Overall Pattern Of Associations Research Articles

Abstract B152: Joint Associations of Neighborhood Socioeconomic Status and Education on the Incidence of Colorectal Cancer: The Multiethnic Cohort Study

Abstract Background: Colorectal cancer (CRC) is the 3rd most diagnosed cancer worldwide. When considered separately, both neighborhood- and individual-level SES exposures have been associated with CRC incidence. However, the joint associations of neighborhood- and individual-level SES on CRC incidence have not been examined. Methods: In a prospective study of 153,725 Multiethnic Cohort (MEC) participants (24,764 African American, 44,447 Japanese American, 34,974 Latino, 11,511 Native Hawaiian, and 38,029 White participants) recruited from predominantly Los Angeles County, California (CA), and Hawaii (HI), we examined the joint association of neighborhood SES (nSES) and individual-level education with CRC incidence (CA: 2,519, HI: 2,210 cases). Education, other demographics, and health behaviors were self-reported in the baseline questionnaire (1993-1996). CRC diagnosis was determined via linkages with state cancer registries. nSES was derived using a composite score based on 1990 US Census block group data and assigned to geocoded baseline addresses. Our joint SES measure included four categories: high nSES (quintiles 4-5) and high education (> high school), high nSES and low education (≤ high school), low nSES (quintiles 1-3) and high education, and low nSES and low education. State-specific hazards ratios (HR) for CRC incidence were estimated for joint SES categories. Cox regression adjusted for age at cohort entry, CRC family history, polyp history, obesity, diabetes, diet, alcohol, smoking, physical activity, and NSAID, multivitamin, and hormone therapy use. Subgroup analyses were conducted by sex, race, and ethnicity. Results: For HI MEC participants, compared to individuals with high nSES and high education, risk for CRC was highest among those with low nSES and low education (HR=1.27; 95% CI:1.11-1.45) followed by high nSES and low education (HR=1.25; 95% CI:1.12-1.41), and low nSES and high education (HR=1.17; 95% CI: 1.03-1.31). This pattern of association was observed across sex but differed across race and ethnicity (p-heterogeneity=0.04). The overall pattern of association was observed among White participants in HI. However, for Japanese American individuals in HI, compared to those with high nSES and high education, risk for CRC was highest for low nSES and high education (HR=1.29; 95% CI:1.09-1.53) and high nSES and low education (HR= 1.28; 95% CI; 1.10-1.50). For Native Hawaiian individuals, compared to those with high nSES and high education, CRC risk was highest for those with low nSES and low education (HR=1.70; 95% CI: 1.20-2.42). Associations were not statistically significant between the joint SES measure and CRC risk in CA (HRs: 0.92-0.97). Conclusion: Among MEC participants in HI, CRC risk varied with the joint measure of nSES and education across racial and ethnic groups. These findings emphasize the importance of considering the joint associations of neighborhood- and individual-level SES in understanding racial and ethnic disparities in CRC. Citation Format: Catherine Walsh, Meera Sangaramoorthy, Songyi Park, Sung-shim (Lani) Park, Gertraud Maskarinec, Lynne Wilkens, Christopher Haiman, Anna Wu, Salma Shariff-Marco, Loic Le Marchand, Iona Cheng. Joint Associations of Neighborhood Socioeconomic Status and Education on the Incidence of Colorectal Cancer: The Multiethnic Cohort Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B152.

Patterns of risk for diabetic retinopathy in the Mumbai slums: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study (AJ-DRUMSS) Report 3.

Diabetes onset precedes diabetic retinopathy (DR) by 5-10 years, but many people with diabetes remain free of this microvascular complication. Our aim was to identify risk factors for DR progression in a unique and diverse population, the slums of Mumbai. We performed a nested case-control study of 1163 diabetics over 40 years of age from slums in 18 wards of Mumbai. Data was collected on 33 variables and assessed for association with DR using both univariate and multivariate analyses. Stratified analyses were also performed on males and females, separately. Among hypertensive individuals we also assessed whether duration of hypertension associated with DR. Of 31 non-correlated variables analysed as risk factors for DR, 15 showed evidence of significant association. The most prominent included sex, where being a female associated with decreased odds of DR, while longer duration of diabetes and poor glycaemic control associated with increased odds. The duration of diabetes effect was partially, but significantly, mediated by age of diabetes diagnoses (8.6% of variance explained, p = 0.012). Obesity as measured by several measures, including body mass index (BMI) and measures of central obesity had a negative association with DR; increased measures of obesity consistently reduced odds of DR. As in most earlier studies, DR was associated with the duration of diabetes and glycaemic control. However, other factors, especially obesity related measures were associated with DR, in ways that contrast with most prior studies. These results indicated that the overall pattern of association in the Mumbai slums was novel. Thus, in previously uncharacterized populations, such as the slums that we examined, it is important to evaluate all risk factors de novo to appropriately assess patterns of association as the patterns of association with DR can be complex and population specific.

