Higher Cumulative Risk Research Articles

Perinatal cumulative risk scores for depression symptoms in young people from the Growing Up in New Zealand longitudinal study

BackgroundAdolescent depression has increased markedly over the last decade and often persists into adulthood with a range of adverse outcomes. Identifying the perinatal risk factors contributing to adolescent depression is crucial to advise early interventions. MethodsThe study included 4563 young people from the Growing Up in New Zealand (GUiNZ) longitudinal study who completed a questionnaire on depression symptoms at age 12 years (Centre for Epidemiological Studies Depression Scale for Children (CESD-10). Cumulative Risk (CR) scores were created by combining the perinatal risk factors significantly associated with depression symptoms. Then, these CR scores were grouped into three levels and their association with depression symptoms was investigated in univariable and multivariable analyses. ResultsWe found a statistically significant association between the CR scores (from one to six perinatal risk factors) and depression score at age 12, compared to the no-risk factor group, suggesting a dose-response relationship. In the adjusted analysis, young people exposed to the lower CR score (1–3 risk factors) had a 0.85 unit increase in depression score (p- < .001), and those exposed to the higher CR (4 ≥ risk factors) had a 1.70 unit increase (p < .001) compared to no perinatal risk factors. LimitationsOur model was focused on the perinatal CR score without including the effects of childhood risk factors. ConclusionsThe perinatal CR score is a valuable approach to identifying the subgroup of young people who are most at risk for depression symptoms. As such, early interventions that simultaneously address multiple perinatal risk factors for depression are recommended.

A sidewalk-level urban heat risk assessment framework using pedestrian mobility and urban microclimate modeling

Climate change and the associated increase in heat-related hazards pose a pressing threat to urban residents’ health and well-being. People, when walking in particular, are at risk of experiencing heat stress as they navigate urban environments. This study proposes a novel heat risk assessment framework combining pedestrian mobility modeling with urban microclimate modeling. Using this framework, we assessed pedestrian heat-related exposure and risk in urban areas by integrating the Universal Thermal Climate Index (UTCI) as the hazard and pedestrian trips to critical destinations as exposure. We considered temporal variation, in both hazard and exposure, by examining different time periods during the day—morning peak, midday, and evening peak. In addition to hazard and exposure, we also considered vulnerability by focusing on young children and older adults. We contribute to improving the spatial resolution of heat risk assessment by analyzing the hazard for pedestrian trips between home locations and five critical destinations—bus stops, rail stations, parks, schools, and commercial amenities—at the address-point level and using a pedestrian network comprising sidewalks and crosswalks. Our framework helps identify sidewalks with high heat exposure levels as well as home locations with high cumulative heat risk, accounting for walking trips to critical destinations along feasible routes. We demonstrated the effectiveness of this framework by applying it to a 36-square-kilometer area of central Los Angeles, CA. Our findings offer valuable information to urban planners and policy-makers, supporting evidence-based prioritization of intervention sites, climate adaptation strategies, and policy decisions essential for climate-proof planning. By implementing targeted interventions in areas where heat hazard is expected to affect the most vulnerable pedestrians, planners can create heat-resilient, pedestrian-friendly environments while prioritizing the health and well-being of vulnerable groups. This study contributes to the growing knowledge of robust risk assessment methodologies for climate-proof planning, specifically with regard to addressing outdoor heat-related risks during extreme heat events.

Mixed methods on adverse childhood experiences predicting transitional and recurrent homelessness.

Research has associated lack of parental care, physical abuse, and parental substance abuse to homelessness, with the presence of two or more such factors dramatically increasing one's chances of becoming homeless as an adult. Less clear is which (cumulation of) factors may mediate the difference between transitional and recurrent homelessness. Quantitative analysis of four risk factors-addiction, weak social network, criminal activity, psychopathology-among 69 transitionally and recurrently homeless (RH) adults, followed by in-depth qualitative analysis of adverse childhood experiences (ACEs) among 30 selected participants. RH participants had higher cumulative risk and a higher prevalence and broader range of ACEs than transitionally homeless participants, with the prevalence of childhood physical abuse marking the greatest difference between the two groups. Recurrent homelessness was also correlated with addiction to hard drugs, criminal activity, and weak social networks. Longitudinal and intervention studies in larger groups are needed to assess causality.

