Risk Reduction Methods Research Articles

Health risk behaviour change and adaptation in cardiac patients

Integrating much from the health belief model, the precaution–adoption model, self-efficacy theory, expectancy theory, and the trans-theoretical model of behaviour change, a cognitive-behavioural model for assessment and intervention in cardiac patients is presented in which health risk appraisal is seen as the central construct. Specifically, we hypothesize that people's beliefs regarding the seriousness of their health risk, the modifiability of their health risk, and their confidence in the risk-reduction methods and in their ability to employ these methods, will influence their adoption of and adherence to health risk-reduction behaviours as well as influencing their psychological adjustment. Furthermore, attentional processes such as ruminative states or avoidance are seen to play a pivotal role in facilitating or impeding cognitive appraisal processes and behaviour change. Dispositional expectancy styles (e.g. optimism versus pessimism) are seen to shape beliefs regarding the modifiability of health risk via their effects on appraisals of self-efficacy and appraisals of the effectiveness of risk-reduction methods. Finally, clinical scenarios are presented to illustrate the utility of the model in guiding assessment and intervention in patients with medical problems. © 1998 John Wiley & Sons, Ltd.

Applying the BeSafe method to product safety evaluation

The BeSafe (Behavioural Safety) Method, has been developed by International Mining Consultants Ltd for assessing and reducing risk in industrial contexts. BeSafe is an ergonomic method of risk analysis and reduction, targeted at prevention of accidents due to human errors and violations, and emphasising management strategies for action. In a consumer product environment, accidents are often due to similar human errors and violations. However, the product usage environment tends to be diffuse and variable, and its management difficult. Many controlling measures used to prevent accidents in industry do not apply in this environment. Using the BeSafe Method, it may be possible to structure safety assessments of the use of products and target improvement measures. The authors tested the relevant parts of the method on children's play equipment in playgrounds, and useful results were obtained. BeSafe could be adapted for other consumer products in a similar way.

Seismic Risk Reduction at Ports: Case Studies and Acceptable Risk Evaluation

Japan's Kobe Port was severely damaged during the Hyogoken Nanbu Earthquake of January 17, 1995, suffering a nearly total loss of operations and direct losses estimated to be about $5.5 billion. This paper summarizes the causes of this damage, and uses this experience as a case study to show that the economic benefits of including seismic risk reduction methods in the design and construction of ports in areas of moderate-to-high seismicity can far exceed the increases in initial construction costs. The paper also describes and illustrates an “acceptable seismic risk” evaluation procedure for assessing the viability of alternative seismic risk reduction strategies for a given port.

Risks of transmitting scrapie and bovine spongiform encephalopathy by semen and embryos.

This paper reviews current knowledge on transmission of scrapie and bovine spongiform encephalopathy (BSE) by semen and embryos. In sheep, in particular, it is difficult to distinguish between the genetic transmission of susceptibility to scrapie and vertical transmission of the infection. Nevertheless, there is evidence that vertical transmission of infection does occur, probably across the placenta, but none to suggest a significant scrapie risk from semen. Two teams have studied scrapie transmission from experimentally infected sheep using embryo transfer. Whereas one team found no evidence for transmission, the results from the other team suggest that embryos, even after washing, might carry the disease into the offspring. In regard to goats, although genetic differences in susceptibility exist, they are much less obvious than in sheep. There is no evidence for vertical transmission or for transmission through semen and embryos. With regard to BSE, although it appears that genetic differences in susceptibility are absent or unimportant, some recent work does suggest that the disease may be passed from cow to calf. The route of transmission and stage or stages when this takes place are unclear, however. In conclusion, despite growing evidence to indicate that scrapie and BSE are unlikely to be transmitted through semen and embryos, more research is needed to confirm this. Furthermore, until all possibility of risk is ruled out, risk reduction methods must be considered, especially when semen and embryos are being imported into countries where the diseases do not exist.

