Contribution of Genetic Background, Traditional Risk Factors, and HIV-Related Factors to Coronary Artery Disease Events in HIV-Positive Persons

Background Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV infection. Methods In the general population, 23 common single-nucleotide polymorphisms (SNPs) were shown to be associated with CAD through genome-wide association analysis. Using the Metabochip, we genotyped 1875 HIV-positive, white individuals enrolled in 24 HIV observational studies, including 571 participants with a first CAD event during the 9-year study period and 1304 controls matched on sex and cohort. Results A genetic risk score built from 23 CAD-associated SNPs contributed significantly to CAD (P = 2.9×10−4). In the final multivariable model, participants with an unfavorable genetic background (top genetic score quartile) had a CAD odds ratio (OR) of 1.47 (95% confidence interval [CI], 1.05–2.04). This effect was similar to hypertension (OR = 1.36; 95% CI, 1.06–1.73), hypercholesterolemia (OR = 1.51; 95% CI, 1.16–1.96), diabetes (OR = 1.66; 95% CI, 1.10–2.49), ≥1 year lopinavir exposure (OR = 1.36; 95% CI, 1.06–1.73), and current abacavir treatment (OR = 1.56; 95% CI, 1.17–2.07). The effect of the genetic risk score was additive to the effect of nongenetic CAD risk factors, and did not change after adjustment for family history of CAD. Conclusions In the setting of HIV infection, the effect of an unfavorable genetic background was similar to traditional CAD risk factors and certain adverse antiretroviral exposures. Genetic testing may provide prognostic information complementary to family history of CAD.

Potentials and constraints of modeling for transdisciplinary co-producing strategies for sustainable water governance

Both climate change and socio-economic development will significantly modify the supply and consumption of water in future. Consequently, regional development has to face aggravation of existing or emergence of new conflicts of interest. In this context, transdisciplinary co-production of knowledge is considered as an important means for coping with these challenges. Accordingly, the MontanAqua project aims at developing strategies for more sustainable water management in the study area Crans-Montana-Sierre (Switzerland) in a transdisciplinary way. It strives for co-producing system, target and transformation knowledge among researchers, policy makers, public administration and civil society organizations. The research process basically consisted of the following steps: First, the current water situation in the study region was investigated. How much water is available? How much water is being used? How are decisions on water distribution and use taken? Second, participatory scenario workshops were conducted in order to identify the stakeholders’ visions of regional development. Third, the water situation in 2050 was simulated by modeling the evolution of water resources and water use and by reflecting on the institutional aspects. These steps laid ground for jointly assessing the consequences of the stakeholders’ visions of development in view of scientific data regarding governance, availability and use of water in the region as well as developing necessary transformation knowledge. During all of these steps researchers have collaborated with stakeholders in the support group RegiEau. The RegiEau group consists of key representatives of owners, managers, users, and pressure groups related to water and landscape: representatives of the communes (mostly the presidents), the canton (administration and parliament), water management associations, agriculture, viticulture, hydropower, tourism, and landscape protection. The aim of the talk is to explore potentials and constraints of scientific modeling of water availability and use within the process of transdisciplinary co-producing strategies for more sustainable water governance.

The number needed to treat to prevent mortality and cirrhosis-related complications among patients with cirrhosis and HCV genotype 1 infection

Cirrhotic patients with chronic hepatitis C virus (HCV) infection remain at risk for complications following sustained virological response (SVR). Therefore, we aimed to evaluate treatment efficacy with the number needed to treat (NNT) to prevent clinical endpoints. Mortality and cirrhosis-related morbidity were assessed in an international multicentre cohort of consecutively treated patients with HCV genotype 1 infection and cirrhosis. The NNT to prevent death or clinical disease progression (any cirrhosis-related event or death) in one patient was determined with the adjusted (event-free) survival among patients without SVR and adjusted hazard ratio of SVR. Overall, 248 patients were followed for a median of 8.3 (IQR 6.2-11.1) years. Fifty-nine (24%) patients attained SVR. Among patients without SVR, the adjusted 5-year survival and event-free survival were 94.4% and 80.0%, respectively. SVR was associated with reduced all-cause mortality (HR 0.15, 95% CI 0.05-0.48, P = 0.002) and clinical disease progression (HR 0.16, 95% CI 0.07-0.36, P < 0.001). The NNT to prevent one death in 5 years declined from 1052 (95% CI 937-1755) at 2% SVR (interferon monotherapy) to 61 (95% CI 54-101) at 35% SVR (peginterferon and ribavirin). At 50% SVR, which might be expected with triple therapy, the estimated NNT was 43 (95% CI 38-71). The NNT to prevent clinical disease progression in one patient in 5 years was 302 (95% CI 271-407), 18 (95% CI 16-24) and 13 (95% CI 11-17) at 2%, 35% and 50% SVR, respectively. In conclusion, the NNT to prevent clinical endpoints among cirrhotic patients with HCV genotype 1 has declined enormously with the improvement of antiviral therapy.

