Additional Risk Assessment Research Articles

Cognitive function characteristics and influencing factors in patients with depressive disorders: a 5-year follow-up report based on the epidemiological survey of mental disorders in Shandong Province, China.

Cognitive impairment represents a notable feature of depressive disorders. Comprehending its characteristics and influencing factors is vital for patient rehabilitation. This study is based on the 2015 Shandong Province epidemiological survey of mental disorders, from which 871 individuals meeting DSM-IV criteria for depressive disorders were selected as the research group. Using 1:1:1 matching by sex, age, and residence, we randomly selected 825 individuals with no DSM-IV diagnosis but positive on GHQ-12 and additional risk assessments as the elevated risk control group, and 825 with negative screenings as the minimal risk control group. In 2020, a follow-up survey was conducted, resulting in a final analysis of 1,855 cases. The survey included demographic data, various clinical information, and a series of screening and questionnaire assessments. The current depressive group scored lower on the MoCA than the non-depressive group (t=8.86, P<0.01). The research group scored lower on the MoCA than the elevated and minimal risk group (F=11.98, P<0.01). The depression-unremitted group scored lower than the depression-remitted group (t=6.44, P<0.01). The Analysis indicated that males, with better life quality, poor early psychological status and, and longer education were associated with higher MoCA scores. Conversely, older age, rural residency, employment, current depression, and poor marital were associated with lower MoCA scores. Individuals with depression commonly suffer cognitive impairment, which tends to partially improve as depression remits. Individual cognitive function is influenced by early psychological health, depressive status, quality of life, age, sex, educational level, residence, occupational, and marital status.

Leveraging integrative toxicogenomic approach towards development of stressor-centric adverse outcome pathway networks for plastic additives

Plastics are widespread pollutants found in atmospheric, terrestrial and aquatic ecosystems due to their extensive usage and environmental persistence. Plastic additives, that are intentionally added to achieve specific functionality in plastics, leach into the environment upon plastic degradation and pose considerable risk to ecological and human health. Limited knowledge concerning the presence of plastic additives throughout plastic life cycle has hindered their effective regulation, thereby posing risks to product safety. In this study, we leveraged the adverse outcome pathway (AOP) framework to understand the mechanisms underlying plastic additives-induced toxicities. We first identified an exhaustive list of 6470 plastic additives from chemicals documented in plastics. Next, we leveraged heterogenous toxicogenomics and biological endpoints data from five exposome-relevant resources, and identified associations between 1287 plastic additives and 322 complete and high quality AOPs within AOP–Wiki. Based on these plastic additive–AOP associations, we constructed a stressor-centric AOP network, wherein the stressors are categorized into ten priority use sectors and AOPs are linked to 27 disease categories. We visualized the plastic additives–AOP network for each of the 1287 plastic additives and made them available in a dedicated website: https://cb.imsc.res.in/saopadditives/. Finally, we showed the utility of the constructed plastic additives–AOP network by identifying highly relevant AOPs associated with benzo[a]pyrene (B[a]P), bisphenol A (BPA), and bis(2-ethylhexyl) phthalate (DEHP) and thereafter, explored the associated toxicity pathways in humans and aquatic species. Overall, the constructed plastic additives–AOP network will assist regulatory risk assessment of plastic additives, thereby contributing towards a toxic-free circular economy for plastics.

The food additive xylitol enhances the butyrate formation by the child gut microbiota developed in a dynamic colonic simulator

