.07-56.65), 30.00 (23.43-35.92), 13.78 (10.89-16.88), and 11.44(9.49-13.68) million DALYs, respectively, all of which combined accounted for 33.7% of overall BOD; in male BOD attributable to these 4 risk factors were 32.91 (28.43-36.54), 22.71 (17.09-28.27), 11.62 (9.19-14.28), and 6.34 (5.09-7.74) million DALYs, respectively, higher than those in women (18.79 (16.31-20.92), 7.29 (4.47-9.73), 2.16 (1.25-3.10), and 5.10 (4.21-6.05) million, respectively). Compared with 1990, attributable BOD among men in 2010 had increased by 55.5% for dietary risk factors, 27.1% for tobacco smoking and 13.6% for alcohol use, whilst only had BOD attributable dietary risk factors increased (by 16.6%) among women, with decreasing trends in smoking (-30.2%) and alcohol use (-22.6%). Diet low in fruits accounted for the largest portion of 35.4% in total BOD attributable to all dietary risk factors, followed by diet high in sodium which accounted for 20.2%. The BOD attributable to the 4 behavioral risk factors was quite high in China, with significant increase in BOD of men.

Treatment: Drug therapy of hypertension

Hypertension is the major attributable risk factor for cardiovascular disease. The effect of Tai Chi on essential hypertension (EH) is contentious.In this study, we investigated the effects of Tai Chi on the risk factors for cardiovascular disease and quality of life in adults with EH.Using data collected from 15 databases up to December 2018, we meta-analyzed randomized controlled trials of the effect of Tai Chi on EH.Tai Chi exercise was associated with lower systolic blood pressure (SBP) (WMD −12.47, 95%CI −16.00 to −8.94, P < 0.001) and diastolic blood pressure (DBP) (WMD −6.46, 95%CI −8.28 to −4.64, P < 0.001); better quality of life (SMD 0.62, 95% CI 0.35 to 0.90, P < 0.001); lower lipid profiles, including total cholesterol (WMD −0.49, 95% CI −0.62 to −0.37, P < 0.001), triglycerides (WMD −0.49, 95% CI −0.92 to −0.07, P = 0.02), and low-density lipoprotein-cholesterol (LDL-C) (WMD −0.86, 95% CI −1.30 to −0.43, P < 0.001); and lower blood glucose (WMD −0.91, 95% CI −1.59 to −0.23, P = 0.009). Tai Chi had no significant effect on high-density lipoprotein–cholesterol (WMD −0.92, 95% CI −2.21 to −0.37, P = 0.16).Tai Chi lowers blood pressure, total cholesterol, triglycerides, LDL-C, and blood glucose and significantly increases the quality of life in adults with EH. There is strong evidence for the short-term efficacy of Tai Chi exercises. Larger well-designed RCTs focused on the long-term effect of Tai Chi exercises and patient adherence are needed.

Dry eye prevalence and attributable risk factors in the eastern Madhya Pradesh

Background: There is increasing prevalence of dry eye in recent years. This disease is chronic and progressive and invariably leads to complications, if left untreated. Objective: To study the prevalence, incidence, and attributable risk factors associated with dry eye syndrome in eastern Madhya Pradesh region. Materials and Methods: This study included 1178 patients of which 114 patients were found to have dry eye. After detailed history, complete work up, and investigations patients were categorized into mild, moderate, and severe grades. Result: In this study, the prevalence of dry eye in hospital-based population in eastern Madhya Pradesh was 9.6%. Dry eye was more common in women (66.6%). Most patients in this study belonged to rural background (60.5%). Air pollution (33.3%) was found to be the most common attributable risk factor affecting most of the farmers/laborers (33.4%). In this study 43.8% patients had moderate and 39.6% patients had mild grade of dry eye. Conclusion: Diagnosis of dry eye is often overlooked as a possible cause of patient's complaint. Therefore, detection of disease at the earliest stage and prevention of attributable risk factors for dry eye alluded to in literature include air pollution, cigarette smoking, low humidity, high temperature, sunlight exposure, drugs, and uncorrected refractive error should be the goal so that disease progression to severe stage and serious sight-threatening complications caused by severe dry eye could be prevented. Thus prevention of attributable risk factors and early diagnosis could be the key for dry eye and offers good hope for better outcome.

Lifetime and 5 years risk of breast cancer and attributable risk factor according to Gail model in Iranian women.

