Proximal Risk Research Articles

How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide

Aim: The Narrative Crisis Model of suicide posits that when individuals with trait vulnerabilities for suicide face stressful life events, they may develop distorted perceptions of themselves and society that culminate in a sense of no future. Referred to as the suicide narrative, these perceptions makes them more likely to experience the Suicidal Crisis Syndrome, an acute affective condition that increases the risk of engaging in suicidal ideation behaviors. The goal of this study was to assess the stage components of this model. Methods: The stage components of the NCM were assessed among adult psychiatric inpatients (N = 223; listwise N = 85) aged 18–65 years old and admitted for suicidal ideation or attempts. Suicidal outcomes were assessed at one month follow-up. Structural equation modeling (SEM) was used to assess the model and its prediction of prospective suicidal outcomes. Results: The model was supported by the SEM and proved to be a good fit for the data. Each temporal stage was significantly predicted by the precedent stage in the model and 13% of the variance in suicidal ideation and behaviors (when assessed conjointly) were explained by the model. When suicidal ideation and attempts were assessed separately, the amount of variance explained was 10.8% for suicidal ideation and 40.7% for suicidal attempts. Discussion: The progression from trait vulnerabilities to suicidal outcomes proposed by the NCM was supported by our findings. These findings have clinical implications in the assessment and treatment of suicide risk and will need replication with larger samples.

Global path planning for autonomous ship: A hybrid approach of Fast Marching Square and velocity obstacles methods

In this research, a hybrid approach for global path planning for Maritime Autonomous Surface Ship (MASS) is proposed, which generates the shortest path considering the collision risk and the proximity between path and obstacles. The collision risk concerning obstacles is obtained using Time-Varying Collision Risk (TCR) concept, taking into account the velocity constraint of the ship that can achieve during operation. The influence of proximity from obstacles is measured with the Fast Marching (FM) algorithm. A new cost function is proposed allowing to combine the influence of obstacle proximity and collision risk in the region. Finally, the Fast Marching Square algorithm is applied to generate the globally optimal path that can reach the pre-set destination. The contribution of this work is two-fold: 1) considering the velocity constraint of the own ship, together with its influences of collision risk into the global path planning stage of autonomous navigation. 2) measuring the collision risk induced by the obstacles from their comprehensive influences on the achievable velocity range using TCR concept, instead of numerical integration of risk measurement. The results of the case study indicate that the proposed approach can find an optimal path considering the collision risk and proximity from the obstacles.

Relationship Between Tick Activity, Tick-Borne Diseases, Cognitive and Affective Risk Assessment in Peri-domestic Areas.

Peri-domestic areas constitute an important source of tick exposure and tick-borne diseases (TBD). Nonetheless, the association between distal TBD risk factors (i.e. cognitive-/affective-risk perceptions, knowledge of the effectiveness of personal protective behaviors) and proximal TBD risk (i.e. tick activity and TBD diagnosis), among adult residents of private residential properties (PRP) is unknown.Data was collected from 299 PRP in south and central Indiana. We used Mann-Whitney U and Kruskal-Wallis non-parametric tests to identify differences in proximal and distal outcome measures.We found evidence of 'tick activity' at thirty-nine percent of PRP (n=116). Thirteen-percent of respondents (n=40) self-reported a TBD diagnosis within their household. We found no significant association between 'self-reported TBD diagnosis within a household' and 'tick activity in the peri-domestic area.' Mean scores on 'affective tick & TBD risk assessment' were significantly higher among respondents when 'tick activity' was present in the peri-domestic area (median=2, M=2.54, p<0.001). Similarly, respondents who 'self-reported TBD diagnosis within their household' had significantly higher mean scores on 'affective tick & TBD risk assessment' (median=3, M=3.30) than those who did not (median=1, M=1.93), (U=2750, p<0.001). The proportion of peri-domestic areas with 'tick activity' was significantly higher if the primary respondent was male or an older adult respectively, compared to females and younger adults.Occupational/recreation-based settings may be more important pathways of tick exposure than peri-domestic settings in Indiana. Beyond education, it is important to consider the feelings and emotions that are elicited when at-risk populations consider their peri-domestic tick exposure and TBD risk, and where necessary design interventions to address those affective assessments.

Minority Stress and Cardiovascular Disease Risk Among Sexual Minorities: Mediating Effects of Sense of Mastery.