Older Adults' Loneliness and Social Relationships in the Philippines: Comparison Between Rural and Urban Contexts.

This study compared patterns of association between social relationship measures and levels of loneliness for rural and urban older adults in the Philippines. We analyzed social relationship measures and loneliness scores (UCLA Three-Item Loneliness Scale) of a nationally representative sample of Filipino adults 60 years and older in the baseline survey of the 2018 Longitudinal Study of Ageing and Health in the Philippines (LSAHP) (n=4,704). The loneliness score was slightly higher for rural older adults (5.8) than for their urban counterparts (5.1; p=.0001). A significantly larger proportion of older adults in rural areas (12.7%) lived alone than in urban areas (5.4%; p=.0008). The overall pattern of association between social relationship measures and loneliness scores for the two groups was mostly similar. For both groups, living alone, having less active social involvement, and seeing friends less frequently were related to higher levels of loneliness. Poorer subjective financial well-being (e.g., the perception of considerable difficulty in making ends meet) was also significantly associated with higher loneliness scores. These findings suggest that the prevention of loneliness for older adults in countries in the early stages of population aging such as the Philippines requires a broad range of public health initiatives.

Child mental health problems as a risk factor for academic underachievement: A multi-informant, population-based study.

ObjectiveTo investigate whether child mental health problems prospectively associate with IQ‐achievement discrepancy (i.e., academic under‐ and over‐achievement) in emerging adolescence. The secondary aims were to test whether these associations are specific to certain mental health problems, to assess potential sex differences, and to examine whether associations are robustly observed across multiple informants (i.e., maternal and teacher‐reports).MethodsThis study included 1,577 children from the population‐based birth cohort the Generation R Study. Child mental health problems at age 6 were assessed by mothers and teachers using the Child Behavior Checklist and the Teacher's Report Form. The IQ‐achievement discrepancy was quantified as the standardized residuals of academic achievement regressed on IQ, where IQ was measured with four tasks from the Wechsler Intelligence Scale for Children‐Fifth Edition around age 13 and academic attainment was measured with the Cito test, a national Dutch academic test, at the end of elementary school (12 years of age).ResultsMental health problems at age 6 were associated with IQ‐achievement discrepancy at age 12, with more problems associating with greater academic underachievement. When examining specific mental health problems, we found that attention problems was the only mental health problem to independently associate with the IQ‐achievement discrepancy (adjusted standardized difference per 1‐standard deviation, mother: −0.11, p < 0.001, 95% CI [−0.16, −0.06]; teacher: −0.13, p < 0.001, 95% CI [−0.18, −0.08]). These associations remained after adjusting for co‐occurring mental health problems. The overall pattern of associations was consistent across boys and girls and across informants.ConclusionMental health problems during the transition from kindergarten to elementary school associate with academic underachievement at the end of elementary school. These associations were primarily driven by attention problems, as rated by both mothers and teachers—suggesting that strategies targeting attention problems may be a particularly promising avenue for improving educational performance irrespective of IQ, although this should be established more thoroughly through further research.

Modest effects of dietary supplements during the COVID-19 pandemic: insights from 445 850 users of the COVID-19 Symptom Study app

ObjectivesDietary supplements may ameliorate SARS-CoV-2 infection, although scientific evidence to support such a role is lacking. We investigated whether users of the COVID-19 Symptom Study app who regularly took dietary...

