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PubMed1981

[Purpose and usefulness of the present day risk catalog (author's transl)].

Risk catalogs have proved to be an important instrument of preventive medicine for the identification of pregnancies at risk. Their purpose and usefulness is beyond all doubt. Nevertheless problems of principle are attached to them since they deflect the attention from the living reality of the individual case to statistically formed collectives. The importance of the problems for risk catalogs changes according to the social change and the constantly improved perinatal results. Age, parity and socioeconomic risks reflect such trends in development most clearly. Future tasks lie in the quantification of risks by differentiating the degrees of severity. A certain intrinsic dynamism of the present risk catalogs leads, e. g. to a constantly increasing incidence of sections. For this reason a constant feedback must exist between risk catalog and statistics.

Adolescent↗

PubMed1998

The role of complex, simultaneous trunk motions in the risk of occupation-related low back disorders.

STUDY DESIGN: Simultaneous trunk kinematic variables of industrial workers performing jobs with varying degrees of low back disorder risk were quantified, by using a three-dimensional electrogoniometer. OBJECTIVES: To assess the distinguishing patterns of simultaneous multidimensional (complex) motion parameters of workers performing manual material handling jobs with varying degrees of low back disorder risk. SUMMARY OF BACKGROUND DATA: There is significant epidemiologic and biomechanical evidence that implicates simultaneously occurring or combined motions and loading as important risk factors follow back disorder. However, the specific levels or magnitudes and patterns of these complex motions at which risk of low back disorder is increased are still unknown. METHODS: An industrial database of 126 workers and jobs was used to quantify the complex trunk motions of groups with varying degrees of low back disorder risk. Three groups, low-, medium-, and high-risk, were defined on the basis of retrospective injury records of the corresponding jobs. The jobs were further classified into five cells of weight-lift rate combinations. Within each weight-lift rate cell, the three-dimensional trunk motion patterns of workers were analyzed. Bivariate distributions and cumulative distribution functions were used to compare the simultaneous occurrence of complex dynamic motions among risk groups. RESULTS: High- and medium-risk groups exhibited complex trunk motion patterns involving high magnitudes of combined velocities, especially at extreme sagittal flexion; whereas the low-risk group did not. Postural trunk information alone did not provide a consistent pattern of distinguishing among risk groups. CONCLUSIONS: Elevated levels of complex simultaneous velocity patterns were unique to groups with increased low back disorder risk. Knowledge of these complex trunk velocity patterns in combination with key workplace factors provides a more sensitive means for identifying low back disorder occupational risk factors than does mere postural information.

Back Injuries↗

PubMed2001

Moral panic versus the risk society: the implications of the changing sites of social anxiety.

This paper compares moral panic with the potential political catastrophes of a risk society. The aim of the comparison is threefold: 1. to establish the position of risk society threats alongside more conventional moral panics; 2. to examine the conceptual shifts that accompany the new types of threats; and 3. to outline the changing research agenda. The paper suggests that as new sites of social anxiety have emerged around environmental, nuclear, chemical and medical threats, the questions motivating moral panic research have lost much of their utility. Conceptually, it examines how the roulette dynamics of the risk society accidents expose hidden institutional violations that redound into 'hot potatoes' that are passed among and fumbled by various actors. Changing conceptions of folk devils, claims making activities, and of a safety are also discussed.

Crime↗

PubMed1996

Risk-sensitive optimal harvesting and control of biological populations

Theory recently developed elsewhere is introduced, to a more applied and biological audience, for the optimal control of linear systems with a risk-sensitive exponential of a quadratic (LEQG) cost function, and for the optimal control of fully nonlinear systems through the risk-sensitive maximum principle (RSMP). The LEQG theory is extended, in this study, to give solutions for locally optimal stochastic control of nonlinear systems. Examples and applications are given of the extended theory, using simple, heuristic logistic models and more complex multicohort models of fisheries. Implementations of the nonlinear RSMP are described. The results show how the theories can be applied to biological harvesting and control problems. They also shed some light upon the character of the dynamics of the risk-sensitive optimal solutions, which have been little explored. Keywords: population dynamics; resource management; fisheries; risk.

