Comprehensive Risk Reduction Research Articles

The Role of the State in Building Local Capacity and Commitment for Hazard Mitigation Planning

State governments play an important, but little understood, role in hazard mitigation through the use of a number of capacity building initiatives intended to assist communities develop hazard mitigation plans and policies. The passage of the Disaster Mitigation Act of 2000 more than 10 years ago provides a baseline from which to assess the degree to which states have developed and applied the tools, funding mechanisms, programs, and policies to help communities achieve this important objective. In this article, several state-level measures are analyzed and discussed relative to the degree to which they facilitate an enhanced local capacity to engage in hazard mitigation activities, including planning. The measures include: state hazard mitigation staffing; state hazard mitigation funding, policies, and programs; state cost-sharing of hazard mitigation programs; and state delivery of hazard mitigation technical assistance. The findings suggest that states maintain a wide variation in state capacity and commitment to support local hazard mitigation activities, including that which is influenced by disaster-based funding. They also tend to emphasize building local governments’ capacities to gain access to project funding rather than focusing on helping them identify and establish a comprehensive, proactive, and sustained risk reduction strategy grounded in land use policy. In addition, state land use policies are not well integrated into state hazard mitigation plans and capacity building initiatives. Finally, state mitigation officials believe that most local governments do not possess the capacity or commitment necessary to develop sound hazard mitigation plans or administer hazard mitigation grants.

Optimization of India's power sector strategies using weight-restricted stochastic data envelopment analysis

India's power sector has a significant impact on the country's development and climate change mitigation efforts. Optimization of energy planning is therefore, key to achieving the overall planning goals. The hierarchical multi-objective policy optimization is a policy-centric multi-level bottom-up iterative approach, designed from a developing country perspective, utilizing the optimality principle of dynamic programming. It is applied to the Indian power sector by grouping the strategies into three portfolios, namely, power generation mix, demand side efficiency group and supply side efficiency group. Each portfolio is optimized taking into account the objectives of cost minimization and comprehensive risk and barrier reduction. The portfolios are further combined and optimized at a higher level with respect to higher level objectives, namely, economic growth, energy equity, energy security and climate sustainability. This paper focuses on the second level optimization utilizing data envelopment analysis (DEA). Both the deterministic and stochastic variations have been analysed and the results compared in respect of unrestricted as well as restricted weight models. The analysis shows that weight-restricted stochastic DEA model is most appropriate for efficiency optimization of power sector strategies. The methodology can be effectively used for energy planning in developing countries.

Association of Lipoprotein Subfractions and Coronary Artery Calcium In Patient at Intermediate Cardiovascular Risk

More precise estimation of the atherogenic lipid parameters could improve identification of residual risk beyond what is possible using traditional lipid risk factors. The aim of the present study was to explore the association between advanced analysis of lipoprotein subfractions and the prevalence of coronary artery calcium. Consecutive participants at intermediate cardiovascular risk who were undergoing computed tomographic assessment of coronary calcium (calcium score) were included. Using a validated ultracentrifugation method (the vertical autoprofile II test), cholesterol in eluting lipoprotein subfractions [i.e., low- (LDL), very-low-, intermediate-, and high-density lipoprotein subclasses, lipoprotein (a), and predominant LDL distribution] was directly quantified. A total of 410 patients were included (29% women, mean age 57 years), of whom 297 (72.4%) had coronary artery calcium. LDL pattern B (predominance of small dense particles) emerged as an independent predictor of coronary calcium after adjustment for traditional risk factors (odds ratio 4.46, 95% confidence interval 1.19 to 16.7). However, after additional stratification for dyslipidemia, as defined by conventional lipid profiling, a statistically significant prediction was only retained for high-density lipoprotein subfraction 2 (odds ratio 3.45, 95% confidence interval 2.03 to 50.1) and "real" LDL (odds ratio 6.10, 95% confidence interval 1.26 to 23.41) in the normolipidemia group and for lipoprotein (a) (odds ratio 7.81, 95% confidence interval 1.41 to 43.5) in the dyslipidemic group. In conclusion, advanced assessment of the lipoprotein subfractions [i.e., LDL pattern B, high-density lipoprotein subfraction 2, "real" LDL, and lipoprotein (a)] using the vertical autoprofile II test provided additional information to that of conventional risk factors on the prevalence of coronary artery calcium in patients at intermediate cardiovascular risk.

