Different Sets Of Risk Factors Research Articles

Transient versus stable nature of fear of falling over 24 months in community-older persons with falls– data of the EU SCOPE project on Kidney function

BackgroundFear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF.MethodsOur series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported “not at all” at baseline and “somewhat/fairly/very concerned” at follow-up, or “not at all” at follow-up, and “somewhat/fairly/very concerned” at baseline, and P-FoF was defined as participants answered “somewhat/fairly/very concerned” in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis.ResultsThe mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03–4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12–5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31–5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23–10.1) and living alone (OR = 2.44, 95%CI = 1.17–5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16–3.27), BMI (OR = 1.08, 95%CI = 1.02–1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02–1.13) and depression (OR = 2.55, 95%CI = 1.33–4.88) were significant predictors of P-FoF.ConclusionsT-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls.Trial registrationThe SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).

Evaluation of Random Forest in Crime Prediction: Comparing Three-Layered Random Forest and Logistic Regression

ABSTRACT This study evaluated random forest’s accuracy in predicting violent or criminal behavior of juveniles compared to that of conventional logistic regression using different sets of risk factors. Drawing on the National Longitudinal Study of Adolescent Health (Add Health), we predicted three outcomes – arrests, convictions, and incarcerations – using three sets of predictors, starting with sociodemographic variables only (Model 1) and incrementally adding behavioral/situational (Model 2) and emotional/environmental risk factors (Model 3). Although both prediction methods yielded similar levels of “overall” predictive accuracy (measured by the area under the receiver operating characteristic curve), our balanced random forest model, with a cost ratio of 10 (false negatives) to 1 (false positives), substantially improved prediction of who will be arrested, convicted, and incarcerated, which is of paramount importance for many researchers and practitioners. In addition to its capability to enhance sensitivity (prediction of “true positives”), random forest is more effective in forecasting juvenile criminal behavior than is conventional logistic regression in that the former is less susceptible to the influences of added predictors than is the latter.

Patterns of Genital Tract Mustelid Gammaherpesvirus 1 (Musghv-1) Reactivation Are Linked to Stressors in European Badgers (Meles Meles).

Gammaherpesvirus reactivation can promote diseases or impair reproduction. Understanding reactivation patterns and associated risks of different stressors is therefore important. Nevertheless, outside the laboratory or captive environment, studies on the effects of stress on gammaherpesvirus reactivation in wild mammals are lacking. Here we used Mustelid gammaherpesvirus 1 (MusGHV-1) infection in European badgers (Meles meles) as a host–pathogen wildlife model to study the effects of a variety of demographic, physiological and environmental stressors on virus shedding in the genital tract. We collected 251 genital swabs from 150 free-ranging individuals across three seasons and screened them for the presence of MusGHV-1 DNA using PCR targeting the DNA polymerase gene. We explored possible links between MusGHV-1 DNA presence and seven variables reflecting stressors, using logistic regression analysis. The results reveal different sets of risk factors between juveniles and adults, likely reflecting primary infection and reactivation. In adults, virus shedding was more likely in badgers in poorer body condition and younger than 5 years or older than 7; while in juveniles, virus shedding is more likely in females and individuals in better body condition. However, living in social groups with more cubs was a risk factor for all badgers. We discuss possible explanations for these risk factors and their links to stress in badgers.

Safety of motorised two wheelers in mixed traffic conditions: Literature review of risk factors

