Excessive Risk Research Articles

Play in the mathematical education of young children. Selected pedagogical and medical aspects

This article aims to present play as one of the most common, natural, and spontaneous forms of activity undertaken by preschool children. Through appropriately chosen mathematical games and didactic means, we can introduce a child to the secrets of culture and art stimulate their motor, emotional, social, and intellectual development. Particular emphasis is placed on games created by the children themselves, which engage not only manipulative and verbal activities but also mental processes to a large extent. In addition to its educational and upbringing functions, the article also highlights the importance of the caring function. It emphasizes the necessity for educators and teachers to adhere to fundamental principles aimed at safeguarding children from excessive risks associated with all playful activities within educational and childcare facilities, as well as beyond them.

Tailoring community preventive care to personal health needs: a data-driven and participatory approach

A digital platform with tools for health promotion was developed as a proof of concept in co-creation with all relevant stakeholders involved: citizens, caregivers, and local policy makers, aiming to optimize community preventive care.
 The platform, referred to as BIBOPP, was developed as a proof of concept focusing on prevention and health promotion for citizens, local policy makers but also for primary care givers wanting to offer personalized follow up. To this end, we set up multiple co-creation sessions with different target groups of end users, including those with expected limited digital literacy skills, eg. older adults and people with no or low formal educational background. Based on this input, the functionalities of the tools were designed and developed and afterwards tested with a new group of end-users.
 The online prevention platform offered citizens from 5 Flemish municipalities a digital screening, allowing them to evaluate their health and lifestyle. This screening is the Domus Medica Health Guide (GGDM), an evidence-based tool predicting personal risk for chronic diseases. The outcome of the screening is linked to the electronic medical health record hosted by the general practitioner, notifying the latter in case of excessive risk and involving him in the process of disease prevention and health promotion.
 Based on the personalized lifestyle advice resulting from the survey responses, end users then received an overview of activities and primary care providers in their community, tailored to their personal risk profile and preferences.
 The data collected with consent from the end users, yielded insights on the self-reported lifestyle and health of these participants. On an aggregated level, this tool has the potential to provide data for population health management.
 First lessons learned indicate that the platform did require significant digital literacy skills from end-users, as indicated by the participants younger age and relatively healthy lifestyle (eg. less than 10% smokers, +50% daily physical activity, …). However, in a co-creation session group with older adults, they indicated that digital skills were not a threshold when peer support was available. Furthermore, they recognized that the tool helped them in the self-management of their health and that they trusted the data governance. People with low to no formal educational background on the other hand were more suspicious about the tool and data governance unless this was offered to them through their trusted care providers. Also, older adults indicated that support with the interpretation of the advices by a health professional could be of added value.
 Next steps for BIBOPP now are involving these health professionals, and more specifically primary care actors in onboarding and guiding people to and through the platform.
 To conclude, this data-driven proof of concept co-designed with end-users, has promise to deliver personalized services, strengthen community preventive care, and optimize the local health policy.
 

Bank connectedness and excessive risk-taking: Some cross-country evidence

We investigate whether the connectedness of banks shapes their incentive to take on excessive risk, using panel data from more than 400 public banks in 19 economies during the period of 2000–2018. We find supportive evidence that banks’ excessive risk-taking is significantly associated with their connectedness and the impact of banks’ directional connectedness varies. A higher outward connectedness significantly fuels banks’ incentive to take excessive risk, while a higher inward connectedness has a countervailing effect

Trust and corporate debt maturity mismatch: Evidence from China

AbstractThis study explores the relationship between social trust and firm debt maturity mismatch in the Chinese context. Additionally, we investigate the economic mechanisms through which social trust affects debt maturity mismatch, and the differential roles played by social trust among firms with different characteristics. We employ enterprise trustworthiness scores and provincial blood donation rates as our measures of regional social trust level and find a negative relationship between local trust and firm debt maturity mismatch, suggesting that social trust which promotes ethical norms acts as a restraint on firms' propensity for excessive risk. An alternative but consistent explanation is higher social trust increases debtors' willingness to lend, hence it reduces firms' funding costs and consequently the potential cost‐saving motivation behind such a mismatch. We further document evidence that social trust improves the firm information environment and consequently risk‐taking and/or the ability to reduce funding costs. The study also reveals variations in the role of social trust based on firm characteristics, such as leverage and profitability, and the ownership structure (state‐owned enterprises vs. non‐state‐owned enterprises). The findings contribute to the literature by highlighting the increasing importance of social capital for policy and governance.