Sexual minority adults are at greater risk for cardiovascular disease (CVD) risk factors than heterosexual adults. There is a dearth of research identifying factors that are associated with CVD risk among sexual minorities. This study examined the associations between distal and proximal minority stressors and CVD risk. We also tested a sense of mastery as one mechanism that might explain the link between minority stressors and CVD risk. Participants were 670 sexual minority adults (53.6% male; 76% White), ages 18 to 76years (M = 41.19, SD = 14.73), obtained from a non-probability sample. Using an online survey, participants self-reported family history of CVD risk, physiological conditions (diabetes mellitus, high cholesterol, hypertension), and health behaviors (e.g., tobacco use, diet, exercise) that confer or protect against CVD risk. A weighted CVD risk index was computed. Linear and logistic regressions were conducted to test the effects of minority stressors on the CVD risk index and its specific indicators and to examine mediation. Minority stressors were associated with a sense of mastery, and mastery was associated with lower CVD risk index scores. Proximal and distal minority stressors were not directly associated with the overall CVD risk index but were associated with some specific risk indicators. Mediation analyses revealed that both distal and proximal minority stressors were indirectly associated with the CVD risk index through mastery. Research and interventions should aim to reduce CVD risk factors and target minority stressors and mastery to improve the cardiovascular health of sexual minorities.

Using Intensive Longitudinal Data to Identify Early Predictors of Suicide-Related Outcomes in High-Risk Adolescents: Practical and Conceptual Considerations.

Mobile technology offers new possibilities for assessing suicidal ideation and behavior in real- or near-real-time. It remains unclear how intensive longitudinal data can be used to identify proximal risk and inform clinical decision making. In this study of adolescent psychiatric inpatients (N = 32, aged 13-17 years, 75% female), we illustrate the application of a three-step process to identify early signs of suicide-related crises using daily diaries. Using receiver operating characteristic (ROC) curve analyses, we considered the utility of 12 features-constructed using means and variances of daily ratings for six risk factors over the first 2 weeks postdischarge (observations = 360)-in identifying a suicidal crisis 2 weeks later. Models derived from single risk factors had modest predictive accuracy (area under the ROC curve [AUC] 0.46-0.80) while nearly all models derived from combinations of risk factors produced higher accuracy (AUCs 0.80-0.91). Based on this illustration, we discuss implications for clinical decision making and future research.

Explaining Symmetry Across Sex in Intimate Partner Violence: Evolution, Gender Roles, and the Will to Harm

Intimate partner violence (IPV) is regarded by key stakeholders involved in shaping arrest and intervention policies as a gendered problem. The prevailing assumptions guiding these policies, centered on patriarchal social structures and men's motivation to dominate their female partners, have collectively been called thegender paradigm. When states started to enact laws against domestic violence in the late 1970s, it was due to the efforts of battered women and their allies, including second wave feminists fighting for the political, social, and economic advancement of women. The focus was on life-threatening forms of abuse in which women represented, and continue to represent, the much larger share of victims. Since then, IPV has been found to be a more complex problem than originally framed, perpetrated by women as well as men, driven by an assortment of motives, and associated with distal and proximate risk factors that have little to do with gender. Nonetheless, the gender paradigm persists, with public policy lagging behind the empirical evidence. The author suggests some reasons why this is so, among them the much higher rates of violent crimes committed by men, media influence and cognitive biases, political factors, and perpetuation of the very sex-role stereotypes that feminists have sought to extinguish in every other social domain. He then critically reviews two theories used in support of the paradigm, sexual selection theory and social role theory, and explores how empirically driven policies would more effectively lower IPV rates in our communities, while advancing core feminist principles.

Differential occupational risk for COVID-19 and other infection exposure according to race and ethnicity.

BackgroundThere are racial and ethnic disparities in the risk of contracting COVID‐19. This study sought to assess how occupational segregation according to race and ethnicity may contribute to the risk of COVID‐19.MethodsData about employment in 2019 by industry and occupation and race and ethnicity were obtained from the Bureau of Labor Statistics Current Population Survey. This data was combined with information about industries according to whether they were likely or possibly essential during the COVID‐19 pandemic and the frequency of exposure to infections and close proximity to others by occupation. The percentage of workers employed in essential industries and occupations with a high risk of infection and close proximity to others by race and ethnicity was calculated.ResultsPeople of color were more likely to be employed in essential industries and in occupations with more exposure to infections and close proximity to others. Black workers in particular faced an elevated risk for all of these factors.ConclusionOccupational segregation into high‐risk industries and occupations likely contributes to differential risk with respect to COVID‐19. Providing adequate protections to workers may help to reduce these disparities.