Prevention of Primary Event: Ischemic Stroke Risk Detection and Reduction

Risk detection and reduction methods for persons at high risk of ischemic stroke involve screening and identification of risk factors. Population-based health surveys affirm a persistent dilemma in the inability to reduce the frequency of ischemic stroke risk factors, such as hypertension, cigarette smoking, obesity, and physical inactivity levels. These alarming trends indicate that "mass approach" policies and programs need to be implemented or rethought to attain maximum levels of benefit in ischemic stroke risk reduction for the entire community.

A Program to Reduce Cardiovascular and Cerebrovascular Disease in the Czech Republic: Design and Methods of the Healthy Dubec Project

Cardiovascular Disease (CVD) morbidity and mortality rates in the Czech Republic are among the highest in the industrialized world. Due to the substantial burden CVD plays on the health and well being of the Czech society, a variety of health promotion/disease management strategies to reduce CVD risk need to be designed and implemented. A project that combined community-based health education programs designed to address pervasive perceptions and cultural traditions that influence lifestyle factors, with secondary and tertiary prevention clinical strategies to aggressively treat high-risk individuals was recently conducted in Dubec, a small Czech community. This article describes the methods used in this project (i.e., the Healthy Dubec Project) which took American-based technology and experiences in community risk reduction methods and clinical management strategies for high risk patients and adapted them to fit the Czech people and their attitudes about CVD risk behaviors.

Risks related to the introduction of exotic diseases : a european view

The European Union (EU) has historically been free of a number of epidemic diseases of livestock and is approaching eradication of several others. This situation is put at risk by the importation of live animals and animal products. Animal products include products which are broadly described as veterinary biologicals. For the purposes of assessing and controlling risks, these fall into two groups: crude products (e.g. serum and other blood products) and medicinal products (e.g. vaccines and other immunological products). This second group is covered by another paper in this issue of the Review. Risk reduction methods may be applied to crude veterinary biologicals pre- or post-importation. Pre-importation methods include product treatment, or ensuring that the source of the product is "risk-free'. Post-importation risk reduction involves product testing, or treatment achieved by channelling products to commercial operations which are covered by European medicines legislation. At present, EU Member States issue health certificates individually for crude veterinary biologicals, and conditions for entry may differ between States. This process will soon be harmonised (the provisions for marketing medicinal products have already been harmonised).

Peer Support as a Method of Risk Reduction in Injecting Drug-User Communities: Experiences in Dutch Projects and the “European Peer Support Project”

This article discusses the central importance in Western Europe of active drug users/injectors working with their peers to combat the spread of HIV and reduce other health problems. The structure and workings of several different peer organizations are described, and an important distinction is made between “self-help” versus drug-user “unions” or “interest” groups. The roots of the first drug-user unions are traced to the junkiebonden that surfaced in the Netherlands in the early 1970s. Now, the European Peer Support Project, which is described, coordinates projects in six different western European countries, supporting several different initiatives, and producing training programs and manuals for users to assist them in their organizing efforts. The underlying premise of drug-user self-organizations is that repressive drug policy, as defined by criminal laws, is not only a fundamentally inappropriate approach to the “drug problem;” repressive drug policy is partly responsible for the creation of the “drug problem” in the first place.