Positive affect moderates the effect of negative affect on cardiovascular disease-related hospitalizations and all-cause mortality after cardiac rehabilitation

BACKGROUND Little is known as to whether negative emotions adversely impact the prognosis of patients who undergo cardiac rehabilitation. We prospectively investigated the predictive value of state negative affect (NA) assessed at discharge from cardiac rehabilitation for prognosis and the moderating role of positive affect (PA) on the effect of NA on outcomes. METHODS A total of 564 cardiac patients (62.49 ± 11.51) completed a comprehensive three-month outpatient cardiac rehabilitation program, filling in the Global Mood Scale (GMS) at discharge. The combined endpoint was cardiovascular disease (CVD)-related hospitalizations plus all-cause mortality at follow-up. Cox regression models estimated the predictive value of NA, as well as the moderating influence of PA on outcomes. Survival models were adjusted for sociodemographic factors, traditional cardiovascular risk factors, and severity of disease. RESULTS During a mean follow-up period of 3.4 years, 71 patients were hospitalized for a CVD-related event and 15 patients died. NA score (range 0-20) was a significant and independent predictor (hazard ratio (HR) 1.091, 95% confidence interval (CI) 1.012-1.175; p = 0.023) with a three-point higher level in NA increasing the relative risk by 9.1%. Furthermore, PA interacted significantly with NA (p < 0.001). The relative risk of poor prognosis with NA was increased in patients with low PA (p = 0.012) but remained unchanged in combination with high PA (p = 0.12). CONCLUSION The combination of NA with low PA was particularly predictive of poor prognosis. Whether reduction of NA and increase of PA, particularly in those with high NA, improves outcome needs to be tested.

An underestimated record breaking event – why summer 1540 was likely warmer than 2003

The heat of summer 2003 in Western and Central Europe was claimed to be unprecedented since the Middle Ages on the basis of grape harvest data (GHD) and late wood maximum density (MXD) data from trees in the Alps. This paper shows that the authors of these studies overlooked the fact that the heat and drought in Switzerland in 1540 likely exceeded the amplitude of the previous hottest summer of 2003, because the persistent temperature and precipitation anomaly in that year, described in an abundant and coherent body of documentary evidence, severely affected the reliability of GHD and tree-rings as proxy-indicators for temperature estimates. Spring–summer (AMJJ) temperature anomalies of 4.7 °C to 6.8 °C being significantly higher than in 2003 were assessed for 1540 from a new long Swiss GHD series (1444 to 2011). During the climax of the heat wave in early August the grapes desiccated on the vine, which caused many vine-growers to interrupt or postpone the harvest despite full grape maturity until after the next spell of rain. Likewise, the leaves of many trees withered and fell to the ground under extreme drought stress as would usually be expected in late autumn. It remains to be determined by further research whether and how far this result obtained from local analyses can be spatially extrapolated. Based on the temperature estimates for Switzerland it is assumed from a great number of coherent qualitative documentary evidence about the outstanding heat drought in 1540 that AMJJ temperatures were likely more extreme in neighbouring regions of Western and Central Europe than in 2003. Considering the significance of soil moisture deficits for record breaking heat waves, these results still need to be validated with estimated seasonal precipitation. It is concluded that biological proxy data may not properly reveal record breaking heat and drought events. Such assessments thus need to be complemented with the critical study of contemporary evidence from documentary sources which provide coherent and detailed data about weather extremes and related impacts on human, ecological and social systems.

Motivational profiles of sport event volunteers.

