Risk Reduction

A focus on low body weight and body fat content, combined with regulations in some weight-sensitive sports, are considered risk factors for extreme dieting, eating disorders (EDs) and related health consequences among athletes. At present there are, from a health perspective, no generally accepted optimum values for body weight or percentage of fat mass in different sports and there is no 'gold standard' method for body composition assessment in athletes. On the basis of health considerations as well as performance, medical support teams should know how to approach elite athletes who seek to achieve an unrealistic body composition and how to prevent restrictive eating practices from developing into an ED. In addition, these teams must know when to raise the alarm and how to advice athletes who are affected by extreme dieting or clinical EDs. However, there is no consensus on when athletes struggling with extreme dieting or EDs should be referred for specialist medical treatment or removed from competition. Based on the present review, we conclude that there is a need for (1) sport-specific and gender-specific preventive programmes, (2) criteria for raising alarm and 'does not start' (DNS) for athletes with EDs and (3) modifications to the regulations in some sports. Further, the key areas for research identified include the development of standard methods for body composition assessment in elite athletes; screening measures for EDs among athletes; development and testing of prevention programmes; investigating the short and long-term effects of extreme dieting; and EDs on health and performance.

To describe empirically the risky sexual behavior of an at-risk sample of adolescent girls, to assess psychosocial correlates of risky behavior, and to examine the utility of applying a risk and protective model to predicting teens' risky sexual behavior. Participants included 158 African American girls, ages 12 to 19, who were receiving medical care in an adolescent primary care clinic. Teens completed measures of depression, conduct problems, substance use, peer norms, social support, HIV knowledge, sexual self-efficacy, and sexual behavior. Teens in this sample reported high rates of risky sexual behaviors, including early sexual debuts and frequent unprotected sexual encounters with multiple partners. African American girls who reported high rates of substance use and who reported that their peers engaged in risky behaviors also reported engaging in high rates of risky sexual behaviors. Little support was obtained for protective factors (HIV knowledge, social support, sexual...

This cross-sectional study tested a conceptual model of women's HIV/AIDS protective behaviors using gender roles, relationship power strategies, and precautionary sexual self-efficacy as predictors in a predominantly Black and Latina community sample of heterosexual women (N ϭ 125). Results revealed no support for the full model, but partial confirmation for several components of the model. Education significantly predicted gender roles, and gender roles and use of direct power strategies were significant predictors of sexual self-efficacy. Most of the participants were married or partnered and were unconcerned about contracting HIV, suggesting that if women perceive that they are at low or no risk, their gender roles, power strategies, and precautionary sexual self-efficacy will be inconsequential to their HIV/ AIDS risk reduction practices. In 1982, a year after HIV/AIDS was first identified, 67 cases of AIDS in women were reported to the Centers for Disease Control [CDC] (1983). Sixteen years later, the CDC recorded 106,059 cases among women and adolescent girls nationwide (CDC, 1998), making women the fastest growing group of people with the disease. Between 1991 and 1995, the number of women diagnosed with AIDS increased by 63% (Wortley & Fleming, 1997).

Although relatively few teenagers have been diagnosed with AIDS and the extent of asymptomatic human immunodeficiency virus (HIV) infection among adolescents remains largely unknown, there is cause for concern about teens' risk of contracting HIV disease. The incubation period (the time from initial infection to the development of full-blown AIDS) is estimated to average eight years, and therefore it is probable that most of the individuals in their twenties who have AIDS (20% of all the people with AIDS) contracted HIV during their teenage years. The sexual and drug use activities of many teenagers place them at increased risk for HIV transmission. Sexually transmitted diseases (STDs) are pervasive and a major cause of morbidity among sexually active adolescents. The rates of STDs have continued to rise even during the 'age of AIDS'. These rates are of concern since the behaviors associated with the acquisition and transmission of STDs are also the behaviors associated with HIV transmission. In addition, the presence of STDs may increase the likelihood of HIV transmission.