Assessment of radiological risk associated with thoron gas at primary schools in Al-Najaf city, Iraq

Children spend considerable time at home and school, so school is likely to be a second source of natural radionuclide exposure after home. This study evaluates the radiological risk associated with thoron gas in the air within the building of one hundred primary schools in Al-Najaf City, Iraq, using a CR-39 detector. The results of the average value of thoron concentration detector, the annual effective dose (AED), Excessive Lifetime Cancer Risk (ELCR) × 10−3, and Lung Cancer Case (LCC) × 10−9 measured in the building of the schools were 7.47 ± 2.85 Bq/m3, 0.03 ± 0.01 mSv/y, 0.11 ± 0.04, and 0.54 ± 0.20, respectively. All the results of indoor thoron were below the global average limit. The results of the radiological survey due to thoron concentrations for studied primary schools suggest that the radionuclides and their radiological hazard indexes in all studied schools in AL Najaf city, Iraq, do not impose a health hazard.

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis.

A considerable proportion of patients admitted with acute coronary syndrome (ACS) have no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking). The outcomes of this population following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established. This retrospective cohort study included 7,847 patients with ACS who underwent PCI. The study outcomes were in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions. Approximately 11% of the study population had none of the SMuRFs. During 12.13 [11.99-12.36] months of follow-up, in-hospital mortality (adjusted-odds ratio (OR):1.51, 95%confidence interval (CI): 0.91-2.65, P:0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88-1.46, P: 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81-1.12, P: 0.412) did not differ between patients with and without SMuRFs. Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher in-hospital (adjusted-OR: 3.28, 95%CI: 1.92-6.21, P < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02-3.21, P: 0.008) than SMuRF+ women. Almost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of in-hospital and one-year mortality.

Causal Association Between Subtypes of Excessive Daytime Sleepiness and Risk of Cardiovascular Diseases.

Excessive daytime sleepiness (EDS), experienced in 10% to 20% of the population, has been associated with cardiovascular disease and death. However, the condition is heterogeneous and is prevalent in individuals having short and long sleep duration. We sought to clarify the relationship between sleep duration subtypes of EDS with cardiovascular outcomes, accounting for these subtypes. We defined 3 sleep duration subtypes of excessive daytime sleepiness: normal (6-9 hours), short (<6 hours), and long (>9 hours), and compared these with a nonsleepy, normal-sleep-duration reference group. We analyzed their associations with incident myocardial infarction (MI) and stroke using medical records of 355 901 UK Biobank participants and performed 2-sample Mendelian randomization for each outcome. Compared with healthy sleep, long-sleep EDS was associated with an 83% increased rate of MI (hazard ratio, 1.83 [95% CI, 1.21-2.77]) during 8.2-year median follow-up, adjusting for multiple health and sociodemographic factors. Mendelian randomization analysis provided supporting evidence of a causal role for a genetic long-sleep EDS subtype in MI (inverse-variance weighted β=1.995, P=0.001). In contrast, we did not find evidence that other subtypes of EDS were associated with incident MI or any associations with stroke (P>0.05). Our study suggests the previous evidence linking EDS with increased cardiovascular disease risk may be primarily driven by the effect of its long-sleep subtype on higher risk of MI. Underlying mechanisms remain to be investigated but may involve sleep irregularity and circadian disruption, suggesting a need for novel interventions in this population.