Associations between cognition and white matter microstructure in first-episode antipsychotic-naïve patients with schizophrenia and healthy controls: A multivariate pattern analysis

BackgroundCognitive functions have been associated with white matter (WM) microstructure in schizophrenia, but most studies are limited by examining only select cognitive measures and single WM tracts in chronic, medicated patients. It is unclear if the cognition-WM relationship differs between antipsychotic-naïve patients with schizophrenia and healthy controls, as differential associations have not been directly examined. Here we examine if there are differential patterns of associations between cognition and WM microstructure in first-episode antipsychotic-naïve patients with schizophrenia and healthy controls, and we characterize reliable contributors to the pattern of associations across multiple cognitive domains and WM regions, in order to elucidate white matter contribution to the neural underpinnings of cognitive deficits. MethodsThirty-six first-episode antipsychotic-naïve patients with schizophrenia and 52 matched healthy controls underwent cognitive tests and diffusion-weighted imaging on a 3T Magnetic Resonance Imaging scanner. Using a multivariate partial least squares correlation analysis, we included 14 cognitive variables and mean fractional anisotropy values of 48 WM regions. ResultsInitial analyses showed significant group differences in both measures of WM and cognition. There was no group interaction effect in the pattern of associations between cognition and WM microstructure. The combined analysis of patients and controls lead to a significant pattern of associations (omnibus test p = .015). Thirty-four regions and seven cognitive functions contributed reliably to the associations. ConclusionsThe lack of an interaction effect suggests similar associations in first-episode antipsychotic-naïve patients with schizophrenia and healthy controls. This, together with the differences in both WM and cognitive measurements, supports the involvement of WM in cognitive deficits in schizophrenia. Our findings add to the field by showing a coherent picture of the overall pattern of association between cognition and WM. These findings increase our understanding of the impact of WM on cognition, contributing to the search for neuromarkers of cognitive deficits in schizophrenia.

The relations between early-life stress and risk, time, and prosocial preferences in adulthood: A meta-analytic review

Abstract This meta-analytic review aims to address the mixed findings in previous research by quantifying the associations between early-life stress and risk, time, and prosocial preferences, and testing the boundary conditions of these associations. We meta-analyze 123 articles reporting 867 effect sizes among 199,019 adults to test different predictions from a life history perspective, a sensitization perspective, and an uncertainty management perspective about how early-life stress is associated with risk, time, and prosocial preferences. First, we find relatively small effect sizes indicating that early-life stress is associated with greater risk taking (r = .123), more present orientation (r = .126), and less prosociality (r = -.085), and its positive association with present orientation is stronger in currently stressful situations. Second, these observed associations do not vary significantly for harshness and unpredictability dimensions of early-life stress. Notably, moderation analyses across different types of preference measures only reveal an overall pattern of associations of early-life stress with self-report measures of risk, time, and prosocial preferences. By contrast, early-life stress is not significantly associated with risk preference or prosocial preference measured with hypothetical choice tasks or laboratory behavior tasks. Taken together, although the overall pattern of results supports a life history perspective, a cautious interpretation is warranted by the variation in the results across different preference measures and potential publication bias in the results. More pre-registered studies are needed to test the extent to which preferences measured with arbitrary laboratory-based tasks capture real-world behaviors and to increase the ecological validity of laboratory-based measures.

Two Swedish screening instruments for exhaustion disorder: cross-sectional associations with burnout, work stress, private life stress, and personality traits.

To examine the relationships of two screening instruments recently developed for assessment of exhaustion disorder (ED) with some other well-known inventories intended to assess ED-related concepts and self-reports of job demands, job control, job support, private life stressors, and personality factors. A cross-sectional population sample ( n = 1355) completed: the Karolinska Exhaustion Disorder Scale (KEDS), Self-reported Exhaustion Disorder Scale (s-ED), Shirom-Melamed Burnout Questionnaire (SMBQ), Utrecht Work Engagement Scale (UWES-9), Job Content Questionnaire (JCQ), Big Five Inventory (BFI), and items concerning family-to-work interference and stress in private life. Compared to participants without any indication of ED, participants classified as having ED on KEDS or s-ED had higher scores on all four SMBQ subscales, lower scores on the UWES-9 subscales vigor and dedication, higher JCQ job demands scores, lower JCQ job support scores, higher degrees of family-to-work interference and stress in private life, and higher BFI neuroticism and openness scores. In addition, participants classified as having ED on KEDS had lower scores on the UWES-9 absorption subscale, the JCQ job control scale, and lower BFI extraversion, agreeableness and conscientiousness scores, compared to the subgroup not classified as having ED. As expected, we observed an overall pattern of associations between the ED screening inventories KEDS and s-ED and measures of burnout, work engagement, job demands-control-support, stress in private life, family-to-work interference, and personality factors. The results suggest that instruments designed to assess burnout, work engagement, and ED share common ground, despite their conceptual differences.