Introduction:Breast cancer is the most commonly diagnosed cancers in women worldwide and in Iran. It is expected to account for 29% of all new cancers in women at 2015. This study aimed to assess the 5 years and lifetime risk of breast cancer according to Gail model, and to evaluate the effect of other additional risk factors on the Gail risk.Materials and Methods:A cross sectional study conducted on 296 women aged more than 34-year-old in Qom, Center of Iran. Breast Cancer Risk Assessment Tool calculated the Gail risk for each subject. Data were analyzed by paired t-test, independent t-test, and analysis of variance in bivariate approach to evaluate the effect of each factor on Gail risk. Multiple linear regression models with stepwise method were used to predict the effect of each variable on the Gail risk.Results:The mean age of the participants was 47.8 ± 8.8-year-old and 47% have Fars ethnicity. The 5 years and lifetime risk was 0.37 ± 0.18 and 4.48 ± 0.925%, respectively. It was lower than the average risk in same race and age women (P < 0.001). Being single, positive family history of breast cancer, positive history of biopsy, and radiotherapy as well as using nonhormonal contraceptives were related to higher lifetime risk (P < 0.05). Moreover, a significant direct correlation observed between lifetime risk and body mass index, age of first live birth, and menarche age. While an inversely correlation observed between lifetimes risk of breast cancer and total month of breast feeding duration and age.Conclusion:Based on our results, the 5 years and lifetime risk of breast cancer according to Gail model was lower than the same race and age. Moreover, by comparison with national epidemiologic indicators about morbidity and mortality of breast cancer, it seems that the Gail model overestimate the risk of breast cancer in Iranian women.

Hypertension in the Old and Very Old: Current Concepts

Old age is defined variably in medical parlor. Blood pressure (BP) increases with age as a continuous variable. Hypertension is the single most attributable risk factor for death worldwide and accounts for considerable morbidity. Control of BP reverses this process. However, when to treat the elderly and how, is sometimes a confusing area. Due to high rates of comor bidities and drug adverse effects, often the elderly are undertreated. But, it should be made clear that the benefit of treatment of BP in the elderly is very high and if treatment is provided with reasonable standard of care, the benefit far outweighs the risk.

Global infant mortality trends and attributable determinants – an ecological study using data from 192 countries for the period 1990–2011

Infant mortality rate (IMR) is regarded as an important indicator of population health. IMR rates vary substantially with the highest found in sub-Saharan Africa (SSA) compared to the lowest in Europe. Identifying spatial disparities in IMR and quantifying attributable risk factors is essential for policymakers when tailoring time-appropriate interventions at a global, regional, and country level. Data for 192 countries were extracted from the World Bank Development Indicator database for the period 1990–2011. Spatial clustering was used to identify significant higher-risk IMR countries. A robust ecological generalized linear negative binomial regression model was used to quantify risk factors and associated decomposition values (Shapley). Significant reductions were observed in IMR for all of the World Health Organization regions for the period 1990–2011 except for SSA, which indicated a reversal of this trend in the 1990s due to HIV. Significant high-risk clustering of IMR is also indicated in SSA countries and parts of Asia. Maternal mortality (survival), lack of water and sanitation and female education were confirmed as prominent and high attributable risk factors for IMR. Distinct temporal changes in the attributability of these factors were observed, as well as significant heterogeneity with regards to the most attributable factor by region and country. Our study suggests that maternal mortality is the most prominent attributable risk factor for infant mortality, followed by lack of access to sanitation, lack of access to water, and lower female education. Variation exists across regions and countries with regards to the most attributable factor. Our study also suggests significant underestimation of IMR in regions known for poorer data quality. The results will aid policymakers in re-tailoring time-appropriate interventions to more effectively reduce IMR in line with Millennium Development Goal 4.

Aggravation of inflammation by smokeless tobacco in comparison of smoked tobacco.

Aggravation of inflammation by smokeless tobacco in comparison of smoked tobacco.

Prevalence of hypertension in member countries of South Asian Association for Regional Cooperation (SAARC): systematic review and meta-analysis.