Governance, maternal well-being and early childhood caries in 3\u20135-year-old children

BackgroundThis study assessed the direct, indirect and total effect of distal – political - risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3–5 year old children.MethodsData on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women’s opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis.ResultsVoice and accountability (β = − 0.60) and GNI per capita for females (β = − 0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (β =0.40) and higher percentage of female legislators, senior officials and managers (β = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (β = − 0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (β = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (β = − 0.49), political stability/absence of terrorism (β = 0.34) and higher female GNI (β = − 0.33) had the greatest effects on ECC prevalence.ConclusionDistal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators.. Approaches to control ECC may need to include political reforms.

Omega-3 fatty acids reduce post-operative risk of deep vein thrombosis and pulmonary embolism after surgery for elderly patients with proximal femoral fractures: a randomized placebo-controlled, double-blind clinical trial.

Elderly patients with proximal femoral fractures face elevated risk of post-operative deep vein thrombosis and pulmonary embolism, due to the lack of suitable treatment plans after surgery and hospital discharge. This study aimed to investigate the effect of omega-3 fatty acid supplementation in the above-described clinical setting. Five hundred and seven elderly patients (> 60 years of age) suffering from proximal femoral fractures were recruited. After exclusion, 452 eligible patients were assigned in a random manner to receive either omega-3 fatty acids at the daily dose of 1000 mg or placebo, via oral administration for a period of 30 days after surgery. At the end of intervention, the incidences of pulmonary embolism, deep vein thrombosis, and other related complications were compared between the two study groups. Incidences of pulmonary embolism as well as deep vein thrombosis, including events leading to fatality, were significantly reduced by the 30-day omega-3 fatty acid intervention. But other related complications, such as haematoma evacuation, post-operative wound bleed, wound infection with frank pus, and other bleed events that required transfusion, were not affected after omega-3 fatty acid consumption. Daily supplementation of omega-3 fatty acids decreases the risk of pulmonary embolism as well as symptomatic deep vein thrombosis, after surgery among elderly patients with proximal femoral fractures, without causing elevated risk of bleeding episodes.

Risk factors for child abuse, neglect and exposure to intimate partner violence in early childhood: Findings in a representative cross-sectional sample in Germany

BackgroundThe KiD 0–3 national main study is a cross-sectional study on adversity in early childhood and parental access to support services, conducted as part of a long-term policy program for early intervention services in Germany. ObjectiveTo identify risk factors for child abuse, neglect and exposure to intimate partner violence (IPV) and investigate if parental use of early intervention programs or contact to child welfare services was associated with reported child maltreatment. Participants and setting8063 families with infants and toddlers participated in the survey. Parents answered a written questionnaire during mandatory health checks for the child. The sampling was based on a regionally clustered model of pediatricians’ practices. MethodsAn automatic variable selection process was used to test risk factors and logistic regression models were employed for each outcome. ResultsSignificant risk factors (p < 0.05) for child abuse (1.91 %) were child age, IPV and parental stress. Neglect (0.83 %) was associated with couple distress, adverse childhood experiences, young maternal age, cramped housing, and migration history. IPV (2.98 %) was associated with child age, couple distress, depression/anxiety, harsh punishment, adverse childhood experiences, young maternal age, and poverty. Parents were more likely to use selective prevention programs in cases of child abuse and exposure to IPV. ConclusionChild abuse is mainly associated with proximal risk factors and neglect with distal factors. Exposure to IPV violence is associated with child abuse as well as with an accumulation of adversities. The association between service use and child maltreatment is discussed.

