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[Occupational chemical risk: elements for a diagnostic in Spain].

BACKGROUND: Lack of information and accurate knowledge about the properties of chemicals and the exposure derived from its use; hinder health and safety measures to protect exposed workers. The aim of this study is to identify the elements that will help us draw a balance of chemical hazards in Spain and register the most dangerous chemicals at the workplace (by sector or field of activity). METHODS: Study of secondary sources, identification of risk perception by workers' representatives and study of the approach on chemical risk in risk assessments. The last step is to set up a Chemical Exposure Database arranged by industrial sectors. RESULTS: Great volumes of production and consumption of chemicals, generalization of exposure, but insufficient data on specific use; little information is provided on specific dangerous factors of commonly used chemicals; chemicals are barely identified in risk assessments. High levels of exposure in industrial sectors; damage is not adequately registered; there are difficulties in risk perception. Set-up of a preliminary database on exposure by sector of activity. CONCLUSIONS: Data is collected; information sources and procedures, which allow a forecast of chemical risk, are identified. A database on exposure by sector of activity is developed (to be checked and enhanced as new evidence is found).

Hazardous Substances↗

An exploratory qualitative study of women's perceptions of risk management options for familial ovarian cancer: implications for informed decision making.

OBJECTIVE: Women who are at increased risk of familial ovarian cancer face complex decisions about strategies for managing their risk due to a lack of evidence regarding the benefits of ovarian cancer screening (OCS) and prophylactic surgery. At present, there is a limited understanding of women's attitudes towards these options. METHOD: In-depth interviews were conducted to explore perceptions of ovarian cancer screening and prophylactic oophorectomy (PO) in 10 women who were newly identified as being at increased risk of familial ovarian cancer. RESULTS: The study findings highlight the gaps in women's knowledge about risk management options. Although most women derived considerable reassurance from ovarian screening, many were not aware of the limitations of the screening process or the likelihood of receiving false positive results. Areas in which women's knowledge about prophylactic oophorectomy could be improved include the practicalities of surgery, the risks and benefits of HRT given postsurgically, the limitations of surgery in removing risk, and the absence of concrete information on which to base surgical decisions. In particular, women who were not previously aware of their increased risk may need additional psychological support and preparation. CONCLUSIONS: The present study raises serious questions about the extent to which women are making informed decisions about familial ovarian cancer risk management strategies. Suggestions are made for improving the information and support provided to women and for large-scale prospective research.

Adult↗

Resisting good news: reactions to breast cancer risk communication.

Many women overestimate their percentage risk of breast cancer, even after they have received careful estimates from health professionals. In 2 experiments with 134 young adult women, 6 variables were explored that might influence such risk perception persistence. In Study 1, each of the following explanations was unrelated to persistence: public commitment, self-consistency, and unique causal risk models. In Study 2, two individual difference measures, pessimism and differences in understanding percentages, were unrelated to risk perception persistence. However, providing a "risk anchor" based on downward social comparison processes resulted in better risk acceptance at posttest that persisted at a 2-week follow-up assessment. This article discusses why comparison anchors might be important in risk feedback situations and concludes with recommendations for professionals who wish to provide accurate risk information and have patients adopt that information.

Adult↗

Modifying attributions of colorectal cancer risk.

We report how a four-group risk communication intervention targeted to individuals in the carpentry trade affected their perceived causes (i.e., attributions) for increased colorectal cancer (CRC) risk. The intervention varied the amount of information presented on CRC risk factors and whether participants received tailored feedback on their risk factors. In baseline and 3-month follow-up telephone surveys, carpenters (N = 860) reported their perceived absolute and comparative CRC risks, perceived causes for increased CRC risk, and knowledge of CRC risk factors. At follow-up, neither the type or amount of information provided, nor the use of tailoring, appreciably and consistently affected whether participants mentioned their specific risk factor (e.g., lifestyle, occupational) emphasized in their intervention information. Furthermore, attributions did not affect CRC risk perceptions. These results suggest that participants do not integrate sufficiently CRC risk factor information into their conceptualizations of CRC risk, and that more effective methods are needed to contextualize risk factors information to achieve the goal of modifying CRC risk perceptions.

Aged↗

Using the common sense model to understand perceived cancer risk in individuals testing for BRCA1/2 mutations.

