Science.gov

Sample records for risk factor management

  1. Managing Multiple Risk Factors.

    DTIC Science & Technology

    1998-09-01

    cardiovascular disease among black women can be better controlled through the use of a stress reduction intervention that reduces the sympathetic nervous...All participants will have high normal (130/80) or mild hypertension and at least two additional risk factors for cardiovascular disease (e.g

  2. Striae gravidarum: Risk factors, prevention, and management.

    PubMed

    Farahnik, B; Park, K; Kroumpouzos, G; Murase, J

    2017-06-01

    Striae gravidarum (SG) are atrophic linear scars that represent one of the most common connective tissue changes during pregnancy. SG can cause emotional and psychological distress for many women. Research on risk factors, prevention, and management of SG has been often inconclusive. We conducted a literature search using textbooks, PubMed, and Medline databases to assess research performed on the risk factors, prevention, and management of SG. The search included the following key words: striae gravidarum, pregnancy stretch marks, and pregnancy stretch. We also reviewed citations within articles to identify relevant sources. Younger age, maternal and family history of SG, increased pre-pregnancy and pre-delivery weight, and increased birth weight were the most significant risk factors identified for SG. Although few studies have confirmed effective prevention methods, Centella asiatica extract, hyaluronic acid, and daily massages showed some promise. Treatment for general striae has greatly improved over the last few years. Topical tretinoin ≥ 0.05% has demonstrated up to 47% improvement of SG and non-ablative fractional lasers have consistently demonstrated 50 to 75% improvement in treated lesions of striae distensae. Overall, SG has seen a resurgence in research over the last few years with promising data being released. Results of recent studies provide dermatologists with new options for the many women who are affected by these disfiguring marks of pregnancy.

  3. Management of patients with risk factors

    PubMed Central

    Waldfahrer, Frank

    2013-01-01

    This review addresses concomitant diseases and risk factors in patients treated for diseases of the ears, nose and throat in outpatient and hospital services. Besides heart disease, lung disease, liver disease and kidney disease, this article also covers disorders of coagulation (including therapy with new oral anticoagulants) and electrolyte imbalance. Special attention is paid to the prophylaxis, diagnosis and treatment of perioperative delirium. It is also intended to help optimise the preparation for surgical procedures and pharmacotherapy during the hospital stay. PMID:24403970

  4. Preventing delirium in dementia: Managing risk factors.

    PubMed

    Ford, Andrew H

    2016-10-01

    Delirium is a common, disabling medical condition that is associated with numerous adverse outcomes. A number of inter-related factors, including pre-existing cognitive impairment, usually contribute to the development of delirium in a particular susceptible individual. Non-pharmacological approaches to prevention typically target multiple risk factors in a systematic manner (multicomponent interventions). There is generally good evidence that multicomponent interventions reduce the incidence of delirium in hospital populations but there are limited data in people with dementia and those living in the community. It is likely that there is a differential effect of specific interventions in those with cognitive impairment (e.g. people with dementia may respond better to simpler, more pragmatic interventions rather than complex procedures) but this cannot be determined from the existing data. Targeted interventions focussed on hydration, medication rationalization and sleep promotion may also be effective in reducing the incidence of delirium, as well as the active involvement of family members in the care of the elderly hospitalized patient. Hospitalization itself is a potential risk factor for delirium and promising data are emerging of the benefits of home-based care as an alternative to hospitalization but this is restricted to specific sub-populations of patients and is reliant on these services being available. Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Pseudarthrosis of the Cervical Spine: Risk Factors, Diagnosis and Management

    PubMed Central

    Leven, Dante

    2016-01-01

    Cervical myelopathy and radiculopathy are common pathologies that often improve with spinal decompression and fusion. Postoperative complications include pseudarthrosis, which can be challenging to diagnose and manage. We reviewed the literature with regard to risk factors, diagnosis, controversies, and management of cervical pseudarthrosis. PMID:27559462