Childhood emotional abuse and adolescent nonsuicidal self-injury: The mediating role of identity confusion and moderating role of rumination

ObjectiveAccording to Nock’s (2009) integrated model, nonsuicidal self-injury (NSSI) is caused by the interplay of distal environmental and proximal intrapersonal risk factors. Based on this theory, the current study tested a moderated mediation model of family and individual characteristics to investigate how they impact adolescent NSSI. Specifically, we examined whether identity confusion mediated the association between childhood emotional abuse and NSSI, and whether this indirect effect was moderated by rumination. Methods949 Chinese adolescents anonymously filled out questionnaires regarding emotional abuse, identity confusion, rumination, and NSSI. ResultsThe results revealed that childhood emotional abuse was positively associated with NSSI, and this association was mediated by identity confusion. Rumination intensified the association between childhood emotional abuse and identity confusion, as well as the association between childhood emotional abuse and NSSI. ConclusionsThese findings highlight the need to consider family and individual factors simultaneously when evaluating risks associated with adolescent NSSI and have important implications for the prevention and intervention of NSSI.

Predictors of pain in general ageing populations: results from a multi-country analysis based on ATHLOS harmonized database

BackgroundPain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents.MethodsWe used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors.ResultsA total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years’ follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80).ConclusionsOur results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese.

Predictors of mental health and academic outcomes in first-year university students: Identifying prevention and early-intervention targets.

Although there is growing interest in mental health problems in university students there is limited understanding of the scope of need and determinants to inform intervention efforts. To longitudinally examine the extent and persistence of mental health symptoms and the importance of psychosocial and lifestyle factors for student mental health and academic outcomes. Undergraduates at a Canadian university were invited to complete electronic surveys at entry and completion of their first year. The baseline survey measured important distal and proximal risk factors and the follow-up assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of risk factors and mental health and academic outcomes were fit and adjusted for confounders. In 1530 students surveyed at entry to university 28% and 33% screened positive for clinically significant depressive and anxiety symptoms respectively, which increased to 36% and 39% at the completion of first year. Over the academic year, 14% of students reported suicidal thoughts and 1.6% suicide attempts. Moreover, there was persistence and overlap in these mental health outcomes. Modifiable psychosocial and lifestyle factors at entry were associated with positive screens for mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and university well-being. Clinically significant mental health symptoms are common and persistent among first-year university students and have a negative impact on academic performance and well-being. A comprehensive mental health strategy that includes a whole university approach to prevention and targeted early-intervention measures and associated research is justified.

Comparison study of bone strength of the proximal femur with and without hip osteoarthritis by computed tomography-based finite element analysis

Proximal femoral fractures are common in elderly osteoporosis patients; however, its prevalence is clinically rare in hip fracture patients with hip osteoarthritis (OA). This study aimed to evaluate bone strength of the proximal femur with or without hip OA and proximal femoral fracture risk using computed tomography (CT)-based finite element analysis (FEA). A retrospective analysis was done on CT data of 20 patients who underwent total hip arthroplasty for unilateral hip OA. Furthermore, the fracture load between OA and contralateral sides was compared and the association between fracture load and risk factor was analyzed. The fracture load was significantly higher in the OA side than that in the contralateral side (3819.5 ± 1557.8 N vs. 3224.5 ± 943.7 N, respectively; P = 0.0405). There was no significant difference in fracture load between OA and the contralateral side in Kellgren–Lawrence (KL)-3 and KL-4 grade, but the KL-4 fracture load tends to be high (P = 0.2461 and P = 0.0527, respectively). Moreover, there was no significant association between fracture load and OA severity or age. The study findings may assist in predicting bone strength and proximal femur fracture risk. The results of this FEA study indicate the bone strength of the proximal femur was affected by the severity of the osteoarthritis.

Characterizing profiles of polysubstance use among high school students in Baltimore, Maryland: A latent class analysis

BackgroundAdolescent drug use has long term health consequences, like substance use disorders and psychiatric illnesses. Proximal health risks, especially for overdose, are amplified when multiple substances are combined. Existing literature on polysubstance use among adolescents has largely focused on alcohol, tobacco, and marijuana, but has largely excluded other drugs like opioids. Understanding how adolescents combine illicit drugs is essential for intervening to prevent poor health outcomes. MethodsWe aimed to explore patterns of lifetime polysubstance use among adolescents in Baltimore City. We used data on 9th-12th graders recruited to participate in the 2017 local Baltimore Youth Risk Behavior Survey who reported any lifetime drug use (n = 387; 60 % female, 77 % non-Hispanic Black). We then conducted a latent class analysis using 10 indicators of lifetime drug and alcohol use. After selecting the class model, we tested for associations between the class profiles and race, sex, school grade, and lifetime injection drug use. ResultsWe identified three profiles of lifetime polysubstance use in our sample: alcohol and marijuana (68.6 % of sample), polysubstance (22.0 %), and alcohol/pain medication/inhalant use (9.4 %). Members of the polysubstance use class were more likely to be male and to report injection drug use. ConclusionsUnderstanding broader patterns of drug use beyond alcohol, tobacco and marijuana among adolescents is a crucial step towards preventing adverse drug and health-related outcomes later in life. More research is needed to characterize the full health impact of youth polysubstance use patterns and related risk behaviors like injection drug use.

