Background: Significant evidence exists about J-shaped relationship between alcohol consumption and total or cardiovascular disease (CVD)-specific mortality in US middleaged adults. Epidemiologic investigations presume that the J-shaped distribution is the sum of the detrimental effect of high levels of consumption on other causes of death and the protective effect on coronary heart disease (CHD) morbidity and mortality. Several studies demonstrated that moderate alcohol consumption reduces the risk of CHD. However, results have been inconsistent among heavy drinkers. In this study, we investigated the association of heavy alcohol consumption with CHD among adults aged 18-years or older in the US. Methods: Data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) were used to conduct this study. BRFSS is an annual cross-sectional survey administered to >400,000 adults in all 50 states to collect information about their health-related risk behaviors, chronic health conditions and the use of preventive services. Self-reported responses to BRFSS questionnaire were used to define study variables. Heavy alcohol consumption was defined as greater than 14 drinks (1 drink =12 ounces of beer) per week for men and 7 drinks per week for women. Logistic regression analysis was conducted to determine the association between history of coronary heart disease or angina and heavy alcohol consumption. The model was also adjusted for demographics (age, sex, and race), behaviors (exposure to tobacco smoking, physical activity, fruit consumption), other chronic conditions such as high blood pressure (ever been told having high blood pressure or not), high cholesterol (ever been told having high blood cholesterol or not) and overweight or obese. Results: Approximately 6% of study population reported history of CHD and 5% reported heavy alcohol consumption. The odds of having coronary heart disease or angina among heavy alcohol drinkers was 43% less than those who were not heavy alcohol drinkers (adjusted odds ratio: 0.57, 95% confidence interval: 0.52-0.62, pConclusion: The study findings demonstrate that heavy alcohol consumption is a protective factor for CHD morbidity. Future observational studies should be conducted to determine the overall benefits of heavy alcohol consumption as it relates to coronary heart diseases.

Governments of developed and developing countries alike are unable to fund the construction and maintenance of vital physical infrastructure such as roads, railways, water and wastewater treatment plants, and power plants. Thus, they are more and more turning to the private sector as a source of finance through procurement methods such as concession contracts. The most common form of concession contract is the Build-Operate-Transfer (BOT) contract, where a government (Principal) grants a private sector company (Promoter) a concession to build, finance, operate and maintain a facility and collect revenue over the concession period before finally transferring the facility, at no cost to the Principal, as a fully operational facility. Theoretically speaking, these projects present a win-win-win solution for the community as well as both private and public sector participants. However, with the opportunity for private sector companies to earn higher returns comes greater risk. This is despite the fact that concession projects theoretically present a win-win-win solution to the problem of infrastructure provision. Unfortunately, this has not been the case in a number of countries including Australia. Private sector participants have admitted that there are problems that must be addressed to improve the process. Indeed they have attributed the underperformance of concession projects to the inability of both project Principals and Promoters to predict the impact of all financial and non-financial (risk) factors associated with concession project investments (CPIs) and to negotiate contracts to allow for these factors. Non-financial project aspects, such as social, environmental, political, legal and market share factors, are deemed to be important; but these aspects would usually be considered to lie outside the normal appraisal process. To allow for the effects of such qualitative aspects, the majority of Principal or promoting organisations resort to estimating the necessary money contingencies without an appropriate quantification of the combined effects of financial and non-financial (risks and opportunities) factors. In extreme cases, neglect of non-financial aspects can cause the failure of a project despite very favourable financial components; or can even cause the failure to go-ahead with a project that may have been of great non-financial benefit due to its projected ordinary returns. Hence, non-financial aspects need careful analysis and understanding so that they can be assessed and properly managed. It is imperative that feasibility studies allow the promoting organisation to include a combination of financial factors and non-financial factors related to the economic environment, project complexity, innovation, market share, competition, and the national significance of the project investment. While much research has already focused on the classification of CPI non-financial (risk) factors, and the identification of interdependencies between risk factors on international projects, no attempt has yet been made to quantify these risk interdependencies. Building upon the literature, this thesis proposes a generic CPI risk factor framework (RFF) including important interdependencies, which were verified and quantified using input provided by practitioners and researchers conversant with risk profiles of international and/or concession construction projects. Decision Support Systems (DSSs) are systems designed to assist in the decision making process by providing all necessary information to the analyst. There are a number of DSSs that have been developed over recent years for the evaluation of high-risk construction project investments, such as CPIs, which incorporate the analysis of both financial and non-financial (risk) aspects of the investment. However, although these DSSs have been useful to practitioners and researchers alike, they have not offered a satisfactory solution to the modelling problem and are all limited in their practical application for various reasons. Thus, the construction industry lacks a DSS that is capable of evaluating and comparing several CPI options, taking into consideration both financial and non-financial aspects of an investment, as well as including the uncertainties commonly encountered at the feasibility stage of a project, in an efficient and effective manner. These two criteria, efficiency and effectiveness, are integral to the usefulness and overall acceptance of the developed DSS in industry. This thesis develops an effective and efficient DSS to evaluate and compare CPI opportunities at the feasibility stage. The novel DSS design is based upon a combination of: (1) the mathematical modelling technique and financial analysis model that captures the true degree of certainty surrounding the project; and (2) the decision making technique and RFF that most closely reproduces the complexity of CPI decisions. Overall, this thesis outlines the methodology followed in the development of the DSS – produced as a stand-alone software product – and demonstrates its capabilities through a verification and validation process using real-life CPI case studies.

