Risk Preventive Measures Research Articles

Risk factors, prevention measures and diagnostics postoperative stermediastinitis

Median sternotomy remains the most frequent access in cardiac surgery, while postoperative sternomediastinitis is one of the most serious complications of transsternal access. The article analyzes the preoperative factors for the development of complications, including concomitant pathology, constitutional features, bad habits, length of hospital stay, and urgency of the operation. It was also noted that intraoperative factors consist of technical errors in the operation, intraoperative features of the course of surgical intervention, the nature of the choice of shunt during myocardial vascularization and the completion of the operation. Postoperative risk factors include the management of the postoperative period in cardiac patients, that can lead to complications. The analysis of preventive measures taken by cardiac surgeons in the development of complications is presented.

Research on Risk Assessment of Complex Mountain Tunnels Based on AHP-FCE

Complex geological environment and difficulties in operation and maintenance of mountain tunnels result in a lot of damage during the operation period of mountain tunnels. Therefore, the risk assessment and reinforcement technologies for complex mountain tunnels during the operation period need to be developed and improved. As a result, in this paper, the research on safety influence factors and their weights during the operation period of complex mountain tunnels was conducted based on Fuzzy Comprehensive Evaluation (FCE) and Analytic Hierarchy Process (AHP), the fuzzy set of weights for risk influencing factors during the operation period of complex mountain tunnels was established, the membership functions of factors at the index level were determined, the comprehensive evaluation matrix of tunnel risks was obtained, and the fuzzy comprehensive evaluation method for risks of complex mountain tunnels was proposed. This method has been verified in the Jinjishan Tunnel, and its analysis results are credible. In addition, corresponding risk prevention and control measures were put forward based on the evaluation results, and they provided guidance and reference for similar projects.

Recuperación de los Destinos Turísticos Después de un Desastre: Una Evaluación del Scorecard de Resiliencia Turística para Destinos (SRTD)

In 2015 a resilience study was carried out in the city of Manta using the Tourist Resilience Scorecard for Destination (SRTD) as a tool. The results of this study showed significant weaknesses in the response capacity of the canton's Tourism Department in the face of crisis scenarios that could affect the destination. Similarly, shortcomings were detected in the portfolio of recovery and adaptation strategies for probable crisis scenarios. In view of the problems found, the researchers presented proposals for improvements, which could not be implemented by the Decentralized Autonomous Government (GAD) of Manta due to the lack of budget for risk prevention measures. In April 2016, exactly one year after the study, an earthquake measuring 7.8 on the Richter scale shook the city of Manta, demonstrating the shortcomings found by the SRTD.

Risk factors and preventive measures for C5 palsy after cervical open-door laminoplasty.

The pathomechanism of C5 palsy after cervical open-door laminoplasty is unknown despite the relatively common occurrence of this condition postoperatively. The aim of this study was to review clinical and imaging findings in patients with C5 palsy and to propose countermeasures for prevention of this complication. Between 2001 and 2018, 326 patients with cervical myelopathy underwent cervical laminoplasty at the authors' hospital, 10 (3.1%) of whom developed C5 palsy. Clinical features and radiological findings of patients with and without C5 palsy were analyzed. In patients with C5 palsy, the width of the C5 intervertebral foramen was narrower and the position of the bony gutter was wider beyond the medial part of the C5 facet joint. The distance between the lateral side of the spinal cord and bony gutter was significantly greater in patients with C5 palsy. Patient characteristics, disease, cervical alignment, spinal canal expansion rate, anterior protrusion of the C5 superior articular process, high-intensity area in the spinal cord on T2-weighted MR images, posterior shift of the spinal cord, and operative time did not differ significantly between patients with and without C5 palsy. The position of the bony gutter may have a central role in the pathomechanism of postoperative C5 palsy, especially in patients with a narrow C5 intervertebral foramen. Making an excessively lateral bony gutter might be a cause of C5 nerve root kinking at the intervertebral foramen. To prevent the occurrence of C5 palsy, it is important to confirm the medial line of the facet joint on the preoperative CT scan, and a high-speed burr should be started from inside of the facet joint and manipulated in a direction that allows the ligamentum flavum to be identified.

