Psychiatric disorders present distinct clinical challenges which are partly attributable to their multifactorial aetiology and the absence of laboratory tests that can be used to confirm diagnosis or ...predict risk. Psychiatric disorders are highly heritable, but also polygenic, with genetic risk conferred by interactions between thousands of variants of small effect that can be summarized in a polygenic risk score. We discuss four areas in which the use of polygenic risk scores in psychiatric research and clinical contexts could have ethical implications. First, there is concern that clinical use of polygenic risk scores may exacerbate existing health inequities. Second, research findings regarding polygenic risk could be misinterpreted in stigmatising or discriminatory ways. Third, there are concerns associated with testing minors as well as eugenics concerns elicited by prenatal polygenic risk testing. Fourth, potential challenges that could arise with the feedback and interpretation of high polygenic risk for a psychiatric disorder would require consideration. While there would be extensive overlap with the challenges of feeding back genetic findings in general, the potential clinical use of polygenic risk scoring warrants discussion in its own right, given the recency of this possibility. To this end, we discuss how lay interpretations of risk and genetic information could intersect. Consideration of these factors would be necessary for ensuring effective and constructive communication and interpretation of polygenic risk information which, in turn, could have implications for the uptake of any therapeutic recommendations. Recent advances in polygenic risk scoring have major implications for its clinical potential, however, care should be taken to ensure that communication of polygenic risk does not feed into problematic assumptions regarding mental disorders or support reductive interpretations.
This study was performed to highlight the relationship between single dietary risk factors and cardiovascular diseases (CVDs) in the WHO European Region. We used the comparative risk assessment ...framework of the Global Burden of Disease Study to estimate CVD mortality attributable to diet; comprising eleven forms of CVDs, twelve food and nutrient groups and 27 risk-outcome pairs in four GBD regions including 51 countries by age and sex between 1990 and 2016. In 2016, dietary risks were associated with 2.1 million cardiovascular deaths (95% uncertainty interval (UI), 1.7–2.5 million) in the WHO European Region, accounting for 22.4% of all deaths and 49.2% of CVD deaths. In terms of single dietary risks, a diet low in whole grains accounted for approximately 429,000 deaths, followed by a diet low in nuts and seeds (341,000 deaths), a diet low in fruits (262,000 deaths), a diet high in sodium (251,000 deaths), and a diet low in omega-3 fatty acids (227,000 deaths). Thus, with an optimized, i.e. balanced diet, roughly one in every five premature deaths could be prevented. Although agestandardized death rates decreased over the last 26 years, the absolute number of diet-related cardiovascular deaths increased between 2010 and 2016 by 25,600 deaths in Western Europe and by 4300 deaths in Central Asia. In 2016, approximately 601,000 deaths (28.6% of all diet-related CVD deaths) occurred among adults younger than 70 years. Compared to other behavioural risk factors, a balanced diet is a potential key lever to avoid premature deaths.
The sharing economy is of increasing importance for various aspects of our society by providing people with cost-efficient and convenient access to services or products. However, the profitability ...and healthy development of the sharing economy platforms are greatly restricted by the intensive uncertainties arising from product quality. How to determine the optimal product quality improvement efforts and the optimal prices for the sharing platforms becomes crucial. Moreover, it is reasonable that many sharing economy platforms and consumers are holding a risk-averse attitude during decision making in the highly volatile market. In this paper, we employ the Mean-Variance theory to model the risk-averse attitudes of decision makers, and analytically derive the optimal average quality levels and prices that the platform should provide for the market. We also explore how the critical factors like product quality uncertainty and risk sensitivity affect the platform's equilibrium decisions and consumer surplus. Our analytical results reveal the importance of reducing the difficulty of improving product quality for enhancing the platforms' profitability and consumer surplus. Besides, we identify that it is not always wise for platforms to invest in improving product quality, especially when the related cost becomes increasingly expensive. Moreover, it is shown that the increasing risk aversion or product quality volatility will induce the platform to reduce his quality improvement efforts. Finally, we interestingly find that the platform will always suffer if he becomes risk averse from risk neutral, while consumers may benefit from this attitude change.