Personality Disorders in Older Adults: Findings From the National Epidemiologic Survey on Alcohol and Related Conditions

To examine the prevalence, sociodemographic correlates, psychiatric and medical comorbidities, and the disability of personality disorders among adults age 65 years and older. Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, focusing on a subsample of 8,205 adults age 65 years and older. A total of 8.07% (SE: 0.37) of American adults age 65 years and older presented at least one personality disorder. The most prevalent personality disorder was the obsessive-compulsive personality disorder. The overall pattern of associations between each personality disorder and lifetime psychiatric comorbidity correlates was statistically significant. Participants with a personality disorder show a lower quality of life than their counterparts. Personality disorders in older adults are highly associated with disability, medical, and psychiatric disorders. These findings highlight the need to develop more effective prevention and intervention programs in this specific population.

Associations between Pathogens in the Upper Respiratory Tract of Young Children: Interplay between Viruses and Bacteria

BackgroundHigh rates of potentially pathogenic bacteria and respiratory viruses can be detected in the upper respiratory tract of healthy children. Investigating presence of and associations between these pathogens in healthy individuals is still a rather unexplored field of research, but may have implications for interpreting findings during disease.Methodology/Principal FindingsWe selected 986 nasopharyngeal samples from 433 6- to 24-month-old healthy children that had participated in a randomized controlled trial. We determined the presence of 20 common respiratory viruses using real-time PCR. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus were identified by conventional culture methods. Information on risk factors was obtained by questionnaires. We performed multivariate logistic regression analyses followed by partial correlation analysis to identify the overall pattern of associations. S. pneumoniae colonization was positively associated with the presence of H. influenzae (adjusted odds ratio 1.60, 95% confidence interval 1.18–2.16), M. catarrhalis (1.78, 1.29–2.47), human rhinoviruses (1.63, 1.19–2.22) and enteroviruses (1.97, 1.26–3.10), and negatively associated with S. aureus presence (0.59, 0.35–0.98). H. influenzae was positively associated with human rhinoviruses (1.63, 1.22–2.18) and respiratory syncytial viruses (2.78, 1.06–7.28). M. catarrhalis colonization was positively associated with coronaviruses (1.99, 1.01–3.93) and adenoviruses (3.69, 1.29–10.56), and negatively with S. aureus carriage (0.42, 0.25–0.69). We observed a strong positive association between S. aureus and influenza viruses (4.87, 1.59–14.89). In addition, human rhinoviruses and enteroviruses were positively correlated (2.40, 1.66–3.47), as were enteroviruses and human bocavirus, WU polyomavirus, parainfluenza viruses, and human parechovirus. A negative association was observed between human rhinoviruses and coronaviruses.Conclusions/SignificanceOur data revealed high viral and bacterial prevalence rates and distinct bacterial-bacterial, viral-bacterial and viral-viral associations in healthy children, hinting towards the complexity and potential dynamics of microbial communities in the upper respiratory tract. This warrants careful consideration when associating microbial presence with specific respiratory diseases.

Managing Threat: Do Social‐Cognitive Processes Mediate the Link Between Peer Victimization and Adjustment Problems in Early Adolescence?

Peer victimization has been linked concurrently and over time with multiple adjustment problems. However, the reasons for this multi‐finality in victimization are not well understood. The current study examines social‐cognitive processes (hostile attributions, social perspective awareness, and interpersonal skills) as mediators of the relations between subtypes of peer victimization (relational, physical) and depression and anxiety, social withdrawal, and physical aggression in early adolescence. The overall pattern of associations among subtypes of victimization, social‐cognitive processes, and adjustment converged with expectations that victimization biases adolescents' cognitions about peers in conflict situations and skills relating to peers. In turn, these cognitions and skills differentially compromised their ability to regulate diverse emotions or limit reticent behaviors in response to peer threats. Modest gender differences in these associations were found.