This study explores the utility of a self-completion survey method to quickly and cheaply generate information on patterns and trends among regular 'recreational' drug consumers. Data is reported here from 1151 subjects accessed through a dance music publication. In keeping with previous studies of drug use within the dance scene polysubstance use was the norm. Many of those reporting use of 'ecstasy' were regularly using multiple tablets often consumed in combination with other substances thus exposing themselves to serious health risks, in particular the risk of dose related neurotoxic effects. Seventy percent were drinking alcohol at hazardous levels. Subjects' patterns of drug purchasing also put them at risk of severe criminal sanction. Data supported evidence that cocaine use had become increasing popular in the UK, but contrasted with some commentators' views that ecstasy use was in decline. The utility of this method and how the results should be interpreted is discussed, as are the data's implications for harm and risk reduction activities.

This paper describes a systematic risk analysis process for occupational safety and health (OSH). A concept of technological risk management and risk assessment is applied. A review of published risk management and assessment applications for various industries is presented and a generalised approach to risk management for OSH in surface mining is proposed. The approach consists of six phases. This process can be used to help judge the tolerability of risk and aid in choosing between potential risk reduction and/or risk avoidance measures. The paper also underlines the benefits of applying risk management concepts from the decision maker's perspective.

The study uncovered a number of major findings which have implications for policy and practice in the country, including: the epidemic may be less severe, less generalized and more heterogeneous than previously believed, with marked regional variations; the diversity of the Human Immunodeficiency Virus (HIV) epidemic seems to be related to sexual behavior patterns; small towns may be HIV hot-spots that have had marginal attention in HIV prevention efforts to date; traditional high-risk groups such as sex workers seem to be reducing some of their risky behaviors. Young populations, especially never-married sexually active females have the greatest risk of HIV infection in the country; discordant couples are also a concern, pointing to a clear need for couple counseling services which are presently non-existent or rudimentary. The lack of recent data and research, especially on high risk groups, makes further conclusions difficult, and highlights the clear need for more research.

É indiscutível o papel da dieta e dos alimentos na manutenção da saúde e na redução do risco de DCNT. Estudos epidemiológicos mostram que o aumento do consumo de alimentos de origem vegetal influencia positivamente a saúde, enquanto estudos in vitro e in vivo em modelo animal elucidam os mecanismos pelos quais compostos bioativos não nutrientes, presentes nos alimentos, atuam na manutenção da saúde e na redução do risco de doenças. A modulação da expressão de genes que codificam proteínas envolvidas em vias de sinalização celular ativadas em DCNT é um dos mecanismos de ação dos compostos bioativos, sugerindo que estes possam ser essenciais à manutenção da saúde. A biodisponibilidade dos compostos bioativos de alimentos, as suas rotas metabólicas e o modo de ação de seus metabólitos são importantes fatores no seu efeito nas DCNT. Todos esses aspectos são temas de investigações recentes, cujos resultados contribuem para a compreensão da ocorrência e desenvolvimento das DCNT e da sua r...

In the pharmaceutical industry, strategic alliances extend worldwide. In this exploratory empirical study of 55 large firms and 54 small firms that are parties to strategic alliances, we investigate the motivations for strategic alliances among small and large licensees and licensors.

Disaster response activities are generally well funded but do little to break communities out of disaster cycles. Actions that reduce exposure or vulnerability to hazards are particularly needed across the Asia-Pacific region where countries swing between pre and post disaster phases of the disaster cycle with a worrying regularity. These cycles make it hard for populations to save, to acquire insurance, and reduce opportunities to move above poverty thresholds. Instead communities living in hazard prone locations are forced into distress sales of assets or are pushed from being in the near-poor to extreme poor when a disaster hits. This paper deals with the question of how to conceptualise relocation in a way that will prevent impoverishment risks usually associated with development induced displacement. It suggests that relocation efforts will be most successful where implementing agencies accurately conceptualise and respond to the social dimension of involuntary resettlement. With a better understanding of the social dimension, hazard prone communities could reduce disaster risk through planned relocation without experiencing impoverishment.