Diagnosis and treatment standard for treatment with endoscopy technique in chronic wounds with sinus tract (trial version)

The " exploration of treatment technology of chronic wound with sinus tract supported by endoscope and related auxiliary methods" study had been conducted by Wound Healing Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The feasibility and effectiveness of this technique have been confirmed, and good clinic results have been achieved. In order to further promote the new technology and its related research, the theoretical knowledge and technical experience accumulated in the early stage are summarized as diagnosis and treatment standard for treatment with endoscopy technique in chronic wounds with sinus tract, including four parts: the applicable subjects, the diagnosis and treatment procedures and classification criteria, the healing criteria, and the risk assessment and prevention measures. The purpose of this standard is to facilitate the application of standardized endoscopy technique, to make the most of its technological advantages, prevent risks, and provide a reference for the official version of the diagnosis and treatment standard.

Major Depressive Syndrome (MDS) and its Association with Time of Residence among Spanish Speaking Au-Pairs Living in Germany.

The number of au-pairs in Germany is on the rise. In 2017, about 13,500 au-pairs were living in German families, almost half of them originating from non-European Union (EU) countries and many of them from Spanish speaking countries. Knowledge about mental health among au-pairs in Germany is limited. Therefore, the main objective of this study was to assess the prevalence of Major Depressive Syndrome (MDS) and its potential association with time of residence among Spanish speaking au-pairs living in Germany via an exploratory analysis. This study included a sample of 409 Spanish speaking au-pairs living in Germany. We classified the au-pairs into those who lived less than three weeks in Germany (newcomer au-pairs) and those who lived more than three weeks (experienced au-pairs). The participants were recruited by an online survey (Facebook and Instagram) from August 2018 to June 2019. Socio-demographic characteristics, time of residence in Germany and the level of education were assessed. MDS was assessed by the Patient Health Questionnaire depression module (PHQ-9). Poisson regression models were calculated to evaluate the association between time of residence in Germany and prevalence of MDS. Most of the participants were female (91%). Almost half of them came from Colombia (48%) and were in the age range between 22–24 years (40%). Prevalence of MDS was 8% among newcomers and 19% among experienced au-pairs (p = 0.002). Differences remained statistically significant after adjustment for potential confounders (age, level of education and time of residence in Germany) (prevalence ratio 2.25; 95% confidence interval: 1.22–4.14). In conclusion, au-pairs may develop mental symptoms during their time abroad. Future prospective studies should aim at identifying potential risk factors and preventive measures.

Incidence and predictors of drug overdoses among a cohort of >10,000 patients treated for substance use disorder

BackgroundDrug overdoses remain a significant public health burden throughout the world. This study assessed the incidence and predictors of non-fatal and fatal drug overdoses among patients with an opioid use, treated for drug use disorders (DUD) at public treatment centers in Denmark. MethodsA consecutive cohort of patients (n = 11,199) were tracked from date of first registered enrollment between the year 2000 and 2010 to first registered drug overdose, death or December 31st 2010, whichever occurred first. Competing-risks regression models were fitted to estimate the sub hazard ratios (SHRs) of non-fatal and fatal drug overdoses and confounding risk factors. ResultsA total of 3186 (28%) patients experienced a non-fatal drug overdose during follow-up, and 572 (6%) died from an overdose. Use of benzodiazepines (SHR: 1.15 95% CI 1.03, 1.28) was significantly associated with non-fatal overdose. Intravenous drug use and previous hospitalization for a non-fatal overdose increased the risk of later non-fatal (SHR: 1.57 95% CI 1.42, 1.73) and fatal overdoses (SHR: 1.43 95% CI 1.12, 1.82). ConclusionsPatients who use opioids remain at risk of overdoses for a long time after discharge from drug treatment. Besides relevant monitoring and psychosocial support in opioid maintenance treatment, there is a need for informing and educating opioid users in risk factors and preventive measures in settings where they are often difficult to access for traditional treatment services.