  6. Risk factors, health risks, and risk management for aircraft personnel and frequent flyers.

    PubMed

    Kim, Jeoum Nam; Lee, Byung Mu

    2007-01-01

    Health risks associated with long periods of time in flight are of concern to astronauts, crew members, and passengers. Many epidemiological studies showed that occupational and frequent flyers may be susceptible to ocular, cardiovascular, neurological, pulmonary, gastrointestinal, sensory, immunological, physiological, and even developmental disorders. In addition, the incidences of cancer and food poisoning are expected to be higher in such individuals. This article reviews health risks and risk factors associated with air travel, and discusses risk management strategies. To reduce adverse health risks, risk factors such as radiation, infection, stress, temperature, pressure, and circadian rhythm need to be avoided or reduced to levels that are as low as technologically achievable to protect flight personnel and passengers.

  7. Nurse management of cardiovascular risk factors in rheumatoid arthritis.

    PubMed

    Garcia-Diaz, Silvia; Corominas, Hèctor

    Rheumatoid arthritis (RA) is a chronic, multi-system inflammatory disease. The incidence and prevalence of RA varies considerably between geographic areas and over time; the prevalence of RA in adults aged > 20 years in Spain is around 0.5% (Carmona et al, 2002). People with RA also have extra-articular manifestations, presenting an increased cardiovascular morbidity and mortality risk; therefore, cardiovascular risk screening and management strategies are necessary in individuals with RA. The importance of interventions in the management of people with RA and cardiovascular risk factors is recognised by the European League Against Rheumatism (EULAR) recommendations (Peters et al, 2010). Rheumatology specialist nurses are well placed to include routine cardiovascular risk assessment for people with RA attending clinic, and to provide educational interventions to reduce cardiovascular risk, such as smoking cessation, weight loss, eating a balanced, low-fat diet and exercising regularly.

  8. Patients' experiences managing cardiovascular disease and risk factors in prison.

    PubMed

    Thomas, Emily H; Wang, Emily A; Curry, Leslie A; Chen, Peggy G

    Despite greater risk of cardiovascular disease (CVD) mortality in patients with a history of incarceration, little is known about how prisons manage CVD risk factors (CVD-RF) to mitigate this risk. We conducted in-depth interviews with individuals with CVD-RF who had been recently released from prison (n = 26). These individuals were recruited through community flyers and a primary care clinic in Connecticut. Using a grounded theory approach and the constant comparative method, we inductively generated themes about CVD-RF care in prisons. Data collection and analysis occurred iteratively to refine and unify emerging themes. Four themes emerged about care in prison: (1) Participants perceive that their CVD-RFs are managed through acute, rather than chronic, care processes; (2) Prison providers' multiple correctional and medical roles can undermine patient-centered care; (3) Informal support systems can enhance CVD-RF self-management education and skills; and (4) The trade-off between prisoner security and patient autonomy influences opportunities for self-management. Patients develop self-management skills through complex processes that may be compromised by the influence of correctional policies on medical care. Our findings support interventions to engage peers, medical providers, care delivery systems, and correctional staff in cultivating effective self-management strategies tailored to prison settings.

