Implementation Of Risk Reduction Strategies Research Articles

EOC 68 - Cluster Investigation of Environmental Fungal Pathogens & Implementation of Risk Reduction Strategies in an Intensive Care Burn Unit

EOC 68 - Cluster Investigation of Environmental Fungal Pathogens & Implementation of Risk Reduction Strategies in an Intensive Care Burn Unit

The impact of interview quality on risk assessment of young people who sexually offend

Forensic risk assessments are used to determine sanctions, identify recidivism risk and inform implementation of risk reduction strategies. The best way to gather reliable data to inform decisions is important and the focus of this mixed-method study. Forty-five experienced professionals performed a risk assessment involving a young person who sexually offended (YPSO). They read a good-quality or a poor-quality interview and collateral information. Under half (42.2%) of participants provided the expected risk ratings. Some participants misidentified elements of good-quality interviewing (e.g. rapport, open questions). Ratings of fairness of the forensic interview were positively associated with increased sense of perceived interview quality. Confidence in risk-assessment decisions tended to be higher in the good-quality than the poor-quality interview group. Practitioners involved in the risk assessment of YPSO should receive effective/robust training in best practice interviewing so they can identify and implement empirically based interviewing techniques for care provision for YPSO.

BUILDING SUSTAINABILITY IN PUBLIC HEALTH ALZHEIMER’S DISEASE PROGRAMS

Abstract While public health experts cannot yet say how to prevent Alzheimer’s disease and related dementias (ADRD), public health has a role in slowing ADRD through the implementation of risk reduction strategies, early diagnosis, and better education and training of front-line health care professionals. Efforts to enhance the sustainability of programs, with changes to systems, environments, and policies enhances uptake and increases the lifespan of these interventions, as well as facilitates continuity and integration of efforts across jurisdictions. This approach includes multiple partners from a wide-range of sectors. This presentation will describe public health approach to ADRD including increasing awareness and action on dementia risk reduction, early detection, and coordination with aging services including supporting dementia caregivers. We will discuss innovative approaches of achieving sustainability, including identifying approaches that seek to reach entire populations for widespread and sustained impact utilizing examples from BOLD Programs to develop widespread public health infrastructure.

Exposure to Treponema pallidum Infection among Adolescent and Young Adult Women in Roraima, Amazon Region of Brazil.

Syphilis is a chronic infectious disease, and its prevalence has been described since the 15th century. Because of the high prevalence of this infection in Brazil, this study aimed to evaluate the prevalence of syphilis and its associated factors among adolescent and young women living in the city of Boa Vista, Roraima, Brazil. The present study was cross-sectional, descriptive, analytical and quantitative. It involved 200 young and adolescent women. Laboratory tests were performed to diagnose syphilis, and a sociodemographic and epidemiological questionnaire was employed. In the studied sample, 10 women had a positive result for syphilis, characterizing a prevalence of 5% for infection with Treponema pallidum. There was a statistically significant association between a monthly family income of less than 1 minimum wage and syphilis (p = 0.0449) and between illicit drug use and syphilis (p = 0.0234). These results indicate the need for public health interventions, action plans, and the implementation of risk reduction strategies focused on this population.

Prospects and retrospects of occupational hazards amongst healthcare workers

Introduction and Aim: Several studies showed that exposed health care workers are prone to numerous workplace hazards. Safety measure implementation in high-income countries, mostly neutralize these risks. But in low- and middle-income countries (LMICs), lack of resources and by-passing essential safety measures mostly increase the risk of occupational exposure to these hazards. This study attempts to map and synthesize the available research activities on occupational hazards among health care workers in India (LMIC) and to identify the research gaps and information policy. Methods: Amongst 190 female health care workers including nursing staff and other caregivers, this humble work attempts to quantify observational and/or experimental studies in various categories of different parameters namely, physical, physiological, biochemical, ergonomic and chronobiological aspects. Results: Several specific biological hazards including blood-borne pathogenic disease, psychological hazards (workplace violence, burn-out, job dissatisfaction), ergonomic hazards including musculo-skeletal disorders and chemical hazards including biochemical abnormalities (example, exposure to latex and anti-neoplastic drugs) were observed. Several unique cross-talks between parameters of different categories were observed. Implementation of risk reduction strategies was found to be sub-optimal. Conclusion: Most of the recorded hazards are of biological type (more than 52%). Occupational safety needs to become a priority public health issue for protection of health care workers in India and other LMICs. Much more research activities are needed to understand the magnitude and the cross-talks between different hazards of the concerned profession.