The gut microbiota should be included in the scientific processes of risk assessment of food additives. Xylitol is a sweetener that shows low digestibility and intestinal absorption, implying that a high proportion of consumed xylitol could reach the colonic microbiota. The present study has evaluated the dose-dependent effects of xylitol intake on the composition and the metabolic activity of the child gut-microbiota. The study was conducted in a dynamic simulator of the colonic microbiota (BFBL Gut Simulator) inoculated with a child pooled faecal sample and supplemented three times per day, for 7 days, with increasing xylitol concentrations (1 g/L, 3 g/L and 5 g/L). Sequencing of 16S rRNA gene amplicons and group-specific quantitative PCR indicated a xylitol dose-response effect on the abundance of Lachnospiraceae, particularly the genera Blautia, Anaerostipes and Roseburia. The microbial changes observed with xylitol corresponded with a dose-dependant effect on the butyrate concentration that, in parallel, favoured an increase in epithelial integrity of Caco-2 cells. The study represents a detailed observation of the bacterial taxa that are the main contributors to the metabolism of xylitol by the child gut microbiota and the results could be relevant in the risk assessment re-evaluation of xylitol as a sweetener.

Release kinetics and risk assessment of additives in plastic advertising banners

Plastic advertising banners (PABs) have been widely used for advertising and publicizing with large usage amount. The PABs are usually added with plenty of chemical additives for improving material performance, and the additives can be released during the lifetime of the PABs. However, limited knowledge is available on the composition and release of the additives in the PABs. In this study, benzenoids were found as the dominant additive categories in PABs. Release kinetics of benzenoid additives with high detection frequency and high abundance from the PABs under indoor and outdoor environments were investigated. During the 150-day release experiment, average release rates of the additives from the PABs under outdoor and indoor environments were 8.3 × 10−10 kg/m2·s and 6.3 × 10−10 kg/m2·s, respectively. The release rates of the additives were negatively related to the thickness of the PAB samples. Health risk assessment indicated that chemicals associated with PABs have potential carcinogenic risks to salesmen in the shopping malls. The risks of chemical exposure associated with PABs to consumers in the shopping malls were acceptable. This study unveils a considerable source of chemical exposure to humans.

Sediment quality classification in freshwater lakes predicted by the history of treatment with copper-based aquatic algaecides.

Copper-based aquatic algaecides have been widely used in the management of aquatic macrophyte and harmful algal blooms for decades due to their effectiveness and low cost. However, repeated treatment of freshwater lakes results in the accumulation of copper in the sediment, which may adversely affect the ecosystem of the lakes through toxicity to benthic invertebrates and other organisms. Consequently, copper-based aquatic herbicides and algaecides have been frequently subjected to regulations aimed at preventing further ecological deterioration in treated waterbodies. Many states in the US are taking or considering taking an approach that limits or prohibits copper treatment in waterbodies. Freshwater lakes with extensive historical copper treatments typically have significantly higher concentrations of copper in the sediment than untreated lakes. However, the correlation between the extent of the treatments and level of copper accumulation in the sediment has not been quantitatively characterized. In the present study, between 2006 and 2017, copper concentrations were measured in the sediment from selected lakes in New York State with different histories of copper-based aquatic algaecide treatment. Analysis of these data confirmed findings from earlier studies conducted by New York State that lakes with histories of copper treatment have significantly higher copper concentrations in the sediment. It also demonstrated that sediment copper concentrations were significantly higher in the sublittoral zone than the littoral zone in treated lakes. Moreover, a positive correlation was detected between sediment copper concentrations and the total number of treatments with copper-based aquatic algaecide for both littoral and sublittoral zones (p-value = 7.94 × 10-8 and 3.1 × 10-13, respectively). This relationship can be used as a screening tool for regulatory agencies to identify lakes with sediment copper levels possibly higher than the toxicity threshold for aquatic life. Consequently, additional ecological risk assessment may be required before allowing future treatment with copper-based aquatic algaecides. Integr Environ Assess Manag 2024;20:1586-1597. © 2024 SETAC.