Thailand is the agricultural country. The dam is the infrastructure that obligation to reservoir in the drought for supply to villages or agricultural area and flood protection during the rainy season. Many Fatalities appeared such as the losses of economics and life which make some unreliability to the public after earthquake incident. Weighting factor method is the guideline technique to rank 224 dams which have complete information for consideration. All of factors about probability of failure, vulnerability and amount used in assessment. Risk reduction plans to be actions with some dams from this decision methodology. The first five scores of preliminary earthquake risk approximated in according to 37.13 (Mae Mao dam), 34.88 (Bhumibol dam), 23.25 (Sri Nakarind. dam), 21.38 (Tha Thungna dam) and 19.88 (Mae-Ngad Somboonchon dam) However, the dam failure depended on many factors: the geological site surveying, used of materials as same as properties specification, suitable design, ...

We use conjoint choice questions to investigate the preferences of people in four cities in Italy for income and future/permanent mortality risk reductions delivered by contaminated site remediation policies. The VSL is €5.6 million for an immediate risk reduction. If the risk reduction takes place 20 years from now, the implied VSL is €1.26 million. Respondents’ implicit discount rate is 7%. The VSL depends on respondent characteristics, familiarity with contaminated sites, concern about the health effects of exposure to toxicants, having a family member with cancer, perceived usefulness of public programs and beliefs about the goals of government remediation programs.

Purpose: To explore the effect of providing lymphedema information on breast cancer survivors' symptoms and practice of risk-reduction behaviors. Design: A cross-sectional design was used to obtain data from 136 breast-cancer survivors in New York City from August 2006 to May 2007. Descriptive statistics, t tests, chi-square tests, and correlations were calculated. Methods: Data were collected using a demographic and medical information interview tool, two questions regarding status of receiving lymphedema information, the Lymphedema and Breast Cancer Questionnaire, and Lymphedema Risk-Reduction Behavior Checklist. Findings: Fifty-seven percent of the participants reported that they received lymphedema information. On average, participants had three lymphedema-related symptoms. Only 18% of participants were free of symptoms. Participants who received information reported significantly fewer symptoms (t=3.03; p<0.00) and practicing more risk-reduction behaviors (t=2.42; p=0.01). Conclusions: Providing lymphedema information has an effect on symptom reduction and more risk-reduction behaviors being practiced among breast cancer survivors. Clinical Relevance: In clinical practice, nurses and other healthcare professionals could consider taking the initiative to provide adequate and accurate information and engage breast-cancer survivors in supportive dialogues concerning lymphedema risk-reduction.

Successful new product development (NPD) requires effective strategies for reducing risk. Knowledge management systems (KMS) have the potential to aid in risk reduction, e.g. by gathering and processing relevant information and encapsulated knowledge from a variety of internal and external sources. The potential benefits of KMS, however, have not been fully realized, and may actually introduce new risks. This paper presents a practioner view of the desired characteristics of tools to support NPD and suggests a research agenda for the use of knowledge-based tools from the perspective of balancing benefits and risks.

This article presents the concepts and basic premises that are necessary for a better understanding of the Brief Interventions (BIs), with a literature review of its effectiveness and a discussion about BIs in Brazil. The theoretical premises are discussed, as well the concepts represented by the acronym FRAMES: Feedback; Responsibility; Advice; Menu; Empathic and Self-efficacy. Results of systematic reviews and metanalysis about BIs effectiveness are discussed and a summary box with the main studies is presented. Finally, the recent developments about the introduction of BIs in Brazil are commented. The importance of health professionals training and the adoption of BIs within different settings are emphasized considering its demonstrated effectiveness and economic feasibility. economically viable techniques are emphasized. In this context, it is increasingly relevant the professional mastering of brief intervention and therapy techniques, as well as the adequate investigation of their cultural adaptation to the Brazilian conditions and the verification of their effectiveness. This article aims to present an update on the issue of brief interventions for SURP.

HIV infection rates are rapidly increasing among young heterosexuals, making it increasingly important to understand how these individuals make decisions regarding risk in sexual encounters. Our objective in this study was to characterize young adults' safer sex behaviour and associate this behaviour with patterns of reasoning, using cognitive, information processing methods to understand the process of sexual risk taking. Sixty urban college students from NYC maintained diaries for two weeks and then were interviewed regarding lifetime condom use and sexual history. Using cognitive analysis, we characterized four patterns of condom use behaviour: consistent condom use (35.0%), inconsistent condom use (16.7%), shifting from consistent to inconsistent condom use (35.0%), and shifting from inconsistent to consistent condom use (13.3%).