Stereotactic Radiosurgery Outcomes in Arteriovenous Malformations: A Pediatric-Adult Comparative Meta-Analysis

Stereotactic radiosurgery (SRS) is an established treatment for brain arteriovenous malformations (AVMs), but outcomes between pediatric and adult populations are not well compared. We conducted a systematic review and meta-analysis comparing SRS outcomes for pediatric versus adult AVMs. PubMed was searched for studies reporting SRS outcomes for pediatric or adult AVMs up to January 2024. Primary outcome was obliteration rate, with secondary outcomes including post-SRS hemorrhage, symptomatic radiation-induced changes (RICs), and permanent RICs. Pooled estimates were calculated using random effects models. Analysis included 22 studies with 3469 patients (1316 pediatric, 2153 adult). Pooled obliteration rate was 63% (95% confidence interval: 56%-70%) overall, with no significant difference between pediatric (61%) and adult (67%) cohorts (P= 0.38). Post-SRS hemorrhage rates were similar (5% pediatric, 6% adult, P= 0.60). Symptomatic RICs occurred in 9% (95% confidence interval: 6%-13%) overall, with 10% in both cohorts (P= 0.91). Permanent RIC rates were 4% in pediatric and 3% in adult cohorts (P= 0.43). Cyst formation (0.6%) and radiation-induced tumors (0.2%) were rare. All-cause mortality was significantly lower in the pediatric cohort (2.6% vs. 9.8%, P= 0.003). Hemorrhagic AVM presentation was inversely correlated with symptomatic RICs across both groups. SRS is a reasonable treatment option for appropriately selected AVM patients in both pediatric and adult populations, offering comparable obliteration rates and adverse event profiles. The lower mortality in pediatric patients underscores the importance of early intervention in this population given their high cumulative lifetime rupture risks.

Predictors of low and very low bone mineral density in long-term childhood acute lymphoblastic leukemia survivors: Toward personalized risk prediction.

Cohorts of childhood acute lymphoblastic leukemia (cALL) survivors reaching adulthood are increasing. Approximately 30% of survivors meet criteria for low bone mineral density (BMD) 10years after diagnosis. We investigated risk factors for low BMD in long-term cALL survivors. We recruited 245 cALL survivors from the PETALE (Prévenir les effets tardifs des traitements de la leucémie aiguë lymphoblastique chez l'enfant) cohort, who were treated with the Dana Farber Cancer Institute protocols, did not experience disease relapse or hematopoietic stem cell transplants, and presented with more than 5years of event-free survival. Median time since diagnosis was 15.1years. Prevalence of low DXA-derived BMD (Z-score ≤-1) ranged between 21.9% and 25.3%, depending on site (lumbar spine (LS-BMD), femoral neck (FN-BMD), and total body (TB-BMD), and between 3.7% and 5.8% for very low BMD (Z-score ≤-2). Males had a higher prevalence of low BMD than females for all three outcomes (26%-32% vs. 18%-21%), and male sex acted as a significant risk factor for low BMD in all models. Treatment-related factors such as cumulative glucocorticoid (GC) doses and cranial radiation therapy (CRT) were associated with lower BMDs in the full cohort and in females at the FN-BMD site. Low and very low BMD is more prevalent in male cALL survivors. Male sex, high cumulative GC doses, CRT, risk group, and low body mass index (BMI) were identified as risk factors for low BMD. A longer follow-up of BMD through time in these survivors is needed to establish if low BMD will translate into a higher risk for fragility fractures through adulthood.

An Update on Triad Prevalence and Exploratory Hormonal Biomarker Analyses in Ultramarathon Runners

Objective: To update the prevalence of male and female athlete Triad risk factors in ultramarathon runners and present exploratory analyses examining correlations between bone mineral density (BMD) and hormones. Design: Multiyear cross-sectional study. Setting: Western States Endurance Run 100-mile race. Participants: Participants were recruited in 2018 and 2019 for our prior cohort. We added an additional cohort in 2021. Assessment of Risk Factors: Participants completed laboratory evaluations of sex hormones, vitamin D, and ferritin (2019 and 2021 cohorts only); dual energy x-ray absorptiometry; and surveys evaluating nutritional habits, menstrual history, and injury history. Main Outcome Measures: The Triad cumulative risk assessment was assessed for each participant. Results: One hundred seventy-nine runners participated (123 men and 56 women). 61.1% of women and 28.1% of men were at moderate or high cumulative risk for the Triad. In women, there were significant correlations between hip and femoral neck BMD and total testosterone (Spearman correlation coefficient r = 0.58, P = 0.001; r = 0.45, P = 0.01). In men, there were weak, significant correlations (r = 0.24-0.30, P = 0.01–0.04) between estradiol and vitamin D at most anatomic sites. Conclusions: Our results build on our prior CJSM publication. With the addition of about 50% more study participants in 2021, we observed a stable, high prevalence of Triad risk factors, which represents a more precise measurement and highlights the need for future Triad research in the ultramarathon population. We found significant exploratory associations between hormones and BMD, which varied considerably from our prior publication and should be interpreted cautiously.