<p>Every year many individuals became sick listed, it could be for a long time, or a short time but irrespective there will be</p><p>effects on the individuals life and on the society. The aim of this study was to describe some relevant psychosocial relationships in the workplace that effect that women become sick listed. The method of the study was a literary study which was based on a number of scientific articles. The result of the study showed that many different factors effects the risk of becoming sick listed. Factors that causes sick leave where many and individual, but lack of social support, bullying, unstructured work environment and the</p><p>workplaces management, imbalance between demands and control and the women's situation were factors that had a big influence. Women had the greatest number of sick leave, and for a better answer to why it is mostly women who are sick listed more</p><p>research is needed. The answer we found was that it was not about the sex, it was more about where you work or in which profession</p><p>you are. To reduce the number of sick listed, big achievements are needed from the individual, the employer and the society. More research on how to reduce the number of people on sick leave is also needed.</p>

<p>Kidney dysfunction increases cardiovascular disease (CVD) risk. The mechanisms for the risk increase seem to involve a combination of traditional and non-traditional CVD risk factors.</p><p>We studied renal dysfunction as CVD and mortality risk factor in middle-aged men free from diabetes and CVD. The risk for myocardial infarction (MI) and CVD mortality was increased by ~40% in the 16.5% of men with worse renal function, independent of other CVD risk factors.</p><p>Renal transplant dysfunction as CVD and mortality risk factor was also studied. Renal transplant dysfunction was a risk factor for mortality and for combined CVD endpoint. The risk by renal transplant dysfunction was independent of traditional CVD risk factors as well as transplantation-specific risk factors. Only moderate increase in serum creatinine resulted in mortality and CVD risk comparable to diabetes, older age and higher low density lipoprotein levels.</p><p>In haemodialysis patients, the effects of a dialysis session on non-traditional CVD risk factors were studied. A HD session reduced asymmetric dimethylarginine (ADMA) and homocysteine levels, as well as augmentation index (AIx). The change in AIx was related to ADMA plasma level change.</p><p>In patients with stage 3-5 chronic kidney disease (CKD), endothelium dependent vasodilation (EDV) was studied together with markers of oxidative stress and C-reactive protein (CRP). CRP was related to lipid peroxidation, while EDV was related to intracellular antioxidative capacity measured by reduced glutathione levels.</p><p>These studies demonstrate that mild to moderate renal dysfunction is independently associated with increased CVD risk in apparently healthy people, as well as in renal transplant recipients. The mechanisms by which renal dysfunction increases CVD risk are yet to be elucidated. We suggest that arterial stiffness could be reduced in haemodialysis patients by increasing nitric oxide bioavailability. In stage 3-5 CKD patients, improving intracellular antioxidative capacity may result in endothelial function improvement.</p>

<p>The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. </p><p>Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. </p><p>SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.</p>

Thesis (Ph.D. (Electronical Engineering))--North-West University, Potchefstroom Campus, 2008.

