Risk Mitigation Interventions Research Articles

The effectiveness of risk mitigation interventions in divers with persistent (patent) foramen ovale.

Persistent (patent) foramen ovale (PFO) is a recognized risk for decompression sickness (DCS) in divers, which may be mitigated by conservative diving or by PFO closure. Our study aimed to compare the effectiveness of these two risk mitigation interventions. This was a prospective study on divers who tested positive for PFO or an atrial septal defect (ASD) and either decided to continue diving without closure ('conservative group'), or to close their PFO/ASD and continue diving ('closure group'). Divers' characteristics, medical history, history of diving and history of DCS were reported at enrollment and annually after that. The outcome measures were the incidence rate of DCS, frequency and intensity of diving activities, and adverse events of closure. Divers in both groups dived less and had a lower incidence rate of confirmed DCS than before the intervention. In the closure group (n = 42) the incidence rate of confirmed DCS decreased significantly. Divers with a large PFO experienced the greatest reduction in total DCS. In the conservative group (n = 23), the post-intervention decrease in confirmed DCS incidence rate was not significant. Of note, not all divers returned to diving after closure. Seven subjects reported mild adverse events associated with closure; one subject reported a serious adverse event. PFO closure should be considered on an individual basis. In particular, individuals who are healthy, have a significant DCS burden, a large PFO or seek to pursue advanced diving may benefit from closure.

A spatial multicriteria prioritizing approach for geo-hydrological risk mitigation planning in small and densely urbanized Mediterranean basins

Abstract. Landslides and floods, particularly flash floods, occurred recently in many Mediterranean catchments as a consequence of heavy rainfall events, causing damage and sometimes casualties. The high hazard is often associated with high vulnerability deriving from intense urbanization, in particular along the coastline where streams are habitually culverted. The necessary risk mitigation strategies should be applied at the catchment scale with a holistic approach, avoiding spot interventions. In the present work, a high-risk area, hit in the past by several floods and concurrent superficial landslides due to extremely localized and intense rain events, has been studied. A total of 21 small catchments have been identified: only some of them have been hit by extremely damaging past events, but all lie in the intense-rain high-hazard area and are strongly urbanized in the lower coastal zone. The question is what would happen if an intense rain event should strike one of the not previously hit catchments; some situations could be worse or not, so attention has been focused on the comparison among catchments. The aim of the research has been identifying a priority scale among catchments, pointing out the more critical ones and giving a quantitative comparison tool for decision makers to support strong scheduling of long-time planning interventions at the catchment scale. The past events' effects and the geomorphic process analysis together with the field survey allowed us to select three sets of parameters: one describing the morphometric–morphological features related to flood and landslide hazard, another describing the degree of urbanization and of anthropogenic modifications at the catchment scale and the last related to the elements that are exposed to risk. The realized geodatabase allowed us to apply the spatial multicriteria analysis technique (S-MCA) to the descriptive parameters and to obtain a priority scale among the analyzed catchments. The scale can be used to plan risk mitigation interventions starting from the more critical catchments, then focusing economic resources primarily on them and obtaining an effective prevention strategy. The methodology could be useful even to check how the priority scale is modified during the progress of the mitigation work realization. In addition, this approach could be applied in a similar context, even among sub-catchments, after identifying a suitable set of descriptive parameters depending on the active geomorphological processes and the kind of anthropogenic modification. The prioritization would allow to invest economic resources in risk mitigation interventions priory in the more critical catchments.

Impact de la santé buccodentaire sur les performances sportives

Overall good health is essential to improve training and performance, especially for elite athletes. However, a high prevalence of oral diseases as dental caries, dental erosion or gingivitis has been observed in the professional sport community. Moreover, according to several studies, poor oral health leads to difficulties in eating and sleeping and has a negative impact on quality of life and self-confidence. Periodontal diseases such as periodontitis seem to induce systemic inflammation. Therefore, oral diseases in the sport community may also affect athletic performance or even have an impact on the systemic level and potentially influence the development of tendinopathies. This literature review aims to identify the incidence of oral diseases in elite athlete and highlight the impact of oral health on athletic performances. Furthermore, oral health preventive measures and risk mitigation interventions will be proposed.

Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection.