The Impact of Local Government Debt on Economic Growth in the Post-Epidemic Period - Taking Beijing as an Example

As an important tool for China to achieve fiscal goals and promote economic growth, government debt has played an important role during the epidemic. Beijing, as one of the earliest regions in China to try the self-issuance and repayment of local government bonds, has a wealth of experience modifying the economic cycle via local government debt. However, by combing the existing literature, this paper reveals that there is ongoing debate in academia over the function of local government debt. Therefore, this paper examines the relationship between local government debt and economic growth using Beijing as an example and concludes that debt held by Beijing's local government primarily encourages economic growth by boosting public and private investment. Finally, based on that the local government debt of Beijing has a favorable impact on economic growth in the post-epidemic period, this paper puts forward the two problems of Beijing's excessive hidden debt risk and the bad debt use structure and then puts forward relevant suggestions.

Severity of excessive gestational weight gain and risk of severe maternal morbidity

Both obesity and excessive gestational weight gain are associated with severe maternal morbidity, but there is limited literature evaluating whether the risk of severe maternal morbidity is further increased by the degree or severity of excessive gestational weight gain. This study aimed to determine whether pregnant patients with excessive gestational weight gain who gained more than 50 lb were at increased risk of severe maternal morbidity compared with those who only moderately exceeded recommended gestational weight gain guidelines. A secondary objective was to determine whether patients who gained 10 lb more than the recommended upper limit of total weight gain for a given prepregnancy body mass index group were at increased risk of severe maternal morbidity compared with those who exceeded that upper limit by a lesser amount. This was a retrospective cohort study of all patients with live, term, singleton deliveries with excessive gestational weight gain from 7 hospitals within a large health system in New York between January 2019 and February 2020. Excessive gestational weight gain was defined as exceeding the recommended upper limit of total weight gain for a given prepregnancy body mass index category using the National Academy of Medicine gestational weight gain guidelines: >40 lb for a body mass index of <18.5 kg/m2, >35 lb for a body mass index of 18.5 to 24.9 kg/m2, >25 lb for a body mass index of 25.0 to 29.9 kg/m2, and >20 lb for a body mass index of ³30.0 kg/m2. Patient height and weight data were self-reported at the time of delivery hospitalization and retrieved from the electronic medical record system. Patients were classified into 2 excessive gestational weight gain groups: moderate (≤50 lb) or severe (>50 lb). Patients with missing body mass index or gestational weight gain were excluded. The primary exposure was severe excessive gestational weight gain. The primary outcome was severe maternal morbidity, defined using the Centers for Disease Control and Prevention criteria. Logistic regression was used to model the likelihood of severe maternal morbidity, adjusting for race and ethnicity, nulliparity, advanced maternal age, gestational diabetes mellitus, and maternal mood disorder. For the secondary analysis, severe maternal morbidity rates were compared between patients who exceeded their body mass index-specific upper limit of total weight gain by ≥10 lb and those who exceeded it by <10 lb. A total of 11,506 patients were included for analysis, and 1965 patients (17.1%) had severe excessive gestational weight gain. The overall rate of severe maternal morbidity was 3.3%. Severe maternal morbidity occurred in 85 of 1965 patients (4.3%) with severe excessive gestational weight gain and 292 of 9541 patients (3.1%) with moderate excessive gestational weight gain. On regression analysis, after adjustment for covariate factors, patients with a severe excessive gestational weight gain were 39% more likely to experience severe maternal morbidity than those with moderate excessive gestational weight gain (adjusted odds ratio, 1.39; 95% confidence interval, 1.08-1.79). Patients with excessive gestational weight gain of ≥10 lb above the recommended body mass index-specific upper limit for gestational weight gain were 32% more likely (adjusted odds ratio, 1.32; 95% confidence interval, 1.07-1.62) to experience severe maternal morbidity than patients who exceeded that upper limit by <10 lb. Patients with live, term, singleton pregnancies who gain more than 50 lb are at increased risk of severe maternal morbidity compared with those who only moderately exceed gestational weight gain guidelines. Similarly, patients who gain ≥10 lb above the recommended body mass index-specific upper limit for gestational weight gain are at increased risk. Further study is warranted to determine the most effective interventions to manage gestational weight gain and mitigate maternal risk.

Associations Between Postdischarge Care and Cognitive Impairment-Related Hospital Readmissions for Ketoacidosis and Severe Hypoglycemia in Adults With Diabetes.

