Moderate Risk Areas Research Articles

Prevalence and distribution of aflatoxin contamination in groundnut (Arachis hypogaea L.) in Mali, West Africa

Groundnut is a major source of livelihood for the rural poor in Mali. However, the crop is prone to pre-and post-harvest aflatoxin contamination caused by Aspergillus flavus and Aspergillus parasiticus. Therefore, to minimize health related hazards from exposure to aflatoxin contaminated food, information on the prevalence and distribution of aflatoxins (AFB1) in the groundnut value chain in Mali is needed for timely interventions. To this end, a study was undertaken in three districts (Kayes, Kita and Kolokani) to assess aflatoxin contamination in the field and storage. Ninety pod samples in each district were collected from fields (30 villages/district and 3 samples/village) during 2009 and 2010. Pre-harvest contamination was estimated at harvest, whereas samples for post-harvest contamination were collected from granaries of the same farmers at a monthly interval for 3 months. The villages in each district were categorized into safe, acceptable, moderate risk and high risk areas based on pre-harvest AFB1 levels. Kayes recorded more pod samples (77%) within 20 μg/kg of pre-harvest aflatoxins followed by Kolokani (55.6%) and Kita (45.6%) based on 2009 and 2010 mean values. Toxin concentrations at harvest were comparatively less in Kayes during both years. Further, Kayes had more villages under safe and acceptable limits when compared to Kolokani and Kita. Overall, 46 out of 90 villages in the three districts had acceptable pre-harvest toxin limits. Further, 12 villages in Kolokani were in the high risk category. An increase in toxin levels was noticed with period of storage during both years. Comparatively, toxin levels after storage were least in Kayes during 2009. Kayes also recorded less AFB1 levels in 2010 after Kita. Our results indicate that Kayes is relatively safe over Kita and Kolokani in pre-harvest aflatoxin contamination. The reasons for district-wide variations in pre-harvest contamination; and the reasons for post-harvest flare up of the problem are discussed. Further, proper storage of pods at farmers' granaries in Mali is suggested to overcome the problem from reaching alarming levels.

Risk assessment of brine contamination to aquatic resources from energy development in glacial drift deposits: Williston Basin, USA

Contamination to aquatic resources from co-produced water (brine) associated with energy development has been documented in the northeastern portion of the Williston Basin; an area mantled by glacial drift. The presence and magnitude of brine contamination can be determined using the contamination index (CI) value from water samples. Recently, the U.S. Geological Survey published a section (~2.59km2) level risk assessment of brine contamination to aquatic resources for Sheridan County, Montana, using oilfield and hydrogeological parameters.Our goal was to improve the Sheridan County assessment (SCA) and evaluate the use of this new Williston Basin assessment (WBA) across 31 counties mantled by glacial drift in the Williston Basin. To determine if the WBA model improved the SCA model, results from both assessments were compared to CI values from 37 surface and groundwater samples collected to evaluate the SCA. The WBA (R2=0.65) outperformed the SCA (R2=0.52) indicating improved model performance. Applicability across the Williston Basin was evaluated by comparing WBA results to CI values from 123 surface water samples collected from 97 sections. Based on the WBA, the majority (83.5%) of sections lacked an oil well and had minimal risk. Sections with one or more oil wells comprised low (8.4%), moderate (6.5%), or high (1.7%) risk areas. The percentage of contaminated water samples, percentage of sections with at least one contaminated sample, and the average CI value of contaminated samples increased from low to high risk indicating applicability across the Williston Basin. Furthermore, the WBA performed better compared to only the contaminated samples (R2=0.62) versus all samples (R2=0.38). This demonstrates that the WBA was successful at identifying sections, but not individual aquatic resources, with an increased risk of contamination; therefore, WBA results can prioritize future sampling within areas of increased risk.