Fetal Alcohol Spectrum Disorders in a Southeastern County of the United States: Child Characteristics and Maternal Risk Traits

To detail the characteristic traits of children with fetal alcohol spectrum disorders (FASDs) and maternal risk factors in a southeastern U.S. County. Independent samples were drawn from 2 different cohorts of first-grade students. All consented children (49.8%) were measured for height, weight, and head circumference, and those≤25th centile entered the study along with a random sample drawn from all enrolled students. Study children were examined for physical growth, dysmorphology, and neurobehavior, and their mothers were interviewed. Total dysmorphology scores discriminated well the physical traits of children across the FASD continuum: fetal alcohol syndrome (FAS)=15.8, partial FAS (PFAS)=10.8, alcohol-related neurobehavioral disorder (ARND)=5.2, and typically developing controls=4.4. Additionally, a neurobehavioral battery distinguished children with each FASD diagnosis from controls. Behavioral problems qualified more children for FASD diagnoses than cognitive traits. Significant proximal maternal risk variables were as follows: reports of prepregnancy drinking, drinking in any trimester, and comorbid use of other drugs in lifetime and during pregnancy, especially alcohol and marijuana (14.9% among mothers of children with FASD vs. 0.4% for controls). Distal maternal risks included reports of other health problems (e.g., depression), living unmarried with a partner during pregnancy, and a lower level of spirituality. Controlling for other drug use during pregnancy, having a child diagnosed with a FASD was 17.5 times greater for women who reported usual consumption of 3 drinks per drinking day prior to pregnancy than for nondrinking mothers (p<0.001, 95% CI=5.1 to 59.9). There was no significant difference in the prevalence of FASD by race, Hispanic ethnicity, or socioeconomic status. The prevalence of FASD was not lower than 17.3 per 1,000, and weighted estimated prevalence was 49.0 per 1,000 or 4.9%. This site had the second lowest rate in the CoFASP study, yet children with FASD are prevalent.

Intimate Partner Violence Perpetration and Psychopathy: A Comprehensive Review

Abstract. Intimate partner violence (IPV) is the physical, sexual, and psychological abuse of an intimate partner and is a widespread, international public health crisis. An important proximate risk factor for IPV perpetration is the presence of psychopathic traits but there has not been a systematic review of the research linking psychopathic traits to IPV perpetration. We identified 43 studies using 13,476 participants (9,024 men and 4,452 women) across 10 countries that met our search criteria that led to the following conclusions. First, psychopathy was associated with IPV perpetration with medium effect sizes, even after accounting for various distal and proximate risk factors. Second, the different dimensions of psychopathy did not consistently differ in their prediction of IPV perpetration. Third, within individuals with a history of IPV perpetration, psychopathy did not relate to the frequency or severity of partner violence. Fourth, a few studies have tested the associations among child abuse, psychopathy, and IPV, with one study reporting that the combination of child abuse and psychopathic traits led to especially high risk for IPV perpetration. Lastly, we conclude by making recommendations for how future research and interventions should consider psychopathy to reduce the societal burden of IPV.

Dynamic associations between interpersonal needs and suicidal ideation in a sample of individuals with eating disorders.

Over half of individuals with eating disorders experience suicidal ideation at some point in their lives, yet few longitudinal studies have examined predictors of ideation in this at-risk group. Moreover, prospective research has focused on relatively distal or trait-level factors that are informative for distinguishing who is most at risk but not when. Little is known about more proximal or state-level risk factors that fluctuate within an individual, which is critical for determining when a person is most likely to engage in suicidal behaviors. Women (N = 97) receiving treatment for their eating disorder completed questionnaires weekly to assess suicidal ideation and interpersonal constructs (i.e. perceived burdensomeness, thwarted belongingness) theorized to be proximal predictors of suicidal desire. Longitudinal multilevel models were conducted to examine both within- and between-person predictors of suicidal ideation across 12 weeks of treatment. Statistically significant within-person effects for burdensomeness (β = 0.06; p < 0.001) indicate that when individuals have greater feelings of burdensomeness compared to their own average, they also experience higher suicidal ideation. We did not find any significant influence of thwarted belongingness or the interaction between burdensomeness and belongingness on suicidal ideation. This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results are only partially consistent with the Interpersonal Theory of Suicide and suggest that short-term changes in burdensomeness may impact suicidal behavior in individuals with eating disorders.

