Risk Reduction Goals Research Articles

Lower Blood Pressure Goals for Cardiovascular and Renal Risk Reduction: Are They Defensible?

Most guidelines in the Western world uniformly recommend two blood pressure (BP) goals, <140 ⁄90 mm Hg for the general population and <130 ⁄80 mm Hg for those with diabetes or chronic kidney disease (CKD). These recommendations for a lower BP goal in these specific groups stem from retrospective data analyses that suggest a slower decline in CKD and greater cardiovascular disease (CVD) risk reduction when BP is <130 ⁄80 mm Hg. The question to be addressed: are these more aggressive BP goals defensible based on appropriately powered prospective outcome trials? Meta-analyses of all clinical trials, to date, demonstrate that reducing BP reduces risk for stroke and coronary heart disease. However, none have achieved a mean BP goal of <130 ⁄80 mm Hg. This lack of lower BP goal achievement is even true in CVD outcome trials of diabetes. In trials such as the United Kingdom Prospective Diabetes Study (UKPDS) and the Hypertension Optimal Treatment Trial (HOT), the systolic BP was more than 10 mm Hg higher than this lower goal. Nevertheless, a benefit occurred on CVD reduction. One prospective study that achieved this lower BP goal in patients with diabetes and no overt nephropathy was the Appropriate Blood Pressure Control in Diabetes (ABCD) trial. This trial demonstrated reduced CV risk, but there was no difference between the groups with a mean systolic pressure of 138 mm Hg vs the intensive group at 132 mm Hg. A summary of large CVD outcome trials during the past decade with the relative CVD risk reduction and achieved mean systolic BP are presented in the Figure. It is clear that none of the trials achieved a systolic BP below 130 mm Hg. The definitive answer regarding whether lower levels of systolic BP further reduce CVD risk will come from the results of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial within the year. If negative, the BP goal of <130 ⁄80 mm Hg will be clearly indefensible.

Middle School Students' Reasons for Selecting Specific Obesity Risk Reduction Goals: Mapping to Potential Mediators from Theory

Middle School Students' Reasons for Selecting Specific Obesity Risk Reduction Goals: Mapping to Potential Mediators from Theory

Risk Reduction When Society Uses the Environment

The importance of a society, conceived at all levels – individual, family, neighborhood, organizational (bureaucracy, business), and community – knowledgeable about natural hazard risk, motivated to incorporate actions and (self) informed about important actions to take, and working together to reduce such risk, is an ideal towards which we all must strive. These papers make an important contribution to these goals. However, the papers vary in their recognition of the importance of community dynamics as a key factor in achieving these risk reduction goals. The most important actions that humans can take to achieve risk reduction from natural hazards are: to undertake a serious, systematic assessment of the risk from natural hazards that development of a locale will have on what is placed there, and

Distribution of Verbal and Physical Violence for Same and Opposite Genders Among Adolescents

The present study was set up to test the perceived distribution of verbal and physical violent behaviors among same- and opposite-genders. More specifically, those perceived violent behaviors are examined as the outcome of adolescents' cost-risk goals. The study assumes two conflicting social goals: Whereas the goal of risk reduction may motivate withdrawal from conflict, and decrease the prevalence of violent events, the goal of pursuing social status may motivate initiation and/or retaliation, thus increasing the prevalence of violence. The study is based on a sample of 155 high-school students that recorded the frequency of observing violent events in their peer group over a one-week period. Findings demonstrate that for males, opponent gender had a primary effect on violence distribution. Males exhibited violence against males more frequently than against females. This result is consistent with the assumption that males set a higher priority to pursuing social status. For females, verbal violence was more frequent than physical forms of aggression. This is consistent with the assumption that females set a higher priority on avoiding risk. These results are discussed from an evolutionary cost-risk perspective.