The ownership of motorised two wheelers (MTWs) has been on the rise across various countries across the globe. The growth has been especially higher in developing countries which have typical traffic characteristics and higher populations. This steady rise has resulted in increased accident and fatalities. This abrupt increase warranted attention from the researchers to carry out specific studies for MTWs, which have a very different behaviour as compared to cars in terms of physical and dynamic parameters. Moreover, the unique traffic patterns usually found in the developing countries pose an additional challenge to the researchers, since the conventional focus of transportation safety researchers was a homogeneous car-based traffic. Many such studies have been attempted, especially in the recent decades, which have considered various risk factors related to MTW safety. However, the studies have considered different sets of risk factors and have given surprising and even conflicting results. Therefore, a comprehensive review of the diverse studies needs to be carried out which incorporates all the risk factors considered in previous research. This study reviews such research papers which have analysed various risk factors related to safety of MTWs, especially in heterogeneous, non-lane based traffic. Specifically, this paper aims to incorporate results from those studies and highlight the conclusions from state of the art. The paper also discusses about the research gaps that are crucial for MTW safety in mixed traffic conditions. The review will be useful for researchers working in the field of MTW safety and for policy implementation and analysis. • Risk factors affecting safety of motorized two wheelers are reviewed. • The review focuses on heterogeneous and lane in disciplined mixed traffic. • The paper highlights discrepancies among existing studies and research gaps.

A holistic approach is needed to control the perpetual burden of soil-transmitted helminth infections among indigenous schoolchildren in Malaysia

ABSTRACTA cross-sectional survey was conducted among 1,142 Orang Ali schoolchildren in six states of Peninsular Malaysia to investigate the current prevalence and risk factors of STH infections. Faecal samples were examined using direct smear, formalin-ether sedimentation, Kato–Katz, and Harada–Mori methods. A pre-tested questionnaire was used to collect information on the demographic, socioeconomic, personal hygiene, and health status of the participants. Overall, 70.1% (95% CI = 67.4, 72.7) of the participants were infected with at least one of the STH species. The prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm infections was 63.1%, 61.8% and 11.5%, respectively. Moderate-to-heavy STH infections accounted for 61.3% of the total infections. Univariate and logistic regression analyses revealed different sets of risk factors, with age (> 10 years) being the significant risk factor of all three STH species. Moreover, other species-specific risk factors were identified including being a member of the Senoi tribe, family size (≥ 7 members), school size (150–250 pupils), maternal unemployment, unimproved source of drinking water, lacking improved toilet in the house, inadequate WASH facilities at school, not washing hands before eating, and not washing fruits before eating; presence of domestic animals, and not wearing shoes when outside. The high prevalence of STH infections found in the study population exceeds the WHO policy intervention threshold (20% prevalence). Thus, an innovative holistic approach should be adopted to control STH infections among these children as part of the efforts to improve the quality of life of the entire Orang Asli population. .

Socioeconomic position, lifestyle habits and biomarkers of epigenetic aging: a multi-cohort analysis.

Differences in health status by socioeconomic position (SEP) tend to be more evident at older ages, suggesting the involvement of a biological mechanism responsive to the accumulation of deleterious exposures across the lifespan. DNA methylation (DNAm) has been proposed as a biomarker of biological aging that conserves memory of endogenous and exogenous stress during life.We examined the association of education level, as an indicator of SEP, and lifestyle-related variables with four biomarkers of age-dependent DNAm dysregulation: the total number of stochastic epigenetic mutations (SEMs) and three epigenetic clocks (Horvath, Hannum and Levine), in 18 cohorts spanning 12 countries.The four biological aging biomarkers were associated with education and different sets of risk factors independently, and the magnitude of the effects differed depending on the biomarker and the predictor. On average, the effect of low education on epigenetic aging was comparable with those of other lifestyle-related risk factors (obesity, alcohol intake), with the exception of smoking, which had a significantly stronger effect.Our study shows that low education is an independent predictor of accelerated biological (epigenetic) aging and that epigenetic clocks appear to be good candidates for disentangling the biological pathways underlying social inequalities in healthy aging and longevity.

Association between carotid atherosclerosis and different subtypes of hypertension in adult populations: A multiethnic study in Xinjiang, China.