GIS and Remote Sensing for Malaria Risk Mapping, Ethiopia

Abstract. Integrating malaria data into a decision support system (DSS) using Geographic Information System (GIS) and remote sensing tool can provide timely information and decision makers get prepared to make better and faster decisions which can reduce the damage and minimize the loss caused. This paper attempted to asses and produce maps of malaria prone areas including the most important natural factors. The input data were based on the geospatial factors including climatic, social and Topographic aspects from secondary data. The objective of study is to prepare malaria hazard, Vulnerability, and element at risk map which give the final output, malaria risk map. The malaria hazard analyses were computed using multi criteria evaluation (MCE) using environmental factors such as topographic factors (elevation, slope and flow distance to stream), land use/ land cover and Breeding site were developed and weighted, then weighted overlay technique were computed in ArcGIS software to generate malaria hazard map. The resulting malaria hazard map depicts that 19.2 %, 30.8 %, 25.1 %, 16.6 % and 8.3 % of the District were subjected to very high, high, moderate, low and very low malaria hazard areas respectively. For vulnerability analysis, health station location and speed constant in Spatial Analyst module were used to generate factor maps. For element at risk, land use land cover map were used to generate element at risk map. Finally malaria risk map of the District was generated. Land use land cover map which is the element at risk in the District, the vulnerability map and the hazard map were overlaid. The final output based on this approach is a malaria risk map, which is classified into 5 classes which is Very High-risk area, High-risk area, Moderate risk area, Low risk area and Very low risk area. The risk map produced from the overlay analysis showed that 20.5 %, 11.6 %, 23.8 %, 34.1 % and 26.4 % of the District were subjected to very high, high, moderate, low and very low malaria risk respectively. This help to plan valuable measures to be taken in early warning, monitor, control and prevent malaria epidemics.

Quantitative risk analysis for landslides: the case of the Three Gorges area, China

The purpose of this study was the analysis of life and property risks due to landslides in the Three Gorges area, China. A landslide susceptibility map was created using rough set theory and a support vector machine model. A scenario based on the past landslide frequency and magnitude was used to convert the susceptibility into quantitative hazard maps. The vulnerability was defined quantitatively as a function of landslide intensity and the resistance of at-risk elements. The elements at risk (population, buildings, lifeline engineering, and land resources) were extracted from color aerial photographs, and detailed information regarding these elements was collected via fieldwork. Reconstruction-cost and market-cost approaches were used to estimate the value of property. Quantitative risk maps were developed by integrating the value of the at-risk elements with the vulnerability and landslide hazard datasets. The resulting maps are presented on a continuous scale in which the numerical values indicate the distribution of risk, including the probability of expected economic losses in renminbi (RMB) and loss of lives per map unit for property and residents, respectively. Based on the final risk maps, it is clear that high-risk areas are located in Badong County and other towns and with transportation networks and urbanized areas with dense populations and high property values. Areas of moderate risk were primarily distributed in rural areas and cultivated lands. In addition, the maps show the low-level probability of expected losses in areas where landslide hazard control measures are present or where human activity is sparse, such as unutilized areas and forests. The resulting risk values involve uncertainties and are not precise predictions of future losses, but they may nevertheless help in identifying areas where damage is likely to be greater and where mitigation measures are warranted.

Spatial and temporal assessment of potential risk to cetaceans from static fishing gears

Ecosystem Based Fisheries Management (EBFM) requires the consideration of potential impacts of a commercial fishery on all components of the ecosystem. Assessment of the impact of commercial fishing on marine mammals generally focuses on species at known risk from bycatch. For cetaceans in particular, inclusion under the Threatened, Endangered and Protected (TEP) species component of Ecological Risk Assessment for the Effects of Fishing (ERAEF) can seem redundant if a species is already known to be at risk or is not thought to interact with the fishery with consequences for its conservation. A spatially and temporally explicit Productivity Susceptibility Analysis (PSA) procedure was developed for inclusion under ERAEF to allow cetacean species to be screened for risk. The technique is demonstrated by assessing the potential risk to harbour porpoise and minke whales from a number of static gear fisheries. The results demonstrate that although a fishery might pose high risk to a species, low or moderate risk areas can exist within the range of the fishery, enabling management measures to focus on areas of greatest risk. Designed to complement and support existing methods of bycatch assessment, this approach is a repeatable and standardised assessment, the outputs of which can be used to systematically document the level of risk posed to different species in a transparent way to aid the inclusion of cetaceans in ERAEF and EBFM both now and in the future.

Quantifying uncertainty in pest risk maps and assessments: adopting a risk-averse decision maker’s perspective