Patients with severe hypoglycemia (SH) or diabetic ketoacidosis (DKA) experience high hospital readmission after being discharged. Cognitive impairment (CI) may further increase the risk, especially in those experiencing an interruption of medical care after discharge. This study examined the effect modification role of postdischarge care (PDC) on CI-associated readmission risk among U.S. adults with diabetes initially admitted for DKA or SH. We used the Nationwide Readmissions Database (NRD) (2016-2018) to identify individuals hospitalized with a diagnosis of DKA or SH. Multivariate Cox regression was used to compare the all-cause readmission risk at 30 days between those with and without CI identified during the initial hospitalization. We assessed the CI-associated readmission risk in the patients with and without PDC, an effect modifier with the CI status. We identified 23,775 SH patients (53.3% women, mean age 65.9 ± 15.3 years) and 140,490 DKA patients (45.8% women, mean age 40.3 ± 15.4 years), and 2,675 (11.2%) and 1,261 (0.9%), respectively, had a CI diagnosis during their index hospitalization. For SH and DKA patients discharged without PDC, CI was associated with a higher readmission risk of 23% (adjusted hazard ratio [aHR] 1.23, 95% confidence interval 1.08-1.40) and 35% (aHR 1.35, 95% confidence interval 1.08-1.70), respectively. However, when patients were discharged with PDC, we found PDC was an effect modifier to mitigate CI-associated readmission risk for both SH and DKA patients (P < 0.05 for all). Our results suggest that PDC can potentially mitigate the excessive readmission risk associated with CI, emphasizing the importance of postdischarge continuity of care for medically complex patients with comorbid diabetes and CI.

Excessive mortality risk associated with new opioid use in older people with dementia

AbstractBackgroundOpioids have been associated with an increased excess mortality‐risk in the general population. Older people with dementia have been prescribed opioids more frequent and the use of strong opioids has increased considerably over the past decade among older people with dementia. Whether opioids are associated with an excess mortality risk in older people with dementia is unknown.MethodMatched cohort study using nationwide registries. All Danish residents aged 65 years and older diagnosed with dementia between 01.01.2008‐31.12.2018 were included. Exposure was defined as first opioid prescription after dementia diagnosis (1 year washout before diagnosis). Persons exposed to opioids were matched with up to two unexposed persons on age and sex. Cox proportional hazards models were used to compare rates of death within 180 days after the initiation of opioid treatment and adjusted for potential confounders (time since diagnosis, nursing home residency, comorbidity, admission within 30 days, number of medications).ResultForty‐two percent (31,619/75,471) of older people with dementia redeemed a prescription for an opioid after their diagnosis of dementia. We matched 31,619 exposed persons to 63,235 unexposed. Among the exposed, 10,642 (33.7%) died within 180 days after initiating their first opioid prescription compared with 3980 (6.4%) of the unexposed, yielding a 4‐fold increased excess mortality risk (adjusted Hazard ratio (95% CI): 4.13 (3.98‐4.30)). Strong opioids were associated with a 6‐fold increased mortality risk (6.34 (6.00‐6.69)), whereas the risk was lower for weak opioids (2.52 (2.38‐2.67). Among those who had redeemed transdermal fentanyl as their first prescription, 65.3% died within the first 180 days compared with 6.7% in the unexposed with a risk of 8.03 (7.02‐9.18). The risk was greatest within the first 14 days, where the mortality (for all opioids) was increased 11‐fold (10.95 (9.87‐12.15)), but there was still a 2‐fold increased mortality risk after 90 days (2.36 (2.21‐2.52)).ConclusionNew opioid use was frequent among elderly with dementia, and this was associated with a markedly increased excess mortality, which is worrisome. The data calls for more research to identify sub‐groups with highest excess mortality risk to make a risk–benefit assessment and guidelines to assure appropriate prescribing.