BackgroundEthnic differences in non-invasive measurements of carotid atherosclerosis are being increasingly reported, but the association between carotid atherosclerosis and different subtypes of hypertension in adult populations is not fully understood in different ethnicities. We aimed to investigate the association of carotid atherosclerosis with different subtypes of hypertension in different ethnicities in Xinjiang, a northwestern province in China.MethodsA total of 14,618 participants (5,757 Hans, 4,767 Uygurs, and 4,094 Kazakhs) from 26 villages of seven cities in Xinjiang were randomly selected from the Cardiovascular Risk Survey conducted during 2007 and 2010. A standard questionnaire, a physical examination and biochemical tests were employed.ResultsThe mean common carotid intima-media thickness (CIMT) for the 14,618 participants was 0.86±0.003 mm. The CIMT gradually increased with age. Men (0.92±0.005 mm) had a higher CIMT than women (0.81±0.004 mm). The Uygur participants (0.82±0.006 mm) had a lower CIMT than the Han (0.88±0.005 mm) and Kazakh participants (0.88±0.005 mm). The overall prevalences of carotid intimal thickening and carotid plaques were 12.4% and 9.7%, respectively. The prevalence of CIMT varied for the different subtypes of hypertension. Multivariate logistic regression analysis showed different risk factors for abnormal CIMT in different ethnicities. The associations between abnormal CIMT and the different subtypes of hypertension within different ethnic backgrounds were also different. The risk factors for abnormal CIMT included systolic-diastolic hypertension (SDH) in Han participants (OR: 1.323, 95% CI: 1.100–1.590), SDH (OR: 1.426, 95% CI: 1.160–1.753) and isolated-systolic hypertension (ISH) (OR: 1.844, 95% CI: 1.470–2.313) in Uygur participants, and isolated-diastolic hypertension (IDH) (OR: 1.536, 95% CI: 1.170–2.016) in Kazakh participants.ConclusionThere was an ethnic difference in the prevalence of abnormal CIMT in Xinjiang, a northwestern province in China. The associations between abnormal CIMT and the subtypes of hypertension varied among the different ethnic groups. Among the studied populations, Han participants with SDH, Uygur participants with SDH and ISH, and Kazakh with IDH were more likely to suffer carotid atherosclerosis than those with other subtypes of hypertension. Participants with different ethnic backgrounds had different sets of risk factors for abnormal CIMT.

Regional level risk factors associated with the occurrence of African swine fever in West and East Africa

BackgroundAfrican swine fever (ASF) causes severe socio-economic impacts due to high mortality and trade restrictions. Many risk factors of ASF have been identified at farm level. However, understanding the risk factors, especially wild suid hosts, determining ASF transmission at regional level remains limited.MethodsBased on ASF outbreak data in domestic pigs during 2006–2014, we here tested, separately for West and East Africa, which risk factors were linked to ASF presence at a regional level, using generalized linear mixed models.ResultsOur results show that ASF infections in the preceding year was an important predictor for ASF presence in both West and East Africa. Both pig density and human density were positively associated with ASF presence in West Africa. In East Africa, ASF outbreaks in domestic pigs were also correlated with higher percentages of areas occupied by giant forest hogs and by high-tick-risk areas.ConclusionsOur results suggest that regional ASF risk in East Africa and in West Africa were associated with different sets of risk factors. Regional ASF risk in West Africa mainly followed the domestic cycle, whereas the sylvatic cycle may influence regional ASF risk in East Africa. With these findings, we contribute to the better understanding of the risk factors of ASF occurrence at regional scales that may aid the implementation of effective control measures.

Differences in the socio-economic distribution of inflammatory bowel disease and microscopic colitis.