Selection, optimization and validation of ten chronic disease polygenic risk scores for clinical implementation in diverse US populations

Polygenic risk scores (PRSs) have improved in predictive performance, but several challenges remain to be addressed before PRSs can be implemented in the clinic, including reduced predictive performance of PRSs in diverse populations, and the interpretation and communication of genetic results to both providers and patients. To address these challenges, the National Human Genome Research Institute-funded Electronic Medical Records and Genomics (eMERGE) Network has developed a framework and pipeline for return of a PRS-based genome-informed risk assessment to 25,000 diverse adults and children as part of a clinical study. From an initial list of 23 conditions, ten were selected for implementation based on PRS performance, medical actionability and potential clinical utility, including cardiometabolic diseases and cancer. Standardized metrics were considered in the selection process, with additional consideration given to strength of evidence in African and Hispanic populations. We then developed a pipeline for clinical PRS implementation (score transfer to a clinical laboratory, validation and verification of score performance), and used genetic ancestry to calibrate PRS mean and variance, utilizing genetically diverse data from 13,475 participants of the All of Us Research Program cohort to train and test model parameters. Finally, we created a framework for regulatory compliance and developed a PRS clinical report for return to providers and for inclusion in an additional genome-informed risk assessment. The initial experience from eMERGE can inform the approach needed to implement PRS-based testing in diverse clinical settings.

Influence of consumption of the food additive carrageenan on the gut microbiota and the intestinal homeostasis of mice.

The safety of the carrageenan (CGN) consumption as a food additive is under debate, with negative effects being associated with the products of hydrolysis of CGN. Moreover, there is an increasing need to integrate gut microbiome analysis in the scientific risk assessment of food additives. The objective of this study was to test the effects of CGN consumption on the gut microbiota and the intestinal homeostasis of young male and female mice. Female and male ICR-CD1 mice (8 weeks old) orally received 540 mg kg-1 day-1 of CGN, representing the maximum-level exposure assessment scenario surveyed for children, over the course of two weeks. Fecal material and peritoneal immune cells were analyzed to determine changes in the fecal microbiota, based on the analysis of bacterial 16S rRNA gene amplicon sequences and short-chain fatty acid (SCFA) concentrations, and some immune functions and redox parameters of peritoneal leukocytes. Non-significant microbiota taxonomical changes associated with CGN intake were found in the mouse stools, resulting the housing time in an increase in bacterial groups belonging to the Bacteroidota phylum. The PICRUSt2 functional predictions showed an overall increase in functional clusters of orthologous genes (COGs) involved in carbohydrate transport and metabolism. A significant increase in the cytotoxicity of fecal supernatants was observed in CGN-fed mice, which correlated with worsening of immune functions and oxidative parameters. The altered immunity and oxidative stress observed in young mice after the consumption of CGN, along with the fecal cytotoxicity shown towards intestinal epithelial cells, may be associated with the gut microbiota's capacity to degrade CGN. The characterization of the gut microbiota's ability to hydrolyze CGN should be included in the risk assessment of this food additive.

Monitoring metal patterns from urban and agrarian sites using the bumblebee Bombus terrestris as a bioindicator

Honeybees are well-established bioindicators for different types of pollutants. This study aims to establish another species of the Apidae family as a bioindicator, with a distinct behaviour and life cycle. The bumblebee Bombus terrestris was used as a bioindicator for 12 metals. Bumblebee hives were placed at sampling sites in and around the city of Aachen, Germany, and metal concentrations were assessed using ICP-MS. Metal concentrations were compared to those found in honeybees described in the literature. Spatial differences in metal patterns were investigated by comparing two land-use types: urban and agrarian. Seasonal differences were compared by taking samples in spring and summer. All analysed metals were detected above the detection limit and within or even above the concentration range found in honeybees. Significant spatial differences were found for the metalloid B and the metal Cd with higher concentrations at the agrarian sites than the urban sites. Significant seasonal differences were found for 8 metals: Fe, Zn, Cu, Ni, Cd, and As concentrations were higher in summer than in spring, while B and V concentrations were higher in spring. To categorise the results, we applied the honeybee contamination index (HCI) and adapted it to bumblebee purposes. According to the HCI, only one agrarian site showed a high contamination level. This study shows that bumblebees are suitable bioindicators for metals. The obtained data can serve as a first baseline in the establishment of additional monitoring studies or risk assessments.