Pest risk maps are important decision support tools when devising strategies to minimize introductions of invasive organisms and mitigate their impacts. When possible management responses to an invader include costly or socially sensitive activities, decision-makers tend to follow a more certain (i.e., risk-averse) course of action. We presented a new mapping technique that assesses pest invasion risk from the perspective of a risk-averse decision maker.We demonstrated the method by evaluating the likelihood that an invasive forest pest will be transported to one of the U.S. states or Canadian provinces in infested firewood by visitors to U.S. federal campgrounds. We tested the impact of the risk aversion assumption using distributions of plausible pest arrival scenarios generated with a geographically explicit model developed from data documenting camper travel across the study area. Next, we prioritized regions of high and low pest arrival risk via application of two stochastic ordering techniques that employed, respectively, first- and second-degree stochastic dominance rules, the latter of which incorporated the notion of risk aversion. We then identified regions in the study area where the pest risk value changed considerably after incorporating risk aversion.While both methods identified similar areas of highest and lowest risk, they differed in how they demarcated moderate-risk areas. In general, the second-order stochastic dominance method assigned lower risk rankings to moderate-risk areas. Overall, this new method offers a better strategy to deal with the uncertainty typically associated with risk assessments and provides a tractable way to incorporate decision-making preferences into final risk estimates, and thus helps to better align these estimates with particular decision-making scenarios about a pest organism of concern. Incorporation of risk aversion also helps prioritize the set of locations to target for inspections and outreach activities, which can be costly. Our results are especially important and useful given the huge number of camping trips that occur each year in the United States and Canada.

Asymptotic profile of the positive steady state for an SIS epidemic reaction–diffusion model: Effects of epidemic risk and population movement

Identifying the epidemic risk for infectious disease is crucial in order to effectively perform control measures. In a series of our work, from an analytical aspect we study the effects of epidemic risk and population movement on the spatiotemporal transmission of infectious disease via an SIS epidemic reaction–diffusion model proposed by Allen et al. (2008) in [36]. In Allen et al. (2008) [36], Peng (2009) [37], it was assumed that the habitat of the populations consists of only the low and high risk areas. The present paper concerns a more complicated heterogeneous environment where the moderate risk area occurs, and deals with two cases: (i) only the moderate and high risk areas exist; (ii) the low, moderate and high risk areas coexist. In each case, we rigorously determine the asymptotic profile of the positive steady state (i.e., the endemic equilibrium) as the migration rate of either the susceptible or infected population tends to zero. Our results show how epidemic risk and population movement affect the spatial distribution of infectious disease and thereby suggest important implications for predicting the patterns of disease occurrence and designing optimal control strategies. Numerical simulations are carried out to support the theoretical results.

Recurrence Rates of Aggressive Histologic Types of Basal Cell Carcinoma After Treatment with Electrodesiccation and Curettage Alone

Basal cell carcinoma (BCC) is the most common cancer in Caucasians. Treatment options include electrodesiccation and curettage (EDC), surgical excision, and Mohs micrographic surgery (MMS). EDC is standard for smaller BCCs in low-risk locations with nonaggressive histologic subtypes. Larger BCCs in higher-risk locations and aggressive histologic subtypes are treated using surgical excision or MMS. We found no studies reporting recurrence rates for aggressive BCC subtypes treated using EDC alone. To determine recurrence rates of histologically aggressive BCC treated using EDC. This population-based, retrospective case study reviewed 37 primary infiltrative, desmoplastic, morpheaform, or micronodular BCCs in 34 patients treated with EDC. Recurrence was defined as reappearance of BCC within the boundaries of or contiguous to the scar resulting from initial treatment. Of 37 primary aggressive BCCs, 10 recurred within 3.3 years. Average primary tumor diameter was 0.69 cm. Average primary tumor diameter was 0.73 cm for those that recurred and 0.67 cm for those that did not recur. Six recurrences were in high-risk areas, three in moderate-risk areas, and one in a low-risk area. We report a 27% recurrence rate for histologically aggressive BCCs treated using EDC alone with median 6.5 years follow-up.

Cold Damage Risk Assessment of Double Cropping Rice in Hunan, China

Combined with remote sensing data and meteorological data, cold damage risk was assessed for planting area of double cropping rice (DCR) in Hunan Province, China. A new methodology of cold damage risk assessment was built that apply to grid and have clear hazard-affected body. Each station cold damage annual frequency and average annual intensity of cold damage was calculated by using 1951–2010 station daily mean temperature and simple cold damage identification index. On this basis, average annual cold damage risk index was obtained by their product. The spatial analysis models of cold damage risk index about double-season early rice (DSER) and double-season later rice (DSLR) were established respectively by the relation of average annual cold damage risk index and its geographic factors. Critical threshold of level of average annual cold damage risk index for DSER and DSLR were respectively divided by the correlative equation of cold damage annual frequency and average annual intensity of cold damage. 2001–2010 planting area of DCR, acquired by time series analysis of MOD09A1 8-d composite land surface reflectance product, was as target of assessment. The results show average annual intensity of cold damage is exponential function of cold damage annual frequency, average annual cold damage risk index is directly proportional to cold damage cumulant and cold damage annual frequency, and is inversely proportional to happen times of cold damage and the square of statistical time sequence length. Cold damage risk of DSER is higher than DSLR in Hunan Province. In the 10-yr stacking map, DCR planting in low risk area accounted for 11.92% of total extraction area, in moderate risk area accounted for 69.62%, in high risk area accounted for 18.46%. According to the cold damage risk assessment result, DCR production can be guided to reduce cold damage losses.

