Lessons learned from rapid environmental risk assessments for prioritization of alien species using expert panels.

Limiting the spread and impacts of invasive alien species (IAS) on biodiversity and ecosystems has become a goal of global, regional and national biodiversity policies. Evidence based management of IAS requires support by risk assessments, which are often based on expert judgment. We developed a tool to prioritize potentially new IAS based on their ecological risks, socio-economic impact and feasibility of management using multidisciplinary expert panels. Nine expert panels reviewed scientific studies, grey literature and expert knowledge for 152 species. The quality assessment of available knowledge revealed a lack of peer-reviewed data and high dependency on best professional judgments, especially for impacts on ecosystem services and feasibility of management. Expert consultation is crucial for conducting and validating rapid assessments of alien species. There is still a lack of attention for systematic and methodologically sound assessment of impacts on ecosystem services and weighting negative and positive effects of alien species.

Anesthesia for non-obstetric surgery during pregnancy in a tertiary referral center: a 16-year retrospective, matched case-control, cohort study.

INTRODUCTION: This retrospective, matched case-control cohort study describes the incidence, indications, anesthesia techniques and outcomes of pregnancies complicated by surgery in a single tertiary-referral hospital. METHODS: Retrospective review of the hospital records of 171 patients who had non-obstetric surgery in the current pregnancy, between 2001 and 2016. Pregnancy outcomes of these women were firstly compared with all contemporary non-exposed patients (n=35 411), and secondly with 684 non-exposed control patients, matched for age, time of delivery and parity. RESULTS: The incidence of non-obstetric surgery during pregnancy was 0.48%, mostly performed during the second trimester (44%) and under general anesthesia (81%). Intra-abdominal surgery (44%) was the most commonly performed procedure, predominantly using laparoscopy (79%). Women undergoing surgery delivered earlier and more frequently preterm (25% vs. 17%, P=0.018); and birth weight was significantly lower [median (95% CI) 3.16 (3.06 to 3.26) vs. 3.27 (3.22 to 3.32) kg, P=0.044]. When surgery was performed under general anesthesia, low birth weight was more frequent (22% vs 6%, P=0.046). Overall pregnancy outcomes were neither influenced by trimester nor location (intra- vs extra-abdominal) of surgery. However, preterm birth rate secondary to surgery was higher for interventions during the third trimester, compared with other trimesters (10% vs 0, P <0.001). CONCLUSION: Pregnant women who underwent surgery delivered preterm more frequently and their babies had lower birth weights. Laparoscopic surgery did not increase the incidence of adverse pregnancy outcomes. General anesthesia was associated with low birth weight. Whether these associations suggest causation or reflect the severity of the underlying condition remains speculative.

Risk factors for disability among U.S. adults with arthritis.

This article studies risk factors for physical and social disability among U.S. adults ages 55+ who have arthritis, compared to non-arthritis persons of those ages. The dependent variables refer to difficulties in walking, physical functioning (motions and strength), personal care, and household care. The data set is the Supplement on Aging (SOA) (n = 16,148) that accompanied the 1984 National Health Interview Survey. The SOA data are cross-sectional; relationships of risk factors to disability suggest causation but do not directly demonstrate it. Logistic regressions show that risk factors are similar for arthritis and non-arthritis people, with one important exception. (1) The similarities are: For both groups, odds of disability rise with age, diminish with education, and are higher for non-whites and non-married persons. Disability rises with number of chronic diseases and impairments, and it is elevated for underweight persons (Body Mass Index (BMI) less than 20; further analysis indicates this reflects incomplete control of their severe illness status). Long duration of arthritis and recent medical care for it are associated with disability. (2) The exception is: Severe overweight (BMI greater than or equal to 30) is a disability risk factor for arthritis people, but not for non-arthritis people. Previous research has shown that obesity/overweight is a risk factor for etiology of osteoarthritis; our analysis now shows its continued importance for disability when the disease is present.

Disability.