In the first half of January 2009, the southern Philippine island of Mindanao was overwhelmed by numerous natural disasters caused by the passage of the tail-end of the cold front. This otherwise ordinary weather condition was accompanied by unusually heavy precipitation sustained over a period of several days. This triggered numerous landslides and caused many drainage systems to swell, flooding huge tracts of low lying areas that have not experienced similar events in the recent past. Many communities were caught unprepared for the calamity. The amount and extent of damage reflect both the magnitude of the natural disaster itself and the community's nominal level of disaster-preparedness. In view of the increasing atmospheric moisture levels and the likelihood that global warming will affect the weather patterns, there is a possibility that similar weather disturbances can become more frequent. Therefore, there is an urgent need for disaster risk management programs to be developed or enhanced at the local community level especially in areas most vulnerable to weather-related natural hazards, in light of changing global climatic patterns.

Rural and urban households in developing countries face substantial idiosyncratic and common risk, resulting in high income variability. Households in risky environments have developed sophisticated (ex-ante) risk-management and (ex-post) risk-coping strategies, including self-insurance via savings and informal insurance mechanisms to do so while formal credit and insurance markets appear to contribute only little to reducing income risk and its consequences. Informal credit and insurance, however incomplete, helps to cope with risky incomes. Despite these strategies, vulnerability remains high, and is reflected in fluctuations in consumption. It is clear therefore, that further development of safety nets will be necessary. In this paper, we focus on the opportunities available to households to use risk-management and risk-coping strategies, and on the constraints on their effectiveness.

Information technology (IT) projects are renowned for their high failure rate. Risk management is an essential process for the successful delivery of IT projects. In-depth interviews with IT professionals from leading firms in Western Australia were undertaken to determine how IT risks were managed in their projects. The respondents ranked 27 IT risks in terms of likelihood and consequences to identify the most important risks. The top five risks, in order, were: personnel shortfalls; unreasonable project schedule and budget; unrealistic expectations; incomplete requirements; and diminished window of opportunity due to late delivery of software. The respondents overwhelmingly applied the treatment strategy of risk reduction to manage these risks. Furthermore, these strategies were primarily project management processes, rather than technical processes. This demonstrates that project management is a risk management strategy. Scope, quality management, and human resource management were solutions applied to several risks. In particular, managing stakeholders' expectations is a specific risk treatment that helps to manage several key IT risks.

The real estate market in Poland is a relatively immature market, but one that has been experiencing substantial transformation. The development of the market has been encouraged by a number of factors, including changes arising as a result of new legislation and the migration of capital between capital markets. The progress of the real estate sector towards a western style competitive market has taken place within the gradual transformation of the Polish economy into a free market economy. As investment grade property is in relatively short supply in Poland, investors consider opportunities within the wider CEE block. An analysis of the risk-return characteristics of the three largest CEE real estate markets namely, Poland, Hungary and Czech Republic, shows that the returns in these markets have been negatively correlated with the UK. As these economies and markets evolve, and being part of the wider EU trading block, their economic performance will slowly converge and become more ...

Risk management in large engineering projects Shipbuilding industry Bayesian belief network a b s t r a c t This paper presents a scheme for large engineering project risk management using a Bayesian belief network and applies it to the Korean shipbuilding industry. Twenty-six different risks were deduced from expert interviews and a literature review. A survey analysis was conducted on 252 experts from 11 major Korean shipbuilding companies in April 2007. The overall major risks were design change, design manpower, and raw material supply as internal risks, and exchange rate as external risk in both large-scale and medium-sized shipbuilding companies. Differences of project performance risks between large-scale and medium-sized shipbuilding companies were identified. Exceeding time schedule and specification discontent were more important to large-scale shipbuilding companies, while exceeding budget and exceeding time schedule were more important to medium-sized shipbuilding companies. The change of project performance risks was measured by risk reduction activities of quality management, and strikes at headquarters and subcontractors, in both large-scale and medium-sized shipbuilding companies. The research results should be valuable in enabling industrial participants to manage their large engineering project risks and in extending our understanding of Korean shipbuilding risks.