Inflammatory bowel disease (IBD) and microscopic colitis are characterized by different geographical distributions across the USA. In this cross-sectional study we utilized demographic and socio-economic information associated with individual ZIP codes to further delineate the epidemiological characteristics of the two diseases. A total of 813057 patients who underwent colonoscopy between 2008 and 2014 were extracted from an electronic database of histopathology reports. The prevalence of patients with IBD or microscopic colitis was expressed as percentage of the population associated with specific demographic (age, sex, ethnicity) and socio-economic characteristics (population size, housing value, annual income, tertiary education). Both diseases were more common among subjects from ZIP codes with predominantly White residents and less common among subjects from ZIP codes with predominantly non-White residents such as Black, Hispanic and Asian. These ethnic variations were more pronounced in microscopic colitis than IBD. Markers of affluence, such as average residential house value and annual income, were positively associated with IBD and negatively with microscopic colitis. The prevalence of both diseases was positively correlated with tertiary education. The occurrence of both IBD and microscopic colitis is influenced by environmental risk factors. The differences in the demographic, ethnic and socio-economic distributions of the two diseases suggest that different sets of risk factors affect the two diseases and that their aetiology is unrelated.

Prevalence of Isolated Diastolic Hypertension and Associated Risk Factors among Different Ethnicity Groups in Xinjiang, China

ObjectivesLittle is known about isolated diastolic hypertension (IDH) among different ethnicity groups. We aimed to investigate the prevalence and risk factors for IDH among the major ethnicity population i.e. Han, Uygur and Kazakh in Xinjiang, northwestern part of China.MethodsIn total, 14,618 adult participants (7,799 males, 6,819 females) were recruited from the Cardiovascular Risk Survey conducted during 2007 and 2010. Blood pressure, body mass index and standard lipid profile and fasting glucose level from plasma were measured.ResultsThe overall prevalence of IDH was 10.8% in the Han, 4.5% in the Uygur and 8.7% in the Kazakh populations. When stratified by gender, IDH prevalence was 9.8% in men and 6.8% in women (P<0.001). The prevalence of IDH also varied significantly with age and it was highest in those aged 35–44 yrs old (9.7%) and lowest in those over 75 yrs old (4.1%, P<0.001). Multivariate logistic regression analysis showed that overweight (OR = 1.179, 95%CI: 1.015–1.369) or obesity (OR = 1.202, 95%CI: 1.015–1.424), smoking (OR = 1.362, 95%CI: 1.156–1.604) and high total cholesterol (TC) hyperlipidemia (OR = 1.237, 95%CI: 1.074–1.423) were significantly associated with a higher prevalence of IDH. Identified risk factors for IDH differed among ethnicity groups with male gender, young age (35–44 yrs old), more coffee or tea consumption and high TC hyperlipidemia in the Han; smoking and often coffee or tea consumption in the Uygur and male gender and overweight or obesity in the Kazakh populations.ConclusionsIDH prevalence in the Han population is higher than that in the Uygur and Kazak populations in Xinjiang, northwestern part of China. Male gender, middle age, overweight or obesity, smoking and high TC hyperlipidemia appear to be relevant risk factors of IDH in adults. Different ethnicity background had different sets of risk factors for IDH.

Different Paths to Core Pathology: The Equifinal Model of the Schizophrenia Syndrome.

Schizophrenia is a clinically heterogeneous disorder that is perhaps more accurately characterized as "the schizophrenia syndrome." This clinical heterogeneity is reflected in the heterogeneous neurobiological presentations associated with the illness. Moreover, even highly specific neural aberrations that are associated with distinct symptoms of schizophrenia are linked to a wide range of risk factors. As such, any individual with schizophrenia likely has a particular set of risk factors that interact and converge to cross the disease threshold, forming a particular etiology that ultimately generates a core pathophysiology. This core pathophysiology may then produce 1 or more symptoms of schizophrenia, leading to common symptoms across individuals in spite of disparate etiologies. As such, the schizophrenia syndrome can be considered as anequifinalentity: a state of dysfunction that can arise from different upstream etiologies. Moreover, schizophrenia etiologies are multifactorial and can involve the interactive effects of a broad range of genetic, environmental, and developmental risk factors. Through a consideration of how disparate etiologies, caused by different sets of risk factors, converge on the same net dysfunction, this paper aims to model the equifinal nature of schizophrenia symptoms. To demonstrate the equifinal model, we discuss how maternal infection and adolescent cannabis use, 2 recognized schizophrenia risk factors, may interact with other genetic, environmental, and/or developmental risk factors to cause the conserved clinical presentation of impaired working memory.