The common sense model posits that individuals' understanding of illness is based upon somatic symptoms and life experiences and thus may differ significantly from the biomedical view of illness. The current study used the common sense model to understand cancer risk perceptions in 99 individuals testing for BRCA1/2 mutations. Specifically, we examined change from post-counseling to post-result in (1) absolute risk (risk of developing cancer in one's lifetime) and (2) comparative risk (risk relative to the general population). Results indicated that absolute risk showed a trend such that those with a personal history of cancer receiving uninformative negative results reported decreased absolute risk. Further, individuals receiving uninformative negative results reported decreased comparative risk. Those with no personal cancer history receiving informative negative results did not decrease in risk over time nor did their risk differ from those with a personal cancer history, evidencing unrealistic pessimism regarding their risk of cancer. The reasons provided for individuals' risk perceptions could be classified in terms of attributes of the common sense model and included the: (1) causes of cancer (e.g. family history, mutation status); (2) control or cure of cancer through health behaviors and/or surgery; and (3) perceived timeline for developing cancer (e.g. time left in life to develop cancer). We conclude that key to developing interventions to improve understanding of cancer risk and promoting effective cancer control mechanisms is an understanding of the specific reasons underlying individuals' perceptions of cancer risk.

Analysis of Variance↗

Decreased pain perception and risk for hypertension: considering a common physiological mechanism.

For almost two decades, researchers have demonstrated that hypertension is reliably associated with decreased perception of pain. More recently, a growing body of evidence has begun to suggest that hypoalgesia is not a consequence of high blood pressure, as the phenomenon precedes the onset of hypertension in individuals at risk for the disorder. This article provides a review of empirical evidence of decreased pain perception in normotensive persons with a family history of hypertension, elevated resting blood pressure, or exaggerated cardiovascular reactivity to stress. Based on the existing evidence, hypoalgesia is argued to be a correlate of dysregulation of central nervous system structures involved in both pain control and cardiovascular regulation in individuals who are genetically predisposed to develop high blood pressure. As such, hypoalgesia may serve as a valuable method of identifying individuals at greatest risk for hypertension.

Animals↗

Boater training, drinking and boating, and other unsafe boating practices.

OBJECTIVES: Identify associations between lack of formal boater training, drinking and boating, and other unsafe boating practices. METHODS: A telephone survey queried respondents (age 16 or older in continental United States) about boating experience, type of boat used, and training. RESULTS: Of the 3,042 boaters surveyed (70% response), most had no formal training (73%). Boaters with formal training failed to use PFDs about as often as those without formal training and were equally or more likely to use alcohol while boating. CONCLUSIONS: The unexpected association between formal training and unsafe boating practices is probably due to reduced risk perception and inadequacies of boater training programs. Such programs seldom mention the risks of alcohol use while boating. Decisions to mandate formal training should be informed by these results; if mandated, training should address the risks of alcohol use while boating, and should be renewed frequently enough to offset reductions in risk perception.

Adult↗

Taking antenatal group B Streptococcus seriously: women's experiences of screening and perceptions of risk.

BACKGROUND: Early-onset group B streptococcal disease is a serious cause of neonatal morbidity and mortality. Although screening protocols for group B streptococcus are common, little is known of women's perceptions of this screening and the disease itself. The purpose of this study was to gain an understanding of women's experiences, knowledge, and perceptions about this bacteria and its screening. METHODS: Nine focus group interviews with 35 women explored their experiences and understanding of group B streptococcus screening. Transcribed interview data were interpreted to identify and articulate the women's experiences. RESULTS: Most women had little knowledge or understanding of group B streptococcus, obtaining their information largely from the stories or experiences of friends or family. Women struggled to understand the meaning and implications, both physical and "moral," of the disease for their baby and for themselves, clearly indicating both the subjective and statistical importance of the concept of risk for pregnant women. CONCLUSIONS: Group B streptococcus continues to be poorly understood by pregnant women who try to understand and weigh up its risks and implications so as to make the best decisions about screening. The women participated in screening ultimately, however, since it was seen to be patently "best for baby," relatively easy for them to undergo, and part of routine antenatal care.

Adult↗

Suggestion of an inverse relationship between perception of occupational risks and work-related injuries.