Hypertension is a leading attributable risk factor for mortality in South Asia. However, a systematic review on prevalence and risk factors for hypertension in the region of the South Asian Association for Regional Cooperation (SAARC) has not carried out before.The study was conducted according to the Meta-Analysis of Observational Studies in Epidemiology Guideline. A literature search was performed with a combination of medical subject headings terms, “hypertension” and “Epidemiology/EP”. The search was supplemented by cross-references. Thirty-three publications that met the inclusion criteria were included in the synthesis and meta-analyses. Hypertension is defined when an individual had a systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, was taking antihypertensive drugs, or had previously been diagnosed as hypertensive by health care professionals. Prehypertension is defined as SBP 120–139 mm Hg and DBP 80–89 mm Hg.The overall prevalence of hypertension and prehypertension from the studies was found to be 27% and 29.6%, respectively. Hypertension varied between the studies, which ranged from 13.6% to 47.9% and was found to be higher in the studies conducted in urban areas than in rural areas. The prevalence of hypertension from the latest studies was: Bangladesh: 17.9%; Bhutan: 23.9%; India: 31.4%; Maldives: 31.5%; Nepal: 33.8%; Pakistan: 25%; and Sri Lanka: 20.9%. Eight out of 19 studies with information about prevalence of hypertension in both sexes showed that the prevalence was higher among women than men. Meta-analyses showed that sex (men: odds ratio [OR] 1.19; 95% confidence interval [CI]: 1.02, 1.37), obesity (OR 2.33; 95% CI: 1.87, 2.78), and central obesity (OR 2.16; 95% CI: 1.37, 2.95) were associated with hypertension.Our study found a variable prevalence of hypertension across SAARC countries, with a number of countries with blood pressure above the global average. We also noted that studies are not consistent in their data collection about hypertension and related modifiable risk factors.

Estimation of effective dose and lifetime attributable risk from multiple head CT scans in ventriculoperitoneal shunted children

PurposeThe purpose of this review is to determine the averaged effective dose and lifetime attributable risk factor from multiple head computed tomography (CT) dose data on children with ventriculoperitoneal shunts (VPS). Method and materialsA total of 422 paediatric head CT exams were found between October 2008 and January 2011 and retrospectively reviewed. The CT dose data was weighted with the latest IRCP 103 conversion factor to obtain the effective dose per study and the averaged effective dose was calculated. Estimates of the lifetime attributable risk were also calculated from the averaged effective dose using a conversion factor from the latest BEIR VII report. ResultsOur study found the highest effective doses in neonates and the lowest effective doses were observed in the 10–18 years age group. We estimated a 0.007% potential increase risk in neonates and 0.001% potential increased risk in teenagers over the base risk. ConclusionMultiple head CTs in children equates to a slight potential increase risk in lifetime attributable risk over the baseline risk for cancer, slightly higher in neonates relative to teenagers. The potential risks versus clinical benefit must be assessed.

Overenthusiastic stroke risk factor modification in the over-80s: Are we being disingenuous to ourselves, and to our oldest patients?

Statins and antihypertensive therapy are widely used in our oldest patients (ie, those aged over 80 years). The epidemiology suggests that, by this age, hypertension is not an attributable risk...

A Retro-prospective Study of Various Clinical Presentations of Isolated Left Sided Hepatolithiasis

Objective: To study various clinical presentations and other related problems in left sided hepatolithiasis in a tertiary care centre at SKIMS, Srinagar. Material and Methods: The present Retro-prospective study was conducted in the Department of Surgical Gastroenterology and Medical Gastroenterology of Sher- I – Kashmir Institute of Medical Sciences, Srinagar from May 2003 to December 2011. A total number of 80 cases were included in this study. Patient’s data was analysed for their age and sex distribution, presenting symptoms, duration of disease and biochemical profile. Results: A total of 80 cases were studied in this series. Out of which, 51 cases were females and 29 cases were males. Male to female ratio was 1: 1.76. Their age at presentation was in range of 19-60 years with mean age at presentation being 38.08 years in males and 37.75 years in females. Abdominal pain was the principal presenting complaint experienced by 70% of patients. Other presentations were cholangitis (13.75%), liver abscess (5%), jaundice (3.75%), incidental (3.75%), cholecystitis (2.5%) and acute pancreatitis (2.5%). Assosciated clinical conditions seen were cloledocholithiasis (17.5), cholelithiasis(22.5%), splenomegaly (3.75%). Duration of illness was 1 year in 53.75%. Cases in present study had significantly raised serum bilirubin, serum alkaline phosphatase and alanine aminotransferase preoperatively. Hemoglobin, serum proteins, serum albumin and prothrombin levels were not significantly deranged. Conclusion: Hepatolithiasis is endemic in Kashmir. Ascariasis is a common attributable risk factor in the present study. In endemic areas of ascariasis measures like improvement in personel hygiene, sanitation and regular deworming may lower the incidence of biliary ascariasis which inturn will reduce the occurrence of hepatolithiasis.