Abstracts study of 100 adult asthmatics. RESULTS: The table reports outcomes over a 10-year period. Results were driven by the impact of ICS on quality of life, rather than on mortality. Findings were stable over most input data ranges. However, at efficacy levels below 3% and toxicity rates greater than 2.9%, the cost-effectiveness estimate exceeded $100,000/QALY. CONCLUSION: Results suggest that inhaled steroids deliver good comparative value in mild-to-moderate adult asthma. More research is needed, however, on the impact of ICS toxicity on patient preferences.

This paper contributes a methodological framework to identify, prioritize, assess, and manage risk scenarios of a large-scale system. Qualitative screening of scenarios and classes of scenarios is appropriate initially, while quantitative assessments may be applied once the set of all scenarios (hundreds) has been prioritized in several phases. The eight-phase methodology is described in detail and is applied to operations other than war. The eight phases are as follows: Phase I, Scenario Identification-A hierarchical holographic model (HHM) is developed to describe the system's ''as planned'' or ''success'' scenario. Phase II, Scenario Filtering-The risk scenarios identified in Phase I are filtered according to the responsibilities and interests of the current system user. Phase III, Bi-Criteria Filtering and Ranking. Phase IV, Multi-Criteria Evaluation. Phase V, Quantitative Ranking-We continue to filter and rank scenarios based on quantitative and qualitative matrix scales of likelihood and consequence; and ordinal response to system resiliency, robustness, redundancy. Phase VI, Risk Management is performed, involving identification of management options for dealing with the filtered scenarios, and estimating the cost, performance benefits, and risk reduction of each. Phase VII, Safeguarding Against Missing Critical Items-We examine the performance of the options selected in Phase VI against the scenarios previously filtered out during Phases II to V. Phase VIII, Operational Feedback-We use the experience and information gained during application to refine the scenario filtering and decision processes in earlier phases. These eight phases reflect a philosophical approach rather than a mechanical methodology. In this philosophy, the filtering and ranking of discrete scenarios is viewed as a precursor to, rather than a substitute for, consideration of the totality of all risk scenarios.

Today vegetarian nutrition is more accepted and widespread in Europe than in former years. For a long time scientific research on vegetarian diets has focused mostly on malnutrition, whereas nowadays research centers increasingly on the preventive potential of plant-based diets. We followed a nutritive and a metabolic-epidemiological approach to obtain dietary recommendations. A MEDLINE research was performed for all plant food groups relevant for a vegetarian diet (key words: all relevant food groups, "vegetarian diet", "chronic disease", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis"). All relevant food groups were characterized regarding their nutrient content and rated with respect to the available metabolic-epidemiological evidence. Based on the evidence criteria of the WHO/FAO, cancer risk reduction by a high intake of vegetables and fruits is assessed as probable or possible, while a lowered risk of cardiovascular disease is convincing and a lowered risk of osteoporosis is probable. The evidence of a risk reducing effect of whole grain relating to colorectal cancer is assessed as possible, whereas it is probable relating to cardiovascular disease and diabetes mellitus type 2. There is an insufficient risk-reducing effect of legumes like soja relating to epithelial tumours and cardiovascular disease. The evidence of a risk-reducing effect of nuts to cardiovascular disease is assessed as probable, and in relation to cholelithiasis and diabetes mellitus type 2 as possible and insufficient, respectively. In conclusion, high consumption of fruits, vegetables, whole grains and nuts can lower the risk for several chronic diseases. In Europa findet der Vegetarismus zunehmend Verbreitung und Akzeptanz. Während früher mögliche Mangelerscheinungen bei vegetarischer Ernährung im Fokus der Ernährungswissenschaft standen, rückt heute zunehmend das präventive Potential einer pflanzenbetonten Ernährung in den Vordergrund des Interesses. Für die Entwicklung entsprechender Ernährungsempfehlungen fanden ein nutritiver und ein metabolischepidemiologischer Ansatz Verwendung. Dazu wurde eine MEDLINE-Recherche für die im Rahmen einer vegetarischen Kostform relevanten pflanzlichen Lebensmittelgruppen durchgeführt (Schlüssel-Suchbegriffe: alle relevanten Lebensmittelgruppen, "vegetarian diet", "chronic disease", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis"). Die einzelnen Lebensmittelgruppen wurden hinsichtlich ihrer ernährungsphysiologischen Eignung und anhand der verfügbaren metabolisch-epidemiologischen Evidenz bewertet. Auf Basis der Evidenzkriterien der WHO/FAO zeigt sich, dass ein risikosenkender Effekt eines hohen Obst- und Gemüseverzehrs bei epithelialen Tumoren als wahrscheinlich oder möglich, bei kardiovaskulären Erkrankungen als überzeugend, bei Diabetes mellitus Typ 2 als unzureichend sowie bei Osteoporose als möglich gilt. Die Evidenz für einen risikosenkenden Effekt des Vollkornverzehrs im Hinblick auf Tumoren des Kolons und Rektums gilt als möglich, bei kardiovaskulären Erkrankungen und Diabetes mellitus Typ 2 als wahrscheinlich. Bei Hülsenfrüchten wie Soja wird die Evidenz für einen risikosenkenden Effekt sowohl in Bezug zum Risiko epithelialer Tumoren als auch bei kardiovaskulären Erkrankungen als unzureichend bewertet. Die Evidenz für einen risikosenkenden Effekt des Nussverzehrs gilt bei kardiovaskulären Erkrankungen als wahrscheinlich, bei Diabetes mellitus Typ 2 als unzureichend und bei Cholelithiasis als möglich. Daraus lässt sich schließen, dass der reichliche Konsum von Obst, Gemüse, Vollkornprodukten und Nüssen das Risiko für verschiedene chronisch-degenerative Erkrankungen vermindert.