Exposure to polycyclic aromatic hydrocarbons (PAHs) through contaminated water may adversely affect human health and ecology. Water and sediment samples collected from the Mahanadi River Basin (MRB) ...were analyzed for the presence of sixteen priority PAHs. Results showed that the concentrations of Σ16 PAHs in water and sediments ranged from 13.1 to 685.4 μg/L and 302.6 to 728.2 ng/g. In river water samples, the highest mean concentrations were recorded for Acenaphthylene (18.73 ± 11.61 μg/L) and Benzo(a)Anthracene (10.11 ± 8 μg/L). On the contrary, the maximum concentration was recorded for Phenanthrene (96.18 ± 50.66 ng/g) and Pyrene (76.69 ± 22.73 ng/g) in sediment samples. Human health risk assessment suggests low risk, with incremental lifetime cancer risk (ILCR) being 37.44 × 10−5 for children and 21.82 × 10−5 for adults. In contrast, ecological risk assessment showed a high toxic equivalent quotient of 40.68 ng/g and mutagenic equivalent quotient of 39.74 ng/g suggesting elevated adverse risk to aquatic species.
•Surface water and sediment samples in the MRB showed PAHs deposition.•PAHs deposition in the MRB is due to petrogenic, combustion of coal, grass, & wood.•Heavy vehicular traffic & industrial emission leads to higher PAH in surface water.•Higher toxic equivalent quotient of PAHs in sediment samples indicates adverse risk.•Continued release of PAHs and its deposition in the MRB is a serious concern.
Urban soil pollution with heavy metals is one of the environmental problems in recent years, especially in industrial cities. The aim of this study is to evaluate the role of geogenic and ...anthropogenic sources in the urban soil pollution in Yazd, Iran. For this purpose, 30 top-soil (0-10 cm) samples from Yazd within an area of 136.37 Km2 and population of nearly 656 thousand are collected, and the concentration of heavy elements is measured. To evaluate factors affecting the concentration of heavy elements in urban soils and determine their possible sources, Multivariate statistical analysis, including correlation coefficient, principal components analysis (PCA) and cluster analysis (CA) are performed. Enrichment Factor (EF), Geo-accumulation index (Igeo), and Modified potential ecological Risk Index (MRI) are used to assess the level and extension of contamination. Results of this study suggest that As, Cd, Pb and Zn are affected by anthropogenic source, while the concentrations of Fe, Mn, Ni, Cr, Co, Cu and Cs have come from mostly natural geologic sources. As, Cd and Pb are considerably enriched in the area, provided moderately enriched for the elements Mn, Zn and Cu. However, the other heavy elements show minimal enrichment. Igeo reveal that Co, Cr, Cs, Cu, Fe, Mn, Zn and Ni with negative values are unpolluted, Pb posed unpolluted to moderately polluted, and As and Cd represent high polluted. Based on the results of the ecological risk factor, the heavy metals of Mn, Ni, Cr, Zn and Cu have a low ecological risk level. More specifically, we find that Pb shows a moderated ecological risk in 39% of the urban soil in the studied area. As and Cd with respectively 100 and 72% contribution have considerable and very high ecological risk. According to the results of MRI, the area is in a very high ecological risk level, and appropriate management practice is essential to reduce the pollution of heavy elements in this area.
Non-typhoidal salmonella invasive disease is a major cause of global morbidity and mortality. Malnourished children, those with recent malaria or sickle-cell anaemia, and adults with HIV infection ...are at particularly high risk of disease. We sought to estimate the burden of disease attributable to non-typhoidal salmonella invasive disease for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017.
We did a systematic review of scientific databases and grey literature, and estimated non-typhoidal salmonella invasive disease incidence and mortality for the years 1990 to 2017, by age, sex, and geographical location using DisMod-MR, a Bayesian meta-regression tool. We estimated case fatality by age, HIV status, and sociodemographic development. We also calculated the HIV-attributable fraction and estimated health gap metrics, including disability-adjusted life-years (DALYs).
We estimated that 535 000 (95% uncertainty interval 409 000–705 000) cases of non-typhoidal salmonella invasive disease occurred in 2017, with the highest incidence in sub-Saharan Africa (34·5 26·6–45·0 cases per 100 000 person-years) and in children younger than 5 years (34·3 23·2–54·7 cases per 100 000 person-years). 77 500 (46 400–123 000) deaths were estimated in 2017, of which 18 400 (12 000–27 700) were attributable to HIV. The remaining 59 100 (33 300–98 100) deaths not attributable to HIV accounted for 4·26 million (2·38–7·38) DALYs in 2017. Mean all-age case fatality was 14·5% (9·2–21·1), with higher estimates among children younger than 5 years (13·5% 8·4–19·8) and elderly people (51·2% 30·2–72·9 among those aged ≥70 years), people with HIV infection (41·8% 30·0–54·0), and in areas of low sociodemographic development (eg, 15·8% 10·0–22·9 in sub-Saharan Africa).
We present the first global estimates of non-typhoidal salmonella invasive disease that have been produced as part of GBD 2017. Given the high disease burden, particularly in children, elderly people, and people with HIV infection, investigating the sources and transmission pathways of non-typhoidal salmonella invasive disease is crucial to implement effective preventive and control measures.