Genetic factors of thrombosis &lt;i&gt;FII G20210A&lt;/i&gt;, &lt;i&gt;FV G1691A&lt;/i&gt; (&lt;i&gt;Arg506Gln&lt;/i&gt;) in patients with thoracoabdominal malignant tumors

Introduction. Malignant tumor is one of the leading factors of venous and arterial thrombosis. But there is no data on the need for a genetic testing protocol of cancer patients for genetic predisposition thrombotic conditions, despite the fact that a number of polymorphisms of hemostasis genes are considered to be unconditionally proven factors of high cumulative thrombogenic risk, and proteins encoded by these genes are direct links in the cascades of pathological hypercoagulation in neoplastic processes.Aim. To identify groups of high genetic risk of thrombotic complications among patients with malignant thoracoabdominal tumors.Materials and methods. The study included 223 patients with malignant tumors of the lung, stomach, esophagus, operated in the Department of Thoracic Oncology of the N.N. Blokhin National Research Center of Oncology in 2018–2019. The study groups consisted of patients with myocardial infarction (n = 62), ischemic stroke (n = 24), venous thrombosis/ venous thromboembolic complications (n = 40), patients without cardiovascular diseases, but with a family history burdened by cardiovascular diseases (n = 33). The control group included 81 patients.Results. Among patients with malignant tumors of thoracoabdominal localization, a statistically significant difference was determined in the frequency of carriage of the heterozygous genotype FV 1691GA (Arg506Gln) in patients who had a myocardial infarction (χ2 = 4.0; p = 0.046), who had venous thrombosis (χ2 = 4.118; p = 0.043), in the group of patients with burdened with a family history (χ2 = 4.997; p = 0.026) in comparison with the control group. Statistically significant difference in the frequency of carriage of the heterozygous variant of the mutation in the FII G20210A gene relative to the control group, it was determined in the group of patients who had an acute cerebrovascular accident (χ2 = 6.881; p = 0.009) and among patients with a burdened history (χ2 = 7.563; p = 0.006).Conclusion. In order to assess the risk of development and prevention of thrombotic complications in the perioperative period in patients with malignant thoracoabdominal tumors, who have suffered myocardial infarction, ischemic stroke, venous thrombosis/venous thromboembolic complications, as well as patients without cardiovascular pathology, but with thrombotic conditions in relatives of the first degree, it is advisable to perform DNA diagnostics at the prehospital stage to identify of gene polymorphisms FII G20210A and FV G1691A (Arg506Gln).

Abstract 4792: Nationwide patterns of incidence and surveillance of second primary lung cancer among long-term lung cancer survivors using SEER Medicare data

Abstract Background: With advances in screening and therapy, the number of lung cancer (LC) survivors is rapidly increasing, with over half a million as of 2019. Prior studies demonstrated that the incidence of second primary lung cancer (SPLC) among LC survivors is 4-6 times that of initial primary lung cancer (IPLC) in the general population. However, the incidence of SPLC and surveillance strategies using computed tomography (CT) have not been examined in long-term LC survivors with over 5-year survival. We aim to estimate SPLC incidence among long-term survivors and the effectiveness of annual surveillance CT exams. Methods: We used data from SEER-Medicare with a cohort of 1,232,338 LC patients from the SEER cancer registry followed till death or last follow-up, who were also enrolled in Medicare in 1999-2020. The study cohort included 12,948 patients who were long-term survivors (≥ 5-year survival from IPLC) by age 65, received curative therapy for IPLC, and were continuously enrolled in Medicare 1 year prior to 5 years after IPLC diagnosis. The primary outcome was the 10-year cumulative SPLC incidence accounting for competing risk of death in the full study cohort and by receipt of surveillance CTs post-5-year survival, defined using detailed billing and LC-related ICD codes. To qualify as surveillance CTs, two annual CTs 9-18 months apart is required. Cox regression was used as exploratory analysis to examine the association between LC-specific survival (LC as cause of death) and the receipt of two CTs post-5-year survival as a binary variable, adjusting for SPLC diagnosis, age, sex, marital status, race, IPLC stage, income, education, and poverty. Results: Of 12,948 long-term LC survivors, 46% (n=6,015) were male, 90% (n=11,476) had early-stage disease, 77% (n=9,945) had undergone surgery for initial curative treatment, and 3.8% (n = 486) received two surveillance CTs initiated within 18 months post-5-year survival. The 10-year cumulative incidence of SPLC was 5.06% [95% CI: 5.00-5.12%] in the SEER cohort but was substantially higher among long-term LC survivors at 13.6% [13.0-14.2%]. Those who received two annual surveillance CTs after 5-year survival had a significantly higher 10-year SPLC incidence (23.3% [19.4 - 27.2%]) than those who received one or no CT (13.2% [12.6 - 13.8%]). The adjusted hazard ratio of the association between LC-specific survival and receipt of two CTs was 0.67 [0.59-0.80, p &amp;lt; 0.0001]. Conclusions: The high cumulative risk of SPLC among long-term LC survivors warrants tailored surveillance strategies. Our exploratory analysis showed a high SPLC detection rate among those who received two annual surveillance CTs vs. those who did not, with significantly higher LC-specific survival in the former. Future work will include extensive analysis accounting for time-varying exposure of multiple surveillance CTs using rigorous causal inference methods. Citation Format: Chloe C. Su, Eunji Choi, Julie T. Wu, Allison W. Kurian, Michelle C. Odden, Manisha Desai, Leah M. Backhus, Heather A. Wakelee, Ann N. Leung, Joel W. Neal, Summer S. Han. Nationwide patterns of incidence and surveillance of second primary lung cancer among long-term lung cancer survivors using SEER Medicare data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4792.