THE APPLICATION OF STEREOTACTIC RADIOSURGERY TO DISORDERS OF THE BRAIN

Stereotactic radiosurgery is the first widely used "biological surgery." The opportunity for surgeons working with radiation oncologists and medical physicists to affect cell structures with both direct and indirect vascular effects has transformed neurosurgery. As a minimal access surgical approach, it fits well into the patient goals of functional preservation, risk reduction, and cost-effectiveness. Longer-term results have been published for many indications. For many disorders, it may be better to "leave the tumor in rather than take it out." Radiosurgery has had an impact on the management of patients with vascular malformations, all forms of cerebral neoplasia, and selected functional disorders such as trigeminal neuralgia and tremor. It can be performed alone when lesion volume is not excessive or as part of a multimodality strategy with resection or endovascular surgery. Epilepsy, behavioral disorders, and other novel indications are the topics of current investigation. The combination of high-resolution imaging, high-speed computer workstations, robotics, patient fixation techniques, and radiobiological research has put radiosurgery into the practice of almost all neurosurgeons.

Partnering with technology to reduce OB losses

Following a catastrophic birth injury that occurred as a result of deviations from the expected standards of care, the OB Risk Reduction Task Force of a healthcare network identified criteria to transform care at the bedside from theory to practice: 1) protocol-driven, real-time alerts to help healthcare providers meet clinical guidelines; and 2) the ability to produce reliable data to monitor and measure adherence to accepted standards of care. The group selected a technological solution to achieve that end. This case study illustrates how a strong partnership model between healthcare and technology solution providers can achieve much when both parties are focused on the same goals of performance improvement and active risk reduction.

Glucose and Cardiac Risk Factor Control in Individuals With Type 2 Diabetes

The purpose of this descriptive study was to describe attainment of glucose and coronary heart disease (CHD) risk factor goals and to identify factors that were associated with successful goal achievement. A cross-sectional survey enrolled 110 subjects with type 2 diabetes undergoing screening for asymptomatic myocardial ischemia. Many participants had HbA1c levels > or =7% (45%), and 46% to 79% were not meeting goals for CHD risk reduction. Individual factors of age, gender, and anxiety; the illness-related factor of lipid-lowering therapy; and the family-related factor of living alone were independently associated with 1 of the 7 outcomes under study. Illness-related factors of a longer duration of diabetes were strongly associated with glucose and blood pressure control, insulin use with glucose control and waist circumference, and antihypertensive use with blood pressure, triglycerides, and body mass index. Family-related factors of higher income were significantly associated with poorer glucose control and higher body mass index, while higher levels of perceived support by family and friends were associated with a lower risk of not meeting lipid goals. However, individual factors, represented by several aspects of personal model beliefs (exercising regularly, testing glucose, and checking one's feet) and physical activity, were consistently related to lipid and weight control. A variety of factors were associated with control of blood glucose and CHD risk factors, suggesting that a one-size-fits-all approach to multiple risk factor reduction efforts may not result in goal attainment.

The slow recovery of San Francisco Bay from the legacy of organochlorine pesticides

The use of organochlorine pesticides, including DDTs, chlordanes, and dieldrin, peaked in San Francisco Bay's watershed 30–40 years ago, yet residues of the pesticides remain high. Known as legacy pesticides for their persistence in the Bay decades after their uses ended, the compounds and their breakdown products occur at concentrations high enough to contribute to advisories against the consumption of sport fish from the Bay. Combined with other data sets, the long-term monitoring data collected by the San Francisco Estuary Regional Monitoring Program (RMP) for trace substances allow us to track recovery of the Bay from these inputs and predict its future improvement. Legacy pesticides enter the water and sediment of San Francisco Bay from a variety of sources, including runoff from California's Central Valley and local watersheds, municipal and industrial wastewater, atmospheric deposition, erosion of historically contaminated sediment deposits, and dredging and disposal of dredged material. Runoff from small-urbanized tributaries may contribute as much or more to the loads than runoff from the agricultural Central Valley, even though 90 percent of the freshwater flow comes from the Central Valley via the Sacramento and San Joaquin rivers. The fates of legacy pesticides in San Francisco Bay are controlled by their chemical properties, including their solubilities and partition coefficients. Degradation in the sediments, outflow through the Golden Gate, and volatilization—in that relative order—result in removal of pesticides from the Bay. A contaminant fate model was used to estimate recovery times of the Bay under various scenarios. For example, under a scenario in which no new legacy pesticides entered the Bay, model predictions suggested that concentrations of pesticides in the water and the active sediment layer would reach risk-reduction goals within one to three decades. Under scenarios of continued inputs to the Bay, recovery time would be considerably longer or not reached at all. Long-term tissue monitoring corroborates model predictions of slow declines in DDT and chlordane concentrations. Field-transplanted bivalve samples indicate declines since 1980, and lipid-weight concentrations of pesticides have declined in fishes, but the declines are slow. The critical management question for the Bay is whether there are feasible management actions that would decrease concentrations in sport fish significantly faster than the existing slow progress that has been observed.