BUILDING OUR LARGEST DEMENTIA (BOLD) INFRASTRUCTURE FOR ALZHEIMER'S ACT: CENTERS OF EXCELLENCE

Abstract While public health experts cannot yet say how to prevent Alzheimer’s disease and related dementias (ADRD), emerging science indicates that ADRD may be slowed through the implementation of risk reduction strategies, early diagnosis, and better education and training of front-line health care professionals. The Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act was introduced into the Senate (S. 2076) on November 6, 2017 and signed into law on December 31, 2018 (P.L. 115-406) amending the Public Health Service Act (Section 398A; 42 U.S.C. 280c-3-4). CDC's Alzheimer's Disease and Healthy Aging Program (AD+HAP) was authorized to implement the activities outlined in BOLD which were designed to create a uniform national public health infrastructure. This presentation will provide an overview of BOLD and the demonstrate how BOLD Program and Public Health Centers of Excellence recipients are working together to build a uniform national public health infrastructure.

Optimal strategy selection framework for minimizing the economic impacts of severe weather induced power outages

Every year power outages cost billions of dollars and affect millions of people. In the U.S., historical data show that between 2000 and 2016, 75% of the outages (in terms of duration) were caused due to severe weather events. Due to climate change and aging of infrastructures, these weather-related events are getting more frequent. To mitigate the risk of economic losses from severe weather induced power outages, utilities need to invest heavily for building resilience against these events. This research has established a framework for risk-based decision making for identifying optimal risk reduction strategies to minimize the economic impact of severe weather induced power outages. The framework determines the economic impacts of severe weather induced power outages in terms of loss of Gross Domestic Product (GDP) for a state and utilizes a Benefit-Cost Analysis (BCA) based optimization technique to identify the optimal scope of different strategies which will maximize the benefits from them. The benefit has been defined as the reduction of expected GDP loss due to implementation of risk reduction strategies. The framework requires the users to identify strategies, their feasible scope, and cost. This has been illustrated through an example. The proposed framework can be effectively used by the investor-owned utilities for getting their resilience building projects approved from state utility regulatory commissions.

Exposure to Occupational Hazards among Health Care Workers in Low- and Middle-Income Countries: A Scoping Review.

Health care workers are exposed to numerous workplace hazards. The implementation of safety measures in high-income countries has largely mitigated these risks. However, in many low- and middle- income countries (LMICs), resources to institute safety measures are lacking, increasing the risk of occupational exposures to these hazards. The aim of this scoping review is to map and synthesize the available research on occupational hazards among health care workers in LMICs, identify research gaps and inform policy. Searches for relevant articles were conducted in five electronic databases using a broad range of search terms. The inclusion criteria were: quantitative observational or experimental studies which examined exposure to one or more occupational hazards among health care workers in a LMCI; and the article was published in English in a peer-reviewed journal. A total of 99 studies met the inclusion criteria, and data were extracted from these studies. Large proportions of health care workers in LMICs were exposed to biological hazards (bloodborne pathogens, tuberculosis), psychosocial hazards (workplace violence, burnout, job dissatisfaction), ergonomic hazards (musculoskeletal complaints), and chemical hazards (exposure to latex and antineoplastic drugs). The implementation of risk reduction strategies was suboptimal. The majority of the literature was on biological hazards (48%), and research on other hazards was limited in comparison. Occupational safety needs to become a priority public health issue to protect health care workers in LMICs. More research is needed to understand the magnitude of the problem in these countries.