Effect of gender on the association between cumulative cardiovascular risk factors and depression: results from the US National Health and Nutrition Examination Survey

BackgroundThe comorbidity of cardiovascular disease (CVD) and depression has been well established, as depression usually presents simultaneously with CVD risk factors. However, the potential association between cumulative exposure to CVD...

Kinetics of uptake and depuration of synthetic pyrethroid insecticides in manila clam (Ruditapes philippinarum).

Synthetic pyrethroid insecticides (SPIs) are frequently detected in water bodies and sediments, and they show high toxicity to aquatic organisms, but their toxicity kinetics remain unknown. In this work, the kinetics of uptake and depuration of three SPIs, fenpropathrin (FP), cypermethrin (CM) and deltamethrin (DM) were evaluated in manila clams (Ruditapes philippinarum) for the first time through a bioconcentration-semi-static test. Clams were exposed to three SPIs of different concentrations (2 ng/mL and 20 ng/mL) for 4 days, followed by a 10-day depuration stage. The results indicated that adult manila clams could absorb SPIs rapidly, and the bioconcentration factor (BCF) values of SPIs were different at high and low concentrations of contaminants. The depuration rate constants (k2) of SPIs in adult manila clams ranged from 0.024 h-1 to 0.037 h-1. The bioaccumulation factors ranged from 319.41 to 574.38. And the half-lives (t1/2) were in the range of 18.49 to 29.22 h. These results showed that manila clams have a high bioconcentration capacity, and SPIs have a high cumulative risk for bivalves. Moreover, after 10 days of elimination, SPIs can still be detected in manila clams at all concentrations, indicating that the complete elimination of SPIs required a longer time.

Weight cycling and risk of clinical adverse events in patients with heart failure with preserved ejection fraction: a post-hoc analysis of TOPCAT.

Previous studies hardly evaluated the association of variability of body mass index (BMI) or waist circumference with clinical adverse events and investigated whether weight cycling had an effect on the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). This study was a post-hoc analysis of TOPCAT. Three outcomes were evaluated: the primary endpoint, cardiovascular disease (CVD) death, and heart failure hospitalization. Among them, CVD death and hospitalization were outcomes of heart failure. Kaplan-Meier curves were used to describe the cumulative risk of outcome and were tested using the log-rank test. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95%CIs for outcomes. We also performed a subgroup analysis, and several subgroups were compared. A total of 3,146 patients were included. In the Kaplan-Meier curves, the coefficients of variation of both BMI and waist circumference were grouped according to quartiles, with the Q4 group having the highest cumulative risk (log-rank P < 0.001). In the coefficient of BMI variation and the outcomes, the HRs for group Q4 of coefficient of variation of BMI were 2.35 (95%CI: 1.82, 3.03) for the primary endpoint, 2.40 (95%CI: 1.69, 3.40) for death, and 2.33 (95%CI: 1.68, 3.22) for HF hospitalization in model 3 (fully adjusted model) compared with group Q1. In the coefficient of waist circumference variation and the outcomes, group Q4 had increased hazard of the primary endpoint [HR: 2.39 (95%CI: 1.84, 3.12)], CVD death [HR: 3.29 (95%CI: 2.28, 4.77)], and HF hospitalization [HR: 1.98 (95%CI 1.43, 2.75)] in model 3 (fully adjusted model) compared with group Q1. In the subgroup analysis, there was a significant interaction in the diabetes mellitus subgroup (P for interaction = 0.0234). Weight cycling had a negative effect on the prognosis of patients with HFpEF. The presence of comorbid diabetes weakened the relationship between waist circumference variability and clinical adverse events.