Should lymphadenectomy performed routinely in patients with primary intrahepatic cholangiocarcinoma undergoing curative hepatectomy? A retrospective cohort study with propensity-score matching analysis

BackgroundThe benefit of routine lymphadenectomy (LD) in improving outcomes for patients with primary intrahepatic cholangiocarcinoma (ICC) undergoing curative hepatectomy remains unclear.Materials and methodsThis study enrolled 269 consecutive patients who underwent liver resection for primary ICC from January 2009 to July 2020 in West China Hospital. The association of the nodal status with disease-free survival (DFS) and overall survival (OS) was analyzed using the Cox proportional hazards model and 1:1 propensity score matching (PSM) analysis.ResultsSeventy-five (27.9%) patients underwent curative liver resection combined with LD (LD+ group), while 194 (72.1%) patients received curative liver resection without LD (LD- group and Nx group). Among the LD+ group, metastatic disease was present in 36 patients (48%, N1 group) and absent in 39 patients (N0 group). During the follow-up period, 116 patients (43.1%) experienced tumor recurrence and 101 patients (37.5%) died due to recurrence. Multivariate analysis revealed that lymph node metastasis (N1, HR 3.682, 95% CI 1.949–6.957, p < 0.001) was associated with worse OS, while LD+ status (HR 0.504, 95% CI 0.298–0.853, p = 0.011) was associated with improved OS. Adjuvant therapy was a protective factor for both DFS (HR 0.602, 95% CI, 0.447–0.810, p = 0.001) and OS (HR 0.683, 95% CI 0.484–0.963, p = 0.030). After 1:1 PSM, the LD+ patients (n = 74) displayed similar 1-, 3- and 5-year DFS rates (40.0, 7.9 and 7.9% vs. 29.0, 13.7 and 13.7%, p = 0.741) and OS rates (56.0, 26.6 and 22.2% vs. 58.9, 25.6, and 16.4%, p = 0.644) to the LD- patients (n = 74). Additionally, among the 75 LD+ patients, 48 patients underwent hepatic hilar lymphadenectomy (HHL), and 27 patients underwent extended hepatic hilar lymphadenectomy (EHL). Both DFS (p = 0.504) and OS (p = 0.215) were similar between the HHL and EHL groups.ConclusionRoutine LD and adjuvant therapy may contribute to improved OS according to the crude analysis. LD could provide accurate staging without excessive risk and guide adjuvant therapy based on the tumor stage, potentially resulting in better survival. These results suggest that a routine LD should be considered during curative hepatectomy for ICC.

Analisis Pengelolaan Keuangan Syariah Usaha Mikro Kecil Menengah Di Candi Muaro Jambi

The purpose of this thesis is to manage Islamic finance MSMEs at Muaro Jambi Temple, to find out the obstacles in managing MSME sharia finance at Muaro Jambi Temple and to find out the efforts of MSMEs in financial management at Muaro Jambi Temple. This thesis uses a qualitative approach with data collection methods through observation, interviews, and documentation. Based on the research conducted, the following results and conclusions are obtained: MSME Islamic Financial Management in Muaro Jambi Temple is carried out by trying only to take what is lawful and good, lawful way of acquisition: through trade that applies voluntarily and willingly, lawful method of acquisition: act fairly and avoid doubts and lawful. How to use: Help each other and avoid excessive risks. Obstacles in MSME Islamic Financial Management at Muaro Jambi Temple include personal needs and business turnover that are not separated and limited knowledge. Efforts in MSME Islamic Financial Management at Muaro Jambi Temple include the use of the budget in the needs that will be carried out so that the business being run can benefit, recording is done to anticipate losses occurring or expenditures occurring, so that income will also be clearer when recording, reporting is done made not just written numbers but have information. Exercising control by fully implementing control over the financial management of its business.

Excessive weight gain onset-age and risk of developing diabetes mellitus: a large, prospective Chinese cohort study.