Intravenous Omeprazole Before Emergency Cesarean Section

In Response: From our studies, the most effective drug was ranitidine 50 mg intravenously (IV) as it successfully eliminated the risk of acid pneumonitis and provided at least 30 min between administration and endotracheal intubation. Omeprazole 40 mg IV was marginally less successful, although equally effective, if allowed another 10 min or so. It is possible that a larger dose of omeprazole would have a more rapid onset. Unfortunately, cost is a consideration, particularly in the context of the number of patients potentially requiring prophylaxis. Because of the extensive investigation establishing the safety of ranitidine to the neonate, our current recommendation would be to use ranitidine 50 mg IV if an H2 receptor antagonist prophylaxis is used. In our own institution, we use neither regimen routinely. The number of patients receiving general anesthesia for urgent cesarean section is approximately 3000/yr (about 60% of the total), and the argument for an increase in our pharmaceutical budget would need to be extremely strong. At present we feel that the issue is not resolved as there may be more simple, effective methods of risk reduction that have yet to be investigated. Currently we and other units are increasing the use of regional anesthesia for urgent cesarean section. If 30 min is available for the onset of ranitidine, then spinal anesthesia is certainly a reasonable alternative. One argument for using aspiration prophylaxis is the cost comparison of intensive care management of the occasional case of acid pneumonitis. However, while cases of aspiration under general anesthesia have occurred, only obstetric patients who aspirated during convulsions prior to admission required intensive care for aspiration pneumotitis over the last 6 yr in our unit. We do not use intravenous metoclopramide routinely as we are unconvinced of its ability to reduce gastric volume in the time available, particularly as many of our patients have received opiates. Like other centers, we have observed occasional episodes of hypotension, supraventricular tachycardia, and extrapyramidal symptoms with its use. The main advantage would be its action upon lower esophageal sphincter tone, but we feel that adequately placed cricoid pressure is more appropriate. We, therefore, rely upon routine use of oral sodium citrate 30 mL (0.3 M) immediately prior to induction and would reserve the use of intravenous ranitidine for patients with a difficult airway where regional anesthesia is contraindicated. D. A. Rocke, FRCP(Edin), FFA(SA) C. C. Rout, FFARCS Department of Anaesthetics, Faculty of Medicine, University of Natal, Congella 4013, South Africa

Smoking prevention in childhood cancer survivors.

In the year 2000, there may be 220,000 adult survivors of childhood cancer. This creates new emphasis on the health of long-term survivors. The oncology team is responsible for educating patients about methods of modifiable risk reduction for the development of cancer. Smoking is the single most avoidable risk factor implicated in the development of cancer, yet survivors of childhood cancer have been found to smoke at the same rate as their peers. Nurses play a key role in developing patients' knowledge, beliefs and skills to avoid smoking behaviors.

An experimental test of three methods of alcohol risk reduction with young adults.

An experimental test of three methods of alcohol risk reduction with young adults.

Relationship between serum total cholesterol, infarct size, and early clinical outcome following acute myocardial infarction.

Strategies designed to decrease coronary heart disease (CHD) associated morbidity and mortality have focused primarily on established risk factors, including hypercholesterolemia, systemic hypertension, and cigarette smoking. Indeed, primary and secondary intervention trials have provided evidence for cholesterol lowering as an efficient method of CHD risk reduction. To test the hypothesis that serum total cholesterol influences the clinical outcome following acute myocardial infarction, infarct size, left ventricular ejection fraction, infarct-related vessel patency, and in-hospital cardiac events were determined in 106 consecutive patients given thrombolytic therapy within 5 h of symptom onset. Cumulative 48-hour creatine kinase (CK) release, peak CK, and calculated infarct size did not differ significantly between patients with an admitting serum total cholesterol level less than 200 mg/dl (group 1) and those with a cholesterol level greater than 250 mg/dl (group 2). Total cholesterol did not correlate with either cumulative CK release, peak CK, infarct size, vessel patency, or left ventricular ejection fraction. The vessel patency correlated inversely with cumulative CK release (r = -0.27; p = 0.03) and directly with left ventricular ejection fraction (r = 0.24; p = 0.03). The incidence of in-hospital cardiac events including recurrent infarction, congestive heart failure, and death was 6.9, 13.9, and 2.6%, respectively, and did not differ significantly between patient groups. Thus, although serum total cholesterol has been shown to influence CHD incidence, morbidity, and overall mortality, the findings of our study suggest that it does not impact directly on infarct size, left ventricular function, or in-hospital clinical outcome among patients sustaining acute myocardial infarction.