Lung resections carry a significant risk of complications necessitating the characterization of peri-operative risk factors. Unhealthy alcohol use represents one potentially modifiable factor. In this retrospective cohort study, the largest to date of lung resections in the Veterans Health Administration (VHA), we examined the association between unhealthy alcohol use and postoperative complications and mortality. Veterans Affairs Surgical Quality Improvement Program data recorded at 86 medical centers between 2007 and 2011 were used to identify 4,715 patients that underwent lung resection. Logistic regression models, adjusted for demographics and comorbidities, were fit to assess the association between unhealthy alcohol use (report of >2 drinks per day in the 2 weeks preceding surgery) and 30-day outcomes. Among 4,715 patients that underwent pulmonary resection, 630 (13.4%) reported unhealthy alcohol use (>2 drinks/day). Overall, postoperative complications occurred in 896 (19.0%) patients, including pneumonia in 524 (11.1%). The rate of mortality was 2.6%. In adjusted analyses, complications were significantly more common among patients with unhealthy alcohol use [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.15-1.74] including, specifically, pneumonia (OR, 1.69; 95% CI, 1.32-2.15). No statistically significant association was identified between unhealthy alcohol use and mortality (OR, 1.27; 95% CI, 0.75-2.02). In secondary analyses that stratified by smoking status at the time of surgery, drinking more than 2 drinks per day was associated with post-operative complications in patients reporting current smoking (OR, 1.51; 95% CI, 1.18-1.91) and was not identified in those reporting no current smoking at the time of surgery (OR, 1.23; 95% CI, 0.79-1.85). In this large VHA study, 13% of patients undergoing lung resection reported drinking more than 2 drinks per day in the preoperative period, which was associated with increased risk of post-operative complications. Unhealthy alcohol use may be an important target for perioperative risk-mitigation interventions, particularly in patients who report current smoking.

Variability in Cross-Domain Risk Perception among Smallholder Farmers in Mali by Gender and Other Demographic and Attitudinal Characteristics.

Previous research has shown that men and women, on average, have different risk attitudes and may therefore see different value propositions in response to new opportunities. We use data from smallholder farm households in Mali to test whether risk perceptions differ by gender and across domains. We model this potential association across six risks (work injury, extreme weather, community relationships, debt, lack of buyers, and conflict) while controlling for demographic and attitudinal characteristics. Factor analysis highlights extreme weather and conflict as eliciting the most distinct patterns of participant response. Regression analysis for Mali as a whole reveals an association between gender and risk perception, with women expressing more concern except in the extreme weather domain; however, the association with gender is largely absent when models control for geographic region. We also find lower risk perception associated with an individualistic and/or fatalistic worldview, a risk‐tolerant outlook, and optimism about the future, while education, better health, a social orientation, self‐efficacy, and access to information are generally associated with more frequent worry—with some inconsistency. Income, wealth, and time poverty exhibit complex associations with perception of risk. Understanding whether and how men's and women's risk preferences differ, and identifying other dominant predictors such as geographic region and worldview, could help development organizations to shape risk mitigation interventions to increase the likelihood of adoption, and to avoid inadvertently making certain subpopulations worse off by increasing the potential for negative outcomes.

Climate Change, Bushfire Risk, and Environmental Values: Examining a Potential Risk Perception Threshold in Peri-Urban South Australia

ABSTRACTStriking a balance between the management of environmental risks and values is a challenge for decision-makers. If people perceive that environmental risks are increasing they may be willing to discount local values to manage those risks, so the identification of thresholds in risk perception in relation to specific behaviors could help to avoid policy failures. The complex relationships between perceptions of climate change and bushfire risks, environmental values and support for actions to mitigate local risks are presented for peri-urban regions in South Australia. The results of a household survey (N=988) suggest that a threshold of risk perception in relation to climate change and bushfire management has not been exceeded and people are broadly supportive of balanced management interventions. A minority of people still do not perceive that climate change is increasing bushfire risk, and are supportive of risk mitigation interventions even at the expense of local biodiversity. However, a larger group believe that climate change is a driver of bushfire risk, yet are still more likely to prioritize ecological values and are unwilling to discount those values for risk mitigation. Targeted communication could assist different groups to respond to gaps in knowledge and action to facilitate effective, differentiated interventions within forested landscapes on the margins of urban areas.

Associations of childhood bullying victimization with lifetime suicidal behaviors among new U.S. Army soldiers.

Prior studies have documented associations of childhood bullying victimization with suicidal behaviors. However, many failed to adjust for concomitant risk factors and none investigated this relationship in military personnel. This study aimed to estimate independent associations of childhood bullying victimization with suicidal behaviors among U.S. Army soldiers. Soldiers reporting for basic training completed a cross-sectional survey assessing mental disorders, suicidal behaviors, and childhood adversities including two types of bullying victimization: (1) Physical Assault/Theft and (2) Bullying Comments/Behaviors. Associations of childhood bullying experiences with suicidal behaviors were estimated using discrete-time survival analysis of person-year data from 30,436 soldiers. Models adjusted for sociodemographic factors, childhood maltreatment by adults, and mental disorders. After comprehensive adjustment for other risk factors, more frequent Physical Assault/Theft by peers during childhood was associated with increased odds of lifetime suicidal ideation (adjusted odds ratio [AOR] = 1.18, 95% CI: 1.11-1.26, P < .001) and attempt (AOR = 1.30, 95% CI: 1.13-1.50, P < .001). More frequent Bullying Comments/Behaviors were associated with increased risk of ideation (AOR = 1.30, 95% CI: 1.26-1.35, P < .001), plan (AOR = 1.44, 95% CI: 1.35-1.54, P < .001), attempt (AOR = 1.24, 95% CI: 1.15-1.33, P < .001), and onset of plan among ideators (AOR = 1.09, 95% CI: 1.03-1.15, P = .002). Relative to no bullying victimization, exposure to the most persistent bullying was associated with two- to fourfold increase in risk for suicidal behaviors. Childhood bullying victimization is associated with lifetime suicidal behaviors among new soldiers. Exposure to Bullying Comments/Behaviors during childhood is associated with progression from suicidal ideation to plan. Improved recognition of these relationships may inform risk mitigation interventions for soldiers.