  9. Obstetric anal sphincter injury: incidence, risk factors, and management.

    PubMed

    Dudding, Thomas C; Vaizey, Carolynne J; Kamm, Michael A

    2008-02-01

    Obstetric sphincter damage is the most common cause of fecal incontinence in women. This review aimed to survey the literature, and reach a consensus, on its incidence, risk factors, and management. This systematic review identified relevant studies from the following sources: Medline, Cochrane database, cross referencing from identified articles, conference abstracts and proceedings, and guidelines published by the National Institute of Clinical Excellence (United Kingdom), Royal College of Obstetricians and Gynaecologists (United Kingdom), and American College of Obstetricians and Gynecologists. A total of 451 articles and abstracts were reviewed. There was a wide variation in the reported incidence of anal sphincter muscle injury from childbirth, with the true incidence likely to be approximately 11% of postpartum women. Risk factors for injury included instrumental delivery, prolonged second stage of labor, birth weight greater than 4 kg, fetal occipitoposterior presentation, and episiotomy. First vaginal delivery, induction of labor, epidural anesthesia, early pushing, and active restraint of the fetal head during delivery may be associated with an increased risk of sphincter trauma. The majority of sphincter tears can be identified clinically by a suitably trained clinician. In those with recognized tears at the time of delivery repair should be performed using long-term absorbable sutures. Patients presenting later with fecal incontinence may be managed successfully using antidiarrheal drugs and biofeedback. In those who fail conservative treatment, and who have a substantial sphincter disruption, elective repair may be attempted. The results of primary and elective repair may deteriorate with time. Sacral nerve stimulation may be an appropriate alternative treatment modality. Obstetric anal sphincter damage, and related fecal incontinence, are common. Risk factors for such trauma are well recognized, and should allow for reduction of injury by proactive

  10. [Depression in HIV infection: prevalence, risk factors and management].

    PubMed

    Wolff L, Claudia; Alvarado M, Rubén; Wolff R, Marcelo

    2010-02-01

    Depression is one of the main psychiatric co-morbidities in HIV infection, presenting with a significantly higher prevalence than in the general population (around 35%). Its presence has been associated with poor quality of life, HIV disease progression and poor adherence to antiretroviral therapy. Although antidepressive treatment has demonstrated effectiveness on the management of depressive symptoms, improvement of clinical and laboratory parameters, and enhancement of antiretroviral adherence, depression is frequently under diagnosed and under treated in these patients. We analyzed the main international findings on depression prevalence, risk factors, con-sequences and management in people with HIV disease.

  11. [Management of vascular risk factors in patients older than 80].

    PubMed

    Gómez-Huelgas, Ricardo; Martínez-Sellés, Manuel; Formiga, Francesc; Alemán Sánchez, José Juan; Camafort, Miguel; Galve, Enrique; Gil, Pedro; Lobos, José María

    2014-08-04

    The number of patients older than 80 years is steadily increasing and it represents the main basis for increasing population figures in developed countries. Cardiovascular diseases are the leading causes of mortality and disability causes result in a huge burden of disease in elderly people. However, available scientific evidence to support decision-making on cardiovascular prevention in elderly patients is scarce. Currently available risk assessment scales cannot be applied to elderly people. They are focused on cardiovascular mortality risk and do not provide information on factors with a proven prognostic value in the very old (functioning disability, dementia). Elderly people are a highly heterogeneous population, with a variety of co-morbidities, as well as several functional and cognitive impairment degrees. Furthermore, aging-associated physiological changes and common use of multiple drugs result in an increased risk of adverse drug reactions. Thus, drug use should always be based on a risk/benefit assessment in the elderly. Therefore, therapeutic decision-making in the very old must be an individually tailored and based on an appropriate clinical judgement and a comprehensive geriatric assessment. The current consensus report aims to present a proposal for clinical practices in the primary and secondary cardiovascular prevention in the very old and to provide a number of recommendations on lifestyle changes and drug therapy for the management of major cardiovascular risk factors.

  12. Management of the aging risk factor for Parkinson's disease.

    PubMed

    Phillipson, Oliver T

    2014-04-01

    The aging risk factor for Parkinson's disease is described in terms of specific disease markers including mitochondrial and gene dysfunctions relevant to energy metabolism. This review details evidence for the ability of nutritional agents to manage these aging risk factors. The combination of alpha lipoic acid, acetyl-l-carnitine, coenzyme Q10, and melatonin supports energy metabolism via carbohydrate and fatty acid utilization, assists electron transport and adenosine triphosphate synthesis, counters oxidative and nitrosative stress, and raises defenses against protein misfolding, inflammatory stimuli, iron, and other endogenous or xenobiotic toxins. These effects are supported by gene expression via the antioxidant response element (ARE; Keap/Nrf2 pathway), and by peroxisome proliferator-activated receptor gamma co-activator 1 alpha (PGC-1 alpha), a transcription coactivator, which regulates gene expression for energy metabolism and mitochondrial biogenesis, and maintains the structural integrity of mitochondria. The effectiveness and synergies of the combination against disease risks are discussed in relation to gene action, dopamine cell loss, and the accumulation and spread of pathology via misfolded alpha-synuclein. In addition there are potential synergies to support a neurorestorative role via glial derived neurotrophic factor expression. Copyright © 2014 The Author. Published by Elsevier Inc. All rights reserved.