Adaptive classification of marine ecosystems: Identifying biologically meaningful regions in the marine environment

The move to ecosystem-based management of marine fisheries and endangered species would be greatly facilitated by a quantitative method for identifying marine ecosystems that captures temporal dynamics at meso-scale (10s or 100s of kilometers) resolutions. Understanding the dynamics of ecosystem boundaries, which may differ according to the species of interest or the management objectives, is a fundamental challenge of ecosystem-based management. We present an adaptive ecosystem classification that begins to address these challenges. To demonstrate the approach, we quantitatively bounded distinct, biologically meaningful marine regions in the North Pacific Ocean based on physical oceanography. We identified the regions by applying image classification algorithms to a comprehensive description of the ocean's surface, derived from an oceanographic circulation model. Our resulting maps illustrate 15 distinct marine regions. The size and location of these regions related well to previously described water masses in the North Pacific. We investigated seasonal and long-term changes in the pattern of regions and their boundaries by dividing the oceanographic data into four seasons and two 10-year time periods, one on either side of the 1976–1977 North Pacific Ocean climate regime shift. We compared our results for each season across the regime shift and for sequential seasons within regimes using the Kappa Index of Agreement and the index of Average Mutual Information. Seasonal patterns were more similar between regimes than from one season to the next within a regime, while the magnitude of seasonal transitions appeared to differ before and after the regime shift. We assessed the biological relevance of the identified regions using seasonal maps derived from remotely sensed chlorophyll- a concentrations ([chl-a]). We used Kruskal–Wallis and Wilcoxon rank sum tests to evaluate the correspondence between the [chl-a] maps and our post-regime shift regions. There was a significant difference in [chl-a] among the regions in all seasons. We found that the number of regions with distinct chlorophyll signatures, and the associations between different regions, varied by season. The overall pattern of association between the regions was suggestive of observed, broad-scale patterns in the seasonal development and distribution of primary production in the North Pacific. This demonstrated that regions with different biological properties can be delineated using only physical variables. The flexibility of our approach will enable researchers to visualize the geographic extents of regions with similar physical conditions, providing insight into ocean dynamics and changes in marine ecosystems. It will also provide resource managers with a powerful tool for broad application in ecosystem-based management and conservation of marine resources.

Testing assumptions for endophenotype studies in ADHD: Reliability and validity of tasks in a general population sample

BackgroundAdvances in both genetic and cognitive-experimental studies on attention deficit hyperactivity disorder (ADHD) have opened new opportunities for cognitive endophenotype research. In such genetic designs the focus is on individual differences in characteristics, associated with ADHD, that can be measured reliably over time. Genetic studies that take a 'quantitative trait loci' approach hypothesise that multiple susceptibility genes contribute to a continuous dimension of ADHD symptoms. As an important initial step, we aimed to investigate the underlying assumptions that (1) key cognitive-experimental tasks indicate adequate test-retest reliability and (2) ADHD symptom scores in a general population sample are associated with performance on these tasks.MethodsForty-nine children were assessed on a go/no-go task and a reaction time task (the 'fast task') that included manipulations with event rate and incentives. The children were assessed twice, with a test-retest interval of two weeks.ResultsThe majority of the task variables demonstrated moderate-to-good test-retest reliability. The correlations between teacher ratings of ADHD symptoms and key task variables were .4–.6: ADHD symptoms were associated with poor performance (especially high reaction time variability) in a slow baseline condition, whereas there was low or no association in conditions with a faster event rate or incentives. In contrast, no clear pattern of findings emerged based on parent ratings of ADHD symptoms.ConclusionThe data support the usefulness of the go/no-go and fast tasks for genetic studies, which require reliable and valid indices of individual differences. The overall pattern of associations between teacher ratings of ADHD symptoms and task variables is consistent with effects of event rate and incentives on performance, as predicted by the model of activation and arousal regulation. The lack of a clear pattern of findings with parent ratings of ADHD symptoms warrants further study.

Breast cancer risk and historical exposure to pesticides from wide-area applications assessed with GIS.