Development and applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide.

Concerns about opioid-related adverse events, including overdose, prompted the Veterans Health Administration (VHA) to launch an Opioid Safety Initiative and Overdose Education and Naloxone Distribution program. To mitigate risks associated with opioid prescribing, a holistic approach that takes into consideration both risk factors (e.g., dose, substance use disorders) and risk mitigation interventions (e.g., urine drug screening, psychosocial treatment) is needed. This article describes the Stratification Tool for Opioid Risk Mitigation (STORM), a tool developed in VHA that reflects this holistic approach and facilitates patient identification and monitoring. STORM prioritizes patients for review and intervention according to their modeled risk for overdose/suicide-related events and displays risk factors and risk mitigation interventions obtained from VHA electronic medical record (EMR)-data extracts. Patients' estimated risk is based on a predictive risk model developed using fiscal year 2010 (FY2010: 10/1/2009-9/30/2010) EMR-data extracts and mortality data among 1,135,601 VHA patients prescribed opioid analgesics to predict risk for an overdose/suicide-related event in FY2011 (2.1% experienced an event). Cross-validation was used to validate the model, with receiver operating characteristic curves for the training and test data sets performing well (>.80 area under the curve). The predictive risk model distinguished patients based on risk for overdose/suicide-related adverse events, allowing for identification of high-risk patients and enrichment of target populations of patients with greater safety concerns for proactive monitoring and application of risk mitigation interventions. Results suggest that clinical informatics can leverage EMR-extracted data to identify patients at-risk for overdose/suicide-related events and provide clinicians with actionable information to mitigate risk. (PsycINFO Database Record

Non-destructive characterization and dynamic identification of a modern heritage building for serviceability seismic analyses

Seismic risk mitigation in urban areas is a very relevant issue in European regions, such as Italy and Greece, characterized by the presence of a large stock of heritage structures. Enhancing the knowledge about the dynamics of structures is definitely useful in view of seismic assessment and design of risk mitigation interventions. However, this task can be difficult in the case of heritage structures, since several uncertainties affect material properties and structural patterns. In this paper, the opportunities provided by dynamic identification techniques for the non-destructive evaluation of heritage structures are discussed with focus on an interesting case study. This refers to the characterization of a modern heritage reinforced concrete building as a preliminary step towards seismic assessment. The structure under investigation is the Tower of the Nations, located in the Mostra D'Oltremare urban park in Naples, Italy. The paper shows how the combination of ambient vibration tests and model refinement can represent a valuable tool for an indirect non-invasive structural assessment of historical structures. Their proper analysis and modeling, in fact, is usually very challenging from the scientific and technical viewpoint due to their unique structural configurations, the several modeling uncertainties and the need to keep destructive investigations very limited. In this framework the present paper shows how a rational choice of the updating parameters and of the objective function can support the model optimization taking into account the ultimate objectives of the analysis, namely the setting of a reliable model for the assessment of the seismic performance of the structure in the linear regime. As a result, the paper describes the refinement of the model of the Tower of the Nations, in a way able to minimize the scatter with the experimental data and, at the same time, enhance the accuracy of response spectrum and seismic time-history linear analyses.

Risk analysis and international trade principles applied to the importation into Canada of caprine embryos from South Africa.

Between November 1994 and February 1995 over nine thousand Boer goat embryos were imported into Canada from the Republic of South Africa. This substantial international movement of animal genetics via embryos was achieved through the application of the risk analysis principles prescribed in Section 1.4. of the International Animal Health Code of the Office International des Epizooties (OIE). Integral to the development of the health certification procedures was the application of the fundamental principles of non-discrimination, harmonisation, equivalence and transparency defined in the World Trade Organisation Agreement on Sanitary and Phytosanitary measures. Risk mitigation interventions were founded upon full consideration of the potential for disease transmission by animal embryos as espoused by the International Embryo Transfer Society and the relevant standards contained in Appendix 4.2.3.3. of the OIE International Animal Health Code. All the embryos imported into Canada were implanted into synchronised recipients on arrival. Twenty months later there has been no evidence of disease in either the recipient animals or the resulting animals born in Canada.