An Annotated Bibliography on the Attributable Risk

The attributable risk constitutes an important epidemiologic risk measure. In epidemiologic studies it quantifies the proportion of cases of disease due to the exposure factor under study. Hence, it assesses the public health importance of an exposure factor in the study population. The literature on the concept of attributable risk is diverse, appears in a variety of journals from different specialities, and most papers cite only a very limited part of it. In addition, it suffers from a substantial confusion in terminology and algebraic formulation. As a consequence, it is difficult to obtain an overview with respect to the statistical results relating to the concept. To remedy this problem, this paper provides an annotated bibliography containing a complete list of all references dealing with methodological aspects of the attributable risk.     

Estimation of population attributable fractions from fitted incidence ratios and exposure survey data, with an application to electromagnetic fields and childhood leukemia

Standard presentations of epidemiological results focus on incidence-ratio estimates derived from regression models fit to specialized study data. These data are often highly nonrepresentative of populations for which public-health impacts must be evaluated. Basic methods are provided for interval estimation of attributable fractions from model-based incidence-ratio estimates combined with independent survey estimates of the exposure distribution in the target population of interest. These methods are illustrated in estimation of the potential impact of magnetic-field exposures on childhood leukemia in the United States, based on pooled data from 11 case-control studies and a U.S. sample survey of magnetic-field exposures.     

On the uniqueness of endemic equilibria of an HIV/AIDS transmission model for a heterogeneous population

In this paper, we examine an HIV/AIDS transmission model which has been widely used for studying the spread of HIV/AIDS through sexual contact. Some sufficient conditions are obtained for the uniqueness of endemic equilibrium. We also present a two-group model whose no-disease equilibrium is unstable but it has at least three positive endemic equilibria.     

A summary of the workshop on passive immunization using monoclonal antibodies for HIV/AIDS, held at the National Institute of Allergy and Infectious Diseases, Bethesda, 10 March 2006

Passive immunization with monoclonal antibodies (MAbs) has been shown to prevent a wide variety of diseases. Currently, there are no MAb products that are licensed for use for immunotherapy or immunoprophylaxis against infection by HIV. However, there are several rational arguments that can be advanced for the use of a passive immunization approaches for counteracting HIV much as for other diseases especially with respect to mother-to-child transmission (MTCT) of HIV and immediate post-exposure situations. Several arguments questioning the feasibility of the approach based on availability of effective drugs, high cost of production and distribution of the MAbs among others, also get raised. It seems that the field now is looking at some promising MAbs as well as several alternate ways to manufacture antibodies and which hopefully may positively affect cost-related issues. This summary of a workshop held to assess the role of MAbs in the treatment and prevention of HIV/AIDS provides a fairly comprehensive analysis of the usefulness of MAb technology for future HIV/AIDS research.     

Radionuclide transport model for risk evaluation of high-level radioactive waste in Northwestern China

The proper disposal of high-level radioactive waste (HLRW) is highly challenging. Numerical simulations are helpful methods of evaluating the risks of radionuclide transport. This paper examines the hydrogeological conditions of a prospective HLRW repository in China. A regional radionuclide transport model is first constructed using the TOUGH2-MP/EOS7R module at a site in northwestern China to evaluate radionuclide transport behavior. A flow model calibration under a steady state shows that the simulated and observed hydraulic heads match well. Hypothetical radionuclides (⁹⁰Sr, ¹³⁷Cs, ²³⁵U and ²³⁹Pu) are assumed to be instantaneously released at three locations with large groundwater velocities. Transport modeling shows that ²³⁵U is the most sensitive element and has the plume size (2400 m) after 10,000 years. Sensitivity analyses of parameters, including the permeability, distribution coefficient and diffusion coefficient, are carried out. The results show that the distribution coefficient is the most critical parameter for nuclide transport. These findings will provide a preliminary reference for the radionuclide migration process at a prospective HLRW disposal site, which could be informative for safety analyses and further transport in and around the repository system.     

Stochastic models for the spread of HIV in a mobile heterosexual population

An important factor in the dynamic transmission of HIV is the mobility of the population. We formulate various stochastic models for the spread of HIV in a heterosexual mobile population, under the assumptions of constant and varying population sizes. We also derive deterministic and diffusion analogues for these models, using a convenient rescaling technique, and analyze their stability conditions and equilibrium behavior. We illustrate the dynamic behavior of the models and their approximations via a range of numerical experiments.     

To Cut or Not to Cut: A Modeling Approach for Assessing the Role of Male Circumcision in HIV Control

A recent randomized controlled trial shows a significant reduction in women-to-men transmission of HIV due to male circumcision. Such development calls for a rigorous mathematical study to ascertain the full impact of male circumcision in reducing HIV burden, especially in resource-poor nations where access to anti-retroviral drugs is limited. First of all, this paper presents a compartmental model for the transmission dynamics of HIV in a community where male circumcision is practiced. In addition to having a disease-free equilibrium, which is locally-asymptotically stable whenever a certain epidemiological threshold is less than unity, the model exhibits the phenomenon of backward bifurcation, where the disease-free equilibrium coexists with a stable endemic equilibrium when the threshold is less than unity. The implication of this result is that HIV may persist in the population even when the reproduction threshold is less than unity. Using partial data from South Africa, the study shows that male circumcision at 60% efficacy level can prevent up to 220,000 cases and 8,200 deaths in the country within a year. Further, it is shown that male circumcision can significantly reduce, but not eliminate, HIV burden in a community. However, disease elimination is feasible if male circumcision is combined with other interventions such as ARVs and condom use. It is shown that the combined use of male circumcision and ARVs is more effective in reducing disease burden than the combined use of male circumcision and condoms for a moderate condom compliance rate.     