Worker perception of risk influences worker behavior and consequently exposure to risks. However, an inverse relationship between perception of occupational risks and work-related injuries has not yet been clearly established. A matched case-control was performed aiming to investigate possible differences in perception of occupational risks between workers who had suffered occupational injuries and those who had not. Cases were defined as all 93 workers from a large metallurgical factory in southeastern Brazil, who had suffered occupational injuries during the year 1996. Controls were 372 workers who had not suffered occupational injuries, matched on the basis of the factory sector and jobs performed. Assessment of occupational risk perception was performed by asking the workers to fill out a questionnaire consisting of questions on specific risks related to problems in work relations, work per se, and mode of production. The findings suggest that the degree of perception that workers with occupational injuries have of some occupational risks is lower than that of their non-injured coworkers.

Accidents, Occupational↗

The impact of risk information on patients' willingness to pay for autologous blood donation.

OBJECTIVES: For contingent valuation to provide valid values for policy making, it is important that respondents be well informed about the goods they are asked to value. Few studies, however, have tested the impact of providing this information This study assessed the impact of risk information on patients' willingness to pay for autologous blood donation and derived the willingness to pay in a sample of informed patients. METHODS: Patients were randomized either to receive information about the risks of complications from allogeneic (volunteer) blood transfusions or to base their willingness to pay responses on their own prior knowledge. Four hundred twelve autologous blood donors were recruited from three study sites. Self-administered questionnaires collected information on willingness to pay, risk perceptions, and socioeconomic information. RESULTS: As predicted by our theoretical model, providing risk information reduced the variance in the willingness to pay for autologous blood donation. A tendency for information to reduce the willingness to pay was also found, suggesting that uninformed patients, on average, overestimate the risks of allogeneic blood transfusions. The median willingness to pay in the informed sample was approximately $750 to $1,100, depending on the estimation method, compared with $800 to $1,900 in the uninformed group. Willingness to pay was significantly related to perceived transfusion risk, personal income, and dread of transfusions. CONCLUSIONS: Our results are consistent with an economic model where individuals update their prior risk perceptions with new information. The willingness to pay in the informed sample was far higher than the costs of autologous blood donation, suggesting that total benefits outweigh the costs of the procedure.

Adult↗

Thinking through cancer risk: characterizing smokers' process of risk determination.

The perception of cancer risk motivates cancer risk reduction behaviors. However, common measurement strategies for cancer risk perceptions, which involve numerical likelihood estimates, do not adequately capture individuals' thoughts and feelings about cancer risk. To guide the development of novel measurement strategies, the authors used semistructured interviews to examine the thought processes used by smokers (N = 15) as they considered their cancer risk. They used grounded theory to guide systematic data coding and develop a heuristic model describing smokers' risk perception process that includes a cognitive, primarily rational process whereby salient personal risk factors for cancer are considered and combined, and an affective/attitudinal process, which shifts risk perceptions either up or down. The model provides a tentative explanation concerning how people hold cancer risk perceptions that diverge from rational assessment of their risks and will be useful in guiding the development of non-numerical measurements strategies for cancer risk perceptions.

Adolescent↗

Pretest assessment as a component of safer sex intervention: a pilot study of brief one-session interventions for women partners of male injection drug users in New York City.

This pilot study evaluated whether brief safer sex interventions for women partners of male injection drug users significantly influenced perceptions of partner risk, human immunodeficiency virus (HIV) knowledge, correct condom usage, and self-reported consistent safer sex (abstinence or 100% of vaginal-penile intercourse acts protected by male or female condoms). The study also examined the impact of pretest assessment on those variables since pretest assessment may challenge participants' current knowledge, safer sex practices, and partner communication techniques. The study randomly assigned participants to pretest or no pretest assessment. Each group was also assigned randomly to a presentation modality: (1) safer sex pamphlet review only, (2) pamphlet review with demonstration of several safer sex alternatives, or (3) pamphlet review with skills practice to mastery with one safer sex alternative of the woman's choice. For the last two conditions, a 35-minute interactive session covered prevention efficacy of safer sex methods for HIV, sexually transmitted infections, pregnancy, correct use, eroticization, local cost and availability, and partner objections. At 7 weeks postintervention, a higher proportion of women who took pretest assessment reported consistent safer sex (66.7%) compared to those without pretests (55.6%). Assignment to the interactive interventions (skills or demonstration) had little additional impact over pretest assessment for these women. Among women who did not take pretests, the interactive interventions had strong effects; 76.9% reported consistent safer sex versus 33.3% in the pamphlet review group. There were additional specific effects for pretest assessment on HIV knowledge and partner risk perception and for interactive intervention on correct condom usage. Brief interventions appear to have some positive short-term effects. Pretest assessment may be an important component of brief interventions.