Indications for fenestrated endovascular aneurysm repair

Endovascular technology has advanced rapidly in the development of fenestrated endovascular aneurysm repair (FEVAR). Current evidence for endovascular aneurysm repair is limited to infra-renal aortic aneurysms. With increased costs and complexity of FEVAR, its current role is unclear. A national multicentre, cross-disciplinary consensus model was developed to propose indications for FEVAR. All UK FEVAR centres and a wide selection of high-volume aneurysm treatment centres were invited to participate. The RAND appropriateness methodology was used. Five key steps were undertaken: meta-analysis of current literature; survey of current UK practice; nominal group establishment and definition of key clinical attributes; round 1--online survey of case vignettes; and round 2--nominal group consensus meeting. More than 90 per cent of UK FEVAR centres participated. Literature review showed heterogeneous case series with no clear indications for use of FEVAR. Survey of current practice showed wide variations in aneurysm management. Consensus agreement on the role of FEVAR was achieved in 68·8 per cent of cases. Consensus for FEVAR was agreed in areas of moderate risk from open repair and need for suprarenal clamping, but it was less likely to be indicated in patients aged 85 years or more with 5·5-6-cm aneurysms, or short-necked infrarenal aortic aneurysms. These data record areas of agreement and define the grey area of equipoise. Consequently, guidelines and recommendations can be developed on the indications for FEVAR to inform clinicians, commissioners and health economists.

Esophageal squamous cell carcinoma - precursor lesions and early diagnosis

Squamous cell carcinoma of the esophagus (SCCE) carries a poor prognosis due to late diagnosis. Early detection is highly desirable, since surgical and endoscopic resection offers the only possible cure for esophageal cancer. Population screening should be undertaken in high risk areas, and in low or moderate risk areas for people with risk factors (alcoholics, smokers, mate drinkers, history of head and neck cancer, achalasia and lye stricture of the esophagus). Esophageal balloon cytology is an easy and inexpensive sampling technique, but the current methods are insufficient for primary screening due to sampling errors. Conventional endoscopy with biopsy remains the standard procedure for the identification of pre-malignant and early malignant changes in esophageal mucosa and endoscopic detection. It may be enhanced by several techniques such as dye and optic chromoendoscopy, magnifying endoscopy, and optical-based spectroscopic and imaging modalities. Since more than 80% of SCCE deaths occur in developing countries, where expensive techniques such as narrow band imaging (NBI) and autofluorescence imaging are unavailable, the most cost-effective tool for targeting biopsies may be Lugol dye chromoendoscopy, since it is easy, accurate, inexpensive and available worldwide. In ideal conditions, or in developed countries, is it reasonable to think that optimal detection will require a combination of techniques, such as the combination of Lugol's chromoendoscopy and NBI to identify esophageal areas that require further characterization by a high resolution technique. The efficacy and cost-effectiveness will determine whether these modalities will become part of standard endoscopy practice.

Assessment of Potential Ecological Hazard of Heavy Metals in Farmland Based on GIS

This paper includes the analysis of total content of Cd element of 102 samples in the surface soil of farmland around the slag field. We evaluated the contamination of Cd of each samples and the space distribution with the potential ecological risk index method based on ArcGIS soft. The results showed that: average of potential ecological risk index of Cd is 241.4, Moderate ecological risk area accounted for 2.7% of the study area, strong ecological risk area of the region accounted for 30.1% of the study area, 22.2% of the study area had the considerable ecological risk, and the rest 39% of the study area had the extremely strong ecological risk.

Advances in the Treatment of Travelers’ Diarrhea

Diarrhea is the most common complaint reported by travelers from industrialized countries visiting developing nations. High-risk areas for travelers' diarrhea (TD) include South Asia, Sub-Saharan Africa, and Latin America, while moderate-risk areas include Southeast Asia, Middle East, Oceania and the Caribbean. Bacterial pathogens are the major cause of TD. Recent advances in the therapy for diarrhea include a better understanding of the potential benefit of symptomatic and antimicrobial therapy. The mainstay of treatment includes antibacterial therapy with one of three drugs, a fluoroquinolone, rifaximin, or azithromycin. Probiotics have been used in preliminary studies for both treatment and prevention of TD, but more studies are needed with these biologic agents. The aim of this review is to identify the recent advances in the therapy of TD and to provide recommendations for treatment during international travel.