Analysis of modern approaches to assessing reliability in construction

Introduction. The study considers modern strategies for ensuring the reliability of building structures in Russian and foreign regulations, including probabilistic, risk-informed and semi-probabilistic criteria of reliability assessment, at all stages of the life cycle of the structure. The advantages and disadvantages of prescriptive and parametric approaches are analyzed and ways of their further improvement are suggested.Aim. To clarify the terminology of parametric regulation in construction, to analyze the existing differences in its interpretation, and to develop an innovative strategy for further development of Russian regulation based on a comparative analysis of domestic and foreign approaches to reliability assessment.Materials and methods. The methodology involved studying the structure of Russian and foreign regulatory documents in the field of reliability and performing their comparative analysis. The study considered the main approaches to technical regulation in the construction industry.Results. The analysis outlined the criteria underlying the fastest introduction of innovations and ensuring the safety of technical solutions. The study demonstrated the difference between the meaning of the term “parametric regulation” in Russian strategy and its foreign interpretation. The regulation standards of the Russian Federation are based mainly on a semi-probabilistic approach and specification of partial reliability factors, i.e. individual parameters of strength and loads, while in the foreign standards, notably in ISO 2394:2016 and Eurocodes, the emphasis is shifted to qualitative and probabilistic criteria for assessing reliability. However, all social, economic and performance criteria should be observed only after all requirements for the reliability and safety of people have been met. Thus, both Russian and foreign approaches to regulation demonstrate no fundamental contradictions. The approaches are gradually moving towards convergence while maintaining continuity in the development of the regulatory framework.Conclusions. The principles of ensuring the reliability of the designed buildings and structures in Russian, international and foreign regulation standards are quite close and are based on the limit state method with a reasonable combination of mandatory and recommended parameters. The main criterion consists in ensuring the safety of human life. Under contemporary conditions, traditional semi-probabilistic approaches to regulation should be accompanied by mechanisms for rapid introduction of innovations and new technologies in construction. In terms of reliability, these mechanisms involve additional probabilistic reliability criteria and risk assessment methods. The reliability criteria will contribute in choosing the optimal design and technological solutions for the construction of unique buildings and structures, higher criticality structures, as well as in assessing existing structures during their life cycle.

The environmental occurrence, fate, and risks of 25 endocrine disruptors in Slovenian waters

Natural hormones, synthetic steroids and bisphenols are among the most active endocrine disruptors (EDs) in the aquatic environment, with great potential for causing adverse effects in aquatic organisms and humans. In this study, a focused group of 25 potent estrogenic and other ED compounds were simultaneously measured in wastewaters (WWs) and receiving surface waters (SWs) before and after wastewater treatment plants (WWTPs), where their removal efficiency was also estimated. Up to 16 of 25 EDs were successfully quantified in SWs and WWs, with bisphenols BPS, BPA, and BPF together with estriol and chlormadinone being the most prevalent with the highest measured concentrations of up to 35 μg/L in WWs and 400 ng/L in SWs. High load and insufficient removal of these substances by WWTPs lead to a significant increase in their concentrations in the receiving SWs downstream, while other sources could be responsible for an important portion of river contamination with EDs. Removal efficiency was very good for most EDs, although only from 0 to 44 % for E2, which shows a need for the improvement of current removal techniques. E2 and EE2 contribute the most to the alarmingly high risks of the total ED estrogenic potential, with the value increased by 36 % in SWs downstream from WWTPs, and the RQ value for the total estrogenic potential in individual SW samples being three orders of magnitude higher than that representing high risk. An additional comprehensive multi-parameter risk assessment determined high risk quotient and priority index values for BPA, E2, BPS and E1 with values of up to 450 in SWs. Our results show a focused insight into the risks associated with an important group of EDs and the role of WWTPs, while further highlighting the importance of regular monitoring of the environmental occurrence and risks of a focused range of EDs.