Physical, mental, and social disability are defined. A sociomedical scheme for disability research is presented. How physical and social disability are measured in general health surveys and in arthritis research is described and evaluated. Societal and individual impacts of arthritis are distinguished. The public health importance of arthritis compared with other chronic conditions is portrayed, and the empirical literature on links between arthritis, impairment, physical disability, and social disability is reviewed. Osteoarthritis is at the forefront of the discussion because of its prevalence, but the theoretical and measurement issues presented are broadly relevant for the rheumatic diseases.

Women, men, and osteoarthritis.

OBJECTIVES AND METHODS: Gender differences in the prevalence and impact of arthritis are discussed, using data and analytic results from national health surveys. RESULTS: Most cases of arthritis are osteoarthritis, an ancient disease that causes pain, physical dysfunction, and social disability, but not death. Arthritis prevalence rates rise sharply with age; it is the leading chronic condition in mid and late life. Women's rates exceed men's at all ages. Women's higher rates of disability and medical services for arthritis in the population are due mainly to higher prevalence. Among persons with arthritis, women are only a little more likely than men to be disabled or receive medical services. Persons with arthritis often have other chronic conditions as well (called comorbidity). Combining arthritis and visual problems gives a strong exacerbating push to disability. CONCLUSIONS: Because biomedical research emphasizes pathogenesis and therapies for fatal conditions, Americans' health future will become dominated by nonfatal ones, especially arthritis. I recommend a better balance and new orientation for arthritis research that stays true to older persons' health and disability experience.

Prescribing drugs to men and women.

This article examines how often physicians prescribe therapeutic drugs to men and women who present the same complaints or receive the same diagnoses. Data are from the 1975 National Ambulatory Medical Care Survey and pertain to visits made by U.S. adults to office-based physicians that year. For most common complaints and diagnoses, women receive prescriptions more often than men do. The differences are on the small side (1 to 18% more of women's visits result in prescriptions than men's), but they are very persistent across a wide variety of health problems. Medical differences between men and women patients do not explain this. Controlling for medically relevant factors (patient age, seriousness of the problem, presence of an illness/injury or not, prior visit status, acute vs. chronic problem), the sex differences persist. Women are especially likely to get prescriptions during visits for weight gain/obesity and visits classed as observation without need for further care. The results suggest that psychosocial factors may help explain why women receive prescriptions more often during office visits than men do. Those factors could stem from patient behaviors such as overt requests for drug therapy or from physician behaviors such as sex-biased prescribing.

From sneezes to adieux: stages of health for American men and women.

This article traces health from daily symptoms to death for American (U.S.) men and women in three age groups 17-44, 45-64, 65+. How do leading problems change as our perspective shifts from daily symptoms to annual incidence and prevalence rates of diseases and injuries; then to problems that induce long term limitations; to conditions brought to physicians for care; to diagnoses for hospital stays; and finally to causes of death? We study the top 15 conditions in each of these stages of health. Young adults are bothered most by acute and chronic respiratory diseases, but deaths among them are due to diseases and violent injuries that seldom figure in daily life. Fatal chronic diseases becomes more prevalent in middle ages and spur professional care, but they rarely cause daily symptoms. For older people, life threatening chronic conditions stretch through all stages of health. Arthritis also becomes a dominant facet of symptoms, social limitations and ambulatory care. Men's and women's leading daily symptoms are very similar; so are their leading acute and chronic conditions, limiting conditions, diagnoses for health care and causes of death. What distinguishes the sexes is the rate, not the ranks, of health problems they suffer. We elaborate the iceberg of morbidity metaphor, as a device to highlight stage, age and sex differences in health.

How physicians treat mentally distressed men and women.