The Impending Epidemic of Cardiovascular Diseases in Patients With Cancer in Japan.

Onco-cardiology, a new academic field, aims to improve the quality of life and prognosis of cancer patients and survivors with cardiovascular diseases (CVD). With the aging of the population, an epidemic of cancer with CVD is emerging in developed countries. Cancer and CVD share risk factors, pathophysiology, treatments, and preventive and rehabilitative measures. A multidisciplinary team-based approach is needed to support cancer treatment to maximize its effectiveness and minimize its cardiotoxic potential. Basic and clinical onco-cardiology are already being practiced harmoniously. However, systematization in academia and clinical practice and accumulation of evidence have just started. In this review, we present the epidemiology, common risk factors between cancer and CVD, future epidemic of CVD in patients with cancer, and the necessity for an onco-cardiological approach to managing the burden of CVD in cancer patients and survivors.

An Exploratory Assessment of Applying Risk Management Practices to Engineered Nanomaterials.

The widespread industrial application of nanotechnology has increased the number of workers exposed to engineered nanomaterials (ENMs), but it is not clear to what extent prevention guidance is practiced. Our aim was to explore the extent that companies manufacturing and/or using ENMs apply risk assessment and management measures. Thirty-four companies were surveyed with an international 35-item questionnaire investigating company and workforce features, types of ENM handled, and risk evaluation and preventive measures adopted. Among participating companies, 62% had a maximum of 10 employees. Metal-based nanomaterials were most frequently identified (73%). Environmental monitoring was performed by 41% of the companies, while engineering exposure controls were approximately reported by 50%. Information and training programs were indicated by 85% of the sample, only 9% performed specific health surveillance for ENM workers. Personal protective equipment primarily included gloves (100%) and eye/face protection (94%). This small-scale assessment can contribute to the limited amount of published literature on the topic. Future investigations should include a greater number of companies to better represent ENM workplaces and a direct access to industrial settings to collect information on site. Finally, deeper attention should be paid to define standardized frameworks for ENM risk assessment that may guide nano-specific preventive actions.

The common foodborne viruses: A review

Transmission pathways of foodborne viruses include contamination of food by infected food handlers, by contamination of food during the production process and by consumption of products of animal origin harbouring a zoonotic virus. Viral foodborne illnesses, which have become a significant cause of all reported foodborne illnesses in recent years and considered as an emerging risk in veterinary public health. Microbiological genomics studies discovered that Noroviruses and hepatitis A viruses were primarily associated with food-handler transmission and sewage-contaminated foods. In contrast, hepatitis E was associated with consumption of raw or undercooked meat of pig or wild animals. In order to facilitate source attribution and identify risk prevention measures, Routine harmonized surveillance of viral outbreaks, and surveillance of virus occurrence in food commodities, in combination with systematic strain typing, and joint expertise from veterinary, food, and clinical microbiologists would be recommended.

Health Safety and Environmental Hazards of the Chlorination Unit of Combined Cycle Power Plants by Using HAZOP and Bow-Tie Methods

Introduction: Power plants are considered as the most important infrastructure for economic development. Risk assessment and risk management in these industries is essential to prevent accidents in these type of industries. The purpose of this study was to identify and evaluate the health safety and environmental hazards of the chlorination unit of combined cycle power plants by using HAZOP and Bow-Tie methods.
 Methods: In this study, the hazards of chlorine production in different parts of the chlorination unit were identified using the HAZOP method. After assessing the hazards, the scenario of converting high risk into critical events was developed. Finally, the Bow-Tie method was used to assess the selected critical event.
 Resulting: 7 top events and 105 risk cases were identified in the chlorination unit of the studied plant by using HAZOP method. The results showed that 65% of identified risks were acceptable and 14% related to the undesirable risks. The risk of the Chlorine Reservoir explosion related to high hydrogen pressure with regard to identified threats and also its financial, environmental and personal injuries consequences was determined as the most important top event. Therefore this event was analyzed by Bow-Tie and risk prevention measures were proposed.
 Conclusion: Using the combined method to identify and analyze the hazards showed the effectiveness of these methods together. Also, choosing the appropriate methods to overlap the strengths and weaknesses of each method can lead to an optimal outcome in risk management.

