Intervention to address homelessness and all-cause and suicide mortality among unstably housed US Veterans, 2012–2016

2020 ◽  
pp. jech-2020-214664
Author(s):  
Ann Elizabeth Montgomery ◽  
Melissa Dichter ◽  
Thomas Byrne ◽  
John Blosnich
Keyword(s):  
Suicide Prevention ◽  
Mental Health Treatment ◽  
Cox Regression ◽  
Suicide Mortality ◽  
Future Research ◽  
Housing Instability ◽  
Human Needs ◽  
Homeless Services ◽  
Stable Housing ◽  
Increased Risk

BackgroundPeople without stable housing—and Veterans specifically—are at increased risk of suicide. This study assessed whether unstably housed Veterans’ participation in homeless services is associated with reduced risk of all-cause and suicide mortality.MethodsThis retrospective cohort study used a sample of 169 221 Veterans across the US who self-reported housing instability between 1 October 2012 and 30 September 2016. Multivariable Cox regression models assessed the association between Veterans’ utilisation of homeless services and all-cause and suicide mortality, adjusting for sociodemographics and severity of medical comorbidities.ResultsMore than one-half of unstably housed Veterans accessed homeless services during the observation period; utilisation of any homeless services was associated with a 6% reduction in hazards for all-cause mortality (adjusted HR[aHR]=0.94, 95% CI[CI]=0.90–0.98). An increasing number of homeless services used was associated with significantly reduced hazards of both all-cause (aHR=0.93, 95% CI=0.91–0.95) and suicide mortality (aHR=0.81, 95% CI=0.73–0.89).ConclusionsThe use of homeless services among Veterans reporting housing instability was significantly associated with reduced hazards of all-cause and suicide mortality. Addressing suicide prevention and homelessness together—and ensuring ‘upstream’ interventions—within the context of the VHA healthcare system holds promise for preventing suicide deaths among Veterans. Mental health treatment is critical for suicide prevention, but future research should investigate if social service programmes, by addressing unmet human needs, may also reduce suicide.

Impact of homozygote variant of bleomycin hydrolase (BLMH) gene on survival after chemotherapy for testicular cancer (TC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5022-5022
Author(s):  
E. C. de Haas ◽  
N. Zwart ◽  
C. Meijer ◽  
H. M. Boezen ◽  
G. van der Steege ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cox Regression ◽  
Patient Characteristics ◽  
Cytotoxic Agents ◽  
Rank Test ◽  
Future Research ◽  
Polymorphism Analysis ◽  
Kaplan Meier ◽  
Response To Chemotherapy ◽  
Increased Risk

5022 Background: With bleomycin, etoposide and cisplatin, cure of disseminated TC exceeds 80%. Next to tumor characteristics, response to chemotherapy may be determined by polymorphisms of genes involved in metabolism or target pathways of cytotoxic drugs. We investigated whether the A1450G polymorphic site in the gene for BLMH, an enzyme that inactivates bleomycin, is associated with differences in survival. Methods: Data were collected on survival of non-seminomatous TC patients treated with bleomycin and platinum from 1977–2003. BLMH genotype was determined from genomic DNA by PCR + restriction fragment length polymorphism analysis. The 3 genotypes [AA (wild-type), AG (heterozygote variant) and GG (homozygote variant)] were compared for patient characteristics, prognostic factors and received chemotherapy (Mann-Whitney U or χ2 test) and survival (Kaplan-Meier + log-rank test and Cox regression). Results: Data on BLMH genotype and survival were available for 304/372 patients (82%) with median follow-up of 10 yrs (range 0–27). The 3 genotypes AA (n=140), AG (n=133) and GG (n=31) did not differ significantly with respect to age, IGCCC prognosis, creatinine clearance and received dose of bleomycin and platinum. Overall survival of the GG genotype (61%) was worse than the overall survival of AA and AG combined (83%) (p=0.004), due to worse TC related survival of GG (71%) compared to AA + AG (90%) (p=0.001). Homozygote variants (GG) had a significantly increased risk for TC related death (odds ratio (OR) = 4.97) compared to wildtypes (AA) ( table ). Conclusion: Germline presence of the homozygote variant (GG) of the BLMH gene appears to be an unfavorable prognostic factor for TC related death after chemotherapy, in addition to the commonly used IGCCC prognosis. It is unclear whether this is due to alterations in metabolism or target pathways of bleomycin or other cytotoxic agents, or linkage disequilibrium to a yet unknown involved gene. This needs to be unraveled in future research. [Table: see text] No significant financial relationships to disclose.

scholarly journals Accelerometer-derived sedentary time and physical activity and the incidence of depressive symptoms – The Maastricht Study