Deep learning–based assessment of CT markers of sarcopenia and myosteatosis for outcome assessment in patients with advanced pancreatic cancer after high-intensity focused ultrasound treatment

ObjectivesTo evaluate the prognostic value of CT-based markers of sarcopenia and myosteatosis in comparison to the Eastern Cooperative Oncology Group (ECOG) score for survival of patients with advanced pancreatic cancer treated with high-intensity focused ultrasound (HIFU).Materials and methodsFor 142 retrospective patients, the skeletal muscle index (SMI), skeletal muscle radiodensity (SMRD), fatty muscle fraction (FMF), and intermuscular fat fraction (IMFF) were determined on superior mesenteric artery level in pre-interventional CT. Each marker was tested for associations with sex, age, body mass index (BMI), and ECOG. The prognostic value of the markers was examined in Kaplan-Meier analyses with the log-rank test and in uni- and multivariable Cox proportional hazards (CPH) models.ResultsThe following significant associations were observed: Male patients had higher BMI and SMI. Patients with lower ECOG had lower BMI and SMI. Patients with BMI lower than 21.8 kg/m2 (median) also showed lower SMI and IMFF. Patients younger than 63.3 years (median) were found to have higher SMRD, lower FMF, and lower IMFF. In the Kaplan-Meier analysis, significantly lower survival times were observed in patients with higher ECOG or lower SMI. Increased patient risk was observed for higher ECOG, lower BMI, and lower SMI in univariable CPH analyses for 1-, 2-, and 3-year survival. Multivariable CPH analysis for 1-year survival revealed increased patient risk for higher ECOG, lower SMI, lower IMFF, and higher FMF. In multivariable analysis for 2- and 3-year survival, only ECOG and FMF remained significant.ConclusionCT-based markers of sarcopenia and myosteatosis show a prognostic value for assessment of survival in advanced pancreatic cancer patients undergoing HIFU therapy.Clinical relevance statementThe results indicate a greater role of myosteatosis for additional risk assessment beyond clinical scores, as only FMF was associated with long-term survival in multivariable CPH analyses along ECOG and also showed independence to ECOG in group analysis.Key Points• This study investigates the prognostic value of CT-based markers of sarcopenia and myosteatosis for patients with pancreatic cancer treated with high-intensity focused ultrasound.• Markers for sarcopenia and myosteatosis showed a prognostic value besides clinical assessment of the physical status by the Eastern Cooperative Oncology Group score. In contrast to muscle size measurements, the myosteatosis marker fatty muscle fraction demonstrated independence to the clinical score.• The results indicate that myosteatosis might play a greater role for additional patient risk assessments beyond clinical assessments of physical status.

Enrichment of cadmium and selenium in soil-crop system and associated probabilistic health risks in black shale areas.

Selenium (Se) is the essential component of selenoenzymes and contributes to antioxidant defenses. The capability of Se to antagonize the toxicity of heavy metals makes it an essential trace element for human and plant health. Soils derived from black shales are naturally enriched with Se; however, these soils often contain high geological cadmium (Cd), due to the weathering of black shales rich in Cd and Se. Cadmium, as a known Group I carcinogen, could induce damage to various organs. This therefore poses a major challenge for safe cultivation of Se-rich land resources. In this study, a total of 247 paired soil-crop samples were collected from a typical farmland derived from black shales. The concentrations of Cd and Se in the samples were analyzed by inductively coupled plasma mass spectroscopy and atomic fluorescence spectrometry. Monte Carlo simulation was applied to evaluate potential health risks associated with Cd exposure. Cadmium was the critical pollutant in the study area, with the average value of 1.53 mg/kg. Moreover, both children and adults living in the area had a significant non-carcinogenic health risk. Additional health risk assessments revealed that diet was the main contributor for both children and adults among the four pathways (diet > soil ingestion > soil dermal adsorption > soil inhalation). Furthermore, our results revealed that leguminous vegetables and maize were ideal for this site due to their high Se and low Cd accumulation abilities. These findings provide support for adjusting planting structure by variety screening to mitigate the health risk induced by Cd.