Journal Article↗

PubMedDate not supplied

Pressure ulcers, Part 1: Prevention strategies.

Pressure ulcers are a costly health concern. Many can be prevented by conscientious, vigorous nursing care. The nurse practitioner (NP) is an ideal professional to direct preventive care and to manage the treatment of ulcers. This article reviews the multiple risk factors and dynamics involved in the development of pressure ulcers, and preventive measures that can be implemented. The role of an NP related to pressure ulcer prevention and specific NP interventions are discussed.

Humans↗

PubMed2005

Significant reduction in risk of falls and back pain in osteoporotic-kyphotic women through a Spinal Proprioceptive Extension Exercise Dynamic (SPEED) program.

OBJECTIVE: To determine the outcome of intervention with a spinal weighted kypho-orthosis (WKO) and a spinal proprioceptive extension exercise dynamic (SPEED) program on the risk of falls in ambulatory community-dwelling persons older than 60 years with osteoporosis-kyphosis at risk for falls. SUBJECTS AND METHODS: The study had 3 stages. At stage 1 (baseline), the 12 women in the kyphotic group were compared with 13 healthy controls to assess the risk of falls and balance disorder in the kyphotic group. At stage 2, the 12 kyphotic women began the SPEED program with a WKO (2 supervised sessions in an outpatient clinic and a 4-week, daily home-based training program). At stage 3, baseline and follow-up data of the kyphotic group were compared to determine the effect of intervention. RESULTS: At baseline, there were significant differences between the osteoporotic-kyphotic group and the control group in balance (P=.002), gait (P<.05), and strength (P<.05). After a 4-week intervention, comparison of the kyphotic group's baseline and follow-up results showed a significant change in balance (P=.003) and several gait parameters (P<.05). Mean back extensor strength improved significantly from baseline (144.0-46.5 N) to follow-up (198.6+/-55.2 N; P<.001). Lower extremity muscle strength was not changed significantly, except for improved left ankle plantar flexors (P=.02). Back pain decreased significantly (P=.001). CONCLUSION: Balance, gait, and risk of falls improved significantly with the 4-week SPEED program.

Accidental Falls↗

PubMed1988

[Tobacco dependence: first risk factor of atherosclerosis. Survey among smokers and non-smokers in group dynamics].

Several epidemiological and experimental studies have demonstrated an increased risk of atherosclerosis in smokers. The secondary prevention of this risk factor is only possible, presently, through anti-tobacco consultations. Several approaches are possible but there are many recurrences within the year following the wean-off. In a group dynamics, including patients having tried another method, we have conducted an investigation among inveterate smokers (n = 106), former smokers (n = 50) and a group of non-smokers (n = 34). Group dynamics remains a suitable method for smokers willing to get rid of their addiction. The number of daily cigarettes consumed by inveterate smokers is considerably and lastingly reduced, and 27 p. cent of the patients quit smoking. Monitoring of laboratory tests (HbCo, Blood count, HDL-cholesterol, thiocyanate, etc.), electrocardiogram and chest X-Ray, completes this weekly consultation and permits a stronger motivation for the smoker to quit smoking. Sometimes associated with acupuncture or homeopathy, this method permits a progressive de-conditioning from tobacco addiction.

Arteriosclerosis↗

PubMed2005

Noninvasive sudden death risk stratification by ambulatory ECG-based T-wave alternans analysis: evidence and methodological guidelines.