2020 ◽  
pp. 1-8
Author(s):  
Magdalena J. Konopka ◽  
Sebastian Köhler ◽  
Coen D. A. Stehouwer ◽  
Nicolaas C. Schaper ◽  
Ronald M. A. Henry ◽  
...  
Keyword(s):  
Physical Activity ◽  
Depressive Symptoms ◽  
Sex Education ◽  
Sedentary Time ◽  
Cox Regression ◽  
Future Research ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Intensity Physical Activity

Abstract Background This study examined the associations between accelerometer-derived sedentary time (ST), lower intensity physical activity (LPA), higher intensity physical activity (HPA) and the incidence of depressive symptoms over 4 years of follow-up. Methods We included 2082 participants from The Maastricht Study (mean ± s.d. age 60.1 ± 8.0 years; 51.2% men) without depressive symptoms at baseline. ST, LPA and HPA were measured with the ActivPAL3 activity monitor. Depressive symptoms were measured annually over 4 years of follow-up with the 9-item Patient Health Questionnaire (PHQ-9). Cox regression analysis was performed to examine the associations between ST, LPA, HPA and incident depressive symptoms (PHQ-9 ⩾ 10). Analyses were adjusted for total waking time per day, age, sex, education level, type 2 diabetes mellitus, body mass index, total energy intake, smoking status and alcohol use. Results During 7812.81 person-years of follow-up, 203 (9.8%) participants developed incident depressive symptoms. No significant associations [Hazard Ratio (95% confidence interval)] were found between sex-specific tertiles of ST (lowest v. highest tertile) [1.13 (0.76–1.66], or HPA (highest v. lowest tertile) [1.14 (0.78–1.69)] and incident depressive symptoms. LPA (highest v. lowest tertile) was statistically significantly associated with incident depressive symptoms in women [1.98 (1.19–3.29)], but not in men (p-interaction <0.01). Conclusions We did not observe an association between ST or HPA and incident depressive symptoms. Lower levels of daily LPA were associated with an increased risk of incident depressive symptoms in women. Future research is needed to investigate accelerometer-derived measured physical activity and ST with incident depressive symptoms, preferably stratified by sex.

scholarly journals Pulmonary Fibrosis among World Trade Center Responders: Results from the WTC Health Registry Cohort

2019 ◽  
Vol 16 (5) ◽  
pp. 825 ◽  
Author(s):  
Jiehui Li ◽  
James Cone ◽  
Robert Brackbill ◽  
Ingrid Giesinger ◽  
Janette Yung ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
World Trade ◽  
Statistical Power ◽  
Cox Regression ◽  
World Trade Center ◽  
Dust Exposure ◽  
Future Research ◽  
Increased Risk ◽  
Trade Center ◽  
Health Registry

Dust created by the collapse of the World Trade Center (WTC) towers on 9/11 included metals and toxicants that have been linked to an increased risk of pulmonary fibrosis (PF) in the literature. Little has been reported on PF among WTC responders. This report used self-reported physician diagnosis of PF with an unknown sub-type to explore the association between levels of WTC dust exposure and PF. We included 19,300 WTC responders, enrolled in the WTC Health Registry in 2003–2004, who were followed for 11 years from 2004 to 2015. Exposure was defined primarily by intensity and duration of exposure to WTC dust/debris and work on the debris pile. Stratified Cox regression was used to assess the association. We observed 73 self-reported physician-diagnosed PF cases, with a PF incidence rate of 36.7/100,000 person-years. The adjusted hazard ratio (AHR) of PF was higher in those with a medium (AHR = 2.5, 95% CI = 1.1–5.8) and very high level of exposure (AHR = 4.5, 95% CI = 2.0–10.4), compared to those with low exposure. A test for exposure—response trend was statistically significant (Ptrend = 0.004). Future research on WTC dust exposure and PF would benefit from using data from multiple WTC Health Program responder cohorts for increased statistical power and clinically confirmed cases.

A Silenced Population

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Kim Gryglewicz ◽  
Melanie Bozzay ◽  
Brittany Arthur-Jordon ◽  
Gabriela D. Romero ◽  
Melissa Witmeier ◽  
...  
Keyword(s):  
At Risk ◽  
Depressive Symptomatology ◽  
The United States ◽  
Future Research ◽  
At Risk Youth ◽  
Peer Relationship ◽  
Student Records ◽  
Cross Sectional ◽  
Increased Risk ◽  
Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

