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Objective: Few data are available on whether changes in metabolic syndrome affect incident gout. This study was undertaken to assess associations between metabolic syndrome status and incident gout, as well as changes in the clinical characteristics of metabolic syndrome and incident gout, in a cohort of young men. Methods: This nationwide, population‐based cohort study included 20–39‐year‐old men who participated in serial health check‐ups. The outcome, incident gout, was defined according to the claims database diagnostic code for gout. Associations among changes in metabolic syndrome status and incident gout were analyzed using Cox proportional hazards models. Results: Among 1,293,166 individuals, 18,473 were diagnosed as having gout (incidence rate 3.36 per 1,000 person‐years). Subjects who had chronic metabolic syndrome (defined as metabolic syndrome at all 3 health check‐ups) had a nearly 4‐fold higher risk of incident gout compared to subjects who did not have metabolic syndrome at any of the 3 health check‐ups (adjusted hazard ratio [HRadj] 3.82 [95% confidence interval (95% CI) 3.67–3.98]). Development of metabolic syndrome more than doubled the risk of incident gout (HRadj 2.31 [95% CI 2.20–2.43]). Conversely, recovery from metabolic syndrome reduced the risk of incident gout by nearly half (HRadj 0.52 [95% CI 0.49–0.56]). Among metabolic syndrome components, changes in elevated triglycerides (development of elevated triglycerides, HRadj 1.74 [95% CI 1.66–1.81]; recovery from elevated triglycerides, HRadj 0.56 [95% CI 0.54–0.59]) and abdominal obesity (development of abdominal obesity, HRadj 1.94 [95% CI 1.85–2.03]; recovery from abdominal obesity, HRadj 0.69 [95% CI 0.64–0.74]) showed the greatest association with altered risk of incident gout. Associations between changes in the status and clinical characteristics of metabolic syndrome and incident gout were more pronounced in subjects ages 20–29 years compared to those ages 30–39 years, and in subjects who were underweight or who had a normal weight. Conclusion: Changes in the status and clinical characteristics of metabolic syndrome were associated with altered risk of incident gout. These results suggest that metabolic syndrome is a modifiable risk factor for gout. [ABSTRACT FROM AUTHOR]

Changes almost always occur on construction projects. Among other things, they can hurt labor productivity. The relationship between change and labor productivity, though commonly acknowledged, is not well understood. In this paper, such causal linkages are illustrated to capture the interactions of changes, disruptions, productivity losses, and the responsible parties. They go an extra step from the current mechanism of changes, disruptions, and inefficiency to underline the critical role of causing parties in cumulative impacts. From these causal linkages it is visible that: (1) even when disruptions are initially caused by one party (e.g., the owner), the other party (e.g., the contractor) may be able to reduce or escalate the disruptions and inefficiency throughout the course of work; and (2) productivity losses rarely result from a single causing factor but multiple and concurrent ones for which both parties can be responsible. Also, the methods available for quantifying lost productivity are systemized in this paper to visualize relationships among uncertainty, effort and expertise to use, and the level of contemporaneous project documentation required of these methods. A conceptual framework is also proposed herein to help project participants match the relevant quantifying analysis with their project circumstances. DOI: 10.1061/(ASCE)1052-3928(2007)133:1 (45) CE Database subject headings: Project management; Productivity; Claims; Change orders.

Objective Background Methods Results Conclusion This study aimed to evaluate the association between rheumatoid arthritis (RA) and subsequent migraine risk using the Korean National Health Insurance Service database.Migraine may be related to immune dysfunction and previous studies have suggested an association with chronic inflammatory rheumatic diseases; however, the relationship between RA and migraine remains unclear.This was a population‐based, nationwide, retrospective, longitudinal cohort study. Participants were enrolled from 2010 to 2017 and followed up until 2019. A total of 42,674 patients who had undergone a health checkup within 2 years prior to the initial diagnosis of RA were included in the study, after applying the exclusion criteria (previous migraine, other rheumatic disease, missing variables of interest). A non‐RA control was obtained by age and sex‐matching (1:5). Finally, 42,644 patients with RA were enrolled, with 213,370 individuals without RA included as controls. Among the patients with RA, 29,744 had seropositive RA (SPRA), and 12,900 had seronegative RA (SNRA). SPRA was defined by the International Classification of Diseases 10th revision (ICD‐10) code M05, prescription of disease‐modifying anti‐rheumatic drugs (DMARDs), and enrollment in a special copayment reduction program. SNRA was defined by the ICD‐10 code M06 and prescription of any DMARD. The primary endpoint was the occurrence of migraine incidents, defined using the ICD‐10 code of migraine (G43).A total of 22,294 migraine cases (17,912/213,370 [8.3%] in controls and 4382/42,674 [10.2%] in RA) were reported during a mean follow‐up of 4.4 years after a 1‐year lag period. Patients with RA had a 1.2‐fold higher risk of migraine compared with controls (adjusted hazard ratio [aHR] 1.21, 95% confidence interval [CI] 1.17–1.26). Increased risk of migraine was found in both patients with SNRA and SPRA compared with controls (aHR 1.20, CI 1.15–1.24 in SPRA; aHR 1.26, CI 1.19–1.34 in SNRA). Compared to patients with SNRA, those with SPRA did not demonstrate a heightened risk (aHR 0.94, CI 0.88–1.01). A significant interaction was confirmed between covariates (male, current smoker, those with diabetes mellitus, and dyslipidemia) and the risk of migraine (p for interaction of <0.05).RA was linked to a higher migraine risk, regardless of seropositivity. [ABSTRACT FROM AUTHOR]