Critical aspects in the handling of reactive silica in cementitious materials: Effectiveness of rice husk ash vs nano-silica in mortar dosage

Nano-silica addition improves mechanical and durability behavior in mortars. However, nanomaterial handling requires use of occupational risk prevention measures as Individual Protection Equipment for the workers. Moreover, the high agglomeration of nanomaterials produces uncertainty in the expected mortar performance. Rice husk ash as a source of reactive silica in cement compositions is compared with nano-silica. The use of rice husk ash provides similar physical-chemical cementitious materials than other commercial nano-silica providing relevant differences during the composition. Near 50% wt of volatility is found for the silica nanoparticles during the handling dosage. Thus, the rice husk ash presents a reduced volatility, ∼12% wt and it allows ensuring high content with adequate workability. Mortars with addition of rice husk ash reach higher compressive strength and resistivity in correlation with lower porosity. For that, the use of rice husk ash is viable as safer alternative material than nano-silica in the cementitious compositions. In addition, as the rice husk ash comes from agricultural waste resources their use as secondary raw material will contributes to circularity in the economy by reducing engineered nanomaterials consumption.

Awareness regarding diabetes mellitus among individuals attending a hospital, Bhaktapur

Background: Diabetes mellitus is the most prevalent metabolic condition and one of the major health and socioeconomic problems worldwide. Awareness of risk factors and prevention of diabetes plays a major role for prevention of diabetes mellitus in general population.Objectives: To assess level of awareness regarding diabetes mellitus risk factors and preventive measures among individuals who attended General Practice outpatient department at Kathmandu Medical College Teaching Hospital, Duwakot, Bhaktapur.Methodology: This is a descriptive study conducted in Department of General Practice and Emergency of Kathmandu Medical College Teaching Hospital. The study included 370 patients attending General Practice outpatient department from November 2018 to April 2019. The data collected was entered in the Statistical Package for the Social Sciences software and analysed for results. Ethical clearance was taken from Institutional Review Committee of Kathmandu Medical College.Results: The study included 370 participants; the mean age was 40.83±12.21 years. More than half of the participants (56.5%) were females and 43.5% were males. The most commonly mentioned risk factor was lack of physical activity and obesity. Almost 80% participants correctly stated that physical activity could help prevent diabetes mellitus. There was no statistical significance between awareness and educational level of participants.Conclusion: This study showed that proper awareness programs need to be carried out in rural and urban communities to prevent diabetes and its complications. In this study, patient awareness about risk factors and preventive measures was not appreciable. Association of awareness with age, sex and education level was not statistically significant.

Dynamic evolution process of financial impact path under the multidimensional spatial effect based on G20 financial network

This paper describes the features of the multidimensional spatial effects among G20 financial markets and investigates the dynamic evolution process of financial impact in the spatial spillover networks. To achieve this objective, we first define the economic metric and gravitational spatial weight matrix to establish a multidimensional economic space, which is shown to have a significant advantage in capturing the multidimensional spatial effects of financial markets. Then, the spatial econometric complex network autoregressive panel model is constructed by combining the spatial econometrics and complex network theory. Finally, we calculate the Bonacich centrality of nodes in spillover network, and study dynamic process of the financial impact path with different Bonacich nodes being the source of infection. The results show that spatial spillover network includes regional aggregation and dynamic evolution. The spatial spillover effects of financial markets are positively correlated with important financial markets, foreign direct investment, turnover ratio and inflation rate. Emerging financial markets are seen to have increasingly become Bonacich key nodes in the impact path. When the Bonacich key nodes in the spillover network have fluctuations, the impact spreads wider and faster. This study can help us predict the source of the financial turmoil, and remind investors to formulate new asset allocation strategies and risk prevention measures for different financial markets.