Suicide-Related Crimes in Contemporary European Criminal Laws

Crisis ◽  
1997 ◽  
Vol 18 (1) ◽  
pp. 35-47 ◽  
Author(s):  
Ilkka Henrik Mäkinen
Keyword(s):  
Suicide Prevention ◽  
Suicide Mortality ◽  
Legal Systems ◽  
Cultural Attitudes ◽  
Public Opinions ◽  
Suicide Rates ◽  
Narrow Scope ◽  
National Affair ◽  
Attitudes Towards Suicide ◽  
Special Circumstances

This article describes suicide-related penal legislation in contemporary Europe, and analyzes and relates the results to cultural attitudes towards suicide and to national suicide rates. Data were obtained from 42 legal entities. Of these, 34 have penal regulations which - according to definition - chiefly and directly deal with suicide. There are three main types of act: aiding suicide, abetting suicide, and driving to suicide. The laws vary considerably with regard to which acts are sanctioned, how severely they are punished, and whether any special circumstances such as the motive, the result, or the object can make the crime more serious. Various ideologies have inspired legislation: religions, the euthanasia movement, and suicide prevention have all left their mark. There are some cases in which neighboring legal systems have clearly influenced laws on the topic. However, the process seems mostly to have been a national affair, resulting in surprisingly large discrepancies between European legal systems. The laws seem to reflect public opinions: countries which punish the crimes harder have significantly less permissive cultural attitudes towards suicide. Likewise, suicide rates were significantly higher in countries with a narrow scope of criminalization and milder punishments for suicide-related crimes. The cultural and normative elements of society are connected with its suicide mortality.

Sibling Alcohol Use Disorder Is Associated With Increased Risk for Suicide Attempt

2021 ◽  
pp. 216770262110250
Author(s):  
Mallory E. Stephenson ◽  
Sara Larsson Lönn ◽  
Jessica E. Salvatore ◽  
Jan Sundquist ◽  
Kenneth S. Kendler ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Suicide Attempt ◽  
Alcohol Use Disorder ◽  
Cox Regression ◽  
Population Based ◽  
Swedish Population ◽  
Sibling Pairs ◽  
Increased Risk ◽  
Using Data ◽  
Shared Genetic

The association between having a sibling diagnosed with alcohol use disorder (AUD) and risk for suicide attempt may be attributable to shared genetic liability between AUD and suicidal behavior, effects of environmental exposure to a sibling’s AUD, or both. To distinguish between these alternatives, we conducted a series of Cox regression models using data derived from Swedish population-based registers with national coverage. Among full sibling pairs (656,807 males and 607,096 females), we found that, even after we accounted for the proband’s AUD status, the proband’s risk for suicide attempt was significantly elevated when the proband’s sibling was affected by AUD. Furthermore, the proband’s risk for suicide attempt was consistently higher when the sibling’s AUD registration had occurred more recently. Our findings provide evidence for exposure to sibling AUD as an environmental risk factor for suicide attempt and suggest that clinical outreach may be warranted following a sibling’s diagnosis with AUD.

Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis

2021 ◽  
Author(s):  
Sahrai Saeed ◽  
Anastasia Vamvakidou ◽  
Spyridon Zidros ◽  
George Papasozomenos ◽  
Vegard Lysne ◽  
...  
Keyword(s):  
Sex Differences ◽  
Aortic Stenosis ◽  
Flow Rate ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Aims It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. Methods and results Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P &lt; 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P &lt; 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03–1.11, P &lt; 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men. Conclusion Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.

scholarly journals Elevated Expression of Glycerol-3-Phosphate Phosphatase as a Biomarker of Poor Prognosis and Aggressive Prostate Cancer

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1273
Author(s):  
Mohamed Amine Lounis ◽  
Veronique Ouellet ◽  
Benjamin Péant ◽  
Christine Caron ◽  
Zhenhong Li ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Metastasis ◽  
Biochemical Recurrence ◽  
Poor Prognosis ◽  
Cox Regression ◽  
Specific Antigen ◽  
Metabolic Stress ◽  
Cancer Specific Survival ◽  
High Risk Prostate Cancer ◽  
Increased Risk

The limitations of the biomarker prostate-specific antigen (PSA) necessitate the pursuit of biomarkers capable of better identifying high-risk prostate cancer (PC) patients in order to improve their therapeutic management and outcomes. Aggressive prostate tumors characteristically exhibit high rates of glycolysis and lipogenesis. Glycerol 3-phosphate phosphatase (G3PP), also known as phosphoglycolate phosphatase (PGP), is a recently identified mammalian enzyme, shown to play a role in the regulation of glucose metabolism, lipogenesis, lipolysis, and cellular nutrient-excess detoxification. We hypothesized that G3PP may relieve metabolic stress in cancer cells and assessed the association of its expression with PC patient prognosis. Using immunohistochemical staining, we assessed the epithelial expression of G3PP in two different radical prostatectomy (RP) cohorts with a total of 1797 patients, for whom information on biochemical recurrence (BCR), metastasis, and mortality was available. The association between biomarker expression, biochemical recurrence (BCR), bone metastasis, and prostate cancer-specific survival was established using log-rank and multivariable Cox regression analyses. High expression of G3PP in PC epithelial cells is associated with an increased risk of BCR, bone metastasis, and PC-specific mortality. Multivariate analysis revealed high G3PP expression in tumors as an independent predictor of BCR and bone metastasis development. High G3PP expression in tumors from patients eligible for prostatectomies is a new and independent prognostic biomarker of poor prognosis and aggressive PC for recurrence, bone metastasis, and mortality.