This article is adapted from a published evidence report concerning neonatal hyperbilirubinemia with an added section on the risk of blood exchange transfusion (BET). Based on a summary of multiple case reports that spanned more than 30 years, we conclude that kernicterus, although infrequent, has at least 10% mortality and at least 70% long-term morbidity. It is evident that the preponderance of kernicterus cases occurred in infants with a bilirubin level higher than 20 mg/dL. Given the diversity of conclusions on the relationship between peak bilirubin levels and behavioral and neurodevelopmental outcomes, it is apparent that the use of a single total serum bilirubin level to predict long-term outcomes is inadequate and will lead to conflicting results. Evidence for efficacy of treatments for neonatal hyperbilirubinemia was limited. Overall, the 4 qualifying studies showed that phototherapy had an absolute risk-reduction rate of 10% to 17% for prevention of serum bilirubin levels higher than 20 mg/dL in healthy infants with jaundice. There is no evidence to suggest that phototherapy for neonatal hyperbilirubinemia has any long-term adverse neurodevelopmental effects. Transcutaneous measurements of bilirubin have a linear correlation to total serum bilirubin and may be useful as screening devices to detect clinically significant jaundice and decrease the need for serum bilirubin determinations. Based on our review of the risks associated with BETs from 15 studies consisting mainly of infants born before 1970, we conclude that the mortality within 6 hours of BET ranged from 3 per 1000 to 4 per 1000 exchanged infants who were term and without serious hemolytic diseases. Regardless of the definitions and rates of BET-associated morbidity and the various pre-exchange clinical states of the exchanged infants, in many cases the morbidity was minor (eg, postexchange anemia). Based on the results from the most recent study to report BET morbidity, the overall risk of permanent sequelae in 25 sick infants who survived BET was from 5% to 10%. Pediatrics 2004;114:e130 -e153. URL: http://www. pediatrics.org/cgi/content/full/114/1/e130; evidence-based review, hyperbilirubinemia, bilirubin, exchange transfusion, kernicterus, brainstem auditory evoked potential, brainstem auditory evoked response.

