Invited commentary: Considerations about specificity of associations, causal pathways, and heterogeneity in multilevel thinking.
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This paper reviews a variety of different graphical notations currently in active use for modelling dynamic processes in bioinformatics and biotechnology, and crystallises from these notations a set of properties essential to any proposal for a modelling language seeking to provide an adequate systemic description of biological processes.
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A case-base study in a population of 214,108 commercial and clerical female workers in Denmark during the period 1983-1985 investigated whether increasing job stress, defined as increasing job demands and decreasing job control, increased the risk of an adverse outcome of pregnancy. Information on the cohort, the outcome of 24,362 pregnancies, was obtained by linkage with nationwide health registers. Six case groups were selected: 1) 2,248 spontaneous abortions, 2) 209 stillbirths or deaths within the first year of life, 3) 661 infants with congenital malformations, 3) 593 preterm deliveries, 4) 587 infants with term low birth weights, 5) 988 infants with light-for-date birth weights, and 6) a random sample of 2,252 pregnancies that constituted the reference group. Information on exposure was obtained by mailed questionnaire. When dichotomized scales on data concerning job demand and control were used, there was an increased relative risk of spontaneous abortion (odds ratio = 1.28, 95% confidence interval (CI) 1.05-1.57) and term low birth weight (odds ratio = 1.46, 95% CI 1.05-2.04) for women experiencing high job stress. For the other case groups, the odds ratios were as follows: congenital malformation, 1.23 (95% CI 0.93-1.63); preterm delivery, 1.03 (95% CI 0.77-1.39); light-for-date birth weight, 1.08 (95% CI 0.83-1.40); and stillbirth/death within the first year of life, 1.42 (95% CI 0.90-2.24). No substantial response bias was found. When occupational titles were used as an exposure matrix, no increased risk was found, except for term low birth weight. Recall bias is one possible explanation. Thus, the results must be interpreted with caution.
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Cervical cancer remains the second most common cancer in women worldwide and the most frequent in developing countries. Pre-neoplasic cervical lesions represent an additional burden in countries where screening is widespread. The human papillomavirus (HPV) prevalence and type distribution in normal smears and in cancer specimens are being described and show relatively small international variation. State-of-the-art detection techniques have unequivocally shown that HPV-DNA can be detected in 95% to 100% of adequate specimens of cervical cancer, supporting the claim that HPV is the necessary cause. The odds ratios for cervical cancer related to a cross sectional detection of HPV-DNA range from 50 to several hundred in all studies. The risk for any of 15 high-risk types is not statistically different from the risk reported for HPV16. The estimates of the attributable fraction range from 90% to 98%. Additional work should be done in providing information on incidence of cervical cancer and on HPV infection in areas where the disease is common. Theoretical work including modeling of the incidence could be of potential use in the evaluation of the existing and novel preventive strategies. Research is currently being conducted on the mechanisms of HPV carcinogenesis. These include the determinants of the systemic and cellular immune response to the viral infection, the interaction between the host and the virus and the relevance of the different strains and variants of the HPV viral types. Technology developments in this area suitable for epidemiological studies are needed.
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OBJECTIVE: To evaluate the contribution of vestibular pathology to cognitive and affective complaints of patients with and without brain trauma. SETTING: An outpatient balance disorders clinic within a tertiary care neuroscience institute. PARTICIPANTS: 200 patients with dizziness--half with a recent history of brain trauma and half without. MAIN OUTCOME MEASURES: The Dizziness Handicap Inventory, the Beck Depression Inventory, and the Neurobehavioral Symptom Inventory were prospectively administered. Neurological examination and vestibular testing were performed to arrive at a diagnosis for the dizziness. Multiple regression analyses were carried out using vestibular diagnosis, psychiatric diagnosis, and trauma history as predictors of the inventory scores. RESULTS: Perceived disability was higher in dizzy patients with a history of brain trauma compared with dizzy patients without a history of trauma. A diagnosis of vestibular disease had no influence on perceived disability. Similarly, cognitive complaints were more common in dizzy patients with a history of brain trauma compared to dizzy patients without a history of trauma, but a diagnosis of vestibular disease had no influence on the frequency of cognitive complaints. CONCLUSIONS: In patients with postconcussive dizziness, cognitive complaints are likely due to neurologic injury or affective disturbance. In dizzy patients without brain trauma, cognitive complaints are likely due to concurrent affective disturbance.
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