Process Failures That Increase the Risk of Infection Through Respiratory Droplets: A Study of Patient Safety Events Reported by Hospitals Across Pennsylvania

Respiratory pathogens can lead to pneumonia, bronchiolitis, and death. Rapid identification, along with appropriate standard and isolation precautions, are necessary to prevent the spread of infectious agents causing respiratory infections. We analyzed patient safety events reported to the Pennsylvania Patient Safety Reporting System that were related to viruses and bacteria spread through respiratory droplets. An analysis of events that occurred from January 1, 2019, through December 31, 2019, led to the identification of 338 events involving process failures related to recognizing infectious agents that are spread through respiratory droplets, implementing measures to prevent their spread, or providing timely treatment. Detailed analysis of the process failures showed that 54.9% were associated with processes in testing or processing of laboratory specimens; 29.7% were associated with isolation-related procedures; and 15.4% were associated with medications, triage/assessment, documentation/verbal communication, or not providing the standard of care for patients in missed/delayed orders, procedures, or referrals. Implementation of risk-reduction strategies can help to further reduce the spread of pathogens through respiratory droplets in the hospital setting and further enhance patient safety. These strategies include evaluating collection processes for testing/laboratory specimens, consistently using empiric isolation precautions based on initial triage and patient presentation, and evaluating processes for admissions and transfers.

Contemporary Challenges and Management of Dental Caries in the Older Population

The prevalence of caries is set to increase in the coming years as a result of a growing ageing population and a concomitant reduction in levels of edentulousness. Evidence for management of caries in older adults is scarce compared to that for the child population, however, similar principles of risk assessment, prevention and minimal intervention should be applied by dental health professionals. Early identification of high-risk older adults facilitates the implementation of risk reduction strategies, such as topical fluoride regimes. When operative intervention cannot be avoided, Atraumatic Restorative Technique (ART) may allow for conservative cavity preparation and has the advantage of being suitable for the domiciliary setting.

Agricultural Insurance as A Risk Management Tool-Comparative Performance of NAIS and PMFBY in Gujarat

Agriculture in India is subject to numerous risks such as drought, flood, cyclone, and pests. There is a need to provide farmers with some safety nets against these natural hazards. It was reported that just 20 percent of farmers in India were covered under crop insurance. This paper analyzed the status and prospects of various crop insurance schemes in Gujarat. It was found that crop insurance coverage under PMFBY increased significantly. However, there are some areas where the present scheme could be further improved. There is a need to address issues such as delay in claim settlements, generating sufficient awareness in farmers about formulation and implementation of risk reduction strategies, developing suitable crop insurance product and effective implementation strategies and infrastructure, investing in R&D on insurance product design, covering price risk along with weather risk and substituting relief payments with crop insurance system.

Implementation of Blockchain Technology in Insurance Contracts Against Natural Hazards: A Methodological Multi-Disciplinary Approach

Abstract Risk insurance for disasters plays a relevant part in the implementation of risk reduction strategies during the pre-disaster phase. This is essential to support risk management towards decreasing the marginal risk allowing policy holders to transfer risk to avoid considerable financial loads from the costs incurred during the recovery phase in a post-disaster phase. There is evidence that the introduction of an integrated risk insurance strategy for community resilience planning is still lacking. Thus, this undermines the possibility to have proper optimized holistic risk management; on the one hand this strengthens pre-disaster risk mitigation measures, mostly relying on mitigative infrastructural solutions, and on the other hand it better defines risk prevention strategies mostly connected to land planning and urban development. This paper will show how insurance markets can play a key role towards mitigating the economic consequences of natural and climate change disasters, and how essential it is to better quantify the beneficial effects and costs of engineer-based mitigative solutions. In this context, the legal framework into which the actuarial quantitative model can be implemented will support the creation of an integrated multidisciplinary approach with potential implementation on a novel platform capable of collecting and processing information from different sources and dimensions such as blockchain technology. The scientific community is, in fact, increasingly interested in implementing blockchain technology to overcome problems linked to the contractual dimension of natural disaster risk insurance which can be interpreted as a sort of smart contracting. Through a study that involved four distinct areas, namely: law, environmental engineering, insurance and IT, this paper proposes a specific multidisciplinary methodology to achieve the drafting and implementation of a digital insurance contract on a blockchain platform against natural hazards. This paper proposes the basis to advance a quantitative concept to optimize the impact of catastrophe risk insurance onto the community resilience; in fact providing a key synergy for definition of pre-disaster conditions.