Abnormalities in homocysteine metabolism have been suggested as risk factors for stroke and myocardial infarction. In retrospective studies, elevated levels of total plasma homocysteine (tHcy) and/or methylenetetrahydrofolate reductase (MTHFR) 677C&gt;T polymorphism have indicated an increase in risk. However, the fewer prospective studies have not been as conclusive. To further explore this, tHcy was studied in four prospective settings. The first was a prospective nested case-referent cohort within the Västerbotten Intervention Program (VIP) and WHO MONICA project on 312 ischemic and 60 haemorrhagic first-ever strokes. The aim was to study tHcy and its main genetic determinant MTHFR. Risk for haemorrhagic stroke increased exponentially through tHcy quartiles, independent of hypertension and BMI, and increased for MTHFR 677 CT and TT. MTHFR 1298A&gt;C appeared to be protective. In multivariate models, after adjustment for tHcy, BMI and hypertension, both tHcy and MTHFR remained as independent predictors for hemorrhagic stroke. Neither tHcy, nor the two MTHFR polymorphisms were significant predictors for ischemic strokes. The second was a prospective long-term follow-up study within the VIP and MONICA cohorts to determine whether a first-ever myocardial infarction (AMI) causes increased levels of tHcy. Fifty cases developing AMI after the first screening participated in a second screening (mean follow-up 8.5 years) with 56 matched referents. Increase in tHcy did not differ between cases and referents. tHcy was related to AMI at follow-up, but not at baseline and no longer significant after adjusting for creatinine and albumin. The third was a method study to determine if cystatin C, creatinine, albumin and other lipoprotein risk markers of cardiovascular disease could be analysed in Stabilyte™ plasma stored at -80°C. It was found to be suitable for all analyses tested and using this tube would simplify sampling for epidemiological studies. The fourth study was a prospective longitudinal long-term study of 735 subjects (340 men and 395 women, age 25-64 at first screening), participating in two MONICA screenings nine years apart, who donated blood in Stabilyte™ tubes to study change over time in tHcy and its determinants. We confirmed the age dependency in a cross sectional setting. In contrast, if followed longitudinally over time, no change in tHcy or in the prevalence of hyperhomocysteinemia was found. Cystatin C and creatinine increased, and albumin decreased. In multivariate models baseline levels of albumin, creatinine, cystatin C, and to some extent hs-CRP, were predictors of tHcy at follow-up but gender differences were seen. Age was not a major determinant of change in tHcy over nine years. In conclusion, tHcy and MTHFR are risk factors for first-ever haemorrhagic, but not ischemic stroke in a prospective setting. A first myocardial infarction does not cause an increase in tHcy. No long-term changes were seen in tHcy over a nine-year period in neither men, nor in women.

The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.

Every year many individuals became sick listed, it could be for a long time, or a short time but irrespective there will be effects on the individuals life and on the society. The aim of this study was to describe some relevant psychosocial relationships in the workplace that effect that women become sick listed. The method of the study was a literary study which was based on a number of scientific articles. The result of the study showed that many different factors effects the risk of becoming sick listed. Factors that causes sick leave where many and individual, but lack of social support, bullying, unstructured work environment and the workplaces management, imbalance between demands and control and the women's situation were factors that had a big influence. Women had the greatest number of sick leave, and for a better answer to why it is mostly women who are sick listed more research is needed. The answer we found was that it was not about the sex, it was more about where you work or in which profession you are. To reduce the number of sick listed, big achievements are needed from the individual, the employer and the society. More research on how to reduce the number of people on sick leave is also needed.

Kidney dysfunction increases cardiovascular disease (CVD) risk. The mechanisms for the risk increase seem to involve a combination of traditional and non-traditional CVD risk factors. We studied renal dysfunction as CVD and mortality risk factor in middle-aged men free from diabetes and CVD. The risk for myocardial infarction (MI) and CVD mortality was increased by ~40% in the 16.5% of men with worse renal function, independent of other CVD risk factors. Renal transplant dysfunction as CVD and mortality risk factor was also studied. Renal transplant dysfunction was a risk factor for mortality and for combined CVD endpoint. The risk by renal transplant dysfunction was independent of traditional CVD risk factors as well as transplantation-specific risk factors. Only moderate increase in serum creatinine resulted in mortality and CVD risk comparable to diabetes, older age and higher low density lipoprotein levels. In haemodialysis patients, the effects of a dialysis session on non-traditional CVD risk factors were studied. A HD session reduced asymmetric dimethylarginine (ADMA) and homocysteine levels, as well as augmentation index (AIx). The change in AIx was related to ADMA plasma level change. In patients with stage 3-5 chronic kidney disease (CKD), endothelium dependent vasodilation (EDV) was studied together with markers of oxidative stress and C-reactive protein (CRP). CRP was related to lipid peroxidation, while EDV was related to intracellular antioxidative capacity measured by reduced glutathione levels. These studies demonstrate that mild to moderate renal dysfunction is independently associated with increased CVD risk in apparently healthy people, as well as in renal transplant recipients. The mechanisms by which renal dysfunction increases CVD risk are yet to be elucidated. We suggest that arterial stiffness could be reduced in haemodialysis patients by increasing nitric oxide bioavailability. In stage 3-5 CKD patients, improving intracellular antioxidative capacity may result in endothelial function improvement.