Weight gain increases risk of cardiovascular disease, but has not been examined extensively in relationship to venous thromboembolism (VTE). The association between weight change over 9 years and ...subsequent VTE among participants in the Atherosclerosis Risk in Communities (ARIC) study was examined, with a hypothesis that excess weight gain is a risk factor for VTE, relative to no weight change.
Quintiles of 9-year weight change were calculated (visit 4 1996-1998 weight minus visit 1 1987-1989 weight in kg: Quintile 1: ≥-1.81 kg; Quintile 2: <-1.81 to ≤1.36 kg; Quintile 3: >1.36 to ≤4.08 kg; Quintile 4: >4.08 to ≤7.71 kg; Quintile 5: >7.71 kg). Incident VTEs from visit 4 (1996-1998) through 2015 were identified and adjudicated using medical records. Hazard ratios (HRs) were calculated using Cox models.
529 incident VTEs were identified during an average of 19 years of follow up. Compared to Quintile 2, participants in Quintile 5 of weight change had 1.46 times the rate of incident VTE (HR = 1.46 (95% CI 1.09, 1.95), adjusted for age, race, sex, income, physical activity, smoking, and prevalent CVD). The HR for Quintile 5 was modestly attenuated to 1.38 (95% CI 1.03, 1.84) when visit 1 BMI was included in the model. When examined separately, results were significant for unprovoked VTE, but not for provoked VTE. Among those obese at visit 1, both weight gain (HR 1.86 95% CI 1.27, 2.71) and weight loss (HR 2.11 95% CI 1.39, 3.19) were associated with incident VTE, compared with normal-weight participants with no weight change.
Weight gain later life was associated with increased risk for unprovoked VTE. Among those with obesity, both weight gain and weight loss were associated with increased risk for VTE.
ABSTRACT
BACKGROUND
Collaborative care (CC) is a well‐established approach for the delivery of accessible behavioral health services in integrated health care settings. Substantial evidence supports ...its effectiveness in improving the quality and outcomes of adult services, and growing research indicates utility with child and adolescent populations.
METHODS
To date, studies examining CC models for youth have focused exclusively on primary‐care settings. Nevertheless, as the most common integrated service delivery setting for youth, the education sector is an equally important context for improving access to behavioral health services for children and adolescents.
RESULTS
We provide a narrative review of the literature on CC, describes the relevance of CC to schools, and details its alignment with contemporary movements in education and school‐based behavioral health.
CONCLUSIONS
Potential adaptations of the CC model for use in schools are detailed to improve: (1) behavioral health service accessibility, (2) the capacity of schools to provide behavioral health services, and (3) school service effectiveness through use of evidence‐based practices. Although little research has explored the applicability of CC in the education sector, the model holds potential promise to improve the quality and efficiency of school‐based behavioral health services.
Avian diet selection is hypothesized to be sensitive to seasonal changes in breeding status, but few tests exist for frugivorous tropical birds. Frugivorous birds provide an interesting test case ...because fruits are relatively deficient in minerals critical for reproduction. Here, we quantify annual patterns of fruit availability and diet for two frugivorous hornbill (Bucerotidae) species over a 5.5-y period to test for patterns of diet selection. Data from the lowland tropical rain forest of the Dja Reserve, Cameroon, are used to generate two nutritional indices. One index estimates the nutrient concentration of the diet chosen by Ceratogymna atrata and Bycanistes albotibialis on a monthly basis using 3165 feeding observations combined with fruit pulp sample data. The second index is an estimate of nutrient concentration of a non-selective or neutral diet across the study area based on tree fruiting phenology, vegetation survey and fruit-pulp sample data. Fifty-nine fruit pulp samples representing 40 species were analysed for 16 nutrient categories to contribute to both indices. Pulp samples accounted for approximately 75% of the observed diets. The results support expected patterns of nutrient selection. The two hornbill species selected a diet rich in calcium during the early breeding season (significantly so for B. albotibialis in July and August). Through the brooding and fledging periods, they switched from a calcium-rich diet to one rich in iron and caloric content as well as supplemental protein in the form of invertebrates. Calcium, the calcium to phosphorus ratio and fat concentration were the strongest predictors of breeding success (significant for calcium and Ca:P for B. albotibialis in June). We conclude that hornbills actively select fruit based on nutritional concentration and mineral concentration and that the indices developed here are useful for assessing frugivore diet over time.
Investigations at the Guard site (12D29), located in Dearborn County, Indiana, have provided evidence pertaining to the development of early Fort Ancient villages. Recent geophysical survey and ...excavations alongside many new radiocarbon dates have allowed for improved understanding of household architecture and intrasite variability. Although some scholars have hypothesized that Middle Fort Ancient villages developed out of small early Fort Ancient hamlets, the Guard site provides explicit evidence for villages early in the Fort Ancient sequence. Guard also contains key Mississippian indicators for interaction, particularly wall-trench architecture and a Ramey knife. These findings demand that we reconceptualize the inception of Fort Ancient villages.