Extensive experimental and clinical evidence supports the utility of T-wave alternans (TWA) as a marker of risk for ventricular fibrillation. This entity appears to reflect the fundamental arrhythmogenic property of enhanced dispersion of repolarization. This relationship probably accounts for its relative ubiquity in patients with diverse types of cardiac disease, as has been recognized with the development of analytical tools. A basic premise of this review is that ambulatory ECG monitoring of TWA as patients experience the provocative stimuli of daily activities can expose latent electrical instability in individuals at heightened risk for arrhythmias. We will discuss the literature that supports this concept and summarize the current state of knowledge regarding the use of routine ambulatory ECGs to evaluate TWA for arrhythmia risk stratification. The dynamic, nonspectral modified moving average analysis method for assessing TWA, which is compatible with ambulatory ECG monitoring, is described along with methodological guidelines for its implementation. Finally, the rationale for combined monitoring of autonomic markers along with TWA will be presented.

Arrhythmias, Cardiac↗

PubMed1999

Development of sero-diagnostic and molecular tools for the control of important tick-borne pathogens of cattle in Africa.

Tick-borne diseases (TBDs) are a major economic constraint to livestock production in sub-Saharan Africa. ILRI is focussing on developing a range of products, such as vaccines, diagnostics and decision support services to underpin improved control programmes against these diseases. We have developed three highly sensitive and specific enzyme linked immuno-assays (ELISAs), which allow precise diagnosis of Theileria parva, Babesia bigemina and Anaplasma marginale. These tests have been standardised and validated using defined experimental and field infection sera. Parasite specific recombinant antigens and monoclonal antibodies against bovine immunoglobulins as secondary antibodies have played an important role in in enhancing the sensitivity and specificity of the assays. They have been further evaluated in on-farm longitudinal sero-epidemiological studies to define infection dynamics and disease risks in various farming systems in Kenya and Uganda. In addition, DNA-based tests for differentiation of Theileria species and characterisation of Theileria parva stocks have been developed. These tests have been derived through physical mapping and sequencing of key elements of the T. parva genome, which include repetitive and telomeric regions, minisatellite sequences, antigen genes and a number of random DNA sequences. These tools are currently being deployed in conjunction with field immunisation programmes to determine the biological impact of introducing live vaccines of T. parva on population dynamics.

Africa↗

PubMed2004

The SOBANE risk management strategy and the Déparis method for the participatory screening of the risks.

INTRODUCTION: The first section of the document describes a risk-prevention strategy, called SOBANE, in four levels: screening, observation, analysis and expertise. The aim is to make risk prevention faster, more cost effective, and more effective in coordinating the contributions of the workers themselves, their management, the internal and external occupational health (OH) practitioners and the experts. These four levels are: screening, where the risk factors are detected by the workers and their management, and obvious solutions are implemented; observation, where the remaining problems are studied in more detail, one by one, and the reasons and the solutions are discussed in detail; analysis, where, when necessary, an OH practitioner is called upon to carry out appropriate measurements to develop specific solutions; expertise, where, in very sophisticated and rare cases, the assistance of an expert is called upon to solve a particular problem. METHOD: The method for the participatory screening of the risks (in French: Dépistage Participatif des Risques), Déparis, is proposed for the first level screening of the SOBANE strategy. The work situation is systematically reviewed and all the aspects conditioning the easiness, the effectiveness and the satisfaction at work are discussed, in search of practical prevention measures. The points to be studied more in detail at level 2, observation, are identified. The method is carried out during a meeting of key workers and technical staff. CONCLUSION: The method proves to be simple, sparing in time and means and playing a significant role in the development of a dynamic plan of risk management and of a culture of dialogue in the company.

Europe↗

PubMed2002

Systematic review of dynamic graciloplasty in the treatment of faecal incontinence.