Platelet-to-Lymphocyte Ratio (PLR) as the Prognostic Factor for Recurrence/Residual Disease in HSIL Patients After LEEP.

The platelet-to-lymphocyte ratio (PLR) is considered correlated with cancer prognosis including cervical cancer, in addition to high-risk papillomavirus (HR-HPV) infection, of which the predictive value in prognosis of high-grade squamous intraepithelial lesions (HSILs) remains unknown. Here, the prognostic predictive value of PLR in HSIL after loop electrosurgical excision procedure (LEEP) was evaluated. This study included 335 nonpregnant participants with histopathologically confirmed HSIL and 3- and 5-year follow-ups from the Fujian Cervical Lesions Screening Cohorts (FCLSCs) between September 2016 and September 2018. PLR and other variables were evaluated to identify the factors related to the recurrence/residual cervical intraepithelial neoplasia (CIN)-free survival (RFS), namely, the time from LEEP at baseline to first detection of recurrence/residual CIN or end of follow-up, by logistic and Cox regression. In the Kaplan‒Meier analysis, HR-HPV infection (p=0.049/0.012), higher PLR (p=0.031/0.038), and gland invasion (p=0.047) had a higher risk for recurrence/residual CIN at the 3-/5-year follow-up. The univariate logistic and Cox regression analyses showed significant differences and a higher cumulative risk in patients with HR-HPV infection (OR=3.917, p=0.026; HR=3.996, p=0.020) and higher PLR (OR=2.295, p=0.041; HR=2.161, p=0.030) at the 5-year follow-up. The findings by multivariate Cox regression analysis were similar, indicating a poor prognosis for patients with HR-HPV infection (HR=3.901, p=0.023) and higher PLR (HR=2.082, p=0.038) at the 5-year follow-up. The calibration plot showed a better model fit for RFS at the 3-year follow-up. Preoperative PLR level and HR-HPV infection could be available markers for predicting recurrence/residual disease of HSIL after LEEP. Clinically, combining PLR with HR-HPV tests may provide novel evaluation method and reference for management in post-treatment patients with cervical precancerous lesions.

Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network

Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and the determinants that potentially affect mortality are poorly evaluated. We assessed the prognosis of VAP in severe COVID-19 cases and the impact of relapse, superinfection, and treatment failure on 60-day mortality. Methods: We evaluated the incidence of VAP in a multicenter prospective cohort that included adult patients with severe COVID-19, who required mechanical ventilation for ≥48 h between March 2020 and June 2021. We investigated the risk factors for 30-day and 60-day mortality, and the factors associated with relapse, superinfection, and treatment failure. Results: Among 1424 patients admitted to eleven centers, 540 were invasively ventilated for 48 h or more, and 231 had VAP episodes, which were caused by Enterobacterales (49.8%), P. aeruginosa (24.8%), and S. aureus (22%). The VAP incidence rate was 45.6/1000 ventilator days, and the cumulative incidence at Day 30 was 60%. VAP increased the duration of mechanical ventilation without modifying the crude 60-day death rate (47.6% vs. 44.7% without VAP) and resulted in a 36% increase in death hazard. Late-onset pneumonia represented 179 episodes (78.2%) and was responsible for a 56% increase in death hazard. The cumulative incidence rates of relapse and superinfection were 45% and 39.5%, respectively, but did not impact death hazard. Superinfection was more frequently related to ECMO and first episode of VAP caused by non-fermenting bacteria. The risk factors for treatment failure were an absence of highly susceptible microorganisms and vasopressor need at VAP onset. Conclusions: The incidence of VAP, mainly late-onset episodes, is high in COVID-19 patients and associated with an increased risk of death, similar to that observed in other mechanically ventilated patients. The high rate of VAP due to difficult-to-treat microorganisms, pharmacokinetic alterations induced by renal replacement therapy, shock, and ECMO likely explains the high cumulative risk of relapse, superinfection, and treatment failure.