Syphilis prevalence and risk factors among young men presenting to the Brazilian Army in 2016: Results from a national survey.

The Conscripts Survey has been conducted periodically by the Brazilian Department of Sexually Transmitted Infections (STIs), AIDS, and Viral Hepatitis (DIAHV) in collaboration with the Brazilian Ministry of Defense for over 2 decades. It aims to assess the syphilis prevalence and obtain data on knowledge regarding STIs and their risk factors among conscripts enlisted for the Brazilian Army.This cross-sectional study was conducted among conscripts across Brazil aged 17 to 22 years from August to December 2016. It included a self-reported questionnaire and blood testing for syphilis, HIV, and hepatitis B and C.In total 38,247 conscripts were enrolled; after exclusion due to a lack of information, 37,282 (93.2%) conscripts were included. The estimated syphilis prevalence rates were: 1.63%, 1.09%, and 0.62% for screened, confirmed, and active syphilis, respectively. Among those with active syphilis, 81.1% reported not having syphilis infection in their lifetime. Higher confirmed syphilis prevalence rates were observed in the South region, followed by North and Southeast regions. Independent factors associated with confirmed syphilis infection were: self-reported STIs in one's lifetime (odds ratio [OR] = 7.24; P < .001), same-sex sexual relationships (OR = 3.43; P = .001), and having the 1st sexual intercourse encounter before 15 years of age (OR = 2.62; P = .04). The proportion of conscripts who reported having sex with other men (MSM) was 4.3%, and the estimated syphilis prevalence in this group was 5.23%, 4.61%, and 3.60% for screened, confirmed, and active syphilis, respectively. The sexual behaviors most frequently associated with confirmed syphilis were: sexual relationship with casual partners in the last year (P < .001), same-sex sexual relationships (P < .001), more than 10 partners (P = .006), and having sexual intercourse before 15 years of age (P = .003). Although not significant, only 25.4% of the conscripts who had a confirmed syphilis reported the use of condoms with steady partners, 32.4% with casual partner, and 24.3% with any partner.We found that syphilis is on the rise among the young Brazilian male population. The increase in its prevalence, particularly among MSM, highlights the need for urgent public health interventions, action plans, and implementation of risk reduction strategies aimed at this population.

Pediatric calculi: cause, prevention and medical management.

The incidence of pediatric nephrolithiasis is on the rise, with a significant related morbidity and a concomitant relevant increase in healthcare costs. The purpose of this review is to portray the current epidemiology and cause of renal stones in children, to provide a framework for appropriate clinical evaluation on an individual basis, and a guidance regarding treatment and prevention for the significant risk of lifelong recurrence and deriving complications. The early identification of modifiable risk factors and other abnormalities is essential, to prevent related morbidity, the onset of chronic kidney disease, and the associated increased risk of developing other diseases. The implementation of risk reduction strategies, including dietary modifications and targeted pharmacological therapies, will significantly influence stone recurrences and preserve renal function. Future research is desirable, with the aim to strengthen personalized conservative management of pediatric nephrolithiasis as first-line treatment.

A normative model for integrating organisations for disaster risk reduction and climate change adaptation within SADC member states