There is speculation that women receive different medical care than men because physicians have stereotyped views about women's symptoms and treatment preferences. This paper asks if men and women who visit physicians for mental distress receive comparable medical care and, if not, whether medical considerations or psychosocial ones explain the differences. Data are from a large national survey of ambulatory care visits in the United States. We find that women and men are equally likely to report mental distress as their main problem to physicians. Physicians determine that distressed men have mental disorders more often than distressed women. On the whole, distressed men and women receive similar numbers of diagnostic services, therapeutic services and dispositions for follow-up care. The kinds of services and dispositions differ a little: women tend to receive limited examinations, blood pressure checks and drug prescriptions more often; men are more likely to have general examinations, medical counseling or no service at all. Women are retained for follow-up care with the same physician more often; men tend to be sent elsewhere for additional care or no follow-up plans at all are made for them. Sex differences in care are statistically small (only 6% of the many comparisons are significant at P less than 0.05). But the significant differences highlight two points: when differential care occurs, it is in non psychiatrists' offices and it usually shows women receiving more of a given service or disposition. Differential care for women and men can be due to medical factors (such as patient age, prior visit status, seriousness of problem) or psychosocial ones (such as patient requests, patient emotionality, physician sex bias).(ABSTRACT TRUNCATED AT 250 WORDS)

Triggers of symptoms and health care.

This article studies triggers of physical symptoms and health care on a daily basis. The data used are health diaries kept for 6 weeks by 589 adults in metropolitan Detroit. The results show that bad moods consistently trigger physical problems and health actions (medical drug use, medical care, lay consultation, restricted activity) for men and women of all ages. Negative events have small effects on these outcomes, sometimes acting as triggers, but sometimes as dampers. Physical malaise (feeling bad overall) is an especially strong trigger for symptomatic people to take health actions. Troubles of all kinds--bad moods, physical malaise, symptoms, negative events--tend to repeat from one day to the next. Yesterday's troubles help trigger symptoms and health care today, but they have less influence than today's troubles do. When troubles continue for 2 days in a row, this spurs people especially to seek professional help. Women tend to respond more predictably and simply to triggers than men do, and older people appear to be more sensitive and responsive to triggers. The results indicate that the social stress and health model, which typically considers the longrun of major life events and chronic mental and physical conditions, is also apt for the shortrun of daily negative events, bad moods and physical discomfort and symptoms.

The disablement process.

Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicians tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.

Sex differentials in health.

Health status and health behavior of males and females in the United States are compared; the data employed in the analysis are from community studies and the surveys of the National Center for Health Statistics. Females generally show a higher incidence of acute conditions, higher prevalence of minor chronic conditions, more short-term restricted activity, and more use of health services (especially outpatient services) and medicines. By contrast, males have higher prevalence rates for life-threatening chronic conditions, higher incidence of injuries, more long-term disability, and after about age 50, higher rates of hospitalization. These sex differences appear at all ages, except for early childhood when boys have a worse health profile than girls. The following interpretations are consistent with the data; they are hypotheses rather than demonstrated facts. Women are more frequently ill than men, but with relatively mild problems. By contrast, men feel ill less often, but their illnesses and injuries are more serious. These morbidity differences help to explain sex differentials in health behavior; frequent symptoms lead to more restricted activity, physician and dentist visits, and drug use for women; severe symptoms lead to more permanent limitations and hospitalization for men. But attitudes about symptoms, medical care, drugs, and self-care are also extremely important. Males may be socialized to ignore physical discomforts; thus, they are unaware of symptoms that females feel keenly. Also, men may be less willing and able to seek medical care for perceived symptoms. When diagnosis and treatment are finally obtained, men's conditions are probably more advanced and less amenable to control. Finally, men may be less willing and able to restrict their activities when ill or injured. Four important factors than underlie sex differentials in health are discussed: inherited risks of illness, acquired risks of illness and injury, illness and prevention orientations, and health reporting behavior. Statistics show that women ultimately have lower mortality rates than men--despite women's more frequent morbidity and possibly because of more care for their illnesses and injuries. The apparent contradiction between sex differences in morbidity and mortality (females are sicker but males die sooner) is explored.

Profile of arthritis disability.