Population attributable risk factors in women: Should we be investing more in the promotion of physical activity?

Background: The Global Burden of Disease (GBoD) report suggests that high BMI, smoking, hypertension and physical inactivity are the major risk factors (in that order) for chronic disease in Australasia [1]. This is based on population attributable risks (PAR), which explain how much the burden from a specific disease would be reduced, if the effects of a single causal risk factor were eliminated. Estimates of PAR depend on the strength of the association between risk factors and disease, and the prevalence of the risk factor in the population.

Gender inequality in the clinical outcomes of equally treated acute coronary syndrome patients in Saudi Arabia

BACKGROUND AND OBJECTIVESGender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored.DESIGN AND SETTINGSA prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis.PATIENTS AND METHODSPatients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed.RESULTSOf 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI [43%]) than unstable angina (UA [29%]) or ST-segment elevation myocardial infarction (STEMI [29%]). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given β-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7–5.5; P=.14).CONCLUSIONThese data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding ACS and improving its management.

Pakistan: health is an opportunity to be seized

Pakistan: health is an opportunity to be seized

Learning from disasters to save lives every day in Pakistan

Pakistan faces a challenging array of complex humanitarian crises. Political instability, conflict, entrenched poverty, and natural disasters are all too common and devastating. Threats to public health, particularly after large-scale disasters such as the earthquake in 2005 and flooding in 2010, have been well publicised. 1 Bhutta ZA Bhutta SZ The unfolding human tragedy in Pakistan: fighting alone. Lancet. 2010; 376: 664-665 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 2 Warraich H Zaidi AKM Patel K Floods in Pakistan: a public health crisis. Bull World Health Organ. 2011; 89: 236-237 Crossref PubMed Scopus (42) Google Scholar However, there is a striking lack of evidence for a direct negative effect of disasters on major health indicators in Pakistan. Post-disaster disease epidemics have been successfully averted and health service indicators have even improved. 3 Ahmad N Annual report 2010. National Disaster Management Authority, Islamabad2010 Google Scholar , 4 Carraro L Estimating the impact of large natural disasters on the Millennium Development Goals—the case of Pakistan. Oxford Policy Management, Oxford2005http://www.opml.co.uk/sites/opml/files/Natural_disasters_and_MDGs_-_Pakistan_case.pdf Google Scholar Although it might seem intuitive that ongoing instability and frequent natural disasters negatively affect health outcomes, this is not necessarily the case. Nepal, for example, with far fewer resources per person than Pakistan, has achieved improved health indicators in the face of humanitarian disasters and unstable governance. 5 Pradhan YV Upreti SR Naresh KC et al. Newborn survival in Nepal: a decade of change and future implications. Health Policy Plan. 2012; 27: iii57-iii71 Crossref PubMed Scopus (62) Google Scholar Medical education and research in PakistanThe construction of health facilities, establishment of medical schools, and recruitment of health workers in the public sector have been important aspects of a popular political agenda in Pakistan, especially for elected governments. According to official reports, the number of medical graduates has increased from 500 in 1947 to 171 450 in 2012 and the number of medical colleges has increased from two to 88, respectively. The total budget of the Pakistan Medical Research Council (PMRC) has increased 2·5 times between the fiscal years 2007–08 and 2011–12; and the number of health research publications has increased 7·5 times between 2001 and 2011 (figure). Full-Text PDF Open AccessPhilanthropic funding for health in PakistanAlthough increasing use of technology continues to escalate health-care costs, Pakistan's experience shows how in a low-income country that allocates little public funding for the health sector,1 more privileged individuals are assisting those who are less privileged. Sadly, similar to public funding, private donations mainly support curative efforts with little spent on preventive care. Health professionals, particularly physicians, have an important role in persuading philanthropists to redress this imbalance. Full-Text PDF Non-communicable diseases and injuries in Pakistan: strategic prioritiesNon-communicable diseases, including cardiovascular diseases, cancers, respiratory diseases, diabetes, and mental disorders, and injuries have become the major causes of morbidity and mortality in Pakistan. Tobacco use and hypertension are the leading attributable risk factors for deaths due to cardiovascular diseases, cancers, and respiratory diseases. Pakistan has the sixth highest number of people in the world with diabetes; every fourth adult is overweight or obese; cigarettes are cheap; antismoking and road safety laws are poorly enforced; and a mixed public–private health-care system provides suboptimum care. Full-Text PDF Health reform in Pakistan: a call to actionPakistan's enormous macroeconomic, internal, and human security challenges coexist alongside the opportunity created by a huge desire for change. With democracy taking root and a new constitutionally ushered era in state governance, The Lancet Series about Pakistan and health focuses on health as a nation-building and social-welfare agenda at a time of unprecedented social upheaval and economic hardships in the country. We call for a unified vision for the goal of universal and equitable health access. Full-Text PDF