In recent years there has been a re-focus on the valuation of a statistical life from the ex post or human capital method to an ex ante willingness to pay (WTP) approach. This is in part a recognition that we may have been undervaluing the cost of fatalities and injuries to society associated with crashes, but also a strong belief in the need to focus on establishing the amount, ex ante, that individuals are willing to pay to reduce the risk of exposure to circumstances that might lead to death or degree of injury on the road network. This study has developed a framework in which to identify the degree of preference heterogeneity in willingness to pay by individuals who are drivers or passengers in cars to avoid being killed or injured. A stated choice experiment approach is developed. The empirical setting is a choice of route for a particular trip that a sample of individuals periodically undertakes in Australia. The particular trip is described in enough detail to provide the respondent with a familiar market environment, providing all the relevant background information required for making a decision. Mixed logit models are estimated to obtain the marginal (dis)utilities associated with each influence on the choice amongst the attribute packages offered in the stated choice scenarios. These estimates are used to obtain the WTP distributions for fatality and injury avoidance, which are then aggregated to obtain estimates of the value of risk reduction (VRR), of which the fatality class is also known as the value of a statistical life (VSL).

BACKGROUND: Residual risk of posttransfusion hepatitis B (PT-HB) may be reduced through implementation of HBV NAT or the new, enhanced-sensitivity HBsAg assays in routine donor testing. However, there are some doubts about the cost-effectiveness of these new safety measures, because hepatitis B acquired in adulthood is not regarded as a severe disease in western countries. STUDY DESIGN AND METHODS: A computer model was designed to estimate the health outcomes and associated costs of patients with PT-HB. Results from this model and estimations of the residual risk of HBV transmission, the risk reduction yielded by the new assays, and their cost were used to calculate the cost-effectiveness of including the new HBsAg assays or singlesample HBV NAT in the routine screening of blood donors. RESULTS: The model predicts that 0.97 percent of patients with PT-HB die of liver disease (54% of them due to fulminant hepatitis). The mean loss of life expectancy was 0.178 years per patient, and the present value of the lifetime costs of treating PT-HB was 4160 euros per patient. Single-donor HBV NAT or the new HBsAg assays would increase the life expectancy of blood recipients by 16 (95% CI, 8-40) or 14 (95% CI, 7-28) years, respectively, per every 10 million donations tested. The projected cost per life-year gained was 0.79 (95% CI, 0.15-1.85) million euros for the enhanced-sensitivity HBsAg assays and 5.8 (95% CI, 1.9-13.1) million euros for single-donation HBV NAT, both compared with current HBsAg assays. If single-donation HBV NAT is compared with the new HBsAg assays, its costeffectiveness ratio increases to 53 (95% CI, 16-127) million euros. CONCLUSION: PT-HB has few health or economic repercussions. Single-donation HBV NAT would provide a small health benefit at a very high cost. Instead, in some circumstances, the cost-effectiveness of enhanced-sensitivity HBsAg assays would be within acceptable ranges for new public health interventions. ABBREVIATIONS: HCC = hepatocellular cancer; LY(s) = life expectancy year(s); PT-HB = posttransfusion hepatitis B; QALY(s) = quality-adjusted, discounted year(s).

The evidence for the efficacy of walking in reducing the risk of and preventing coronary heart disease (CHD) is not completely understood. This meta-analysis aimed to quantify the dose-response relationship between walking and CHD risk reduction for both men and women in the general population. Studies on walking and CHD primary prevention between 1954 and 2007 were identified through Medline, SportDiscus and the Cochrane Database of Systematic Reviews. Random-effect meta-regression models were used to pool the relative risks from individual studies. A total of 11 prospective cohort studies and one randomized control trial study met the inclusion criteria, with 295,177 participants free of CHD at baseline and 7,094 cases at follow-up. The meta-analysis indicated that an increment of approximately 30 min of normal walking a day for 5 days a week was associated with 19% CHD risk reduction (95% CI = 14-23%; P-heterogeneity = 0.56; I 2 = 0%). We found no evidence of heterogeneity between subgroups of studies defined by gender (P = 0.67); age of the study population (P = 0.52); or follow-up duration (P = 0.77). The meta-analysis showed that the risk for developing CHD decreases as walking dose increases.