Oesophageal and proximal gastric adenocarcinomas are rare after detection of Helicobacter pylori infection.

Helicobacter pylori infection is the most important risk factor for non-proximal gastric adenocarcinoma, yet some posit it is protective against oesophageal adenocarcinoma and proximal gastric cancers. To evaluate the incidence of and risk factors for future oesophageal and proximal gastric cancers, utilizing the largest North American cohort of patients with previously identified Hpylori. Also to identify whether treatment and eradication of Hpylori alter future oesophageal and proximal gastric cancer risk. Retrospective cohort study within the Veterans Administration of 36 803 patients (median age 60.4years; 91.8% male) with confirmed Hpylori between 01 January 1994 and 31 December 2018. Primary outcome was diagnosis of future oesophageal and proximal gastric cancers. A time to event with competing risk analysis was performed, evaluating patient factors and whether the patient received Hpylori treatment. Secondary analysis of those treated evaluated whether confirmed eradication was associated with cancer. The cumulative incidence of oesophageal and proximal gastric cancers 5, 10 and 15years after Hpylori detection was 0.145%, 0.26% and 0.34%. Risk of future oesophageal or proximal gastric cancer was similar amongst whites (reference), African Americans (SHR 0.87, 95%CI 0.57-1.43) and American Indians (SHR 1.31, 95%CI 0.18-9.60) but substantially reduced in those of Asian (no cases amongst 213 H pylori positive) or native Hawaiian origin (no cases amongst 295 H pylori positive) (P < .001). Increasing age (SHR 1.17 per 5 years, 95% CI: 1.09-1.25, P< 0.001) and smoking (SHR 2.06, 95% CI: 1.33-3.18, P=0.001) were associated with oesophageal and proximal gastric cancers. Neither treatment of Hpylori nor eradication status were associated with cancer (P>0.20). In the largest study of US patients with Hpylori, we demonstrate that rates of oesophageal and proximal gastric cancers after treatment of Hpylori are low. Older age, and smoking are associated with future cancer, whilst Asian or Native Hawaiian race are protective. Hpylori treatment and eradication are not associated with futurecancer.

Predictors of Mental Health and School-Related Outcomes in First Year University Students: Identifying Prevention Targets

Background: Student demand for mental health support is straining university resources, yet there is limited information about the scope of need and determinants. Therefore, our objective was to longitudinally examine the importance of potentially modifiable psychosocial and lifestyle factors for mental health and school-related outcomes. Methods: Canadian undergraduates were invited to complete electronic surveys at entry and completion of first year. The baseline survey measured important distal and proximal risk factors and the follow-up survey assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of proximal risk factors and mental health and school-related outcomes were fit and adjusted for confounders. Outcomes: In a representative sample of 1,530 students, over one-third screened positive for clinically significant depressive and anxiety symptoms at entry, increasing to 36% and 39% respectively at completion of first year. Over the school year, 14% of students reported suicidal thoughts and 1.5% suicide attempts. There was evidence of persistence and overlap in mental health outcomes. Modifiable psychosocial and lifestyle risk factors at entry were associated with positive screens for all mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and school well-being. Interpretation: A substantial proportion of first year university students experience clinically significant mental health symptoms that are negatively associated with academic performance and school well-being. A research-informed comprehensive mental health strategy that includes a whole university approach and development of effective prevention initiatives seems justified. Funding Statement: The U-Flourish Student Well-Being and Academic Success study is funded by an operating grant from the Canadian Institutes of Health Research. Declaration of Interests: All authors confirm that they have no financial or personal conflict of interest to disclose in relationship to this manuscript. Ethics Approval Statement: Ethics approval for this study was received from the Queen’s University and Affiliated Teaching Hospitals Research Ethics Board (HSREB PSIY-609-18).