PurposeResearch has demonstrated that governance of disaster risk reduction (DRR) and climate change adaptation (CCA) have evolved largely in isolation from each other – through different conceptual and institutional frameworks, response strategies and plans, at both international, national and subnational levels. As a result, the management of disaster risk through DRR and CCA is highly fragmented. The purpose of this paper is to investigate the set of actors and their location in government that create and shape governance in DRR and CCA integration within the Southern African Development Community (SADC) member states.Design/methodology/approachThe study draws upon a range of data collection techniques including a comprehensive literature review relating to DRR and CCA in general and in the SADC member states, face-to-face interviews and an online survey. A mixed method research design was applied to the study with a total of 35 respondents from Botswana, Madagascar, Malawi, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe participating in the face-to-face interviews and an online survey.FindingsThe analysis shows that DRR and CCA are carried out by different departments, agencies and/or ministries in all but three SADC member states, namely, Mozambique, Mauritius and the Seychelles. Participants were able to highlight the different ways in which integration should unfold. In light of this, the paper proposes a normative model to integrate government organisations for DRR and CCA within SADC member states.Originality/valueThe implementation of the model has the potential to accelerate the integration of organisations for DRR and CCA, with the resultant improvement in the implementation of risk reduction strategies and efficient use of resources.

Serum phosphorus levels and risk of incident dementia.

Higher serum phosphorous is associated with cerebral small vessel disease, an important driver of cognitive decline and dementia. Whether serum phosphorous, a potentially modifiable parameter, associates with risk of incident dementia is not known. We aimed to examine the association between serum phosphorous and risk of incident dementia and to determine if the association is modified by age. We used the United States Department of Veterans Affairs national databases to build a longitudinal observational cohort of US veterans without prior history of dementia and with at least one outpatient serum phosphorus between October 2008 and September 2010 and followed them until September 2014. Serum phosphorus was categorized into quintiles: ≤2.9, >2.9 to ≤3.2, >3.2 to ≤3.5, >3.5 to ≤3.9, >3.9 mg/dL. There were 744,235 participants in the overall cohort. Over a median follow-up of 5.07 years (Interquartile range [IQR]: 4.28, 5.63), adjusted Cox models show that compared to quintile 2, the risk of incident dementia was increased in quintile 4 (Hazard Ratio [HR] = 1.05; CI = 1.01–1.10) and quintile 5 (HR = 1.14; CI = 1.09–1.20). In cohort participants ≤60 years old, the risk of incident dementia was increased in quintile 4 (HR = 1.29; CI = 1.12–1.49) and 5 (HR = 1.45; CI = 1.26–1.68). In participants > 60 years old, the risk was not significant in quintile 4, and was attenuated in quintile 5 (HR = 1.10; CI = 1.05–1.16). Formal interaction analyses showed that the association between phosphorous and dementia was more pronounced in those younger than 60, and attenuated in those older than 60 (P for interaction was 0.004 and <0.0001 in quintiles 4 and 5; respectively). We conclude that higher serum phosphorous is associated with increased risk of incident dementia. This association is stronger in younger cohort participants. The identification of serum phosphorous as a risk factor for incident dementia has public health relevance and might inform the design and implementation of risk reduction strategies.

Barriers to risk reduction: Dontse Yakhe, South Africa

Purpose– The purpose of this paper is to identify hazard risks and factors impeding the implementation of disaster risk management policies and strategies in Dontse Yakhe in Hout Bay, South Africa.Design/methodology/approach– A case study approach was selected for this research. Interviews were conducted with community leaders and other relevant government and civil society stakeholders. Insights and perceptions of Dontse Yakhe residents were obtained from a focus group interview. Secondary data sources were reviewed and field observations made.Findings– The findings reveal a number of key risks and a complex web of geographical, political, social and environmental factors, and stakeholder interactions, prioritisations and decision making that has created barriers to the implementation of the aims and objectives of disaster risk management policies and strategies in Dontse Yakhe.Originality/value– The contribution of the research is that it provides insight into the complex factors that are stalling development and infrastructure provision, and implementation of risk reduction strategies, in Dontse Yakhe as outlined in disaster risk management policies and strategies, demonstrating a gap between policy rhetoric and practice.