Aim of the study Due to the valuable contribution made by volunteers to sporting events, a better understanding of volunteers’ motivation is imperative for event managers in order to develop effective volunteer re-cruitment and retention strategies. The adoption of working conditions and task domains to the mo-tives and needs of volunteers is one of the key challenges in volunteer management. Conversely, an ignorance of the motives and needs of volunteers could negatively affect their performance and attitude, which will have negative consequences for the execution of events (Strigas & Jackson, 2003). In general, the motives of volunteers are located on a continuum between selflessness (e.g. helping others), and self-interest (e.g. pursuing one’s own interests). Furthermore, it should take into account that volunteers may be motivated by more than one need or goal, and therefore, configure different bundles of motives, resulting in heterogeneous types of motives for voluntary engagement (Dolnicar & Randle, 2007). Despite the extensive number of studies on the motives of sport event volunteers, only few studies focus on the analysis of individual motive profiles concerning volun-teering. Accordingly, we will take a closer look at the following questions: To what extent do volun-teers at sporting events differ in the motives of their engagement, and how can the volunteers be ade-quately classified? Theoretical Background According to the functional approach, relevant subjective motives are related to the outcomes and consequences that volunteering is supposed to lead to and to produce. This means, individuals’ mo-tives determine which incentives are anticipated in return for volunteering (e.g. increase in social contacts), and are important for engaging in volunteering, e.g. the choice between different oppor-tunities for voluntary activity, or different tasks (Stukas et al., 2009). Additionally, inter-individual differences of motive structures as well as matching motives in the reflections of voluntary activities will be considered by using a person-oriented approach. In the person-oriented approach, it is not the specific variables that are made the entities of investigation, but rather persons with a certain combination of characteristic features (Bergmann et al., 2003). Person-orientation in the field of sports event volunteers, it is therefore essential to implement an orientation towards people as a unit of analysis. Accordingly, individual motive profiles become the object of investigation. The individ-ual motive profiles permit a glimpse of intra-individual differences in the evaluation of different motive areas, and thus represent the real subjective perspective. Hence, a person will compare the importance of individual motives for his behaviour primarily in relation to other motives (e.g. social contacts are more important to me than material incentives), and make fewer comparisons with the assessments of other people. Methodology, research design and data analysis The motives of sports event volunteers were analysed in the context of the European Athletics Championships 2014 in Zürich. After data cleaning, the study sample contained a total of 1,169 volunteers, surveyed by an online questionnaire. The VMS-ISA scale developed by Bang and Chel-ladurai (2009) was used and replicated successfully by a confirmatory factor analysis. Accordingly, all seven factors of the scale were included in the subsequent cluster analysis to determine typical motive profiles of volunteers. Before proceeding with the cluster analysis, an intra-individual stand-ardization procedure (according to Spiel, 1998) was applied to take advantage of the intra-individual relationships between the motives of the volunteers. Intra-individual standardization means that every value of each motive dimension was related to the average individual level of ex-pectations. In the final step, motive profiles were determined using a hierarchic cluster analysis based on Ward’s method with squared Euclidean distances. Results, discussion and implications The results reveal that motivational processes differ among sports event volunteers, and that volunteers sometimes combine contradictory bundles of motives. In our study, four different volunteer motive profiles were identified and described by their positive levels on the individual motive dimension: the community supporters, the material incentive seekers, the social networkers, and the career and personal growth pursuers. To describe the four identified motive profiles in more detail and to externally validate them, the clusters were analysed in relation to socio-economic, sport-related, and voluntary work characteristics. This motive-based typology of sports event volunteers can provide valuable guidance for event managers in order to create distinctive and designable working conditions and tasks at sporting events that should, in relation to a person-oriented approach, be tailored to a wide range of individ-ual prerequisites. Furthermore, specific recruitment procedures and appropriate communication measures can be defined in order to approach certain groups of potential volunteers more effectively. References Bang, H., & Chelladurai, P. (2009). Development and validation of the volunteer motivations scale for international sporting events (VMS-ISE). International Journal Sport Management and Market-ing, 6, 332-350. Bergmann, L. R., Magnusson, D., & El-Khouri, B. M. (2003). Studying individual development in an interindividual context. Mahwah, NJ: Erlbaum. Dolnicar, S., & Randle, M. (2007). What motivates which volunteers? Psychographic heterogeneity among volunteers in Australia. Voluntas, 18, 135-155. Spiel, C. (1998). Four methodological approaches to the study of stability and change in develop-ment. Methods of Psychological Research Online, 3, 8-22. Stukas, A. A., Worth, K. A., Clary, E. G., & Snyder, M. (2009). The matching of motivations to affordances in the volunteer environment: an index for assessing the impact of multiple matches on volunteer outcomes. Nonprofit and Voluntary Sector Quarterly, 38, 5-28.

Motivational profiles of sporting event volunteers

This article presents an approach for segmenting sporting event volunteers according to differences in their motives. Empirical data were obtained from a sample of 1169 volunteers who registered for the 2014 European Athletics Championships in Zürich. They completed the ‘Volunteer Motivation Scale for International Sporting Events’ (VMS-ISE) questionaire. The validity of the VMS-ISE was replicated by confirmatory factor analysis and the data were cluster analysed to identify distinct motivation-based volunteer profiles. These segmented volunteers on the basis of mutually exclusive motivational characteristics. The external validity of the four motivation-based types (‘community supporters’, ‘material incentive seekers’, ‘social networkers’ and ‘career and personal growth orienteers’) was confirmed with socio-economic, sport-related and volunteer activity-related variables. It is concluded that motivation-based segmentation represents a useful way of gaining a clearer understanding of the patterns underlying the heterogeneity of sporting events volunteers.