Dilution effect and identity effect by wildlife in the persistence and recurrence of bovine tuberculosis

Current theories on disease-diversity relationships predict a strong influence of host richness on disease transmission. In addition, identity effect, caused by the occurrence of particular species, can also modify disease risk. We tested the richness effect and the identity effects of mammal species on bovine tuberculosis (bTB), based on the regional bTB outbreak data in cattle from 2005-2010 in Africa. Besides, we also tested which other factors were associated with the regional bTB persistence and recurrence in cattle. Our results suggested a dilution effect, where higher mammal species richness (MSR) was associated with reduced probabilities of bTB persistence and recurrence in interaction with cattle density. African buffalo had a positive effect on bTB recurrence and a positive interaction effect with cattle density on bTB persistence, indicating an additive positive identity effect of buffalo. The presence of greater kudu had no effect on bTB recurrence or bTB persistence. Climatic variables only act as risk factors for bTB persistence. In summary, our study identified both a dilution effect and identity effect of wildlife and showed that bTB persistence and recurrence were correlated with different sets of risk factors. These results are relevant for more effective control strategies and better targeted surveillance measures in bTB.

Elaborations on Sexual Assault on Dates Among Israeli Students

The current study of 668 Israeli male and female students examines the prevalence of gendered risk factors for sexual assault (SA) on dates, posttraumatic stress disorder (PTSD) as a detrimental effect of SA, and self-efficacy as resiliency to refuse unwanted sex following SA. Two different sets of risk factors that increased the likelihood of SA on dates emerged from the hierarchical regression. Sexual experience, use of drugs, and private location increased the risk of being SA victims among males, whereas sexual experience, perceived provocative behavior, and alcohol use increased the risk among females. In addition, PTSD and self-efficacy to refuse unwanted sex following SA on dates were predicted by the extent of coercive sexual victimization. PTSD was also predicted by subjective perception of sexual behavior and rape myths, whereas efficacy was predicted by private location. The findings contribute to the literature by showing the contribution of various risk factors to experiencing SA, and by showing SA effect on PTSD and self-efficacy.

Paradoxical Risk Stratification for Contralateral Neck Recurrence in Oral Cavity Squamous Cell Carcinoma

Dr. Liao and colleagues retrospectively reviewed the failure pattern of 913 consecutive patients with squamous cell carcinoma of oral cavity cancer (OSCC) and analyzed the risk factors for contralateral neck recurrence (CLRN). The 5-year actuarial CLRN rate of 18% in patients with local recurrence (LR) is significantly higher than the 5% in patients with local control (LC). After extensive univariate analyses, the authors separated the patients into 2 groups, LC versus LR, for further subset and multivariate analyses (MVA). MVA suggested that extracapsular spread (ECS) is the only risk for CLRN in LR group. In LC group, separate MVA of 3 subsets of patients: tongue, buccal mucosa, and alveolar ridge, found different sets of risk factors for CLRN for tongue and buccal mucosa patients. Based on the above risk stratification analyses, the authors then recommended a treatment flowchart scheme intended to reduce the incidence of CLNR in OSCC. It all seemed logical but not statistically sound. The paradox in their risk stratification management flowchart is that a physician has to foresee local control versus local recurrence for a patient before treatment in order to apply the recommended management scheme. Surprisingly, the authors did not have a predictive model for LC versus LR to make the stratification flowchart more believable. To derive a truly clinically applicable treatment flowchart for OSCC, the authors could redo the multivariate analysis of the 2 major subsets of patients, namely tongue cancer and buccal mucosa cancer, regardless of the status of LR and LC.