Sex Education Programs for Schools Still in Question: A Commentary on Meta-Analysis

m i “ The meta-analysis reported in the three Guide to Community Preventive Services papers published in this issue of the American Journal of Preventive edicine targets two basic prevention strategies— comprehensive risk reduction (CRR) and abstinence education—which have the common purpose of lowering adolescent sexual risk behavior. Meta-analyses were conducted for each strategy on key behavioral and biological outcomes. This study did a commendable job of identifying the available studies of sexual risk-reduction interventions and evaluating them according to criteria for study quality. The Community Preventive Services Task Force (Task Force) also developed a rigorous category system to create appropriate dependent and independent variables for the analysis, and employed a sophisticated analytic strategy. They are to be commended for undertaking the study. Following are comments on the impact of heterogeneity on the study’s conclusions, as well as comments on the authors’ interpretation of study findings with regard to the public health impact of CRR and abstinence education.

Methods for Conducting Community Guide Systematic Reviews of Evidence on Effectiveness and Economic Efficiency of Group-Based Behavioral Interventions to Prevent Adolescent Pregnancy, Human Immunodeficiency Virus, and Other Sexually Transmitted Infections: Comprehensive Risk Reduction and Abstinence Education

This paper describes methods used to conduct systematic reviews and meta-analyses and economic reviews of group-based behavioral interventions for adolescents to prevent pregnancy, HIV, and other sexually transmitted infections. The steps described include developing a conceptual approach, defining the interventions, identifying outcome and moderator variables, searching the literature, abstracting the data, and analyzing the results. In addition, identification of potential harms and benefits, applicability of results, barriers to implementation, and research gaps are described.

Using Science to Improve the Sexual Health of America's Youth

a s i f s e p p For decades, sexuality education policies and practices in the U.S. have been a mixture of science, morality, politics, and the personal opinions of key ecisionmakers. Far too often, science has fared dismally hen policy, practice, and curriculum decisions were ade in state legislatures and local school board meetngs. The new research focusing on the meta-analyses of roup-based comprehensive risk reduction (CRR) and bstinence education interventions is one additional tool n the toolkit of those who want to use science, not ideolgy, to address the sexual risk-taking of America’s youth. The impact of poor and limited policies regarding sex ducation and access to contraception has far-reaching mpact in American society. For example, the U.S. teen regnancy rate is more than six times that of the Netherands, four times that of Germany, and three times that of rance. Similar statistics are found when examining rates f HIV/AIDS diagnoses as well. Rates in the U.S. are six imes greater than in Germany, three times greater than n the Netherlands, and 1.5 times greater than in France. n addition, youth in U.S. are significantly less likely to se contraception than European youth. Although it is not suggested that any one sex education policy or curriculum will result in a significant decline in these statistics, having good evidence-based policies and practices is a positive first step in creating a climate where sexuality is discussed as a normal part of the human experience. In addition, using science helps address sexual risk-taking by teens as a public health issue and not a morality debate.

Trace anthropogenic arsenic in Taiwan—substance flow analysis as a tool for environmental risk management

Site-specific risk assessment is intended for single source analysis, and provides limited options to reduce environmental risk. The links between multiple sources and population exposure deserve better understanding. In this way, the industrial activities can be managed to protect the population from the exposure to the substances in multiple environmental media, food, and drinking water. We took the anthropogenic arsenic in Taiwan into our case study. Substance flow analysis was used to map the circulation of arsenic in Taiwan. Emissions from arsenic related industries were modeled to estimate the health risk for each region. From the life cycle perspective, we found the major inputs were the imported ores and fossil fuels. The outputs would be a great concern to future arsenic exposure, because the use of arsenic-containing products is accumulating arsenic in wastes. Under current steady-state emission, the cancer risk in each region ranged from 10−6 to 10−3. The regions of high risk co-exist with fired-power plants, oil refineries, or waste treatment facilities. Several risk reduction strategies were compared. More than 95% of risk could be reduced if all airborne emissions were eliminated. The proposed methodology that integrates substance flow analysis with exposure assessment and risk evaluation offers quick examination on more comprehensive risk reduction alternatives. Further dedicated risk assessment might be required to estimate the more precise risks for the areas or industries that were pre-identified as hot spots.