Mapping malaria risk using environmental and anthropic variables

Despite much research in the identification of areas with malaria, it is urgent to further investigate mapping techniques to achieve better approaches in strategies to prevent, mitigate, and eradicate the mosquito and the illness eventually. By using spatial distributed modeling techniques with Geographical Information Systems (GIS), the study proposes methodology to map malaria risk zoning for the municipality of Buenaventura in Colombia. The model proposed by Craig et al.¹ using climatic information was adapted to the conditions of the study area regarding scale and spatial resolution. Geomorphologic and anthropic variables were added to improve spatial allocation of areas with higher risk of contracting the illness, refining zoning. Then, they were contrasted with the locations reported by health entities², taking into account spatial distribution. The comparison of results shows a decrease in the area obtained initially using the Craig et al. model¹ (1999), from 5,422.4 km² (89.1% of the municipality's territory) to 624.3km² (approximately 10% of the municipality's area), yielding a total reduction of 78.8% when environmental and anthropic variables were included in the model. Data show that of the 9,863 cases reported during 2001 to 2005 for 20 selected towns as basis for the amount of surveyed malaria cases², 1,132 were located in the very high-risk areas, 7,662 were in the areas of moderate risk, and 1,066 cases in low-risk areas, showing that 89% of the cases reported fell into the areas with higher risk for malaria.

GIS-based environmental risk assessment in the Ribeira Valley, São Paulo, Brazil

The Ribeira Valley region (State of Sao Paulo, Brazil) hosts the largest Brazilian Atlantic forest reserve. The region was an important mineral district during the ‘60s, from where several tons of lead and other metals were exploited. Residual materials produced by the mining are diffused in the environment until today. The area also encompasses a regional arsenium anomaly associated with unexplored gold deposits. The population presently living in this region performs basic farming activities, from which most of their food is yielded. These features coupled together imply in a complex relationship between natural and anthropogenic factors that are likely to affect the life and health of the local communities. The aim of this paper is to apply digital data integration techniques for environmental risk assessment in the Ribeira Valley using environmental geochemistry. Geochemical, digital elevation and remote sensing data (Landsat Thematic Mapper) were merged and analyzed using a geographical information system. The assumed model considered environmental mobilization through erosion and anomalous As–Pb areas. Data were analyzed through Boolean and fuzzy logic techniques. Fuzzy logic proved superior in this case study as it allowed not only the detection but also the distinction between low, moderate and high environmental risk areas.

Hygienic safety of reusable tap water filters (Germlyser®) with an operating time of 4 or 8 weeks in a haematological oncology transplantation unit

BackgroundMicrobial safe tap water is crucial for the safety of immunosuppressed patients.MethodsTo evaluate the suitability of new, reusable point-of-use filters (Germlyser®, Aquafree GmbH, Hamburg, Germany), three variations of a reusable filter with the same filter principle but with different outlets (with and without silver) and inner surface coating of the filter encasements (with and without nano-crystalline silver) were tested. The filter efficacy was monitored over 1, 4 and 8 weeks operating time in a haematological oncology transplantation unit equipped with 18 water outlets (12 taps, 6 showers).ResultsThe filtered water fulfilled the requirements of absence of pathogens over time. From 348 samples, 8 samples (2.3%) exceeded 100 cfu/ml (no sample ≥ 500 cfu/ml). As no reprocessed filter exhibited 100% filter efficacy in the final quality control after each reprocessing, these contaminations could be explained by retrograde contamination during use.ConclusionAs a consequence of the study, the manufacturer recommends changing filters after 4 weeks in high risk areas and after 8 weeks in moderate infectious risk areas, together with routine weekly alcohol-based surface disinfection and additionally in case of visible contamination. The filter efficacy of the 3 filters types did not differ significantly regarding total bacterial counts. Manual reprocessing proved to be insufficient. Using a validated reprocessing in a washer/disinfector with alkaline, acid treatment and thermic disinfection, the filters were effectively reprocessable and now provide tap water meeting the German drinking water regulations as well as the WHO guidelines, including absence of pathogens.