Pesticides are of interest in etiologic studies of breast cancer because many mimic estrogen, a known breast cancer risk factor, or cause mammary tumors in animals, but most previous studies have been limited by using one-time tissue measurements of residues of only a few pesticides long banned in the United States. As an alternative method to assess historical exposures to banned and current-use pesticides, we used geographic information system (GIS) technology in a population-based case-control study of 1,165 women residing in Cape Cod, Massachusetts, who were diagnosed with breast cancer in 1988-1995 and 1,006 controls. We assessed exposures dating back to 1948 (when DDT was first used there) from pesticides applied for tree pests (e.g., gypsy moths), cranberry bogs, other agriculture, and mosquito control on wetlands. We found no overall pattern of association between pesticide use and breast cancer. We found modest increases in risk associated with aerial application of persistent pesticides on cranberry bogs and less persistent pesticides applied for tree pests or agriculture. Adjusted odds ratios for these exposures were 1.8 or lower, and, with a few exceptions, confidence intervals did not exclude the null. The study is limited by uncertainty about locations of home addresses (particularly before 1980) and unrecorded tree pest and mosquito control events as well as lack of information about exposures during years when women in the study lived off Cape Cod and about women with potentially important early life exposures on Cape Cod who were not included because they moved away.

Substance abuse, suicidality, and self-esteem in South African adolescents.

Associations among six different domains of self-esteem (peers, school, family, sports/athletics, body image, and global self-worth) and risk behaviors related to substance use and suicidality were investigated in a sample of South African adolescents. Students enrolled in Grades 8 and 11 at independent secondary schools in Cape Town (N = 116) completed the Self-Esteem Questionnaire (SEQ) and a questionnaire that asked about their participation in a range of risk behaviors. Logistic regression analyses indicated that particular domains of self-esteem were differentially associated with indicators of alcohol, cigarette and drug use and suicidal ideation or behaviors in adolescents. Family self-esteem showed the strongest overall pattern of associations with the risk behaviors. Overall, the findings of this study suggest that interventions which aim to protect adolescents from engaging in risk behaviors by increasing their self-esteem are likely to be most effective and cost-efficient if they are aimed at the family and school domains.

Is household antibiotic use a risk factor for antibiotic-resistant pneumococcal infection?

We used microbiology and pharmacy data from health-maintenance organizations to determine whether antibiotic use by a household member increases the risk of penicillin-non-susceptible pneumococcal disease. Though it has been well established that an individual's antibiotic use increases one's risk of antibiotic-resistant infection, it is unclear whether the risk is increased if a member of one's household is exposed to antibiotics. We therefore conducted a case-control study of patients enrolled in health maintenance organizations in Western Washington and Northern California. Cases were defined as individuals with penicillin-non-susceptible pneumococcal infection; controls were individuals with penicillin-susceptible pneumococcal infection. Socioeconomic variables were obtained by linking addresses with 1997 census block group data. One-hundred and thirty-four cases were compared with 798 controls. Individual antibiotic use prior to diagnosis increased the odds of penicillin non-susceptibility, with the strongest effect seen for beta-lactam use within 2 months (OR 1.8, 95% CI 1.2, 2.8). When household antibiotic use by persons other than the patient were considered, at 4 months prior to diagnosis there was a trend towards an association between penicillin non-susceptibility and beta-lactam antibiotic use, and a possible association in a small subgroup of patients with eye and ear isolates. However, no significant overall pattern of association was seen. We conclude that though antibiotic use of any kind within 2 months prior to diagnosis is associated with an increased risk of penicillin-non-susceptible pneumococcal disease, there is no significant overall pattern of association between household antibiotic use and penicillin-non-susceptible pneumococcal infection.

Individually optimized regimen of intravesical mitomycin C reduces superficial bladder tumor recurrence compared with a standard regimen

This meta-analytic review aims to address the mixed findings in previous research by quantifying the associations between early-life stress and risk, time, and prosocial preferences, and testing the boundary conditions of these associations. We meta-analyze 123 articles reporting 867 effect sizes among 199,019 adults to test different predictions from a life history perspective, a sensitization perspective, and an uncertainty management perspective about how early-life stress is associated with risk, time, and prosocial preferences. First, we find relatively small effect sizes indicating that early-life stress is associated with greater risk taking (r = .123), more present orientation (r = .126), and less prosociality (r = -.085), and its positive association with present orientation is stronger in currently stressful situations. Second, these observed associations do not vary significantly for harshness and unpredictability dimensions of early-life stress. Notably, moderation analyses across different types of preference measures only reveal an overall pattern of associations of early-life stress with self-report measures of risk, time, and prosocial preferences. By contrast, early-life stress is not significantly associated with risk preference or prosocial preference measured with hypothetical choice tasks or laboratory behavior tasks. Taken together, although the overall pattern of results supports a life history perspective, a cautious interpretation is warranted by the variation in the results across different preference measures and potential publication bias in the results. More pre-registered studies are needed to test the extent to which preferences measured with arbitrary laboratory-based tasks capture real-world behaviors and to increase the ecological validity of laboratory-based measures.