Abstract P225: Impact of a Comprehensive Cardiovascular Risk Reduction Program on Treatment and Outcomes of Participants at High Risk for Cardiac Events

With increased emphasis on prevention in recent healthcare reform initiatives, more information is needed to validate the effectiveness of programs designed to diagnose and treat individuals at high risk for cardiac events and increased mortality. The purpose of this study was to evaluate early and late outcomes of a community-based cardiovascular risk reduction program (CRRP). Methods: Individuals at high risk for cardiovascular events were referred from community primary care physicians for advanced diagnostic testing and medication management at a hospital-based CRRP. Between March 1, 2005 and August 1, 2007, 182 participants were enrolled and had advanced lipid testing, chemistry panels, stress testing, CT calcium scoring, vascular elasticity studies, and comprehensive assessment of cardiovascular risk factors, family history, diet, activity level and psychological status. Participants had on average 4 visits. Mortality and need for hospitalization were assessed at a mean follow-up time of 45±14 months. Results: On CRRP entry, 84% had elevated lipids, 70% had hypertension, 31% had diabetes, 32% had metabolic syndrome, 10% were current smokers, 17% had an abnormal stress test, 36% had depression, 44% had sleep disturbances, and over 50% were not exercising. Over 30% had conditions that had not been recognized or were left undertreated. By last visit, over 95% of participants were on appropriate medications and had received life-style interventions. Late mortality occurred in 9 (5%) participants and 15 (8%) had at least one hospitalization for cardiac reasons. Those who died were older (67 vs. 56; p=0.007), had significantly higher CT calcium scores (998 vs. 114; p<0.0001) and elevated homocysteine levels (14 vs. 9; p<0.0001). Multivariate analyses showed that homocysteine level was the only independent predictor of mortality. No one with metabolic syndrome died (p=0.038). The only factor related to hospitalization was higher NCEP Framingham Age/Sex-adjusted risk score (18 vs. 12; p=0.037). Conclusions: A comprehensive community-based risk reduction program can provide enhanced evaluation and treatment for individuals who are at high risk for cardiovascular events. Appropriate medications and risk modification may impact late events.

Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options--a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference

While management of atrial fibrillation (AF) patients is improved by guideline-conform application of anticoagulant therapy, rate control, rhythm control, and therapy of accompanying heart disease, the morbidity and mortality associated with AF remain unacceptably high. This paper describes the proceedings of the 3rd Atrial Fibrillation NETwork (AFNET)/European Heart Rhythm Association (EHRA) consensus conference that convened over 60 scientists and representatives from industry to jointly discuss emerging therapeutic and diagnostic improvements to achieve better management of AF patients. The paper covers four chapters: (i) risk factors and risk markers for AF; (ii) pathophysiological classification of AF; (iii) relevance of monitored AF duration for AF-related outcomes; and (iv) perspectives and needs for implementing better antithrombotic therapy. Relevant published literature for each section is covered, and suggestions for the improvement of management in each area are put forward. Combined, the propositions formulate a perspective to implement comprehensive management in AF.

Interaction of Barrier Islands and Storms: Implications for Flood Risk Reduction in Louisiana and Mississippi

Coastal barrier islands are natural lines of defense and an integral part of a comprehensive flood risk reduction and management plan. A high resolution numerical modeling system capable of representing complicated coastal landscapes and simulating all the primary relevant physical processes is applied to better understand the influence of barrier island restoration on hurricane surge propagation. Model results indicate that barrier island restoration may significantly alter surge pathways and flood volumes of surge reaching inland coastal areas as open water passes become the dominant flow mechanism during a storm event. However, the exclusion of the morphologic evolution of a barrier island during a storm's passage is a significant limitation with the existing numerical models and is currently under development. The results in this paper demonstrate the need to include morphologic changes to fully evaluate the impact barrier islands have on water levels at the mainland coast.

What is XMRV and should we be worried about it?

What is XMRV and should we be worried about it?

Comprehensive risk reduction in patients with atrial fibrillation: Emerging diagnostic and therapeutic options

SummaryThere are exciting new developments in several areas of atrial fibrillation (AF) management that carry the hope of improving outcomes in AF patients. This paper is an executive summary that summarises the proceedings from the 3rd AFNET/EHRA consensus conference on atrial fibrillation, held in Sophia Antipolis from November 7th to 9th 2010, shortly after the release of the new ESC guidelines on AF. The conference was jointly organised by the German Atrial Fibrillation competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). This executive summary report covers four sections: 1. Risk factors and risk markers for AF, 2. Pathophysiological classification of AF, 3. Relevance of monitored AF duration for AF-related outcomes, and 4. Perspectives and needs for implementing better antithrombotic therapy.

Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: Key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation

Cardiac patients after an acute event and/or with chronic heart disease deserve special attention to restore their quality of life and to maintain or improve functional capacity. They require counselling to avoid recurrence through a combination of adherence to a medication plan and adoption of a healthy lifestyle. These secondary prevention targets are included in the overall goal of cardiac rehabilitation (CR). Cardiac rehabilitation can be viewed as the clinical application of preventive care by means of a professional multi-disciplinary integrated approach for comprehensive risk reduction and global long-term care of cardiac patients. The CR approach is delivered in tandem with a flexible follow-up strategy and easy access to a specialized team. To promote implementation of cardiac prevention and rehabilitation, the CR Section of the EACPR (European Association of Cardiovascular Prevention and Rehabilitation) has recently completed a Position Paper, entitled 'Secondary prevention through cardiac rehabilitation: A condition-oriented approach'. Components of multidisciplinary CR for seven clinical presentations have been addressed. Components include patient assessment, physical activity counselling, exercise training, diet/nutritional counselling, weight control management, lipid management, blood pressure monitoring, smoking cessation, and psychosocial management. Cardiac rehabilitation services are by definition multi-factorial and comprehensive, with physical activity counselling and exercise training as central components in all rehabilitation and preventive interventions. Many of the risk factor improvements occurring in CR can be mediated through exercise training programmes. This call-for-action paper presents the key components of a CR programme: physical activity counselling and exercise training. It summarizes current evidence-based best practice for the wide range of patient presentations of interest to the general cardiology community.

Promoting patient safety through prospective risk identification: example from peri-operative care

BackgroundInvestigation of patient safety incidents has focused on retrospective analyses once incidents have occurred. Prospective risk analysis techniques complement this but have not been widely used in healthcare.Study DesignProspective risk...

The role of community policies in defensible space compliance

Recently enacted federal and state policies provide incentives, including financial assistance, for local jurisdictions to manage risks associated with wildland fire. This has led to an array of local-level policies designed to encourage homeowners to create fire-safe landscapes. This qualitative study collected data from focus group interviews with homeowners in three diverse communities and used the theory of reasoned action to interpret dimensions of local-level wildland fire policies that are associated with homeowner acceptance of or compliance with defensible space guidelines or regulations. Common factors emerged in two policy evaluation categories: acceptance and compliance. WUI homeowners are more accepting of policies that are seen as fair and part of a more comprehensive risk reduction strategy. Topics that shaped acceptance of voluntary versus mandatory approaches included perceived risk severity, views about the proper roles of government, and beliefs about alternatives to regulatory approaches (e.g. private insurance, education, ignition source reduction). Program characteristics that were found to be related to beliefs about defensible space and acceptance included provision of one-on-one expert consultation, direct mail communication modes, needs-based financial assistance, and enhanced yard waste disposal options. Homeowner compliance is related to the feasibility in terms of household costs and yard waste disposal options, neighborhood norms, competing land use objectives, insurance considerations, and whether or not the policy is mandatory. These findings led to a proposed conceptual model of vegetation management policy acceptance and compliance that local governments can use to develop or amend defensible space vegetation management policies to increase policy acceptance and compliance.

Hyperglycemia, dyslipidemia and hypertension in older people with diabetes: the benefits of cardiovascular risk reduction

Diabetes mellitus is increasingly recognized as an essentially vascular disease, and a principal objective of diabetes care is prevention or reduction of cardiovascular risk. In this context, control of hyperglycemia, dyslipidemia and hypertension is at the heart of this care. As the combination of age and diabetes increases baseline vascular risk in older people, they stand to gain most from cardiovascular risk prevention. Although most of the clinical trials have excluded or included only few older people, there is now enough evidence to suggest that aggressive treatment of vascular risk factors in this age group is beneficial and could be cost effective. Current comprehensive mutifactorial risk reduction is suboptimal in older people with diabetes. Aggressive intervention is suitable in older people with diabetes who have reasonable life expectancy. Many older people with diabetes may not achieve recommended targets for risk factors reduction due to various reasons, including polypharmacy and comorbidities, but even a small reduction in these risk factors is beneficial. However, for frail older people with multiple disabilities, including cognitive and functional impairment, tight interventions may not be effective considering their short life expectancy and the risks associated with multiple medications, particularly hypoglycemia. Quality of life remains the primary target in the medical care of this group of patients.