Parental affect profiles predict child emotion regulation and classroom adjustment in families experiencing homelessness

AbstractParenting shapes the development of emotion regulation skills in early childhood, laying a key foundation for social‐emotional adjustment. Unfortunately, high adversity exposure may disrupt parental emotion socialization practices and children's regulatory development. The current study used variable‐ and person‐centered approaches to evaluate links among parental emotion expressiveness, children's observed emotion regulation, and teacher‐reported adjustment among 214 4‐ to 6‐year‐old children experiencing homelessness, an indicator of high cumulative risk and acute adversity. Structured parent‐child interaction tasks were recorded on site in emergency shelters over the summer and micro‐socially coded for parent and child expressions of anger, positive affect, and internalizing distress. We anticipated that parental modeling of predominantly negative emotion expression would be associated with more child dysregulation during parent‐child interaction and worse adjustment at school, as reported by teachers the following school year. Preliminary analyses indicated that children's observed difficulty downregulating anger was associated robustly with teacher‐reported social‐behavioral problems. Latent profile analysis was used to identify three patterns of parental emotion expression characterized by above‐average expression of positive affect, internalizing distress, and anger. Parents’ likelihood of membership in the elevated anger profile significantly predicted children's observed difficulty down‐regulating anger and higher social‐behavioral problems at school. In addition to ongoing efforts to reduce poverty‐related risk, supporting adaptive anger regulation in parents and young children may be important for enhancing resilience among families experiencing homelessness and similar conditions of high cumulative risk.

One-year recurrence of stroke and death in Lebanese survivors of first-ever stroke: Time-to-Event analysis.

To date, despite the application of secondary prevention worldwide, first-ever stroke survivors remain at imminent risk of stroke recurrence and death in the short and long term. The present study aimed to assess the cumulative risk rates and identify baseline differences and stroke characteristics of Lebanese survivors. A prospective longitudinal study was conducted among survivors ≥18 years old who were followed-up for 15 months through a face-to-face interview. Kaplan-Meier method was used to calculate the cumulative rates of stroke mortality and recurrence. Cox-regression univariate and multivariable analyses were performed to identify the predictors of both outcomes. Among 150 subjects (mean age 74 ± 12 years; 58.7% men vs. 44.3% women; 95.3% with ischemic stroke vs. 4.3% with intracerebral hemorrhage), high cumulative risk rates of stroke recurrence (25%) and death (21%) were highlighted, especially in the acute phase. Survival rates were lesser in patients with stroke recurrence compared to those without recurrence (Log rank test p < 0.001). Older age was the main predictor for both outcomes (p < 0.02). Large artery atherosclerosis was predominant in patients with stroke recurrence and death compared to small vessel occlusion (p < 0.02). Higher mental component summary scores of quality of life were inversely associated with stroke recurrence (p < 0.01). Lebanese survivors exhibited the highest percentages of depression and anxiety; elevated Hospital Anxiety and Depression Scale (HADS) scores were seen in those with stroke recurrence and those who died (≥80% with mean HADS scores ≥8). Lower Mini-Mental State Examination scores at the acute phase increased the risk of both outcomes by 10% (p < 0.03). Three out of 13 mortalities (23.1%) were presented with early epileptic seizures (p = 0.012). High educational level was the protective factor against stroke recurrence (p = 0.019). Administration of intravenous thrombolysis decreased the risk of both outcomes by 10% (p > 0.05). Higher rates of stroke recurrence and death were observed in the first year following a stroke in Lebanon. Various factors were identified as significant determinants. Thus, health care providers and officials in Lebanon can use these findings to implement effective preventive strategies to best address the management of these factors to reduce the stroke burden and improve the short and long-term prognosis of stroke survivors.

Associations between cumulative risk, childhood sleep duration, and body mass index across childhood

BackgroundAlthough associations between cumulative risk, sleep, and overweight/obesity have been demonstrated, few studies have examined relationships between these constructs longitudinally across childhood. This study investigated how cumulative risk and sleep duration are related to current and later child overweight/obesity in families across the United States sampled for high sociodemographic risk.MethodsWe conducted secondary analyses on 3690 families with recorded child height and weight within the Fragile Families and Child Well-Being Study. A cumulative risk composite (using nine variables indicating household/environmental, family, and sociodemographic risk) was calculated for each participant from ages 3-9 years. Path analyses were used to investigate associations between cumulative risk, parent-reported child sleep duration, and z-scored child body mass index (BMI) percentile at ages 3 through 9.ResultsHigher cumulative risk experienced at age 5 was associated with shorter sleep duration at year 9, b = − 0.35, p = .01, 95% CI [− 0.57, − 0.11]. At 5 years, longer sleep duration was associated with lower BMI, b = − 0.03, p = .03, 95% CI [− 0.06, − 0.01]. Higher cumulative risk at 9 years, b = − 0.34, p = .02, 95% CI [− 0.57, − 0.10], was concurrently associated with shorter sleep duration. Findings additionally differed by child sex, such that only male children showed an association between sleep duration and BMI.ConclusionsResults partially supported hypothesized associations between child sleep duration, cumulative risk, and BMI emerging across childhood within a large, primarily low socioeconomic status sample. Findings suggest that reducing cumulative risk for families experiencing low income may support longer child sleep duration. Additionally, child sleep duration and BMI are concurrently related in early childhood for male children.