Awareness of risk factors and preventive measures for neural tube defects: Perception towards pregnancy termination in the Saudi population.

Neural tube defects (NTDs) are among the most common congenital anomalies worldwide with an incidence of 300,000/year. Spina bifida, which is the most prevalent NTD, has an incidence of 1.2/1000 live births in Saudi Arabia. Our study aimed to assess the awareness of NTDs and the implementation of preventative measures against them. In addition, to gauge public opinion regarding abortion following early diagnosis of NTDs. This was a cross-sectional study in which questionnaires were distributed using non-probability convenient sampling technique and data was collected in a face-to-face interview. Subjects were approached in an outpatient clinic and in a shopping mall in Jeddah city, Saudi Arabia. Out of 353 subjects, 35.7% were males, 64.3% females (33% pregnant), and the median age was 34 (IQR = 14) years. Of subjects, 66.3% were not aware of NTDs, and regarding folic acid 54% believed that it helps in preventing NTDs, and only 25% agreed on starting it before pregnancy. However, only 19% agreed on all points, which even dropped to 9% after considering planned pregnancies. Gender differences were extremely significant (p-value <0.001) as females were more aware. Interestingly, 62% would abort in early-diagnosed NTD cases. Of pregnant women, only 20% started taking folic acid before pregnancy. The data shows that the majority of the study's population are in favor of terminating the pregnancy in justified NTD cases. There is a need for increasing public awareness, especially to males, and should be provided through all channels of knowledge.

The risk factors and preventive measures of hospital infections on preoperative children with cleft lips and palates

To analyze the risk factors of preoperative upper respiratory infections in children with cleft lips and palate (CLP) and investigate preventive measures to reduce infections and improve the quality of treatments. A total of 510 children with CLP of ages 3 years old or younger were selected from hospital cases from June to December 2017. The test group comprised 50 children with upper respiratory infections, whereas the control group comprised 460 children without upper respiratory infections. A t-test and a multivariate logistic analysis were utilized to analyze the risk factors and to investigate the preventive measures. Feeding patterns, the presence of infected companions during hospitalization, and ventilation at night were statistically significant. The feeding patterns and the presence of infected companions during hospitalization were independent risk factors for upper respiratory infections in children with CLP. Bottle feeding, infected companions during hospitalization, and the absence of window ventilation at night are risk factors for preoperative upper respiratory infections in children 3 years old or younger with CLP. Among the risk factors identified, feeding patterns and the presence of infected companion during hospitalization were the most influential. Medical staff members should streng-then corresponding health education and nursing measures to control the risk factors.

Risk assessment of electric vehicle supply chain based on fuzzy synthetic evaluation

In recent years, electric vehicles have witnessed rapid development. However, with the characteristic of numerous complexity links, there are many uncertainties exist in the supply chain which will cause high risks to the electric vehicles. Thus, carrying out a risk assessment is essential for the supply chain. The purpose of this paper is to identify and assess the potential risk factors for China's electric vehicle supply chain under uncertain circumstance. Firstly, this paper establishes a risk assessment index system for electric vehicle supply chain, which consists of three aspects and associated 15 indexes. Secondly, a combined hesitant fuzzy linguistic term set with fuzzy synthetic evaluation is developed. Thirdly, the risk assessment on China's electric vehicle supply chain is conducted. The results show that the risk level of the electric vehicle supply chains in China is between “general” and “high”. And the technical aspect and market aspect should be noted, mainly involving the information sharing risk and the assembly line setting risk. This paper can help managers of electric vehicle supply chain not only identify potential risks but also develop appropriate risk prevention measures.