Excessive weight gain and obesity are widely accepted as risk factors for diabetes mellitus, and the age at which obesity onsets may be related to the development of cardiovascular diseases and certain cancers. Here, we aimed to investigate associations between the onset-age of overweight/obesity and risk of developing diabetes mellitus in China. 42,144 people with the normal weight range and without diabetes at baseline, were enrolled from the Kailuan cohort which began on the 1st June 2006. All participants were followed-up, biennially, until 31st December 2017. During follow-up, 11,220 participants had become overweight/obese. For each case, one normal-weight control was matched according to age ( ± 1 year) and sex. Our final analysis included 10,858 case-control pairs. An age-scaled Cox model was implemented to estimate hazard ratios (HR) with corresponding 95% confidence intervals (CI) for diabetes mellitus incidence across age-groups. At a median follow-up of 5.46 years, 1,403 cases of diabetes mellitus were identified. After multivariate adjustments, age-scaled Cox modelling suggested that risk gradually attenuated with every 10 year increase in age of onset of overweight/obesity. Diabetes mellitus adjusted HRs (aHRs) for new-onset overweight/obesity at <45years, 45-54 years, and 55-64 years were 1.47 (95%CI, 1.12-1.93), 1.38 (95%CI, 1.13-1.68), 1.32 (95%CI, 1.09-1.59), respectively. However, new-onset of overweight/obesity at ≥65 years did not relate to diabetes mellitus (aHR, 1.20; 95%CI, 0.92-1.57). This trend was not observed in women or the new-onset obesity subgroup but was evident in men and the new overweight onset subgroup. Participants with early onset of excessive weight gain issues are at considerably higher risk of developing diabetes mellitus compared to those who maintain a normal weight.

Health poverty among people with type 2 diabetes mellitus (T2DM) in Malaysia

In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40–75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation.

Factors Influencing Cervical Cancer Screening in Women Referring to the Therapeutic Centers of Tehran: A Cross-sectional Analysis

Cervical cancer is the second most common cancer in women; screening intervals are the basis of early diagnosis. Moreover, this study was conducted in Tehran, considering the importance of cervical cancer screening for diagnosing this cancer and the lack of sufficient information about the factors related to cervical cancer screening in women. However, this paper studies the extent of screening behaviors and factors influencing it in cervical cancer. This descriptive and analytical paper established the target population of 384 women of different ages who refer to healthcare centers in Tehran. The purpose of data collection was based on the researcher's questionnaire based on the studies and data of the patients registered in Shariati Medical Center in Tehran, whose reliability was confirmed by the test (Cronbach's Alpha= 0.7). Furthermore, data was analyzed by SPSS and Smart PLS. This paper reveals that six factors influence the direct effect of cervical cancer screening. However, the factors include personal hygiene, psychological, pap smear test screening, colposcopy screening, social factors, and Health Care Utilization—the existing observation aimed to assess the influence of risk factors of cervical cancers. Accordingly, most cervical cancers may be diagnosed with previous knowledge of threat factors. Identification of excessive–risk populations and beginning early screening are influential in the early recognition of cervical cancers.

Inflammatory biomarkers in polymyositis/dermatomyositis patients with interstitial lung disease: a retrospective study

Background Dermatomyositis (DM)/polymyositis (PM) is a systemic autoimmune disease characterized by proximal limb muscle with high morbidity and mortality and poor prognosis mediated by immune dysfunction; its etiology is unknown. DM/PM patients are at excessive risk of interstitial lung disease (ILD) and a higher risk of death. However, the role of circulating lymphocyte subsets, which play a pivotal role in occurrence and progression of DM/PM and ILD, respectively, remains unclear in DM/PM patients with ILD. Methods Demographic characteristics, general data, and peripheral lymphocyte levels measured by flow cytometry were collected and analyzed in 47 DM/PM patients with ILD, 65 patients without ILD, and 105 healthy controls (HCs). Results The most important first symptom of DM/PM patients is rash. Compared with non-ILD patients, the levels of neutrophil/lymphocyte ratio (NLR), systemic inflammatory response index (SIRI) were significantly higher and the levels of C reactive protein (CRP) were significantly lower in patients with ILD. Compared with HCs, DM/PM patients, with or without ILD, had decreased absolute counts of T, CD4 + T, CD8 + T, natural killer (NK), helper T (Th) 1, Th2, Th17, and regulatory T (Treg)cells. The fewest Th1 and Treg cells and the the lowest CD8 + T and Th1 cells percentages were seen in peripheral blood of patients with ILD. Longer duration, decreased lymphocyte/monocyte ratio (LMR)levels and CD8 + T and Th1 cells proportions, and fewer circulating Treg cells were independent risk factors for DM/PM with ILD. Conclusions The identification of peripheral blood T lymphocyte subsets, especially Treg cells, and blood count in DM/PM appears to be useful in the comprehensive assessment of clinical lung involvement.