Radioactive Iodine Treatment for Thyroid Cancer Patients Increases the Risk of Long-Term Gastrointestinal Disorders: A Nationwide Population-Based Cohort Analysis.

Simple SummaryThe standard treatment for well-differentiated thyroid cancer is thyroidectomy followed by radioactive iodine (RAI) treatment or active surveillance. Despite adequate documentation of acute gastrointestinal adverse effects after RAI treatment, whether the gastrointestinal exposure causes long-term comorbidity or not remained unclear. We conducted a nationwide, population-based retrospective cohort study using the data from the Taiwan National Health Insurance Research Database (NHIRD) to clarify the association between long-term gastrointestinal disorders (including ulcers, atrophic gastritis, and secondary stomach malignancy) and RAI treatment in thyroid cancer patients. We found that patients with RAI treatment were at a significantly higher risk of developing gastric and duodenal ulcers than those without. In addition, a higher cumulative dose is associated with higher risk. Therefore, follow-ups at gastrointestinal clinics might be of great importance for patients presenting with chronic gastrointestinal discomforts, after receiving a single RAI dose of more than 1.11 GBq, and undergoing repeated treatment due to recurrent or residual thyroid cancer.(1) Background: The study aimed to investigate the association between radioactive iodine (RAI) treatment and long-term gastrointestinal disorders including ulcers, atrophic gastritis, and secondary malignant neoplasm of the stomach in patients with thyroid cancer. (2) Methods: The data of the study were extracted from the National Health Insurance Database (NHIRD) of Taiwan between 2000 to 2015. Patients of ages older than 20 with thyroid cancer after thyroidectomy were included and divided into groups with RAI (study cohort) and without RAI (comparison cohort). Multivariate Cox proportional hazards regression analysis and the Kaplan–Meier method were used for statistical analysis. (3) Results: A total of 7250 (with RAI: 5800, without RAI: 1450) patients were included. The Kaplan-Meier analysis revealed a significantly higher cumulative risk for overall gastrointestinal disorders in the group with RAI (log-rank p = 0.034). The risk for gastrointestinal disorders was higher when receiving a cumulative RAI dose higher than 1.11 GBq in the Cox regression analysis. In the subgroup analysis, the risks of gastric and duodenal ulcers are significantly higher in the group with RAI treatment. (4) Conclusions: This study revealed that RAI was associated with an increased risk for long-term gastrointestinal disorders, specifically gastric and duodenal ulcers, in thyroid cancer, especially when the cumulative dose exceeds 1.11 GBq.

Assessing Breast Cancer Risks to Improve Care for an Increased-Risk Population within Eastern North Carolina.

BACKGROUND The average lifetime risk of breast cancer for an American woman is 12.5%, but individual risks vary significantly. Risk modeling is a standard of care for breast cancer screening and prevention with recommended tools to stratify individual risks based on age, family history, breast density, and a host of other known risk factors. Because of a lack of resources rurally, we have not consistently met this standard of care within all of North Carolina.METHODS We implemented a quality improvement project to assess the risk for breast cancer by gathering data on community risks. We implemented an evidence-based tool (Tyrer-Cuzick) for quantifying risk within a mostly rural population of Eastern North Carolina and developed customized services for women meeting elevated-risk definition. These services included additional imaging for elevated-risk women and a risk-reduction program. We also assessed genetic risks for hereditary breast and ovarian cancer in our at-risk population using National Comprehensive Cancer Network (NCCN) guidelines based on family history and added local genetics extenders to help test more women. We analyzed data regularly using Plan-Do-Study-Act methods to improve outcomes over 1 year.RESULTS We screened a population of 4500 women at a community hospital over a 1-year period for their individual lifetime cancer risk and genetic risk. Breast cancer risk was quantitated at the time of mammography, and women were stratified into 3 groups for risk management. Within our screening population, 6.3% of women were at high risk (defined by a lifetime breast cancer risk greater than or equal to 20%) and another 8.1% were above-average risk (defined by a lifetime breast cancer risk of 15%-20%). These women (14.4%) could potentially benefit from additional risk-management strategies. Additionally, 20% of all unaffected women within a typical screening population of Eastern North Carolina met NCCN guidelines for hereditary breast cancer and ovarian cancer testing independent of their cancer risk score. Using a model of targeted intervention within a population with elevated risks can be helpful in improving outcomes.LIMITATIONS This population within Eastern North Carolina is mostly rural and represents a potentially biased population, as it involves older women undergoing annual mammography. It may not be broadly applicable to the entire population based on age, geography, and other risks.CONCLUSIONS This model for improving cancer risk assessment and testing at a small community hospital in Eastern North Carolina was successful and addressed a community need. We discovered a high rate of increased-risk women who can benefit from individualized risk management, and a higher percentage of women who potentially benefit from genetic testing. These higher cumulative risks may in part explain some of the disparities seen for breast-cancer-specific outcomes in some parts of the state.