Sputum analysis: Non‐invasive early lung cancer detection

Lung cancer is the leading cause of cancer-related deaths over the world, characterized by a very high mortality rate. Molecular technique development tries to focus on early detection of cancers by studying molecular alterations that characterize cancer cells. Worldwide lung cancer research has focused on an ever-increasing number of molecular elements of carcinogenesis at genetic, epigenetic and protein levels. The non-invasiveness is the characteristic that all clinical trials on cancer detection should have. Abnormal chest imaging and/or non-specific symptoms are initial signals of lung cancer that appear in an advanced stage of disease. This fact represents the cause of the low 5-year survival rate: over 90% of patients dying within 5 years of diagnosis. Since smokers have higher quantity of sputum containing exfoliated cells from the bronchial tree, and the sputum represents the most easily accessible biological fluid and its collection is non-invasive, analysis of this sample represents a good area of research in early lung cancer diagnosis. Continued cigarette smoking is the cause of chronic obstructive pulmonary disease (COPD), with an estimated attributable risk factor exceeding 80% in smoking affected individuals. Lung cancer is found in 40-70% of patients with COPD, particularly in severe disease, and it is a common cause of death in these patients. A large prospective trial of almost half a million non-smokers showed as lung cancer is also common in patients with COPD who have never smoked. This review describes issues related to early lung cancer screening using non-invasive methods.

A rare case of chronic idiopathic spinal epidural haematoma

Spinal epidural haematoma (SEH) though rare is the most frequent cause of spinal haemorrhage. It is an important cause of compressive myelopathy, frequently presents as an emergency and requires prompt diagnosis and management. SEH can be classified as secondary (e.g., secondary to coagulopathies or anticoagulant therapy), spontaneous (absence of any definite cause but associated with risk factors like minor trauma) and idiopathic (no attributable risk factors identified) or acute and chronic.1 The spontaneous and idiopathic groups comprise about 50% of cases.2 The chronic form is the rarest and its most frequent location is the lumbar spine. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosis. Irrespective of the aetiology, the mainstay of treatment is urgent surgical decompression and evacuation of the haematoma. There are only a few reports of successful conservative treatment in this condition where symptoms and signs have resolved without surgery.3,4 Here we present an unusual case of chronic idiopathic spinal epidural haematoma where the patient was only symptomatic with chronic low backache. This article aims to discuss the pathogenesis, clinical and radiological features, and differential diagnosis in this condition.

