BSE risk assessments in the UK: a risk tradeoff?

Risk assessments for bovine spongiform encephalopathy (BSE) should be based on the group risk and not the median individual risk. The group risk is calculated from the arithmetic mean risk, which in the case of dorsal root ganglia, is a factor of 50-fold higher than the median. For environmental routes, the arithmetic mean exposure is sufficient for risk assessment, while for food-borne routes failure to accommodate the variation in exposures to individuals across the UK population could overestimate the group risk considerably. Ignoring prion destruction by cooking could overestimate the food-borne risks still further. The recent estimate for the arithmetic mean cow-to-man species barrier of 4000 does not take into accounts either of these factors and thus may be too high. Until evidence for a threshold dose is demonstrated, public health scientists should avoid assessing safety on the basis of a 'minimum infective dose'. The incubation period observed in cattle-feeding studies, when completed, would continue to increase with decreasing dose below the ID50if there is a threshold or co-operative effect. The question is raised of whether fears over BSE in drinking water contributed to the spread of foot-and-mouth disease across the UK in 2001; a risk tradeoff.     

Are all risk perceptions created equal? Comparing general risk assessments and specific risk assessments associated with climate change

For policy-making to address public risk perceptions effectively, policy-makers must have a clear understanding of the nature of public risks. Public opinion polls regularly solicit perceptions of risk toward a variety of topics. These assessments, though, tend to be general with no specificity offered for a nuanced interpretation. Yet, there is good reason to assume that risk perceptions are not based on the same criteria. If true, policy-makers may be unable to address risks adequately without a better understanding of the drivers of risk perceptions. This project focuses on two primary research questions: (1) Does the public weigh the risk associated with global climate change differently in specific sub-domains? (2) If so, which climate change sub-domains are various members of the public most concerned about when offering a general assessment of global climate change risk? We assess public risk perceptions of climate change in three sub-domains—public health, economic development, and environment—and find that two of the three sub-domains are predictors of a general assessment of risk.     

The Dutch SCORE-based risk charts seriously underestimate the risk of cardiovascular disease

Introduction

Dutch cardiovascular disease (CVD) prevention guidelines recommend the use of modified SCORE risk charts to estimate 10-year risk of fatal and nonfatal CVD (myocardial infarction, cerebrovascular disease and congestive heart failure). This combined risk is derived from the SCORE mortality risk using multipliers. These multipliers have been shown to underestimate overall CVD risk. We aimed to compare the current Dutch risk charts with charts that estimate a broader range of clinically relevant CVD using updated multipliers.

Methods

We constructed new risk charts for 10-year CVD using updated, recently published multipliers from the EPIC-Norfolk study, based on ratios of fatal CVD to clinically relevant CVD (fatal plus nonfatal CVD requiring hospitalisation for ischaemic heart disease, cardiac failure, cerebrovascular disease, peripheral artery disease, and aortic aneurysm). Our primary outcome was the proportion of the three risk categories, i.?e. ‘high risk’ (>20% 10-year risk), ‘intermediate risk’ (10–19%) and ‘low risk’ (<10%) in the new risk charts as compared with the current risk charts.

Results

Applying the updated fatal CVD/clinical CVD multipliers led to a marked increase in the high-risk categories (109 (27%) vs. 244 (61%), (p < 0.001)), an absolute increase of 229%. Similarly, the number of low-risk categories decreased (190 (48%) vs. 81 (20%) (p < 0.001)).

Conclusion

The current Dutch risk charts seriously underestimate the risk of clinical CVD, even in the first 10 years. Even when analyses are restricted to CVD events that required hospitalisation, true 10-year risks are more than double the currently estimated risks. Future guidelines may be revised to reflect these findings.

     

How does scientific risk assessment of GM crops fit within the wider risk analysis?

The debate concerning genetically modified crops illustrates confusion between the role of scientists and that of wider society in regulatory decision making. We identify two fundamental misunderstandings, which, if rectified, would allow progress with confidence. First, scientific risk assessment needs to test well-defined hypotheses, not simply collect data. Second, risk assessments need to be placed in the wider context of risk analysis to enable the wider 'non-scientific' questions to be considered in regulatory decision making. Such integration and understanding is urgently required because the challenges to regulation will escalate as scientific progress advances.     

Can we predict perceived risk?