Evaluation of fetal absorbed doses from computed tomography examinations of pregnant patients: A systematic review

BACKGROUND: Currently, no systematic data are available on fetal radiation exposure as a result of radiographic studies during pregnancy. Consequently, there are no approved methods of its calculation that can be used in clinical practice. It is especially relevant for computed tomography scans as it is a widely used and highly informative method of diagnostic imaging associated with high exposure levels.&#x0D; AIM: to systematize currently available data on radiation dose absorbed by the fetus from computed tomography scans in pregnant women.&#x0D; MATERIALS AND METHODS: The search for publications in Russian and English was conducted in PubMed/Medline, Google Scholar and еLibrary. The final analysis included 12 papers including 8 studies using human body phantoms, 3 retrospective studies and one prospective clinical study.&#x0D; RESULTS: Abdominal and pelvic computed tomography scans as well as whole-body scans were found to be associated with the highest fetal radiation exposure. However, in none of the publications the fetal exposure limit was exceeded.&#x0D; CONCLUSION: Clinically indicated non-contrast-enhanced computed tomography scans in pregnant women are not likely to be associated with the fetal absorbed doses that exceed the limit of 100 mGy regardless of the scanned area. However, this limit might be exceeded in case of performing multiple studies or if multiphase abdominal or pelvic computed tomography scans, or whole-body computed tomography scans are performed in patients with multiple trauma. In these cases, a decision regarding the need for these investigations should be made by a multi-disciplinary team (including radiation safety specialists, diagnostic radiologists and clinicians) based on the results of additional risk assessment.

Narrowing the Horizon: Using Known Invasives and Propagule Pressure to Focus Risk Screening Efforts on Potential Invasives

About 11 million marine ornamental fish of ca 1800 non-native species are imported into the USA each year. Selecting species for risk assessment is daunting for such a diverse pathway. Herein, we discuss a focused method for species selection: choosing important taxa related to known invaders in high-volume pathways and narrowing prospective species lists to manageable groups of potential hazards. We provide an example using 11 damselfishes, a family with high volume in trade and one of the species established in USA waters. We used a specialized literature review and a risk screening tool (Aquatic Species Invasiveness Screening Kit) to provide an estimate of risk of invasiveness of marine waters of Florida. The established species was identified as a hazard and potential invasive. All other species scored well below the threshold for invasiveness and future climate had little effect on estimates of invasiveness. The analysis revealed little need for additional risk assessment or prohibitions on damselfishes in trade. Education, monitoring, and early detection and rapid response were the main risk management recommendations. The focused species selection process employed herein provided hazard identification and preliminary risk estimates for just 11 species, but collectively, they represent 40% by volume of fishes imported in the marine ornamental trade.

Quantitative analysis and risk assessment to full-size microplastics pollution in the coastal marine waters of Hong Kong

Given the potential risk to the ecosystem, attention has increased in recent decades to the contamination of the aquatic environment by microplastics (MPs). Due to the limitations of conventional analysis methods of MPs, little is known about the size distribution and abundance of a full-size MPs from 1 μm to 5 mm. The present study quantified MPs with size ranges of 50 μm – 5 mm and 1–50 μm in the coastal marine waters from twelve locations in Hong Kong using fluorescence microscopy and flow cytometry respectively, during the end of wet (September 2021) and dry (March 2022) seasons. The average abundance of MPs with size ranges of 50 μm – 5 mm and 1–50 μm from twelve sampling locations marine surface waters were found ranging from 27 to 104 particles L−1 and 43,675–387,901 particles L−1 in the wet season respectively, and 13–36 particles L−1 and 23,178–338,604 particles L−1 in the dry season respectively. Significant temporal and spatial variations of small MPs abundance might be observed at the sampling locations, which were contributed by the influences of the estuary of Pearl River, sewage discharge points, land structure, and other anthropogenic activities. Based on the MPs abundance information, ecological risk assessment was conducted and revealed that the small MPs (< 10 μm) in coastal marine surface waters may pose potential health risks to aquatic organisms. Additional risk assessments are needed in order to determine whether or not the MPs exposure would cause health risks to the public.