There are financial and humanitarian consequences to unmet need amongst service users of high secure hospital care, not least in terms of length of stay. This article presents two reviews of high secure service user needs. They provide support for the sequencing of interventions to meet service user needs and the utility of a structured framework for their review. Through analyses of these reviews, eight domains of need were identified: Therapeutic Engagement, Risk Reduction, Education, Occupational, Mental Health Recovery, Physical Health Restoration, Cultural and Spiritual Needs, Care Pathway Management. A model is presented, within which logically sequenced, timely and relevant interventions could be framed in order to provide a comprehensive and streamlined pathway through a high secure hospital.

Today vegetarian nutrition is more accepted and widespread in Europe than in former years. For a long time scientific research on vegetarian diets has focused mostly on malnutrition, whereas nowadays research centers increasingly on the preventive potential of plant-based diets. We followed a nutritive and a metabolic-epidemiological approach to obtain dietary recommendations. A MEDLINE research was performed for all plant food groups relevant for a vegetarian diet (key words: all relevant food groups, "vegetarian diet", "chronic disease", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis"). All relevant food groups were characterized regarding their nutrient content and rated with respect to the available metabolic-epidemiological evidence. Based on the evidence criteria of the WHO/FAO, cancer risk reduction by a high intake of vegetables and fruits is assessed as probable or possible, while a lowered risk of cardiovascular disease is convincing and a lowered risk of osteoporosis is probable. The evidence of a risk reducing effect of whole grain relating to colorectal cancer is assessed as possible, whereas it is probable relating to cardiovascular disease and diabetes mellitus type 2. There is an insufficient risk-reducing effect of legumes like soja relating to epithelial tumours and cardiovascular disease. The evidence of a risk-reducing effect of nuts to cardiovascular disease is assessed as probable, and in relation to cholelithiasis and diabetes mellitus type 2 as possible and insufficient, respectively. In conclusion, high consumption of fruits, vegetables, whole grains and nuts can lower the risk for several chronic diseases. In Europa findet der Vegetarismus zunehmend Verbreitung und Akzeptanz. Während früher mögliche Mangelerscheinungen bei vegetarischer Ernährung im Fokus der Ernährungswissenschaft standen, rückt heute zunehmend das präventive Potential einer pflanzenbetonten Ernährung in den Vordergrund des Interesses. Für die Entwicklung entsprechender Ernährungsempfehlungen fanden ein nutritiver und ein metabolischepidemiologischer Ansatz Verwendung. Dazu wurde eine MEDLINE-Recherche für die im Rahmen einer vegetarischen Kostform relevanten pflanzlichen Lebensmittelgruppen durchgeführt (Schlüssel-Suchbegriffe: alle relevanten Lebensmittelgruppen, "vegetarian diet", "chronic disease", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis"). Die einzelnen Lebensmittelgruppen wurden hinsichtlich ihrer ernährungsphysiologischen Eignung und anhand der verfügbaren metabolisch-epidemiologischen Evidenz bewertet. Auf Basis der Evidenzkriterien der WHO/FAO zeigt sich, dass ein risikosenkender Effekt eines hohen Obst- und Gemüseverzehrs bei epithelialen Tumoren als wahrscheinlich oder möglich, bei kardiovaskulären Erkrankungen als überzeugend, bei Diabetes mellitus Typ 2 als unzureichend sowie bei Osteoporose als möglich gilt. Die Evidenz für einen risikosenkenden Effekt des Vollkornverzehrs im Hinblick auf Tumoren des Kolons und Rektums gilt als möglich, bei kardiovaskulären Erkrankungen und Diabetes mellitus Typ 2 als wahrscheinlich. Bei Hülsenfrüchten wie Soja wird die Evidenz für einen risikosenkenden Effekt sowohl in Bezug zum Risiko epithelialer Tumoren als auch bei kardiovaskulären Erkrankungen als unzureichend bewertet. Die Evidenz für einen risikosenkenden Effekt des Nussverzehrs gilt bei kardiovaskulären Erkrankungen als wahrscheinlich, bei Diabetes mellitus Typ 2 als unzureichend und bei Cholelithiasis als möglich. Daraus lässt sich schließen, dass der reichliche Konsum von Obst, Gemüse, Vollkornprodukten und Nüssen das Risiko für verschiedene chronisch-degenerative Erkrankungen vermindert.