Torrent risk zonation in the Upstream Red River Basin based on GIS

This paper explores the methodology for compiling the torrent hazard and risk zonation map by means of GIS technique for the Red River Basin in Yunnan province of China, where is prone to torrent. Based on a 1:250,000 scale digital map, six factors including slope angle, rainstorm days, buffer of river channels, maximum runoff discharge of standard area, debris flow distribution density and flood disaster history were analyzed and superimposed to create the torrent risk evaluation map. Population density, farmland percentage, house property, and GDP as indexes accounting for torrent hazards were analyzed in terms of vulnerability mapping. Torrent risk zonation by means of GIS was overlaid on the two data layers of hazard and vulnerability. Then each grid unit with a resolution of 500 m × 500 m was divided into four categories of the risk: extremely high, high, moderate and low. Finally the same level risk was combined into a confirmed zone, which represents torrent risk of the study area. The risk evaluation result in the upper Red River Basin shows that the extremely high risk area of 13,150 km2 takes up 17.9% of the total inundated area, the high risk area of 33,783 km2 is 45.9%, the moderate risk area of 18,563 km2 is 25.2% and the low risk area of 8115 km2 is 11.0%.

Aktueller Malariaschutz bei Kurzzeitaufenthalt

An average of 800 malaria cases are recorded annually in Germany. One person in a hundred dies of the disease. Travel advice given by experienced physicians is essential to raise awareness of malaria risk in endemic areas. Rational mosquito protection on skin and textiles reduces the risk of malaria and other arthropod-transmitted diseases (e. g. dengue fever). Regular intake of an antimalarial drugs to suppress the development forms the basis of reliable chemo prophylaxis in highly endemic areas. The concept of standby emergency treatment (SET) in areas of low or moderate risk needs to be communicated in a detailed and clear way: take the temperature when feeling unwell; seeing a doctor immediately if a fever arises after 6 days of stay in an area, intake of SET if a doctor can not be reached within 24 hours; see a doctor after taking the SET as quickly as possible. These elements help to reduce the rate of severe malaria cases among travelers.

Analysis of fracture risk factors from the ’Arimidex’, Tamoxifen, Alone or in Combination (ATAC) trial: 5-year data

563 Background: The Completed Treatment Analysis of the ATAC trial at 68 months’ median follow-up confirmed that initial adjuvant treatment with anastrozole has significant efficacy and tolerability advantages compared with tamoxifen (ATAC Trialists’ Group. Lancet 2005; 365: 60–2). In the ATAC trial, the rate of all fracture types for anastrozole was higher than with tamoxifen. To better understand the impact of fracture risk factors on actual fracture rates, we undertook an analysis of the risk factors for all reported fractures in the ATAC trial up to 5 years. Methods: The analysis followed a time-to-event approach, using the Cox model with forward selection of prognostic covariates, together with the likelihood ratio test at the 5% significance level. Considered risk factors were age, body mass index (by tertile), previous hormone replacement therapy, concomitant medications (vitamin D, calcium, thiazides, statins, corticosteroids, thyroid hormones, bisphosphonates, antiepileptics, anxiolytics), geographical region (very high, high, or moderate and low hip fracture risk areas) (Kanis et al. J Bone Miner Res 2002; 17: 1237–44), smoking, and trial therapy (anastrozole or tamoxifen). Hazard ratios and associated 95% confidence intervals were obtained from the final model, which contained all statistically significant factors. Results: Of 6186 women, 524 (8.5%) had a fracture. Statistically significant predictors of fracture were age, region, and trial therapy ( Table ). A significant decrease in fracture risk was also observed in statin users although this decrease may not have been due to statin use, but rather to related factors. Conclusions: It is essential that individuals at high risk of fracture be identified so that they can receive appropriate evaluation and treatment. Profiling of risk as described here could enable the development of risk scores that would allow the identification and close observation of patients at high risk of fracture prior to commencing adjuvant therapy. [Table: see text] [Table: see text]

The Impact of Work-related Risk on Nurses During the SARS Outbreak in Hong Kong

Severe acute respiratory syndrome (SARS) is a highly infectious disease, with high potential for transmission to close contacts, particularly among healthcare workers. This is the first systematic study investigating hospital nurses' physical and psychological health status and the kinds of healthcare used-stratified by the level of contact with SARS patients-during the 2003 outbreak in Hong Kong. Nurses in moderate-risk areas appeared to have more stress symptoms than those working in high-risk areas. It is essential to design hospital support systems and occupational health policy to promote the psychological well-being of nurses during future outbreaks of emerging infections.