Big Data Analytics to Reduce Preventable Hospitalizations—Using Real-World Data to Predict Ambulatory Care-Sensitive Conditions

The purpose of this study was to develop a prediction model to identify individuals and populations with a high risk of being hospitalized due to an ambulatory care-sensitive condition who might benefit from preventative actions or tailored treatment options to avoid subsequent hospital admission. A rate of 4.8% of all individuals observed had an ambulatory care-sensitive hospitalization in 2019 and 6389.3 hospital cases per 100,000 individuals could be observed. Based on real-world claims data, the predictive performance was compared between a machine learning model (Random Forest) and a statistical logistic regression model. One result was that both models achieve a generally comparable performance with c-values above 0.75, whereas the Random Forest model reached slightly higher c-values. The prediction models developed in this study reached c-values comparable to existing study results of prediction models for (avoidable) hospitalization from the literature. The prediction models were designed in such a way that they can support integrated care or public and population health interventions with little effort with an additional risk assessment tool in the case of availability of claims data. For the regions analyzed, the logistic regression revealed that switching to a higher age class or to a higher level of long-term care and unit from prior hospitalizations (all-cause and due to an ambulatory care-sensitive condition) increases the odds of having an ambulatory care-sensitive hospitalization in the upcoming year. This is also true for patients with prior diagnoses from the diagnosis groups of maternal disorders related to pregnancy, mental disorders due to alcohol/opioids, alcoholic liver disease and certain diseases of the circulatory system. Further model refinement activities and the integration of additional data, such as behavioral, social or environmental data would improve both model performance and the individual risk scores. The implementation of risk scores identifying populations potentially benefitting from public health and population health activities would be the next step to enable an evaluation of whether ambulatory care-sensitive hospitalizations can be prevented.

Postoperative venous thromboembolism risk stratification in patients with uterine cancer

Uterine cancers are associated with a high risk for venous thromboembolisms. The American Society of Clinical Oncology practice guidelines recommend that all patients undergoing pelvic surgery for cancer should receive extended pharmacologic thromboprophylaxis with the duration being dependent on risk. However, risk stratification for patients with uterine cancer is not clearly defined. The Caprini score is the most widely used risk assessment model but it has been found to have limited use in the gynecologic oncology population. A modified Caprini score has been explored in other populations. The Khorana score is an additional risk assessment model that has not been studied in this context. Our objective was to evaluate the ability of a modified Caprini model and the Khorana score to risk stratify patients with uterine cancer for postoperative venous thromboembolisms within 90 days of surgery. Following institutional review board approval, a retrospective cohort study was performed, and all patients with uterine cancer who underwent a hysterectomy over a 4-year period were included. The Caprini and Khorana scores were calculated for each patient. The Caprini score cutoff for highest risk was evaluated at ≥7, ≥8, and ≥9 (modified Caprini) and the Khorana score cutoff was evaluated at ≥2 and ≥3. To determine the prognostic use of each score and other clinico-pathologic criteria related to the development of a venous thromboembolism, univariate analyses were performed using independent ttests, chi-square tests, or Fisher's exact tests; a multivariate analysis was performed using logistic regression. A total of 954 patients were included. The rate of venous thromboembolism development was 1.7% (16/954). A minimally invasive surgical approach was used in 90.5% (863/954) of patients. The mean Caprini score for patients with a venous thromboembolism was 10.3 compared with 8.1 for patients without a venous thromboembolism (95% confidence interval, 1.17-3.33; P<.0001). The mean Khorana score for the venous thromboembolism group was 2.4 vs 1.9 for those without (95% confidence interval, 0.04-0.82; P=.03). Both the Caprini and Khorana scores were found to be associated with venous thromboembolisms, but only a Caprini score with a cutoff of ≥8 or ≥9 was statistically significant (risk ratio, 31.25; 95% confidence interval, 1.88-519.49; risk ratio, 4.59; 95% confidence interval, 1.49-14.13, respectively), with high accuracy based on the area under the curve (0.75 and 0.68, respectively). Of the minimally invasive subgroup, 11.7% (101/863) of patients had same-day discharge with no postoperative thromboprophylaxis; none of these patients developed venous thromboembolisms. Despite extended prophylaxis among the laparotomy patients (30 days), the rate of venous thromboembolisms was more than 3 times that of the minimally invasive group (5.49% vs 1.7%). Advanced tumor stage and leukocytosis were noted to be independent risk factors for venous thromboembolisms. Our study suggests that using a modified Caprini score could help to identify the highest-risk patients who would benefit from prolonged thromboprophylaxis, could reduce the incidence of postoperative venous thromboembolisms, and could minimize the cost and harm of overtreatment. These findings need to be validated in a prospective manner, and further research is needed to determine the optimal duration of therapy.