Co-occurrence of Axis I and Axis II disorders in substance abusers.

This study examined the co-occurrence of anxiety/mood and personality disorders (PDs) in substance abusers, the impact of anxiety/ mood disorders on the symptom profiles of PDs, and the impact of anxiety/mood disorders and PDs on pre-treatment status. Current anxiety/mood disorders and PDs and pre-treatment status were assessed using semi-structured interviews in 370 treated substance abusers. Anxiety/mood disorders and PDs frequently co-occurred, with the overall pattern of associations being non-specific. The strongest associations were of social phobia with avoidant and schizotypal PD, and of major depression with borderline PD. However, symptom profiles of PDs were not associated with anxiety/mood disorders. Finally, anxiety/mood disorders and PDs were both independently and differentially associated with poor pre-treatment characteristics. The findings suggest the clinical importance of obtaining both Axis I and Axis II diagnoses in treated substance abusers, and highlight the distinctiveness of the Axis I and Axis II disorders.

Occupational Risk Factors in Parkinson’s Disease

An apparent excess of teachers and healthcare workers among the Parkinson's disease patients of a large tertiary care movement disorders clinic suggested the hypothesis that high exposure to viral (or other) respiratory infections in these occupations might be a risk factor for Parkinson's disease.A case-control study of the association between occupation and Parkinson's disease was conducted. Cases (414) were all Parkinson's disease patients seen at the University of British Columbia Hospital Movement Disorders Clinic between 1986 and 1993, residing in Greater Vancouver, and under 65 in 1991. Controls (6,659) were randomly selected from the 1991 Canadian Census.Parkinson's disease was associated with teaching (OR 2.50, 95% CI 1.67-3.74) and occupation in healthcare services (OR 2.07, 95% CI 1.34-3.20), but there were several other substantial associations, both positive and negative.While referral bias cannot be ruled out, the authors find the consistency of the overall pattern of associations with the respiratory infection hypothesis striking.

Costs and remuneration for cervical screening in general practice in the west of Scotland.

To investigate associations between costs and remuneration for cervical screening in general practice in relation to skill mix, features of practice structure and deprivation levels in the local area; and, to identify efficient policies for organising cervical screening in general practice. Questionnaire survey and interview study in 87 general practices in Greater Glasgow Health Board an area in the west of Scotland which covers a socio-economically varied population. The main outcome measures were remuneration to cost ratios (RCRs) for cervical screening and their natural logarithms (logRCRs). Both the costs of cervical screening and RCRs varied widely between the 87 practices taking part. RCRs ranged from 0.29 to 14.67 (mean 2.64, median 2.18, interquartile range 1.15-2.98). Twenty-one per cent (18) of practices earned less than they spent on the organisation of screening, whilst 9% (8) of practices had PCRs of more than 5:1. RCRs were significantly lower if medical staff were involved in either taking smears or dealing with results. RCRs did not vary by social deprivation score, despite uptake being lower in practices in more deprived areas. This was explained by nurses working in practices in deprived areas being more likely to take smears than nurses working in more affluent areas. Sensitivity analyses were undertaken, altering key time and cost assumptions. As a result, the absolute values of the RCRs changed, although the overall pattern of association did not, with the exception of doctor involvement in processing results which was no longer significant when average general practitioners' income was substituted for locum rates. Practices in deprived areas may be responding to greater pressure of work by making optimal use of skill mix within the primary health care team. A more graduated incentive payment scheme may more fairly reward practices in deprived areas which are less likely to achieve 80% uptake due to relatively intractable features of practice structure. Assuming that practice nurses provide an equivalent quality of service to that provided by general practitioners, results suggest that doctor-nurse substitution would be cost-effective for general practice based cervical screening. Resource savings (principally doctor's time) could be redeployed to other areas of primary health care.