scholarly journals Individuals with familial hypercholesterolemia have increased risk of re-hospitalization after acute myocardial infarction compared with controls

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Svendsen ◽  
H.W Krogh ◽  
J Igland ◽  
G.S Tell ◽  
L.J Mundal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Familial Hypercholesterolemia ◽  
Cox Regression ◽  
Public Institution ◽  
University Hospital ◽  
Funding Source ◽  
Hazard Ratios ◽  
Increased Risk ◽  
University Of Oslo

Abstract Background and aim We have previously reported that individuals with familial hypercholesterolemia (FH) have a two-fold increased risk of acute myocardial infarction (AMI) compared with the general population. The consequences of having an AMI on re-hospitalization and mortality are however less known. The aim of the present study was to compare the risk of re-hospitalization with AMI and CHD and risk of mortality after incident (first) AMI-hospitalization between persons with and without FH (controls). Methods The original study population comprised 5691 persons diagnosed with FH during 1992–2014 and 119511 age and sex matched controls randomly selected from the general Norwegian population. We identified 221 individuals with FH and 1947 controls with an incident AMI registered in the Norwegian Patient Registry (NPR) or the Cardiovascular Disease in Norway Project during 2001–2017. Persons with incident AMI were followed until December 31st 2017 for re-hospitalization with AMI or coronary heart disease (CHD) registered in the NPR, and for mortality through linkage to the Norwegian Cause of Death Registry. Risk of re-hospitalization was compared with sub-hazard ratios (SHR) from competing risk regression with death as competing event, and mortality was compared using hazard ratios (HR) from Cox regression. All models were adjusted for age. Results Risk of re-hospitalization was 2-fold increased both for AMI [SHR=2.53 (95% CI: 1.88–3.41)] and CHD [SHR=1.82 (95% CI: 1.44–2.28)]. However, persons with FH did not have increased 28-day mortality following an incident AMI (HR=1.05 (95% CI: 0.62–1.78), but the longer-term (&gt;28 days) mortality after first AMI was increased in FH [HR=1.45 (95% CI: 1.07–1.95]. Conclusion This study yields the important finding that persons with FH have increased risk of re-hospitalization of both AMI and CHD after incident AMI. These findings call for more intensive follow-up of individuals with FH after an AMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): University of Oslo and Oslo University Hospital

scholarly journals Defining a research agenda for youth sport specialisation in the USA: the AMSSM Youth Early Sport Specialization Summit

2021 ◽  
Vol 55 (3) ◽  
pp. 135-143
Author(s):  
Stephanie A Kliethermes ◽  
Stephen W Marshall ◽  
Cynthia R LaBella ◽  
Andrew M Watson ◽  
Joel S Brenner ◽  
...  
Keyword(s):  
Research Agenda ◽  
Sport Participation ◽  
Youth Sport ◽  
Well Being ◽  
Medical Society ◽  
Current Evidence ◽  
Future Research ◽  
Long Term Effects ◽  
Increased Risk ◽  
The Usa

Sport specialisation is becoming increasingly common among youth and adolescent athletes in the USA and many have raised concern about this trend. Although research on sport specialisation has grown significantly, numerous pressing questions remain pertaining to short-term and long-term effects of specialisation on the health and well-being of youth, including the increased risk of overuse injury and burnout. Many current elite athletes did not specialise at an early age. Methodological and study design limitations impact the quality of current literature, and researchers need to prioritise pressing research questions to promote safe and healthy youth sport participation. The American Medical Society for Sports Medicine hosted a Youth Early Sport Specialization Summit in April 2019 with the goal of synthesising and reviewing current scientific knowledge and developing a research agenda to guide future research in the field based on the identified gaps in knowledge. This statement provides a broad summary of the existing literature, gaps and limitations in current evidence and identifies key research priorities to help guide researchers conducting research on youth sport specialisation. Our goals are to help improve the quality and relevance of research on youth sport specialisation and to ultimately assure that opportunities for healthy and safe sport participation continue for all youth.

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