Predictors of suicidal ideation among acute stroke survivors

• Risk of suicide ideation and depression is high in the early post-stroke period • Severity of stroke disability is associated with post-stroke suicidal ideation • Post-stroke suicidal ideation is associated with ischemic stroke and a longer hospital stay : The risk of suicide in patients with stroke is high compared to the general population. To identify specific subgroups at higher risk of suicide in the early post-stroke period, we examined the relationship between the acute stroke-related clinical variables, patient demographics, depression, and suicidal ideation (SI). : We reviewed prospectively collected data from the comprehensive stroke center with patients who had an ischemic or hemorrhagic stroke and screened for depression with the Patient Health Questionnaire 9-Item (PHQ-9) at 90 days post-stroke outpatient follow-up. Question 9 of the PHQ-9 was screened for the presence of SI. : A total of 6.7% of patients reported SI. There were significant differences between groups among patients who reported SI as compared to those without SI with respect to ischemic stroke (p=0.026), longer hospital stay (p=0.009), and higher disability modified Rankin scale score at seven days post-stroke (p=0.014). : We did not have access to the number of stroke survivors with SI who attempted suicide. : Our results show that screening based on PHQ-9 can identify the stroke survivors at risk of suicide and then enable additional risk assessment and stratify the patient to appropriate mental health support, thus reducing suicide, a preventable condition.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Diabetes en cardiovasculaire risicobepalingen in Belgische officina-apotheken

Diabetes and cardiovascular risk assessments in Belgian community pharmacies Type 2 diabetes mellitus (T2DM) and cardiovascular disease are major health problems related to a number of modifiable risk factors such as obesity, an unhealthy lifestyle, hypertension and hypercholesterolemia. Early detection and management of these risk factors are essential to avoid severe long-term complications. Until now, screening for risk factors for T2DM and cardiovascular diseases in Belgium has been largely the task of the general practitioner. However, various international studies show that the community pharmacist can play a complementary role in this. This article provides an overview of the Belgian projects with T2DM and cardiovascular risk assessment in pharmacies. Between 2014 and 2021, there were 5 projects with T2DM and cardiovascular risk assessment in the community pharmacy in Belgium. These projects show that community pharmacists have screening tools at their disposal to perform an adequate risk assessment. Relative to the total number of patients screened, the percentage of patients referred by the pharmacist because of a high risk for T2DM varied between 25% and 58%. In 1 project with an additional cardiovascular risk assessment, 63% was referred because of an increased risk for cardiovascular disease. These results highlight the potential for the pharmacist’s role in the prevention of DM and cardiovascular diseases. Due to their proximity and accessibility, pharmacists can play an important complementary social role in the early recognition of chronic diseases in people who do not or irregularly use medical care.