Addressing modifiable risk factors for coronary heart disease in primary care: an evidence-base lost in translation

Risk factors for cardiovascular disease can be modified in primary care. Electronic patient record (EPR) systems include embedded cardiovascular risk factor calculators and should facilitate this process. To observe how the evidence base for assessing and managing cardiovascular risk is implemented in practice. We compared the different risk calculators promoted for calculating cardiovascular risk in primary care using four test cases. We looked to see how these calculators were implemented in primary care EPR systems. We explored through a workshop which risk factors GPs thought were important and felt motivated to address as part of clinical care. The risk calculators reviewed use different sets of risk factors and the levels of risk calculated for the same test patient profiles vary by up to 100%. The risk factor calculators embedded within UK computer systems all include the Framingham equation though there is variation in interface, default values and patient groups included. GPs showed consensus around the importance of managing smoking, blood pressure, obesity (body mass index), diabetes and cholesterol but also stressed the importance of providing personalized care and exercising professional judgement. There appears to be an evidence-base lost in translation. Different guidelines calculate risk differently, and even when the same guideline is used, variation in implementation leads to further variation. Education and development of improved risk calculators should enable the most appropriate calculator to be used for an individual patient; accreditation of implementation could be achieved through the use of a standard set of test cases.

New Insight Into Epirubicin Cardiac Toxicity: Competing Risks Analysis of 1097 Breast Cancer Patients

Current recommendations that cancer patients receive a maximum cumulative dose of 900 mg/m(2) epirubicin are based on the risk of epirubicin-mediated cardiotoxicity and do not take into account the competing risk of death from cancer. Here, we identify risk factors for cardiotoxicity and overall mortality and determine the cumulative dose of epirubicin that yields a 5% risk for cardiotoxicity for cancer patients from different risk backgrounds. Data were collected from 1097 consecutive anthracycline-naive patients treated for metastatic breast cancer with epirubicin. Patients who developed congestive heart failure classified as New York Heart Association class 2 or higher were recorded as having cardiotoxicity. Independent Cox multiple regression analyses for cardiotoxicity and for overall mortality were followed by competing risks analysis, with cardiotoxicity as the primary event and death from all other causes as the competing event. All statistical tests were two-sided. A total of 11.4% of patients developed cardiotoxicity. Risk factors for cardiotoxicity included increased cumulative dose of epirubicin (hazard ratio per every 100 mg/m(2) administered = 1.40, 95% confidence interval = 1.21 to 1.61), patient age, predisposition to cardiac disease, history of mediastinal irradiation, or antihormonal treatment for metastatic disease. Risk factors for death from all other causes (including breast cancer) included lesser dosages of epirubicin, increased tumor burden, prior use of adjuvant chemotherapy, and patient age. The cumulative dosage of epirubicin that carries a 5% risk of cardiotoxicity was lower than previously assumed and was dependent on risks of both cardiotoxicity and overall mortality. Maximum cumulative dosages of epirubicin are presented that confer a 5% risk of cardiotoxicity for patients with different sets of risk factors.

Dysmenorrhea: Risk Factors in Women with Endometriosis

Although it is generally accepted that endometriosis is responsible for dysmenorrhea, as well as other symptoms such as infertility, the precise relationship between the severity of dysmenorrhea and various characteristics of disease, such as stage and the type or site of endometriotic lesions, has been elusive and often a matter of heated debate, owing largely to conflicting reports. Here we review factors that are reported to be associated with dysmenorrhea in endometriosis. We also demonstrate, through a real example, that different statistical models employed in data analyses may yield somewhat different sets of risk factors, and the difference may not be always resolved within the same data set. In addition, we make the point that despite the best-fitting models, there may still be a sizable portion of variation in the severity of dysmenorrhea that can not be explained completely by the identified risk factors, suggesting that factors other than those of surgical findings or patient characteristics may also be responsible for dysmenorrhea severity. We review some possible factors that may also be responsible for the risk and severity of dysmenorrhea. Finally, we expose areas in need of further research.