  13. [Changes in work organization and management of psychosocial risk factors].

    PubMed

    Costa, G

    2008-01-01

    In recent years, major changes have occurred in Italian working conditions and employment patterns due to several concurrent factors: increasing occupation in the tertiary sector, implementation of new technologies, labour market globalization, higher variability of working time arrangements, decrease of traditional physical-chemical risks, ageing of general/working population, access to work of people with disabilities, growing immigration of extra-community workers. Thus, psychosocial risk factors are becoming crucial issues of the present work organization, dealing with job content (complexity, meaning, uncertainties), mental work load, time pressure, variable working hours; career perspectives, role conflicts and ambiguity, education and training, personal relations, social support, work/family conflicts; age and cultural discrimination. The Occupational Health Physician has to deal with these multidimensional and multifaceted aspects of work stress by different and concurrent approaches, at both group and individual levels, with epidemiological and clinical perspectives, enacting preventive and therapeutic strategies. Both "external" work load and individual "responses" have to be properly considered and risk has to be assessed with "relative" rather than "absolute" criteria, addressed not only at fitness to work, but also to corrective actions. Hence, the OHP has to act in closer collaboration with work psychologists, sociologists, human resources managers and work organisation experts.

  14. Risk Management

    NASA Technical Reports Server (NTRS)

    Thomas, Lloyd

    1998-01-01

    This presentation focuses on the identification of risk management, risk management processes such as: quantification and prioritization; mitigation planning; implementation of risk reduction; and tracking process. It develops examples and answers questions about Risk Management.

  15. Uterine prolapse in pregnancy: risk factors, complications and management.

    PubMed

    Tsikouras, Panagiotis; Dafopoulos, Alexandros; Vrachnis, Nikolaos; Iliodromiti, Zoe; Bouchlariotou, Sofia; Pinidis, Petros; Tsagias, Nikolaos; Liberis, Vasileios; Galazios, Georgios; Von Tempelhoff, Georg Friedrich

    2014-02-01

    Presentation of uterine prolapse is a rare event in a pregnant woman, which can be pre-existent or else manifest in the course of pregnancy. Complications resulting from prolapse of the uterus in pregnancy vary from minor cervical infection to spontaneous abortion, and include preterm labor and maternal and fetal mortality as well as acute urinary retention and urinary tract infection. Moreover, affected women may be at particular risk of dystocia during labor that could necessitate emergency intervention for delivery. Recommendations regarding the management of this infrequent but potentially harmful condition are scarce and outdated. This review will examine the causative factors of uterine prolapse and the antepartum, intrapartum and puerperal complications that may arise from this condition as well as therapeutic options available to the obstetrician. While early recognition and appropriate prenatal management of uterine prolapse during pregnancy is imperative, implementation of conservative treatment modalities throughout pregnancy, these applied in accordance with the severity of the uterus prolapse and the patient's preference, may be sufficient to achieve uneventful pregnancy and normal, spontaneous delivery.