Bill & Melinda Gates Foundation.
To develop and validate a novel, machine learning-derived model to predict the risk of heart failure (HF) among patients with type 2 diabetes mellitus (T2DM).
Using data from 8,756 patients free at ...baseline of HF, with <10% missing data, and enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, we used random survival forest (RSF) methods, a nonparametric decision tree machine learning approach, to identify predictors of incident HF. The RSF model was externally validated in a cohort of individuals with T2DM using the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
Over a median follow-up of 4.9 years, 319 patients (3.6%) developed incident HF. The RSF models demonstrated better discrimination than the best performing Cox-based method (C-index 0.77 95% CI 0.75-0.80 vs. 0.73 0.70-0.76 respectively) and had acceptable calibration (Hosmer-Lemeshow statistic χ
= 9.63,
= 0.29) in the internal validation data set. From the identified predictors, an integer-based risk score for 5-year HF incidence was created: the WATCH-DM (Weight BMI, Age, hyperTension, Creatinine, HDL-C, Diabetes control fasting plasma glucose, QRS Duration, MI, and CABG) risk score. Each 1-unit increment in the risk score was associated with a 24% higher relative risk of HF within 5 years. The cumulative 5-year incidence of HF increased in a graded fashion from 1.1% in quintile 1 (WATCH-DM score ≤7) to 17.4% in quintile 5 (WATCH-DM score ≥14). In the external validation cohort, the RSF-based risk prediction model and the WATCH-DM risk score performed well with good discrimination (C-index = 0.74 and 0.70, respectively), acceptable calibration (
≥0.20 for both), and broad risk stratification (5-year HF risk range from 2.5 to 18.7% across quintiles 1-5).
We developed and validated a novel, machine learning-derived risk score that integrates readily available clinical, laboratory, and electrocardiographic variables to predict the risk of HF among outpatients with T2DM.
Crises like the COVID-19 pandemic are wake-up calls for enterprises to review their current risk management models. This book suggests a more robust risk management maturity model and illustrates the ...application in crisis situations. The book surveys existing risk management maturity models and proposes a new model appropriate for assessing the risk management processes in enterprises during times of crisis. Its key advantages include the correlation of its attributes with crisis situations and an innovative methodological approach to model development. The authors use the model to examine 107 enterprises from the financial services, construction and IT sector, showing how it allows the user to identify risk management maturity changes in the aftermath of the COVID-19 pandemic. The book will interest entrepreneurs, managers and risk management professionals, who can use the model in their management processes, as well as enterprise stakeholders and academics.
Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about ...their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women).
Methodological study with cross-sectional design conducted online during October/2019 (key populations sample 1 and other populations) and February-March/2020 (key populations not on pre-exposure prophylaxis sample 2). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale.
4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: "I worry about getting infected with HIV", item 4: "I am sure I will not get infected with HIV", and item 8: "Getting HIV is something I have") exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk.
The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.
•Rural people who inject drugs experience significant stigma in healthcare settings.•Healthcare stigma among rural PWID contributes to high-risk injection practices.•Expanding healthcare provision in ...rural SSPs may further reduce HIV risk among PWID.
The HIV epidemic is increasingly penetrating rural areas of the U.S. due to evolving epidemics of injection drug use. Many rural areas experience deficits in availability of HIV prevention, testing and harm reduction services, and confront significant stigma that inhibits care seeking. This paper examines enacted stigma in healthcare settings among rural people who inject drugs (PWID) and explores associations of stigma with continuing high-risk behaviors for HIV.
PWID participants (n = 324) were recruited into the study in three county health department syringe service programs (SSPs), as well as in local community-based organizations. Trained interviewers completed a standardized baseline interview lasting approximately 40 min. Bivariate logistic regression models examined the associations between enacted healthcare stigma, health conditions, and injection risk behaviors, and a mediation analysis was conducted.
Stigmatizing health conditions were common in this sample of PWID, and 201 (62.0 %) reported experiencing stigma from healthcare providers. Injection risk behaviors were uniformly associated with higher odds of enacted healthcare stigma, including sharing injection equipment at most recent injection (OR = 2.76; CI 1.55, 4.91), and lifetime receptive needle sharing (OR = 2.27; CI 1.42, 3.63). Enacted healthcare stigma partially mediated the relationship between having a stigmatizing health condition and engagement in high-risk injection behaviors.
Rural PWID are vulnerable to stigma in healthcare settings, which contributes to high-risk injection behaviors for HIV. These findings have critical public health implications, including the importance of tailored interventions to decrease enacted stigma in care settings, and structural changes to expand the provision of healthcare services within SSP settings.
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