Hock Injury Prevalence and Associated Risk Factors on Organic and Nonorganic Dairy Farms in the United Kingdom

The presence of hock injury was assessed in the milking herds of 80 dairy farms (40 organic, 40 nonorganic) across the United Kingdom. A wide range of information on farm management and husbandry was gathered via interview to assess the factors contributing to hock damage for all 80 farms, and a comprehensive building appraisal was conducted for 40 farms visited during the winter housing period. The prevalence of hock lesions was lower on organic compared with nonorganic farms (37.2 vs. 49.1%). Prevalence of hock damage was greater in the spring than fall (59.9 vs. 21.6%) and cows housed in free-stalls had a greater prevalence of hock lesions than those housed on straw (46.0 vs. 25.0%). Prevalence of hock damage increased with lactation number. In the analysis of fall/spring data, the age first mated, herd biosecurity, duration of summer grazing, and cow milk yield were significant factors relating to herd hock damage. Larger herds had a greater proportion of cows with hock swellings. Farms with a shorter calving interval had more cows with hock swellings. Factors relating to housing conditions that were positively associated with the prevalence of hock damage were low feed face space per cow, inferior passageway cleanliness, low total standing area per cow, and the type of bedding added to the free-stall. To assess whether free-stall versus straw-pen or organic versus nonorganic farms had different sets of risk factors, the data were reanalyzed for these types separately. For the straw-pen farms a high culling rate was associated with more hock damage. Within nonorganic farms, the length of summer grazing was significant, with longer periods meaning less hock injury. The prevalence of hock injuries on many UK farms, both organic and non-organic, exceeded levels that are deemed acceptable for cow comfort. Efforts are needed to improve housing standards to reduce the prevalence of hock injury and consequently improve cow welfare.

Psychosis risk as a function of age at onset

BackgroundLittle is known about late-onset psychosis (onset after the age 45 years) and how it relates to early-onset psychosis (before age 45 years). The aims of this study were to calculate the incidence of non-affective, non-organic psychotic symptoms across the life span and to explore the contribution of different sets of risk factors in relation to age at onset.MethodsData were obtained from the three measurements of the Netherlands Mental Health Survey and Incidence Study. Symptoms of psychosis were assessed in individuals aged 18–64 years using the Composite International Diagnostic Interview. All individuals reporting first-onset of psychotic symptoms within a three-year interval were included. The degree to which sets of risk factors affected the psychosis outcome similarly across age groups was assessed.ResultsThe number of subjects displaying incident psychotic symptoms was similar across age groups. Cumulative incidence rates ranged from 0.3% to 0.4%. Age differences were found for life-time depressive symptoms (risk difference = 5%, 95% CI = 1%, 9%) and baseline neuroticism (risk difference = 3%, 95% CI = 0%, 6%), indicating that late-onset psychosis was less often preceded by these. In contrast, no effect modification by age was observed for female sex, hearing impairment, being single, or life-time cannabis use.ConclusionsOnset of psychotic symptoms in late life is no rare event. Compared to early onset psychosis, the late-onset counterpart less often arises in a context of emotional dysfunction and negative affectivity, suggesting qualitative differences in aetiology and more effective premorbid coping styles.

Decoupling the Relation Between Risk Factors for Conduct Problems and the Receipt of Intervention Services: Participation Across Multiple Components of a Prevention Program

This study examined whether the link between risk factors for conduct problems and low rates of participation in mental health treatment could be decoupled through the provision of integrated prevention services in multiple easily-accessible contexts. It included 445 families of first-grade children (55% minority), living in four diverse communities, and selected for early signs of conduct problems. Results indicated that, under the right circumstances, these children and families could be enticed to participate at high rates in school-based services, therapeutic groups, and home visits. Because different sets of risk factors were related to different profiles of participation across the components of the prevention program, findings highlight the need to offer services in multiple contexts to reach all children and families who might benefit from them.