Towards improved public awareness for climate related disaster risk reduction in South Africa: A Participatory Development Communication perspective

Southern Africa has frequently been struck by damaging climate hazards which increasingly continue to threaten sustainable development efforts. Ominously, climate models predict that the incidence of major ‘wet’ events, such as floods and cyclones will increase in frequency against the background of a changing climate. Unfortunately, local mechanisms for communicating and raising public awareness of the consequent risks and appropriate risk reduction options remain weak. At the core of policy responses to the threat posed by climate related hazards, the South African government has adopted a disaster risk reduction approach to disaster management. This article details how, among many other measures to limit the adverse impacts of natural hazards, South Africa’s National Disaster Management Framework calls for the implementation of effective public awareness activities to increase the knowledge among communities of the risks they face and what risk-minimising actions they can take. Emphasis is laid on the importance of information provision and knowledge building among at-risk communities. Citing established theories and strategies, the author proposes a participatory development communication approach through Development Support Communication strategies for the provision of disaster risk reduction public awareness activities by government and other disaster risk reduction role-players in South Africa. By way of a review of completed studies and literature, the article provides guidance on the planning and execution of successful public communication campaigns and also discusses the constraints of communication campaigns as an intervention for comprehensive disaster risk reduction.

A Human Immunodeficiency Virus Risk Reduction Intervention for Incarcerated Youth: A Randomized Controlled Trial

PurposeTo evaluate, by gender, the impact of a structured, comprehensive risk reduction intervention with and without boosters on human immunodeficiency virus (HIV) knowledge, attitudes and behaviors in incarcerated youth; and to determine predictors of increasing HIV knowledge and reducing high-risk attitudes and behaviors. MethodsThis randomized controlled trial involved participants completing structured interviews at 1, 3, and 6 months. Repeated measures analysis of variance was used to analyze changes over time. The study was conducted in secure custody facilities and in the community. The study sample comprising 391 incarcerated youth, 102 female and 289 male aged 12–18, formed the voluntary sample. Participants were randomly assigned to one of three conditions: education intervention; education intervention with booster; or no systematic intervention. The outcome and predictor measures included the Rosenberg Self-Esteem Scale, Youth Self Report, Drug Use Inventory, and HIV Knowledge, Attitudes and Behavior Scale. ResultsThe 6-month retention rate was 59.6%. At 6 months, males in the education and booster groups sustained increases in knowledge scores (p < 0.001). Females in these groups sustained increased condom attitude scores (p = 0.004). Males in the booster group sustained increased prevention attitude scores (p = 0.017). Females in the booster group reported more consistent condom use (odds ratio [OR] = 4.20; 95% confidence interval [CI] = 1.81, 9.77). Age, gender, drug use, and psychological profiles were predictive of outcome. ConclusionsThe intervention and boosters led to gender-specific improvements in knowledge, attitudes, and condom use. Result variations by gender underline the importance of gender issues in prevention interventions. Predictors of success were identified to inform future HIV education interventions.

On the Integration of Equality Considerations into the Life Quality Index Concept for Managing Disaster Risk

Decisions about investments in public disaster risk mitigation projects are to be made in presence of many other investments a society could possibly perform. In order to derive a statement about the advantageousness of a particular disaster risk reduction initiative in comparison to other potential investments, the cost of the intervention has to be put in relation to the expected benefits that go in line with it. The question if the benefits outweigh the cost entails a transformation of the primary non monetary benefits due to disaster risk reduction into monetary units, where especially the valuation of reduced mortality risk can be conveniently assessed by applying the net benefit criterion derived from the life quality index (LQI). But as public risk reduction interventions usually involve a great variety of affected people, cost effectiveness is only one determinant in declaring a project as being socially beneficial. Only if the concept is widened to also account for the distributional consequences, i.e. the identification of winners and losers from the intervention, it can be guaranteed that a great number of individuals profit from the enhanced safety standards. This paper addresses this issue by extending the conventional net benefit criterion to also incorporating distributional effects in the decision process and demanding an equally distributed share of cost and benefits throughout society. Thus, in a welfare economic sense more comprehensive risk reduction acceptance criteria are derived.

Diabetes and vascular disease

Type 2 diabetes has reached epidemic proportions and is now recognized as a coronary heart disease equivalent. While the most common metabolic abnormality associated with diabetes is hyperglycemia, there are also abnormalities in carbohydrate, fat and protein metabolism. These abnormalities increase oxidative stress and activate the renin–angiotensin system leading to endothelial dysfunction and, thereafter, to systemic atherosclerosis. This systemic atherosclerosis is responsible for the increased cardiovascular morbidity and mortality related to diabetes. In this article, we review the evidence and discuss the rationale for comprehensive risk reduction to prevent and treat vascular disease in individuals with diabetes mellitus. The components of comprehensive risk reduction strategy consist of lifestyle changes, glycemic control, control of dyslipidemia and hypertension.