Evidence for Menopause as a Sex-Specific Risk Factor for Glaucoma

Glaucoma is a leading cause of irreversible blindness worldwide and is characterized by progressive loss of visual function and retinal ganglion cells (RGC). Current epidemiological, clinical, and basic science evidence suggest that estrogen plays a role in the aging of the optic nerve. Menopause, a major biological life event affecting all women, coincides with a decrease in circulating sex hormones, such as estrogen. While 59% of the glaucomatous population are females, sex is not considered a risk factor for developing glaucoma. In this review, we explore whether menopause is a sex-specific risk factor for glaucoma. First, we investigate how menopause is defined as a sex-specific risk factor for other pathologies, including cardiovascular disease, osteoarthritis, and bone health. Next, we discuss clinical evidence that highlights the potential role of menopause in glaucoma. We also highlight preclinical studies that demonstrate larger vision and RGC loss following surgical menopause and how estrogen is protective in models of RGC injury. Lastly, we explore how surgical menopause and estrogen signaling are related to risk factors associated with developing glaucoma (e.g., intraocular pressure, aqueous outflow resistance, and ocular biomechanics). We hypothesize that menopause potentially sets the stage to develop glaucoma and therefore is a sex-specific risk factor for this disease. Graphical Abstract

Environmental Risk Factors for Talaromycosis Hospitalizations of HIV-Infected Patients in Guangzhou, China: Case Crossover Study

Talaromycosis is a fatal opportunistic infection prevalent in human immunodeficiency virus (HIV)-infected patients, previous studies suggest environmental humidity is associated with monthly talaromycosis hospitalizations of HIV-infected patients, but the acute risk factor remains uncertain. In this study, we evaluated the associations between talaromycosis hospitalizations of HIV-infected patients (n = 919) and environmental factors including meteorological variables and air pollutants at the event day (assumed “lag 0” since the exact infection date is hard to ascertain) and 1–7 days prior to event day (lag 1–lag 7) in conditional logistics regression models based on a case crossover design. We found that an interquartile range (IQR) increase in temperature at lag 0–lag 7 (odds ratio [OR] [95% CI] ranged from 1.748 [1.345–2.273] to 2.184 [1.672–2.854]), and an IQR increase in humidity at lag 0 (OR [95% CI] = 1.192 [1.052–1.350]), and lag 1 (OR [95% CI] = 1.199 [1.056–1.361]) were significantly associated with talaromycosis hospitalizations of HIV-infected patients. Besides, temperature was also a common predictor for talaromycosis in patients with co-infections including candidiasis (n = 386), Pneumocystis pneumonia (n = 183), pulmonary tuberculosis (n = 141), and chronic hepatitis (n = 158), while humidity was a specific risk factor for talaromycosis in patients with candidiasis, and an air pollutant, SO2, was a specific risk factor for talaromycosis in patients with Pneumocystis pneumonia. In an age stratified evaluation (cutoff = 50 years old), temperature was the only variable positively associated with talaromycosis in both younger and older patients. These findings broaden our understanding of the epidemiology and pathogenesis of talaromycosis in HIV-infected patients.

Critical risk factors in international construction projects

Purpose International construction projects encompass various risks, and it is essential to evaluate and manage them to achieve project and firms’ success. As approaches to addressing international market risks vary from one country to another, the purpose of this paper is to identify the critical risk factors of embarking on international construction projects according to Indian experiences. Design/methodology/approach After primarily verifying the identified 26 risk variables, a questionnaire survey was conducted to draw upon the views of experts who possess international project experience. The 105 responses were analyzed using univariate and multivariate techniques. An analysis of variance identified the significant variables that influence overall performance on international construction projects, which were then grouped according to underlying relationships using factor analysis to determine the specific risk factors. Furthermore, considering these risk factors as independent variables and overall project performance as a dependent variable, a stepwise regression analysis was carried out to identify relatively critical risk factors. Findings The results revealed that of the identified four risk factors, the project-specific risk factor emerged as the foremost critical risk factor, the economic and market-specific risk factor was the second most critical risk factor, the firm-specific risk factor was the third most critical risk factor and the political-specific risk factor was the least critical risk factor. These findings were also validated appropriately. Research limitations/implications This study was limited to the data acquired from Indian construction firms, predominantly consultants and contractors. Though the survey respondents possessed adequate familiarity in international construction, commonly perceived limitations in self-reported surveys such as the lack of conscientious responses and reporting bias were not an exception in this research. Practical implications The risk factors and their criticality – as identified in this study – can aid the multinational firms and international aspirants to prioritize the critical aspects and develop a suitable risk mitigation strategy to achieve greater project success in international market. Originality/value By investigating the various risk factors that influence overall performance of international construction projects, this research considerably contributes to the body of knowledge pertaining to international construction risk management that will enable firms from India and similar developing nations to emphasize on critical risk factors.