ABSTRACT
Most studies examining dominance hierarchies have focused at the intraspecific level. While some examples of interspecific hierarchies have been noted, these have usually been limited to a ...few species in the same taxonomic group that utilize resources in similar ways. Here, we examine evidence for dominance interference competition among vertebrates comprising a diverse frugivore community, including 19 species of birds, squirrels, and primates in a mature Central African rainforest. A total of 38 fruiting trees from 18 species were observed for 2058 h to record dominance interactions between foraging vertebrates. We show that interference competition occurs within and between taxonomically diverse species of vertebrates at fruiting trees. The resulting cross‐taxonomic dominance hierarchy includes larger vertebrates, such as primates and hornbills, as well as smaller ones, such as squirrels and parrots. Within this hierarchy, the dominance rank of each species is highly correlated with body mass, and is shown to significantly affect the number of fruits removed from a given tree. Because a majority of tropical tree species depend on vertebrates to disperse their seeds, and particular vertebrates may preferentially disperse the seeds of specific tree species, results may have important conservation implications for the maintenance of tree diversity in regions where populations of larger frugivores have been depressed or extirpated.
Most studies examining dominance hierarchies have focused at the intraspecific level. While some examples of interspecific hierarchies have been noted, these have usually been limited to a few ...species in the same taxonomic group that utilize resources in similar ways. Here, we examine evidence for dominance interference competition among vertebrates comprising a diverse frugivore community, including 19 species of birds, squirrels, and primates in a mature Central African rainforest. A total of 38 fruiting trees from 18 species were observed for 2058 h to record dominance interactions between foraging vertebrates. We show that interference competition occurs within and between taxonomically diverse species of vertebrates at fruiting trees. The resulting cross-taxonomic dominance hierarchy includes larger vertebrates, such as primates and hornbills, as well as smaller ones, such as squirrels and parrots. Within this hierarchy, the dominance rank of each species is highly correlated with body mass, and is shown to significantly affect the number of fruits removed from a given tree. Because a majority of tropical tree species depend on vertebrates to disperse their seeds, and particular vertebrates may preferentially disperse the seeds of specific tree species, results may have important conservation implications for the maintenance of tree diversity in regions where populations of larger frugivores have been depressed or extirpated.
The authors examined the relation of recalled weight variability and history of intentional and unintentional weight loss with disease history in 41,837 older women. Lifetime history of disease, ...current medication use, health-related behaviors, body weight, and intentional and unintentional weight loss episodes of at least 20 lbs (9.1 kg) were assessed by means of two surveys, completed 6 years apart. Weight variability, as measured by the root mean square error around the linear regression line of weight on age at ages 18, 30, and 40 years, was positively related to disease history. Women who reported losing > or = 20 lbs (> or = 9.1 kg) unintentionally between the ages 18 and 39 years were more likely to report a history of disease than were women who had never lost > or = 20 lbs (> or = 9.1 kg) during this age period. Intentional weight loss episodes of > or = 20 lbs (> or = 9.1 kg) between ages 18 and 39 years were also associated with higher cumulative disease prevalence. These results suggest that both unintentional and, to a lesser degree, intentional weight loss may contribute to the observed positive relation between weight loss or variability and disease. Prospective studies are needed to confirm whether weight variability is a risk factor for disease only when unintentional, or whether intentional weight loss also increases risk.
Several epidemiologic investigations have suggested that weight loss is associated with increased mortality risk but have not examined whether the weight loss was intentional or unintentional. The ...authors examined whether the association between weight loss and mortality differs by whether the weight loss was intentional or unintentional as part of the Iowa Women's Health Study, a prospective cohort study of health risk factors in postmenopausal women. Women aged 55-69 years completed questions about intentional and unintentional weight losses since age 18 years via mail survey in 1992 and were followed through 1995. One or more intentional weight loss episodes of 20 or more pounds (> or =9.1 kg) during adulthood was not significantly associated with higher total or cardiovascular disease mortality risk compared with never losing > or =20 pounds. One or more unintentional weight loss episodes of 20 or more pounds was associated with a 26-57% higher total mortality risk and a 51-114% higher cardiovascular disease mortality risk, compared with never losing 20 or more pounds. Associations between unintentional weight loss and increased mortality risk were confined mostly to women with prevalent disease, hypertension, or diabetes. Patterns of association did not vary by overweight status. These findings suggest that the association between weight loss and increased mortality risk observed in epidemiologic studies may be due to unintentional weight loss that reflects existing disease and not due to intentional weight loss.
ABSTRACT
Most studies examining dominance hierarchies have focused at the intraspecific level. While some examples of interspecific hierarchies have been noted, these have usually been limited to a ...few species in the same taxonomic group that utilize resources in similar ways. Here, we examine evidence for dominance interference competition among vertebrates comprising a diverse frugivore community, including 19 species of birds, squirrels, and primates in a mature Central African rainforest. A total of 38 fruiting trees from 18 species were observed for 2058 h to record dominance interactions between foraging vertebrates. We show that interference competition occurs within and between taxonomically diverse species of vertebrates at fruiting trees. The resulting cross‐taxonomic dominance hierarchy includes larger vertebrates, such as primates and hornbills, as well as smaller ones, such as squirrels and parrots. Within this hierarchy, the dominance rank of each species is highly correlated with body mass, and is shown to significantly affect the number of fruits removed from a given tree. Because a majority of tropical tree species depend on vertebrates to disperse their seeds, and particular vertebrates may preferentially disperse the seeds of specific tree species, results may have important conservation implications for the maintenance of tree diversity in regions where populations of larger frugivores have been depressed or extirpated.
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