Obesity and Cardiac Rehabilitation

Obesity is a significant health burden and increasing in prevalence among patients enrolled in cardiac rehabilitation (CR)/secondary prevention programs. Strategies to address exercise and dietary needs are especially important for the obese patient, but assessing other factors that affect risk-reduction goals is also important. PURPOSE: To compare obese and normal-weight patient groups on: 1) baseline characteristics, 2) changes in exercise minutes and MET levels during CR, and 3) changes in exercise and diet related outcomes pre- to post-CR. METHODS: Between 1/96 and 9/05, 574 patients (ages 27–90, all CHD) completed our CR program. Patients were grouped by baseline body mass index (BMI): normal weight, BMI <25 kg/m2 (n = 119), overweight, BMI 25–29.9 kg/m2 (n = 211), and obese, BMI ≥30 kg/m2 (n = 244). Group comparisons were limited to the obese and normal weight groups and data analyzed with t-tests or chi-square as appropriate. RESULTS: Compared to the normal weight group, the obese group was younger (59 ±10 vs65 ±10 years, p<0.001), included more men (70% vs 66%), had poorer diet scores (33 ± 29 vs 25 ±24), a higher comorbidity index (1.8 ±1.6 vs 1.3 ±1.5) and non-HDL cholesterol level (144 ±45 mg/dl vs 129 ±43 mg/dl) and a higher prevalence of hypertension (84% vs 70%) (all p<0.01) and diabetes (48% vs 24%, p<0.001). There were no significant group differences at baseline for 6-minute walk distances, self-reported physical activity and prescribed minutes of supervised exercise minutes or MET level. At completion of CR, the obese group exercised more supervised minutes (46±10vs43 ±8, p = <0 .002), but there was no difference in MET level or self-reported weekly physical activity. Although each group made improvements from pre- to post-CR, the degree of improvement was greater in the normal-weight group for 6-minute walk distance (ft) (278 ±266 vs 217 ±266, p = 0.04) and greater for the obese group for the diet score (−15 ±28 vs −8 ±19, p <0 .001). As expected, there was a modest comparative decrease in change for the obese group in BMI (−0.8 ± 1.3 vs +0.1 ± 0.9, (p<0.001) and waist circumference (inch) (−0.9 ±2.6 vs −0.1 ±1.7, p<0.01). CONCLUSIONS:Despite the younger age, obese patients had a higher comorbidity and risk factor burden than normal weight patients that poses additional risk-reduction challenges. Although more supervised exercise minutes were logged for the obese group, the degree of improvement in functional capacity was less than the normal weight group and only modest weight-reduction benefits were achieved. More intense strategies targeting home physical activity behaviors are needed to enhance the desired outcomes among obese patients participating in CR.

An Evaluation of a Brief HIV/AIDS Prevention Intervention for College Students Using Normative Feedback and Goal Setting

This study evaluated the ability of a 20-minute self-administered intervention to increase HIV/AIDS risk reduction among sexually active college students. The intervention presented normative data on the relatively low prevalence of HIV risk behaviors among college students for the purpose of conveying the idea that risk reduction was the prevailing social norm among their same age peers. The intervention also invited students to select specific risk reduction goals to be implemented over a 30-day follow-up period. Participants (N = 155) were assigned in alternating order to receive either the intervention or a control condition that entailed reading a general AIDS information pamphlet. Results were partially moderated by gender. Compared with controls, men in the intervention group reported significantly higher condom use, whereas women in the intervention group reported significantly fewer sexual partners.