Adult↗

An intervention method for occupational safety in farming -- evaluation of the effect and process.

In order to increase safety in Swedish farming an intervention methodology to influence attitudes and behaviour was tested. Eighty eight farmers and farm workers in nine groups gathered on seven occasions during 1 year. The basic concept was to create socially supportive networks and encourage discussions and reflection, focusing on risk manageability. Six of the groups made structured incident/accident analyses. Three of the latter groups also received information on risks and accident consequences. Effects were evaluated in a pre-post questionnaire using six-graded scales. A significant increase in safety activity and significant reduction in stress and risk acceptance was observed in the total sample. Risk perception and perceived risk manageability did not change. Analysing incidents/accidents, but not receiving information, showed a more positive outcome. Qualitative data indicated good feasibility and that the long duration of the intervention was perceived as necessary. The socially supportive network was reported as beneficial for the change process.

Accident Prevention↗

The prevalence and correlates of gamma-hydroxybutyrate (GHB) overdose among Australian users.

AIM: The aim of this study was to examine the correlates, context and risk perceptions regarding gamma-hydroxybutyrate (GHB) overdose among a sample of recreational GHB users in Australia. DESIGN: A cross-sectional survey of 76 GHB users who were administered a structured interview on GHB use. They were asked a series of questions regarding whether they had ever experienced a GHB overdose, the context of their most recent GHB overdose, and about their perceptions of the risks of GHB overdose. FINDINGS: This sample of GHB users had not had a long or extensive experience with GHB use; despite this, half (53%) had experienced a GHB overdose. This sample of GHB users appeared to be well-educated, employed and a history of either drug treatment or incarceration was uncommon. There were no differences between those who had or had not overdosed in terms of socio-demographic characteristics, extent of other drug use or typical patterns of other drug use when using GHB. However, those who had overdosed on GHB had used it more times during their life-time, and had been using it for a longer period of time. CONCLUSIONS: GHB-related overdoses were common among a sample of GHB users who had only recently begun using the drug. The only apparent distinguishing factor between those who had and had not overdosed on GHB was the amount of experience with GHB use.

Adult↗

Using time intervals between expected events to communicate risk magnitudes.

Because members of the public have difficulty understanding risk presented in terms of odds ratios (e.g. 1 in 1000) and in comparing odds ratios from different hazards, we examined the use of time intervals between expected harmful events to communicate risk. Perceptions of the risk from a hypothetical instance of naturally-occurring, cancer-causing arsenic in drinking water supplies was examined with a sample of 705 homeowners. The risk was described as either 1 in 1000 or 1 in 100,000 and as present in a town of 2000 people or a city of 200,000 people. With these parameters, the time intervals ranged from 1 expected death in 3500 years (1 in 100,000 risk, small town) to 1 death every 4 months (1 in 1000 risk, city). The addition of time intervals to the odds ratios significantly decreased perceived threat and perceived need for action in the small town but did not affect response for the city. These framing effects were nearly as large as a 100-fold difference in actual risk. Instances when this communication approach may be useful are discussed.

Communication↗

Passenger car size and driver seat belt use.

The National Highway Traffic Safety Administration (NHTSA) claims, on the basis of survey results, that seat belt use in small cars is twice as high as in large cars. The agency interprets this as being due in part to perceptions of higher risk by small car occupants. In fact, little is known about the factors motivating belt use, including whether risk perception is important. A reanalysis of the NHTSA data indicates that most of the differences in belt use by car size can be explained by higher use in imported cars, and by geographical differences in belt use in domestic cars.

Automobiles↗

Pregnancy avoidance and coital behavior.

This study proposes a behavioral model that identifies determinants of coital activity in the context of pregnancy avoidance and assesses the relationships using weekly panel data collected on 300 rural married women in Sri Lanka in 1988. We discuss the utility of the design, which is similar to that of an epidemiological surveillance system, for the measurement of coital behavior and pregnancy risk perceptions. Perceptions of pregnancy risk, spousal agreement on sexual relations, menstrual and lactational status, and cycle timing, all measured daily, are found to influence significantly the probability of coitus on that day. The findings suggest that substantial gains in studying fertility regulation are likely from closer investigation of the behavioral connections between motivation for pregnancy avoidance and coital incidence. Comparison of such panel data with those of cross-sectional sample surveys also provides insights into the validity of measures of coital and contraceptive behavior.

Adolescent↗