Using the 1994-95 National Health Interview Supplement Disability Supplement, the authors study levels of disabilities and accommodations among US adults with arthritis disability, compared to people with disability due to other conditions. Arthritis-disabled people are defined in two ways. One definition covers a broad range of arthritis and rheumatic conditions, and the other concentrates solely on arthritis. The authors find that arthritis-disabled people have more total disabilities than other-disabled peop e. However, their disabilities are less severe, have shorter durations, and accumulate more gradually over time. Despite more disabilities, people with arthritis disability use fewer assistive and service accommodations than other-disabled people. They do use more mobility aids. Because arthritis is the leading chronic condition for middle-aged and older adults, th s profile of extensive but mild-to-moderate disability is experienced by many millions of adults. Accommodations for arthritis may also be extensive but aimed more toward self-care than toward assistive and medical services.

Age differences and age changes in activities: Baltimore Longitudinal Study of Aging.

This study examines cross-sectional age differences, longitudinal age changes, and secular changes in obligatory, committed, and discretionary activities, using activity questionnaire completed by men and women participants in the Baltimore Longitudinal Study of Aging between 1958 and 1992. (1) Time spent, on obligatory activities and passive leisure is greatest, and on committed activities and active leisure least, for older adults. (2) Longitudinal patterns usually mirror cross-sectional ones. There are pronounced exceptions for women whose paid work time has been increasing and housework decreasing, while cross-sectional patterns show the reverse. (3) Over recent decades, time in committed activities shifted in opposite ways for men and women. Men decreased paid work and increased housework, repairs and yardwork, shopping, and child-care, while women increased paid work and decreased housework. In sum, the age structure of activities has persisted in the midst of new social opportunities; gender roles have proven more malleable than age roles.

Windows to their world: the effect of sensory impairments on social engagement and activity time in nursing home residents.

This study examined relationships between three sensory and communication abilities and two areas of nursing home resident behavior. Data from 18,873 nursing home residents include measures of hearing, visual, and communication abilities, and social engagement and time spent in activities. Increasing level of visual impairment is associated with low levels of social engagement and low time in activities. Both moderate and severe hearing impairment are associated with low time in activities, while inadequate communication is associated with limits in both social engagement and time in activities. The combined effects of visual and communications impairments are associated with low social engagement. Increasing attention to sensory and communication losses may lead to improve quality of life in this population.

Females and illness: recent trends in sex differences in the United States.

Data from the national Health Interview Survey for 1957-72 show that females have higher age-standardized rates of acute conditions, chronic conditions, and disability due to acute conditions, compared to males. More males, however, suffer limitations of activity or mobility due to chronic conditions, Females' excess morbidity for acute conditions persists when reproduction-related events are excluded. From 1957-72, females' disadvantage for acute conditions continues unchanged. But for chronic conditions, males are "catching up" to females in overall prevalence, and their conditions are becoming more severe relative to females'. These trends are compatible with trends in sex mortality differences over the same period. Four types of explanation are advanced to account for females' excess morbidity: interview behavior, illness behavior, acquired health risks, and inherited health risks. Empirical evidence suggests the first two factors inflate female rates compared to males; the last two do the opposite. It is hypothesized that excess female morbidity is due primarily to social and psychological factors, and a procedure to test this is stated.

The twain meet: empirical explanations of sex differences in health and mortality.