AIDS-Related Risk Perception and Sexual Behaviour among Sexually Transmitted Disease Clinic Attenders

Perception of risk has been suggested as an important element of sexual behaviour change among people who engage in behaviours which place them at risk of HIV infection. A study of the relationship between perception of risk of HIV infection and risk-related sexual behaviours was conducted in a genitourinary medicine clinic. The sample comprised 767 patients attending over a 3-month period; data collection was by self-completed questionnaire. A total of 574 questionnaires were suitable for analysis, representing a response rate of 75%. The majority of people in the sample reported behaviours which increased their risk of HIV infection, but only 19% (n = 112) of the sample perceived themselves to be personally 'at risk', despite adequate knowledge of HIV transmission and methods of risk reduction. Significant differences between social class groups were found for knowledge scores, with highest scores among professionals and lowest among unemployed subjects (Kruskal Wallis test chi 2 = 24.6, P less than or equal to 0.001). Increasing age was significantly associated with better knowledge; significantly more young people aged 16-20 years who did not perceive themselves 'at risk' (64%), had lower knowledge scores than older people who did not perceive themselves 'at risk' (41%). Among heterosexuals who reported having sex with other people in addition to their regular partner, 79% did not perceive themselves as 'at risk' of HIV infection, and of these, 64% reported only infrequent condom use with casual sexual partners. Significantly more heterosexual men (67%) than women (44%) reported multiple sex partners.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome and Adolescents: Knowledge, Attitudes, Beliefs, and Behaviors in a New York City Adolescent Minority Population

In this survey, the knowledge, attitudes, beliefs, and behaviors concerning acquired immunodeficiency syndrome (AIDS) in a group (N = 196) of innercity adolescents in New York City were assessed. Sexual activity was the major risk factor for AIDS in this population; 58% of the adolescents had engaged in sexual intercourse; 12% of these had never used contraception. There were small reported rates of homosexuality, anal intercourse, and prostitution. Of respondents, 22% reported alcohol use and 22% had tried recreational drugs. None had ever taken drugs intravenously. Knowledge of human immunodeficiency virus (HIV) transmission was generally good, although there were prominent misconceptions. For example, 52% of the adolescents believed that donating blood could transmit HIV. Of respondents, 47% "never" or "rarely" worried about the disease. Of the total group, 39% reported behavior changes because of concern about AIDS in the previous 6 months. Those who changed behaviors tended to have a greater perceived risk, worry more frequently about the disease, and have a better knowledge of means of HIV transmission. Of those reporting behavior changes, 66% (25% of the total study group) claimed to be using condoms currently, and 16% (6% of the total study group) claimed to be abstemious. More black adolescents than Hispanic adolescents instituted behavior changes. Of black female adolescents, 71% were sexually active, as compared with 30% of Hispanic female adolescents.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer prevention in the workplace and natural environment. A review of etiology, research design, and methods of risk reduction.

Guidelines for developing programs in cancer prevention and reduction of risk related to occupational and environmental carcinogens are provided in this review, which includes a summary of experimental and epidemiologic research designs for assessing potential etiologic agents, an overview of known occupational and environmental carcinogens, and a summary of general approaches to risk reduction. This review includes human cancer risks in the workplace and in the natural environment, which encompasses air pollution, water pollution, and hazardous waste disposal. Fourteen tables present the following: (1) established and probable carcinogens that may be encountered in the workplace, as contaminants of air or water, or as hazardous waste; (2) regulated carcinogens; (3) primary sources of exposure; (4) research designs; and (5) risk reduction methods. The interactive effects of multiple exposures are discussed as they relate to etiology and prevention. The importance of federal regulation is emphasized, as well as the need to understand the potential for cancer prevention in the context of broader economic, political and social issues.

Exchange Rate Uncertainty, Forward Contracts, and International Portfolio Selection

ABSTRACTIn this paper, ex ante efficient portfolio selection strategies are developed to realize potential gains from international diversification under flexible exchange rates. It is shown that exchange rate uncertainty is a largely nondiversifiable factor adversely affecting the performance of international portfolios. Therefore, it is essential to effectively control exchange rate volatility. For that purpose, two methods of exchange risk reduction are simultaneously employed: multicurrency diversification and hedging via forward exchange contracts. The empirical findings show that international portfolio selection strategies designed to control both estimation and exchange risks almost consistently outperform the U.S. domestic portfolio in out‐of‐sample periods.