CT Scans: Balancing Health Risks and Medical Benefits

Computed tomography (CT) has been a boon for medical care. By generating detailed anatomical pictures, the technology can improve diagnoses, limit unneeded medical procedures, and enhance treatment. However, CT scans also dose patients with ionizing radiation, a known human carcinogen, posing a potential downside for public health. Mounting health worries over radiation risks are now driving efforts to limit avoidable CT scans and to reduce radiation doses where possible. “There’s a national focus on this issue right now,” says Marilyn Goske, a professor of radiology at Cincinnati Children’s Hospital Medical Center and chairwoman of the Image Gently campaign, a pediatric education and awareness campaign from the Alliance for Radiation Safety in Pediatric Imaging. In December 2011 the Institute of Medicine (IOM) published a report concluding that ionizing radiation contributes more to the development of breast cancer than any other type of routine environmental exposure.1 About half the U.S. annual exposure to ionizing radiation comes from natural sources, including cosmic rays, but most of the rest comes from medical imaging and from CT scans in particular.1 The IOM cited research by Amy Berrington de Gonzalez, a senior investigator in the Radiation Epidemiology Branch of the National Cancer Institute (NCI), whose calculations suggest that the CT scans performed in the United States in 2007 might produce up to 29,000 cancers in the future, about 6% of them in the breast and the remainder in the lungs, brain, and other organs.2 But the spotlight on CT safety has also drawn a backlash from those who say the risks are overblown. On 13 December 2011 the American Association of Physicists in Medicine (AAPM) issued a statement claiming that risks from CT imaging are “too low to be detectible and may be non-existent.”3 The AAPM added that “speculative predictions about cancer incidence and death” should be discouraged because they generate sensationalist media coverage that deters some patients who need CT scans from having them. Donald Miller, acting chief of the Diagnostic Devices Branch of the U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health, cites 2 basic principles for decreasing CT radiation risks. One is justification, which refers to prescribing a CT exam only when it is medically necessary. The other is optimization, which refers to adjusting and operating a CT scanner so that images adequate for diagnosis are obtained at the lowest possible dose. Justification is more difficult to address, Miller says, because it involves case-by-case decisions made by individual clinicians. More attention has been paid to optimization, he says, but both principles are equally important.

Abstract PR1: Hepatocellular carcinoma research and prevention in South Texas: The imperative

Abstract Introduction: Hepatocellular carcinoma (HCC) incidence is increasing in the U.S. for unknown reasons despite a decline in cancer overall during 1975–2006. Latinos have higher rates of HCC than other groups, and attributable risks for HCC among Latinos have been identified. This study compared HCC incidence and behavioral risk factors associated with it from 1995 through 2006 between U.S. Latinos, Texas Latinos and a South Texas Latino subset. We hypothesized that HCC incidence is higher among South Texas Latinos in conjunction with higher attributable behavioral risk factors during the same period. Methods: Data from the U.S. SEER (Surveillance, Epidemiology, and End Results) Program, Texas Cancer Registry, and the Texas Department of State Health Services (TDSHS) were obtained. Annual age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs) and 95% confidence intervals (CI) were calculated as well as prevalences of obesity, diabetes, heavy alcohol use and smoking. Analyses were performed using SEER*Stat and SPSS Complex Samples software. Groups were compared using Chi-Squared and T-Tests with differences assessed at p &amp;lt; .05 if confidence intervals did not overlap. Results: Latinos accounted for more than a third of HCC in Texas and nearly three-fourths of all HCC in South Texas, significantly greater proportions than SEER. More than 70% of HCC in Latinos occurred in men, with similar percentages observed among SEER, Texas and South Texas groups. HCC in Latinos was highest in South Texas (10.6/100,000) and Texas (9.7/100,000) compared to SEER (7.5/100,000). South Texas Latinos were older than their SEER counterparts (Median = 67 vs. 62). More South Texas and Texas Latinos than SEER resided in rural areas (14.8%, 14.3% vs. 5.2%). Prevalence percentages of HCC-related behavioral risk factors for Latinos in the U.S., Texas and South Texas for two time periods, 1995–1997 and 2004–2006 show that obesity increased among all three groups of Latinos overall from the first to the second time period. Additionally, Texas and South Texas Latinos had higher obesity prevalence than U.S. Latinos during the most recent period (30.2% and 35.0% versus 26.7%). Moreover diabetes prevalence increased among U.S. Latinos. Texas and South Texas Latinos also showed an increasing pattern, although confidence intervals overlapped. For 2004–2006, the prevalence of diabetes was higher in South Texas Latinas than U.S. Latinas (10.3% and 7.8%, respectively). Heavy alcohol and cigarette use did not change significantly over time among any Latino group. Conclusion: Our findings support observations that HCC is alarmingly on the rise in the United States. We have described an important constellation of risks for HCC in this group that may result in higher rates of the disease among Latinos. Most if not all of these risks are modifiable, preventable or treatable. Clearly there is a need to focus on HCC etiological research and intervention that takes into account not only the most significant attributable risks for the disease, but also genetic, cultural and socioeconomic predisposing features. The potential contribution of these to HCC indicates a need for etiologic research to firmly establish associations and inform HCC-related prevention interventions. Acknowledgements: This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174) and the National Cancer Institute, Redes En Acción (U01-CA86117). Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PR1.