From Subprime Mortgages to a Global Pandemic: An Assessment of Systemic Risk in the 2008 Financial Crisis and COVID-19

The COVID-19 crisis and the 2008 financial crisis are two major global events that have significantly impacted the global economy and society. Although both contributed to the economic downturn to some extent, they were fundamentally not social events of the exact nature. The COVID-19 crisis was caused by a global pandemic that has resulted in business closures and travel restrictions. The 2008 financial crisis, which resulted in widespread financial panic and a credit shortage, was mostly caused by the collapse of the housing market and the accompanying financial catastrophe. This paper first explores what triggered the 2008 financial crisis. The Federal Reserve's loose policy made it extremely easy to borrow during that period, which fueled the subprime loan market and the housing market bubble; the lack of regulation in the market made many financial institutions take excessive risks. This paper then also analyzes government interventions, including the implementation of the Dodd-Frank Act and the introduction of Basel III, to prevent further collapse of the economy. Despite extensive government intervention, the post-crisis recovery has been slow and uneven. The lessons that countries should learn from the crisis strengthen the resilience of the global financial system and prevent similar crises from recurring in the future.

Accounting information and risk shifting with asymmetrically informed creditors

This paper explores the effects of public information such as accounting earnings in a competitive lending setting with risk shifting. Debt financing creates incentives for borrowers to take on excessive risks, in particular in bad states of the world. If a privately informed inside creditor bids against outside creditors to extend a loan, public information levels the playing field, which affects the bidding and risk shifting. Nonetheless, a perfect public signal would yield the least efficient outcome: introducing some measurement noise alleviates risk shifting by subjecting outside creditors to the winner’s curse, allowing borrowers in bad states cheaper access to loans. However, for pessimistic priors about the borrower, greater public signal precision can alleviate risk shifting, at the margin. We discuss implications for financial reporting regulations along the business cycle and for creditor turnover.

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a sex-stratified analysis

Abstract Background The standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking) are known to play a major role in the pathogenesis of coronary heart disease (CHD). Despite endeavors aiming at primary and secondary prevention of these risk factors, CHD has remained a leading cause of mortality and morbidity worldwide. A considerable proportion of patients admitted with acute coronary syndrome (ACS) have no SMuRFs, the outcomes of whom following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established. Purpose The present study aimed to evaluate the association between SMuRF-less status and post-PCI outcomes among patients with ACS. Further, we sought to determine possible sex differences in the post-PCI outcomes related to the SMuRF-less status. Methods This retrospective cohort study included 7847 patients with ACS who underwent PCI. The study outcomes were all-cause mortality and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions. A separate landmark analysis with the landmark (cutoff) set at 30 days after the index procedure was performed as well. Models were adjusted for age, sex, body mass index, chronic obstructive pulmonary disease, cerebrovascular accident, previous myocardial infarction, estimated glomerular filtration rate, ejection fraction, and left main disease. Results Approximately 11% of the study population had none of the SMuRFs. The SMuRF-less and SMuRF+ groups aged 63.10 ±8.91 (85.1% males) and 62.53 ± 10.91 years (74.9% males), respectively. During 12.13 [11.99-12.36] months of follow-up, the followings were respective event numbers in the SMuRF-less and SMuRF+ groups: all-cause mortality: 35 (4.1%) and 273 (3.9%); MACCE: 99 (11.6%) and 898 (12.8%). All-cause mortality (adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88-1.46, P: 0.731), and MACCE (adjusted-HR: 0.93, 95%CI:0.81-1.12, P: 0.412) did not differ between patients with and without SMuRFs (Figure 1). Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02-3.21, P: 0.008) than SMuRF+ women (Figure 1). Notably, following landmark analyses, this significant association among women disappeared (adjusted-HR: 0.99, 95%CI: 0.41-2.59, P:0.991), implying that its significance stemmed, to some extent, from higher 30-day mortality (Figure 1,2). Conclusions Almost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of one-year mortality.