Health statistics routinely show higher morbidity and health services use for women, while mortality rates are higher for men. This analysis empirically identifies reasons for women's poorer health. It is based on retrospective (interview) and prospective (health diaries) data from the Health In Detroit Study. Three kinds of risk factors, which may help explain females' excess, are considered: acquired risks, psychosocial aspects, and health-reporting behavior. Men and women differ markedly in acquired risks: smoking and job hazards are higher for men, but inactivity, nonemployment, stress, and many other factors are higher for women. Psychosocial aspects predispose women to more illness and health care. Women also had keener interest in the survey. When all of the risk factors are controlled, the morbidity gap narrows considerably. In fact, indicators of general and chronic health reverse to reveal higher morbidity for men. Similarly, females' excesses for therapeutic care (short- and long-term disability, medical visits, lay consultation, drug use) diminish when risks and morbidity level are controlled. They actually reverse to a male excess for disability and medical care. Though most of the unveiled male excesses are statistically nonsignificant, their pattern allows a reasonable interpretation. Our results are closely compatible with recent analyses of sex mortality differences in several California sites, which could not eliminate men's mortality excess by controlling for social factors. In conclusion, contemporary women's poorer health profile stems largely from their roles and stress (acquired risks), and to a smaller degree from their health attitudes. When social factors are taken into account, health data suggest a disadvantage for men, and mortality data maintain men's disadvantage. Do the reasons lie in biology?

Death makes news: the social impact of disease on newspaper coverage.

UNLABELLED: This paper is an integrated analysis of newspaper coverage, epidemiological rates, and recent social history of six prominent diseases. HYPOTHESES: Newspaper coverage of a disease has three developmental stages (emergence, maturation, and decline & death). Trends in newspaper coverage of a disease reflect trends in its mortality, prevalence, and incidence. Magnitudes of newspaper coverage of diseases reflect their differential mortality rates. DATA: Using the LEXIS-NEXIS news archive for major U.S. newspapers, we retrieve articles about cancer, heart disease, AIDS, diabetes, Alzheimer disease, and arthritis for the period 1977-1997. We also obtain mortality, prevalence, and incidence trends for the six diseases. RESULTS: During the two decades, newspaper coverage emerges for AIDS and Alzheimer disease and is in the mature stage for the other diseases; declines begin for heart disease and AIDS. Trends in news coverage closely parallel mortality trends, and less consistently prevalence and incidence trends. Sharp downturns and upturns in mortality are mirrored in news volume. High-mortality diseases prompt both the most news coverage and the largest proportions of articles with death topics. CONCLUSION: Newspaper coverage of diseases is responsive to their mortality levels and trends.

Short-term dynamics of disability and well-being.

For persons with serious chronic morbidity, disability is a very dynamic process as morbidity advances or retreats, and as interventions succeed or fail. This article studies trajectories of function (cognitive, emotional, social, physical, and global well-being) over a year for 165 persons whose chronic morbidity prompted a hospital stay. Changes in functioning from hospital admission to one year post-discharge are analyzed; functional statuses were measured nine times in that period. Both intra-individual and inter-individual changes are studied by means of a combination of visual and statistical techniques. (1) Individuals: After the hospital stay, functions typically improve in the first month, stabilize for several months, then begin to fluctuate and worsen. Individual trajectories are very changeful over a year, yet there is short-run continuity (from one measurement point to the next). (2) Groups: Persons with fracture of hip show the most striking and protracted improvements over the year, compared to persons with other conditions. Chances of functional recovery are highest for persons with just one chronic condition; those chances decline as comorbidity increases. Having many social contacts is associated with initial high function that is maintained over the year; having few contacts is associated with stable low function. The analyses point to the scientific value of short remeasurement intervals for persons with severe or multiple morbidity.

Measuring disability with parsimony.

PRIMARY OBJECTIVE: Health surveys, especially those for older persons, include numerous detailed items about disability. There has been little effort to develop a global disability item, that is, one question that covers the concept of disability briefly but well. This article discusses how parsimony can be achieved through a single item, or less desirably by reductions of detailed items. MAIN OUTCOME AND RESULTS: Results of three analyses on the issue of compact disability indicators, using public-use data sets (AHEAD, HRS, BRFSS), are presented. The analyses study relationships of global disability to both detailed disability items and global health. Overall, the results show that a global disability item has good coverage of specific disabilities and is distinct from self-rated health. CONCLUSIONS: Routine inclusion of a global disability item in surveys is recommended, and specific suggestions are made to aid its design.