Risks of hazardous waste sites versus asteroid and comet impacts: accounting for the discrepancies in U.S. resource allocation.

Approximately $6 billion is spent annually in the United States on the cleanup of sites regulated under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA, or Superfund). The current health risks posed by such sites are thought to be quite small; the expenditures are justified primarily as protecting hypothetical future residents of these sites. Approximately 0.05% of this amount, or $3 million, is spent annually by the U.S. government on the detection of asteroids or comets that could strike the earth. Such damaging impacts do occur from time to time--most recently in 1908 in an unpopulated region of Siberia--but no person is confirmed ever to have died as a result. Anticipated impacts over the course of 1 million years would yield deaths that, when annualized, total approximately 4,000 per year. The risk reduction goal for CERCLA is 15 orders of magnitude greater than that for asteroid/comet detection. A modest increase in resources devoted to asteroid detection would greatly increase the chances of early detection of a threatening object, allowing an effective defense to be attempted. This article argues that the much lower risk-to-resources ratio for CERCLA cleanups than for asteroid and comet detection can be explained by four primary factors: (1) the regard for future generations, since CERCLA benefits mainly the unborn; (2) concrete fears, since toxics are much more feared than asteroids or comets; (3) the source of the threat, since toxic contamination is caused by human beings, unlike impacts from space objects; and (4) the greater political constituencies for hazardous waste cleanup than for space object detection.

The American College of Cardiology Evaluation of Preventive Therapeutics (ACCEPT) Study: Attainment of Goals for Comprehensive Risk Reduction in Patients With Coronary Disease in the US

The American College of Cardiology Evaluation of Preventive Therapeutics (ACCEPT) Study: Attainment of Goals for Comprehensive Risk Reduction in Patients With Coronary Disease in the US

The American College of Cardiology Evaluation of Preventive Therapeutics (ACCEPT) study: attainment of goals for comprehensive risk reduction in patients with coronary disease in the US

The American College of Cardiology Evaluation of Preventive Therapeutics (ACCEPT) study: attainment of goals for comprehensive risk reduction in patients with coronary disease in the US

Remediation of the Radioactive Waste Landfill and Chemical Disposal Pits Sites at Sandia National Laboratories

AbstractSandia National Laboratories' Environmental Restoration (ER) Project remediated the Radioactive Waste Landfill and Chemical Disposal Pits (RWL/CDPs) sites located in Albuquerque, New Mexico. The remediation was conducted in 1996 using conventional excavation, as well as hybrid remote robotic manipulation technology at a cost of approximately $3 million. Wastes generated included approximately 73 cubic meters (m3) of debris (including thermal batteries, spark gap tubes, radioactive sources, weapons components, and some classified material), 535 m3 of plutonium‐contaminated soil, and 2,294 m3 of soil contaminated with thorium, cesium, uranium, and tritium. The remediation was successful since the project goal of risk reduction was accomplished and no injuries or negative occurrences resulted. This cleanup is one example of the Department of Energy's (DOE's) accelerated approach to environmental restoration. The remediation was performed as a voluntary corrective measure to reduce schedule and budget, compared with the traditional approach following Resource Conservation and Recovery Act (RCRA) regulations.

Comprehensive Cardiovascular Disease Risk Reduction in a Cardiac Rehabilitation Setting

Cardiac rehabilitation combines prescriptive exercise training with coronary artery disease (CAD) risk factor modification in patients with established CAD. As such, cardiac rehabilitation programs are ideally positioned to assume a pivotal role in the rendering of many components of comprehensive cardiovascular disease risk reduction in a secondary prevention setting. However, the extent to which traditional cardiac rehabilitation programs can successfully accomplish this goal is limited by low participation rates, inadequate emphasis on many of the essential aspects of secondary prevention, and lack of long-term follow-up of patients. To overcome these deficiencies, cardiac rehabilitation programs should evolve into cardiovascular risk reduction programs by implementing approaches that have been shown to be effective in randomized clinical trials. In this manuscript we describe one such approach, based on the Stanford Coronary Risk Intervention Project, which has been implemented in >1,000 patients. Key components of this physician-supervised, nurse case-manager model include: (1) initial evaluation and risk assessment; (2) identification of specific goals for each CAD risk factor; (3) formulation and implementation of an individualized treatment plan that includes lifestyle modification and pharmacologic interventions for accomplishing specific risk reduction goals; (4) long-term follow-up to enhance compliance and revise the treatment plan as indicated; and (5) a mechanism for outcomes based long-term assessment of each patient.