Nosocomial Infection Outbreak with Enterobacter aerogenes at a Neonatal Intensive Care Unit and Its Outcomes

Objective Health care associated infections (HAIs) in the neonatal intensive care unit (NICU) are a significant cause of neonatal morbidity and mortality. Enterobacter aerogenes, a gram-negative bacterium, rarely causes HAI in the pediatric and NICUs. We report the case of a HAI outbreak of E. aerogenes in an NICU and discuss the clinical spectrum and outcome of the affected preterm newborns and successful prevention measures. Materials and Methods A retrospective study was conducted in a level III NICU of Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital. The infants with blood cultures positive for E. aerogenes during the outbreak were enrolled. Perinatal risk factors, laboratory findings, symptoms, treatment, and prognosis were recorded. Clinical applications and prevention measures were identified. Results A preterm infant of 27 weeks of gestation who was diagnosed on the eighth postnatal day was the initial case of the reported outbreak of health care associated E. aerogenes infection. Subsequently, 12 more infants were diagnosed in the next 3 months. Infants' mean gestational age was 27.1 ± 2.3 weeks, and mean birthweight was 902 ± 161 g. The clinical symptoms at presentation were respiratory distress, sclerema, circulatory failure, and shock, which appeared at a mean age of 7.6 ± 5.8 days. Analysis of E. aerogenes strains revealed that all strains were of the same clonal type. Eight patients died in follow-up due to E. aerogenes septicemia during this outbreak. The mean interval between the onset of symptoms and death was 1.5 ± 1 days. Conclusion Outbreaks of health care associated E. aerogenes infection result in a high mortality rate among very low birthweight infants. Awareness of adjustable risk factors and preventive measures to control the outbreak decreases both morbidity and mortality.

Pressure ulcer risk assessment and preventive measures in mobile / chairfast / bedfast hospital patients

Pressure ulcer risk assessment and preventive measures in mobile / chairfast / bedfast hospital patients Abstract. Background: Internationally, it is recommended to use the clinical view with a validated instrument for pressure ulcer risk assessment to determine subsequent measures. We could not identify any study investigating risk assessment and subsequent measures for mobile / chairfast / bedfast patients. Aim of the study: To identify the degree of agreement between the Bradenscale and clinical view regarding pressure ulcer risk in mobile / chairfast / bedfast patients and subsequent preventive measures. Method: Data from 5274 hospital patients from the "Nursing quality measurement 2015", a cross-sectional multicenter study, were collected. Results: Out of all mobile, chairfast or bedfast patients assessed as at risk of pressure ulcer with the Bradenscale, 22.3 % (mobile), 61.7 % (chairfast) and 86.1 % (bedfast) were also assessed as at risk by clinical view. More than 3 / 4 of the chairfast patients that were not at risk according to clinical view received preventive measures. Conclusion: The consequences over time for patients that received no measures due to discrepancies in the risk assessments should be focused. Furthermore the evaluation of measures in patients without a risk of pressure ulcer is of critical importance. The aspect of patient mobility deserves special attention due to the low agreement of the risk assessments in chairfast and mobile patients.

Childhood Obesity: Risk Factors and Preventive Measures

The obesity epidemic has grown worldwide in both the developed and developing countries. We are the “present” of the era with ever increasing growth of obesity; the coming generation is our “future”. Future of obesity largely depends on how we are handling it in present. Overweight and obesity prevailing in children has multiple causes from genetic factor, hormonal imbalance to environmental factors, lifestyle preferences and cultural practice. Keeping apart the hormonal, genetic and any physiological causes of obesity which are not in direct control, the remaining factors such as lifestyle, environment and cultural background which can be modulate to help eliminating percentage of existing and future obesity. Evidences have suggested that the major cause of obesity is imbalance between food habits and physical activity. Additional factors as per the recent researches show that excessive use of smart phones has increased the overweight issues and also increases the anxiety among the user. Childhood obesity has maximum chances to develop into adulthood obesity. Therefore, to eradicate the future obesity, there is need to increase the awareness of do's &amp; don'ts to prevent obesity and also the educate common people to know about the pros &amp; cons of obesity. This paper is inclined towards the various risk factors of childhood obesity, and also pointing some preventive and educational measure to avoid obesity in the future.