BACKGROUND: The aim of this systematic review was to compare the safety and efficacy of dynamic graciloplasty with colostomy for the treatment of faecal incontinence. METHODS: Two search strategies were devised to retrieve literature from the Medline, Current Contents, Embase and Cochrane Library databases up until November 1999. Inclusion of papers depended on a predetermined protocol, independent assessments by two reviewers and a final consensus decision. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials and case series. Forty papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance. RESULTS: No high-level evidence was available and there were no comparative studies. Mortality rates were around 2 per cent for both graciloplasty and colostomy. Morbidity rates reported for graciloplasty appear to be higher than those for colostomy. Dynamic graciloplasty was clearly effective at restoring continence in between 42 and 85 per cent of patients, whereas colostomy is, by its design, incapable of restoring continence. However, dynamic graciloplasty is associated with a significant risk of reoperation. CONCLUSION: While dynamic graciloplasty appears to be associated with a higher rate of complications than colostomy, it is clearly a superior intervention for restoring continence in some patients. It is recommended that a comparative, but non-randomized, study be undertaken to evaluate the safety of dynamic graciloplasty in comparison to colostomy, and that the procedure should be performed only in centres where it is carried out routinely.

Anal Canal↗

PubMed1996

A new, standardized approach to fracture risk interpretation.

Screening for osteoporosis has been hampered by the absence of a standard approach to the interpretation of bone density and other risk factors. A consensus conference of international experts has now recommended a report which is based upon two concepts: (1) comparison of an individual's bone density to the mean value for 30 year old women, and (2) estimation of Remaining Lifetime Fracture Probability (RLFP), based upon current age and bone density, life expectancy, future bone loss, and other risk factors. This model is dynamic and can be perfected as new risk factors become established. It also allows for estimation of therapeutic impact, and thus improves and individualizes clinical decision making.

Adult↗

PubMed2005

Clinical use of serum and urine bone markers in the management of osteoporosis.

Osteoporosis is a common disease characterized by decreased bone mass, increased bone turnover, and increased susceptibility to fracture. Almost 44 million Americans are estimated to have low bone mass, which puts them at increased risk of developing osteoporosis and fractures. Osteoporosis is diagnosed by a low bone density (BMD) measurement, because a low BMD is known to contribute to increased fracture risk, which is the main source of morbidity and mortality for osteoporosis. However, changes in bone mass and density in response to anti-resorptive therapy account for only a small portion of the predicted fracture risk reduction. Whereas dynamic changes in bone turnover, estimated by measurement of bone biochemical markers, such as breakdown products of type-I collagen and proteins secreted by osteoblasts and osteoclasts in blood and urine, can account for a major portion of anti-fracture efficacy of anti-resorptive agents. Most anti-resorptive agents act by rapidly reducing bone markers. This has led to advocacy for use of bone turnover markers, in complement to BMD measurement, in the management of osteoporosis. In general, higher bone turnover is associated with accelerated bone loss and potential deterioration in bone quality. Several clinical trials have established the potential utility of markers to identify patients with rapid bone loss, to aid in therapeutic decision-making, and to monitor therapeutic efficacy of various treatments. Elevated marker levels have been shown to be associated with increased risk of fracture in elderly women, but their utility in predicting fracture is not yet established. In this article, we provide a brief summary to primary practitioners about the role bone markers can play in the management of osteoporosis.

Biomarkers↗

PubMed1986

Identifying the sexually abused deaf child: the otolaryngologist's role.

As a primary physician for most deaf children, the otolaryngologist must be able to identify signs and symptoms of sexual abuse. Child sexual abuse is a topic of national concern as epidemiologic data indicate more than 100,000 American children become victims annually. This paper provides an overview of the incidence, demographic characteristics, risk factors, and dynamics of child sexual abuse within both the general handicapped and, specifically, the hearing imparied populations. Strategies for identifying the sexually abused hearing impaired child are delineated including the physical appearance and behavioral manifestations of child victims, as well as the characteristics of abusive caretakers and perpetrators. Case summaries are presented which illustrate these characteristics. A national center specializing in the evaluation and treatment of abused handicapped children is described.

Adolescent↗

PubMed2006

Modeling bursts and heavy tails in human dynamics.