Evolving Strategies, Opportunistic Implementation: HIV Risk Reduction in Tanzania in the Context of an Incentive-Based HIV Prevention Intervention

BackgroundBehavior change communication (BCC) interventions, while still a necessary component of HIV prevention, have not on their own been shown to be sufficient to stem the tide of the epidemic. The shortcomings of BCC interventions are partly due to barriers arising from structural or economic constraints. Arguments are being made for combination prevention packages that include behavior change, biomedical, and structural interventions to address the complex set of risk factors that may lead to HIV infection.MethodsIn 2009/2010 we conducted 216 in-depth interviews with a subset of study participants enrolled in the RESPECT study - an HIV prevention trial in Tanzania that used cash awards to incentivize safer sexual behaviors. We analyzed community diaries to understand how the study was perceived in the community. We drew on these data to enhance our understanding of how the intervention influenced strategies for risk reduction.ResultsWe found that certain situations provide increased leverage for sexual negotiation, and these situations facilitated opportunistic implementation of risk reduction strategies. Opportunities enabled by the RESPECT intervention included leveraging conditional cash awards, but participants also emphasized the importance of exploiting new health status knowledge from regular STI testing. Risk reduction strategies included condom use within partnerships and/or with other partners, and an unexpected emphasis on temporary abstinence.ConclusionsOur results highlight the importance of increasing opportunities for implementing risk reduction strategies. We found that an incentive-based intervention could be effective in part by creating such opportunities, particularly among groups such as women with limited sexual agency. The results provide new evidence that expanding regular testing of STIs is another important mechanism for providing opportunities for negotiating behavior change, beyond the direct benefits of testing. Exploiting the latent demand for STI testing should receive renewed attention as part of innovative new combination interventions for HIV prevention.

Generating tsunami risk knowledge at community level as a base for planning and implementation of risk reduction strategies

Abstract. More than 4 million Indonesians live in tsunami-prone areas along the southern and western coasts of Sumatra, Java and Bali. Although a Tsunami Early Warning Center in Jakarta now exists, installed after the devastating 2004 tsunami, it is essential to develop tsunami risk knowledge within the exposed communities as a basis for tsunami disaster management. These communities need to implement risk reduction strategies to mitigate potential consequences. The major aims of this paper are to present a risk assessment methodology which (1) identifies areas of high tsunami risk in terms of potential loss of life, (2) bridges the gaps between research and practical application, and (3) can be implemented at community level. High risk areas have a great need for action to improve people's response capabilities towards a disaster, thus reducing the risk. The methodology developed here is based on a GIS approach and combines hazard probability, hazard intensity, population density and people's response capability to assess the risk. Within the framework of the GITEWS (German-Indonesian Tsunami Early Warning System) project, the methodology was applied to three pilot areas, one of which is southern Bali. Bali's tourism is concentrated for a great part in the communities of Kuta, Legian and Seminyak. Here alone, about 20 000 people live in high and very high tsunami risk areas. The development of risk reduction strategies is therefore of significant interest. A risk map produced for the study area in Bali can be used for local planning activities and the development of risk reduction strategies.

Sexual Negotiation, HIV-Status Disclosure, and Sexual Risk Behavior Among Latino Men Who Use the Internet to Seek Sex with Other Men

As part of a wider study of Internet-using Latino men who have sex with men (MSM), we studied the likelihood that HIV-negative (n=200) and HIV-positive (n=50) Latino MSM would engage in sexual negotiations and disclosure of their HIV status prior to their first sexual encounters with men met over the Internet. We also analyzed the sexual behaviors that followed online encounters. Our results showed that both HIV-negative and positive men were significantly more likely to engage in sexual negotiation and serostatus disclosure on the Internet than in person. Those who engaged in sexual negotiations were also more likely to use condoms for anal intercourse. Compared to HIV-negative MSM, HIV-positive MSM were significantly less likely to disclose their serostatus, and 41% of them acknowledged having misrepresented their serostatus to a prospective sexual partner met over the Internet. Although similar proportions of HIV-positive and negative men had condomless anal intercourse, HIV-positive MSM were more likely to report lack of intention to use condoms. Pleasure was the reason most frequently cited for lack of condom use. Cybersex was reported by only one-fifth of the sample. We conclude that the Internet, an understudied milieu of sexual networking, may present new possibilities for the implementation of risk reduction strategies, such as the promotion of sexual negotiation prior to first in-person encounter and serostatus disclosure.