Predicting increased condom use with main partners: potential approaches to intervention.

HIV/AIDS risk reduction interventions have been based on 5 psychological models: Transtheoretical Model of Change, AIDS Risk Reduction Model, Social Cognitive Theory, Theory of Reasoned Action, and Theory of Planned Behavior. This longitudinal study examined changes in condom use as a function of variables from these theories. Risk assessment, "stages of change," and condom use questionnaires were administered to 78 crack smokers or intravenous drug users with a main partner recruited from 2 US towns. Networks of subjects were randomly assigned to a standard intervention (2 educational sessions including basic information about HIV and its prevention as well as demonstrations and practice of correct condom use and cleaning of drug injecting equipment) or an enhanced program (2 additional sessions in which participants set individual risk reduction goals and identified barriers to change). Logistic regression analysis indicated that changes in condom use after 6 months were not predicted by age, gender, ethnicity, type of drug use, perceived HIV risk, or intervention group. Having multiple sex partners significantly predicted increased condom use. The 2 strongest predictors of increased condom use were self-reported assertiveness and the stage of change. High assertiveness at intake (odds ratio, 4.97) and a plan to start using condoms in the next 6 months (odds ratio, 15.49) were significant predictors of an increase in condom use at 6-month follow-up. Proposed is a model that combines Theory of Planned Behavior and Social Cognitive Theory and conceptualizes assertiveness as the mediator between intention and behavior change.

An experiential program to reduce AIDS risk among female sex partners of injection-drug users.

This article describes the development and implementation of an acquired immune deficiency syndrome (AIDS) intervention program for female sex partners of male injection-drug users. Four psychoeducational workshops were designed to motivate personal risk reduction, provide participants with necessary cognitive and behavioral skills, and enhance participants' perceived ability to enact positive changes in their lives. The development of the workshop modules was guided by traditional theories of health behavior change and social learning. Also included in the intervention are referral and advocacy services, personal risk reduction counseling, and human immunodeficiency virus (HIV) antibody testing. Preliminary results indicate that the program has made a significant impact on the AIDS risk of participants--91 percent of women who completed the program reported that they had made positive changes in their lives to reduce their risk of HIV infection.

Ways of improving the management of environmental risks

From the public's discovery of environmental quality in the late 1960s to the present, there has been increasing recognition that a more systematic approach is required to manage risks and to achieve the gains at low cost. Such a systematic approach must begin with risk identification, then go on to risk assessment, consideration of management options, a decision analysis of the options, and an examination of strategies for reducing loss. One of the most difficult aspects of environmental risk management is setting goals. There is a tendency to engage in rhetoric about zero risks and a pristine environment. However, moving toward more realistic goals requires consideration of what is an acceptable risk level. This level cannot be defined without knowing the benefits that come with the risk and the costs of reducing the risk. More generally, the criteria for selecting a risk management strategy include the residual level of risk, efficiency in reducing risk, equity, administrative simplicity, and public acceptability. A number of frameworks are currently used by U.S. regulatory agencies to manage risk: no-risk, risk-risk, technology-based standards, risk-benefit, cost-effectiveness, regulatory budget, and benefit-cost analysis. In specifying that an agency must use one of these frameworks, the U.S. Congress is implicitly specifying the goals for risk reduction. It appears to be easier for the U.S. Congress to specify a framework than a goal. Some of the nonregulatory means of managing risk include the market, and legal mechanisms. These risk management institutions have been effective and are a necessary part of any risk management program.