This paper examines the possibility that we may be able to use subjective measures of perceived risk in order to assess the relative safety of different shift systems. A large-scale survey of safety-critical engineers included three items relating to risk on each shift, namely alertness, likelihood of making a mistake and confidence in driving home after it. These three measures were found to load on a separate factor for each shift. Hierarchical regression analyses indicated that perceived night shift risk could be predicted on the basis of circadian type, the extent to which the engineers could control their work schedule, and a number of features of the scheduled shift system. In most cases the relationships observed were reasonably consistent with established trends in either performance capability or accident and injury frequency. However, there were exceptions to this indicating that results based on measures of perceived risk should be interpreted with the utmost caution.     

Radon-associated lung cancer risk among French uranium miners: modifying factors of the exposure–risk relationship

Radon is classified as a known pulmonary carcinogen in humans. A better understanding of the effects of low exposure and time-dependent factors, modifying the lung cancer risk is of continued interest. We present analyses of the exposure–risk relationship in the French cohort of uranium miners updated until 1999 and including five additional years of follow-up. These new analyses provide a better opportunity to look at low radon exposures with longer follow-up intervals, and allow consideration of new modifying factors, such as physical activity, mine location and job type. The cohort includes 5,086 miners, and 159 lung cancer deaths have been observed among these over a follow-up of more than 30 years. The exposure–risk relationship was estimated using excess relative risk models, which allow investigation of several modifying factors such as period of exposure, time since exposure, age at exposure, duration of exposure, exposure rate, job type, mine type and physical activity. The analysis confirms the association between radon exposure and lung cancer risk (ERR per 100 WLM = 0.58, P < 0.01). Period of exposure and physical activity appear as major modifying factors. Higher risks are observed for hard physical activity works. The effect of hard physical activity persists when the period of exposure is taken into account (ERR per 100 WLM = 2.95, P < 0.01).     

Aldosterone: A cardiovascular risk factor?

The hormone aldosterone has a well-recognized physiological role in epithelial fluid and electrolyte homeostasis, and more recently defined pathophysiological roles in the cardiovascular system. The term “risk factor” implies an active role in pathophysiology, with levels lower (e.g. HDL) or higher (e.g. LDL, BP) than normal contributing to an increased likelihood of morbidity and/or mortality. In this regard, primary aldosteronism represents a classic illustration of aldosterone as a cardiovascular risk factor. In this syndrome of (relatively) autonomous aldosterone secretion, the effects of elevated hormone levels are on a range of organs and tissues—the heart, blood vessels and brain, inter alia. In other cardiovascular disorders (e.g. CCF, EH) while an elevation of aldosterone levels is often regarded as a risk factor, it is more correctly a response to the severity of disease (or to treatment intervention), rather than necessarily a risk factor with a primary role in disease progression. An enduring enigma relevant to any discussion of aldosterone as a risk factor is that very high levels of aldosterone in response to chronic sodium deficiency have homeostatic (and protective of cardiovascular) functions, while the considerably lower levels commonly seen in primary aldosteronism are incontrovertibly damaging. A final section of the paper will thus propose a mechanism which might solve this enigma, based on the commonalities–and a single crucial difference–in the factors stimulating the secretion of aldosterone and endogenous ouabain from the zona glomerulosa of the adrenal gland.     

Perinatal and early life risk factors for childhood brain tumors: Is instrument-assisted delivery associated with higher risk?

BackgroundThe childhood peak of brain tumors suggests that early-life exposures might have a role in their etiology. Hence, we examined in the Greek National Registry for Childhood Hematological Malignancies and Solid tumors (NARECHEM-ST) whether perinatal and early-life risk factors influence the risk of childhood brain tumors.MethodsIn a nationwide case-control study, we included 203 cases (0–14 years) with a diagnosis of brain tumor in NARECHEM-ST (2010–2016) and 406 age-, sex-, and center-matched hospital controls. Information was collected via interviews with the guardians and we analyzed the variables of interest in multivariable conditional logistic regression models.ResultsInstrument-assisted delivery was associated with higher (OR: 7.82, 95%CI: 2.18–28.03), whereas caesarean delivery with lower (OR: 0.67, 95%CI: 0.45-0.99) risk of childhood brain tumors, as compared to spontaneous vaginal delivery. Maternal alcohol consumption during pregnancy (OR: 2.35, 95%CI: 1.45–3.81) and history of living in a farm (OR: 4.98, 2.40–10.32) increased the odds of childhood brain tumors. Conversely, higher birth order was associated with lower risk (OR for 2nd vs. 1st child: 0.60, 95%CI: 0.40-0.89 and OR for 3^rd vs. 1^st: 0.34, 95%CI: 0.18-0.63). Birth weight, gestational age, parental age, history of infertility, smoking during pregnancy, allergic diseases, and maternal diseases during pregnancy showed no significant associations.ConclusionsPerinatal and early-life risk factors, and specifically indicators of brain trauma, exposure to toxic agents and immune system maturation, might be involved in the pathogenesis of childhood brain tumors. Larger studies should aim to replicate our findings and examine associations with tumor subtypes.     