Risk factors for breast cancer in the breast cancer risk model study of Guam and Saipan

BackgroundChamorro Pacific Islanders in the Mariana Islands have breast cancer incidence rates similar to, but mortality rates higher than, those of U.S. women. As breast cancer risk factors of women of the Mariana Islands may be unique because of ethnic and cultural differences, we studied established and suspected risk factors for breast cancer in this unstudied population.MethodsFrom 2010–2013, we conducted retrospective case-control study of female breast cancer (104 cases and 185 controls) among women in the Mariana Islands. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each of various lifestyle-related factors from logistic regression of breast cancer, in all women and in pre- and postmenopausal women separately. Tests for interaction of risk factors with ethnicity were based on the Wald statistics for cross-product terms.ResultsOf the medical and reproductive factors considered — age at menarche, breastfeeding, number of live births, age at first live birth, hormone use, and menopause — only age at first live birth was confirmed. Age at first live birth, among parous women, was higher among cases (mean 24.9 years) than controls (mean 23.2 years); with increased breast cancer risk (OR = 2.53; 95% CI, 1.04–6.19 for age ≥ 30y compared to <20y, P for trend = 0.01). Of the lifestyle factors —body mass index, waist circumference, physical activity, alcohol and betel-nut intake, and education — only waist circumference (OR = 1.65; 95% CI 0.87–3.14 for the highest tertile group compared to the lowest, P for trend = 0.04) was significantly associated with breast cancer risk and only in Filipino women. The association with many other established risk factors, such as BMI, hormone use and physical activity, were in the expected direction but were not significant. Associations for family history of breast cancer and alcohol intake were not evidentConclusionsThe results provide a basis for cancer prevention guidance for women in the Mariana Islands.     

Effectiveness of a reserve network for the conservation of the endemic marsupial Micoureus travassosi in Atlantic Forest remnants in southeastern Brazil

Habitat loss and fragmentation are serious threats to biodiversity conservation in the Atlantic Forest. A network of protected reserves is essential to the protection of native fauna and flora. However, internal and external factors may threaten the preservation of biota, thus population viability analyses (PVA) are important tools in reserve design and management planning. A PVA was carried out, using the computer package VORTEX, to assess the effectiveness of the reserve network of Rio de Janeiro State in Brazil in retaining viable populations of the endemic marsupial Micoureus travassosi. The PVA takes into account demographic, genetic and environmental stochastic events and catastrophes (fire). Rio de Janeiro state has 31 reserves, and 20 of those were considered to retain viable populations for 100 years, whereas eight were predicted to suffer from genetic decay, two from both genetic decay and demographic stochasticity, and one of them probably has an extinct population. The minimum area of suitable habitat needed to maintain a minimum viable population of M. travassosi is estimated at 3600ha. Sensitivity analysis was run for mortality, sex ratio, percentage of reproductive females, inbreeding depression and probability of catastrophes, and suggests that inbreeding depression is important in small population sizes, whereas the effects of catastrophes were significant only for large populations. Although the model indicates that some populations will suffer from demographic and/or genetic stochasticity, the reserve network of Rio de Janeiro state will likely keep M. travassosi's populations for the next 100 years.     

Cultivation of the heart urchin Echinocardium cordatum and validation of its use in marine toxicity testing for environmental risk assessment

To study environmental risk assessment, echinoderms provide a useful model for ecotoxicological testing. However, limited knowledge of the life history of field collected heart urchins is a problem and the use of cultured urchins has been investigated here. The present study describes a culture method for the heart urchin Echinocardium cordatum under controlled laboratory conditions, providing organisms with a low biological variation. Based on our optimized growth protocol both larvae and juveniles have a growth rate comparable to E. cordatum in the wild. The toxicological response of cultured and field-collected E. cordatum was compared in standard saltwater toxicity bioassays. Using ammonium chloride as a water-soluble reference toxicant, mean 96 h LC₅₀ values for cultured heart urchins versus field collected animals were 37.4 ± 7.6 mg NH₄+/l (n = 5) versus 22.5 ± 4.9 mg NH₄+/l (n = 19), respectively. Additional toxicity experiments with tributyl tin (TBT) spiked sediments revealed 14d LC₅₀ values of 1,242 (95% confidence interval 986–1,564) and 964 (95% confidence interval 843–1,102) µg Sn/kg dw respectively in cultured and field collected E. cordatum. From this it was concluded that cultured heart urchins are less sensitive to TBT than field collected E. cordatum. Furthermore in whole sediment toxicity tests, survival of cultured sea urchins was higher or at least similar to that of field collected E. cordatum. The increased sensitivity of field urchins compared to cultured urchins in various toxicity tests may be due to multiple environmental stressors reducing their overall performance. Overall it was demonstrated that the use of cultured E. cordatum provides a significant advance for urchin-based bioassays for marine environmental toxicity testing, resulting in a more homogeneous, vital population with experimental data displaying reduced variability.