Strategic market planning in a turbulent business environment

This study investigates the relationship between business environment and strategic market-planning procedures. The study results are based on the responses of 149 marketing executives of the Fortune 1000 companies. The results indicate that as the business environment becomes turbulent, the strategic market plans become more complete and more long-term orientated. The companies facing a turbulent environment emphasize decentralization in developing the strategic market plans. These companies use a variety of risk-reduction methods such as the usage of conceptual models, consultants, and computer-mathematical models in their strategic market-planning process.

Groundwater contamination from waste management sites: The interaction between risk‐based engineering design and regulatory policy: 2. Results

The risk‐cost‐benefit analysis developed in the companion paper (J. Massmann and R. A. Freeze, this issue) is here applied to (1) an assessment of the relative worth of containment‐construction activities, site‐exploration activities, and monitoring activities as components of a design strategy for the owner/operator of a waste management facility; (2) an assessment of alternative policy options available to a regulatory agency; and (3) a case history. Sensitivity analyses designed to address the first issue show that the allocation of resources by the owner/operator is sensitive to the stochastic parameters used to describe the hydraulic conductivity field at a site. For the cases analyzed, the installation of a dense monitoring network is of less value to the owner/operator than a more conservative containment design. Sensitivity analyses designed to address the second issue suggest that from a regulatory perspective, design standards should be more effective than performance standards in reducing risk, and design specifications on the containment structure should be more effective than those on the monitoring network. Performance bonds posted before construction have a greater potential to influence design than prospective penalties to be imposed at the time of failure. Siting on low‐conductivity deposits is a more effective method of risk reduction than any form of regulatory influence. Results of the case history indicate that the methodology can be successfully applied at field sites.

Personal and mediated health counseling for sustained dietary reduction of hypercholesterolemia

Methods of effective cardiovascular risk reduction that are suitable for use in clinical settings are needed. Several behavioral interventions were designed to be compatible with office-based medical practice, to be delivered by paraprofessional counselors, and to be of low intensity and low cost. Eighty-three hypercholesterolemic volunteers were assigned to one of three experimental conditions (face-to-face counseling, mail and telephone counseling, initial session only). Twenty-six nonrandomized subjects served as a no-contact group and were followed for 1 year. Participants in the first three groups received risk factor education, behavioral recommendations, and a packet of materials, while those in the face-to-face and mail/telephone counseling groups were contacted for five brief follow-up sessions over a 4-month period. At the 1-year follow-up evaluation, subjects in the face-to-face and mail/telephone counseling conditions showed decreases in plasma cholesterol of 6.2 and 4.6%, respectively ( P < 0.01), while the other two groups evidenced small increases. There were no differences by condition for plasma triglycerides, systolic or diastolic blood pressure, or weight. Low-intensity, low-cost behavioral interventions delivered by paraprofessionals can produce long-term decreases in a major cardiovascular risk factor. Physicians are encouraged to incorporate similar interventions into their practices.

Preoperative transhepatic biliary decompression in pancreatic and periampullary cancer.

AbstractPancreatic resection for pancreatic and periampullary cancer between 1969 and 1975 at The Ohio State University Hospitals had an associated operative mortality rate of 30% and a morbidity rate of 80%. Transhepatic biliary decompression (THD) has been accepted as a method of preoperative risk reduction in the deeply jaundiced patient and an alternative to surgical biliary decompression. The use of preoperative THD in pancreatic and periampullary cancer was examined. Of 44 patients with bilirubin greater than 10 mg/100 ml, 17 had radical resection (THD=7, no THD=10), and 27 had palliative operation (THD=17, no THD=10). Preoperative serum bilirubin in the THD group was 7.3±1.0 compared to 16.3 ±1.5 in the no THD group (p &lt; 0.05). Operative morbidity rate was: radical surgery: THD (40%), no THD (70%); palliative surgery: THD (18%), no THD (20%). Operative mortality rate was: radical surgery: THD (28%), no THD (60%); palliative surgery: THD (6%), no THD (0%). Catheter‐related complications were minimal. Preoperative THD tends to reduce the risk of curative resection for pancreatic and periampullary cancer, but does not alter the outcome of palliative surgery. Long‐term THD may be an alternative if palliative surgical biliary decompression either fails or is not technically possible in the patient with unresectable cancer.