Does copulation increase the risk of predation?

Studies of mating behaviour have assumed that individuals are at greater risk when paired than when engaged in other activities. Recently, four experimental studies of insects and crustaceans have tested this assumption using predators from divergent taxa. Three of these studies indicate that mating carries no additional risk to the participants. Indeed, the findings suggest decreased vulnerability, relative to other activities, due to decreased predation on one or the other of the mating pair.     

Fatty acid–genotype interactions and cardiovascular risk

Cardiovascular disease (CVD) risk and rate of progression is determined by genetic, environmental and behavioural factors. Majority of genotype–diet–CVD phenotype research till date has focussed on the interactive impact of single nucleotide polymorphisms (SNP) and dietary fat composition, on blood lipids levels, with strong evidence of the existence of hypo- and hyper-responders. However, a recognised concern in the field of nutrigenetics is a lack of consistency between findings of different studies. This apparent lack of consistency is likely to be attributable to the impact of factors such as ethnicity and gender on the ‘size’ of nutrigenetic interactions, a clear understanding of which needs to be gained. Although not yet ready for widespread use, in the future a greater use of genetic profiling is likely to enhance current strategies of CVD prediction, and improve the design of more personalised approaches to minimise risk in the individual.     

Nest predation risk and growth strategies of passerine species: grow fast or develop traits to escape risk?

Abstract Different body components are thought to trade off in their growth and development rates, but the causes for relative prioritization of any trait remains a critical question. Offspring of species at higher risk of predation might prioritize development of locomotor traits that facilitate escaping risky environments over growth of mass. We tested this possibility in 12 altricial passerine species that differed in their risk of nest predation. We found that rates of growth and development of mass, wings, and endothermy increased with nest predation risk across species. In particular, species with higher nest predation risk exhibited relatively faster growth of wings than of mass, fledged with relatively larger wing sizes and smaller mass, and developed endothermy earlier at relatively smaller mass. This differential development can facilitate both escape from predators and survival outside of the nest environment. Tarsus growth was not differentially prioritized with respect to nest predation risk, and instead all species achieved adult tarsus size by age of fledging. We also tested whether different foraging modes (aerial, arboreal, and ground foragers) might explain the variation of differential growth of locomotor modules, but we found that little residual variation was explained. Our results suggest that differences in nest predation risk among species are associated with relative prioritization of body components to facilitate escape from the risky nest environment.     

Chlamydia pneumoniae--an infectious risk factor for atherosclerosis?

Cardiovascular disease, of which atherosclerosis is an important component, is the leading cause of death in the western world. Although there are well-defined risk factors for atherosclerosis, these factors do not account for all incidences of the disease. Because atherosclerotic processes are typified by chronic inflammatory responses, which are similar to those that are elicited by chronic infection, the role of infection in promoting or accelerating atherosclerosis has received renewed attention. This review focuses on the accumulating evidence that chronic infection with Chlamydia pneumoniae, a ubiquitous human respiratory pathogen, might contribute to atherosclerotic lesion progression.     

Do estrogens always increase breast cancer risk?

The etiology of breast cancer is closely linked to the female hormone estrogen, with high life-time exposure being suggested to increase breast cancer risk [Nature 303 (1983) 767]. However, there appears to be a disparity between studies attempting to establish an association between high estrogen levels and breast cancer risk. This disparity becomes smaller by taking into consideration a timing factor, and we propose that estrogens can increase, decrease, or have no effect on breast cancer risk, depending on the timing of estrogen exposure. We further propose that the timing of estrogenic exposures may play at least as important a role in affecting breast cancer risk as life-time exposure.