A comparison of clinicopathologic features of prostate cancer between Nigerian and South African black men

BackgroundGlobally, prostate cancer (PCa) is the commonest non-cutaneous male malignancy. It is more aggressive among black men with little known reasons as to the cause and continued trend among black men. This disproportionate pattern of PCa especially among black men of African ancestry resident in Africa calls for a closer look. Nigeria and South Africa, combined, have the highest cumulative risk incidence of PCa in Africa. The present study investigated the clinicopathologic behaviour of PCa among Nigerian and South African black men and the relationship between the disease and socio-demographic characteristics alongside medical co-morbidities.MethodsA retrospective cross-sectional study was undertaken in which de-identified records of 234 black men with pathologically confirmed PCa between 2007 and 2017 from two tertiary hospitals, in Nigeria (National Hospital, Abuja) and South Africa (Tygerberg Hospital, Cape Town), were reviewed.ResultsMedian age at presentation from both countries was 66 years (interquartile range, IQR 61–73 years) while the median PSA at presentation was 46 ng/ml (IQR 16–336.5 ng/ml). Half of the men (117/234) presented with locally advanced disease while metastatic disease was observed in 65.9% (27/41) of Nigerian men and 34.1% (14/41) of South African men. Thirty-three per cent of the men presented with organ-confined disease. Overall, Nigerian men presented with less organ-confined disease and significantly higher stage of disease (p < 0.001). Risk stratification using PSA, Gleason scores and T-staging showed that 84.2% (n = 197) of all the men presented with high-risk PCa disease. There was a statistically significant difference between Nigerian and South African black men (p = 0.003) in terms of disease risk at presentation. Logistic regression analysis showed that age (Adjusted OR 1.053 (95% CI 1.003–1.106), p = 0.003) and country of residence (Adjusted OR 4.281 (95% CI 1.690–10.844), p = 0.002) had a statistically significant relationship with high risk of PCa while disease co-morbidities (like diabetes and hypertension) and rural/urban location in both countries did not.ConclusionsDisparities exist between PCa presentation and clinicopathologic behaviour among Nigerian and South African black men. Nigerian men showed higher disease risk at presentation. Environmental-genetic interactions need further exploration in the aetio-pathogenesis of PCa in black men of African ancestry.

Variation and factors on heavy metal speciation during co-composting of rural sewage sludge and typical rural organic solid waste

In this study, a co-composting of rural organic solid waste (rural sewage sludge, kitchen waste and corn stalks) was conducted to analyze the variation of heavy metals (As, Cu, Cr, Ni, Pb, Hg, and Zn) and their major influencing factors. During composting, significant changes were observed in the total contents of heavy metals (p < 0.01): the total concentrations of As, Cu, Hg, Pb and Zn increased by 7.5%, 54.1%, 26.3%, 15.8%, and 34.2%, whereas that of Cr and Ni decreased by 71.3% and 33.4%, respectively. Heavy metals were mainly bound to the oxidizable and residual fractions. Spearman and Redundancy analysis (RDA) indicated that substances were significantly correlated with the changes in speciation of heavy metals, among all the factors, while pH and temperature were the dominating environmental influencing parameters. Several metal-resistant bacterial genera (Pseudomonas, Paenibacillus, Bacillus, Acinetobacter, Desulfovibrio, and Ochrobactrum, etc) were observed, with significant explanatory capacity for the changes in heavy metals. Composting showed a poor effect on heavy metal passivation, except for that of As. After composting, the heavy metal contents were consistent with the application standards. The evaluation of potential ecological risk showed a high cumulative ecological risk (336.9) of heavy metals. This study provides technical support and practical information for the disposal and safe recycling for rural organic solid waste.