The dynamics of many social, technological and economic phenomena are driven by individual human actions, turning the quantitative understanding of human behavior into a central question of modern science. Current models of human dynamics, used from risk assessment to communications, assume that human actions are randomly distributed in time and thus well approximated by Poisson processes. Here we provide direct evidence that for five human activity patterns, such as email and letter based communications, web browsing, library visits and stock trading, the timing of individual human actions follow non-Poisson statistics, characterized by bursts of rapidly occurring events separated by long periods of inactivity. We show that the bursty nature of human behavior is a consequence of a decision based queuing process: when individuals execute tasks based on some perceived priority, the timing of the tasks will be heavy tailed, most tasks being rapidly executed, while a few experiencing very long waiting times. In contrast, priority blind execution is well approximated by uniform interevent statistics. We discuss two queuing models that capture human activity. The first model assumes that there are no limitations on the number of tasks an individual can handle at any time, predicting that the waiting time of the individual tasks follow a heavy tailed distribution P(tau(w)) approximately tau(w)(-alpha) with alpha=3/2. The second model imposes limitations on the queue length, resulting in a heavy tailed waiting time distribution characterized by alpha=1. We provide empirical evidence supporting the relevance of these two models to human activity patterns, showing that while emails, web browsing and library visitation display alpha=1, the surface mail based communication belongs to the alpha=3/2 universality class. Finally, we discuss possible extension of the proposed queuing models and outline some future challenges in exploring the statistical mechanics of human dynamics.

Journal Article↗

PubMed1990

The use of sonography in the evaluation of the high-risk pregnancy.

The role of dynamic ultrasound fetal assessment and, in particular, fetal biophysical profile scoring in the recognition and management of the high-risk pregnancy is discussed. Specific details pertaining to performing and interpreting the fetal biophysical profile score are provided. In addition, the specific application of their methods to the postdate, diabetic pregnancy and the fetus with intrauterine growth retardation is discussed.

Female↗

PubMed2004

Assessing normative approaches to communicating violence risk: a national survey of psychologists.

There is growing attention to the importance of violence risk communication, and emerging empirical evidence of how evaluating clinicians who conduct risk assessments communicate their conclusions about the risk of violence toward others. The present study addressed the perceived value of different forms of risk communication through a national survey of practicing psychologists (N = 1,000). Responses were received from a total of 256 participants, who responded to eight vignettes in which three factors relevant to risk communication were systematically varied in a 2 x 2 x 2 within-subjects design, counterbalanced for order: (i) risk model (prediction oriented versus management oriented), (ii) risk level (high risk versus low risk), and (iii) risk factors (static versus dynamic). Participants were asked to rate the value of six styles of risk communication for each of eight vignettes. The most highly valued style of risk communication involved identifying risk factors applicable to the individual, and specifying interventions to reduce risk. These results were consistent with findings from several previous studies in this area, and reflect an emerging trend in preferences for style and context of risk communication of violence.

Communication↗

PubMed2003

Association chain graphs: modelling etiological pathways.

Multiple time-dynamic and interrelated risk factors are usually involved in the complex etiology of disorders. This paper presents a strategy to explore and display visually the relative importance of different association pathways for the onset of disorder over time. The approach is based on graphical chain models, a tool that is powerful but still under-utilized in most fields. Usually, the results of these models are displayed using directed acyclic graphs (DAGs). These draw an edge between a pair of variables whenever the assumption of conditional independence given variables on an earlier or equal temporal footing is violated to a statistically significant extent. In the present paper, the graphs are modified in that confidence intervals for the strengths of associations (statistical main effects) are visualized. These new graphs are called association chain graphs (ACGs). Statistical interactions cause 'edges' between the respective variables within the DAG framework (because the assumption of conditional independence is violated). In contrast they are represented as separate graphs within the subsample where the different association chains may work within the ACG framework. With this new type of graph, more specific information can be displayed whenever the data are essentially described only with statistical main- and two-way interaction effects.

Alcoholism↗