  16. Factors Predicting Adherence to Risk Management Behaviors of Women at Increased Risk for Developing Lymphedema

    PubMed Central

    Sherman, Kerry A.; Miller, Suzanne M.; Roussi, Pagona; Taylor, Alan

    2014-01-01

    Purpose Lymphedema affects 20-30% of women following breast cancer treatment. However, even when women are informed, they do not necessarily adhere to recommended lymphedema self-management regimens. Utilizing the Cognitive-Social Health Information Processing framework, we assessed cognitive and emotional factors influencing adherence to lymphedema risk management. Methods Women with breast cancer who had undergone breast and lymph node surgery were recruited through the Fox Chase Cancer Centre breast clinic. Participants (N=103) completed measures of lymphedema-related perceived risk, beliefs and expectancies, distress, self-regulatory ability to manage distress, knowledge, and adherence to risk management behaviors. They then received the American Cancer Society publication “Lymphedema: What Every Woman with Breast Cancer Should Know”. Cognitive and affective variables were reassessed at 6- and 12-months post-baseline. Results Maximum likelihood multilevel model analyses indicated that overall adherence increased over time, with significant differences between baseline and 6- and 12- month assessments. Adherence to wearing gloves was significantly lower than that for all other behaviors except electric razor use. Distress significantly decreased, and knowledge significantly increased, over time. Greater knowledge, higher self-efficacy to enact behaviors, lower distress, and higher self-regulatory ability to manage distress were associated with increased adherence. Conclusions Women who understand lymphedema risk management and feel confident in managing this risk are more likely to adhere to recommended strategies. These factors should be rigorously assessed as part of routine care to ensure that women have the self-efficacy to seek treatment and the self-regulatory skills to manage distress, which may undermine attempts to seek medical assistance. PMID:24970542

  17. Preterm Birth: An Overview of Risk Factors and Obstetrical Management

    ERIC Educational Resources Information Center

    Stewart, Amanda; Graham, Ernest

    2010-01-01

    Preterm birth is the leading cause of neonatal mortality and a major public health concern. Risk factors for preterm birth include a history of preterm birth, short cervix, infection, short interpregnancy interval, smoking, and African-American race. The use of progesterone therapy to treat mothers at risk for preterm delivery is becoming more…

  18. Preterm Birth: An Overview of Risk Factors and Obstetrical Management

    ERIC Educational Resources Information Center

    Stewart, Amanda; Graham, Ernest

    2010-01-01

    Preterm birth is the leading cause of neonatal mortality and a major public health concern. Risk factors for preterm birth include a history of preterm birth, short cervix, infection, short interpregnancy interval, smoking, and African-American race. The use of progesterone therapy to treat mothers at risk for preterm delivery is becoming more…

  19. Risk Management.

    ERIC Educational Resources Information Center

    Randal, L. Nathan

    This chapter of "Principles of School Business Management" presents an overview of risk management for school districts. The chapter first discusses four fundamental elements of risk management: (1) identifying and measuring risks; (2) reducing or eliminating risks; (3) transferring unassumable risks; and (4) assuming remaining risks.…

  20. Risk Management.

    ERIC Educational Resources Information Center

    Randal, L. Nathan

    This chapter of "Principles of School Business Management" presents an overview of risk management for school districts. The chapter first discusses four fundamental elements of risk management: (1) identifying and measuring risks; (2) reducing or eliminating risks; (3) transferring unassumable risks; and (4) assuming remaining risks.…

  1. Stroke prevention care delivery: predictors of risk factor management outcomes.

    PubMed

    Ireland, Sandra E; Arthur, Heather M; Gunn, Elizabeth A; Oczkowski, Wieslaw

    2011-02-01

    /or glucose targets: self-efficacy expectations (OR, 1.61; 95% CI, 1.03-2.54; p=0.04), Mini-Mental State (OR, 1.28; 95% CI, 1.06-1.54; p=0.009); and self-reported adherence (OR, 1.14; 95% CI, 1.01-1.29; p=0.03). Three simple screening measures identified patients at increased risk of not achieving clinical risk factor management targets. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. [Integrated Management Area of Vascular Risk: A new organisational model for global control of risk factors].

    PubMed

    Armario, P; Jericó, C; Vila, L; Freixa, R; Martin-Castillejos, C; Rotllan, M

    2016-11-17

    Cardiovascular disease (CVD), is a major cause of morbidity and mortality that increases the cost of care. Currently there is a low degree of control of the main cardiovascular risk factors, although we have a good therapeutic arsenal. To achieve the improvement of this reality, a good coordination and multidisciplinary participation are essential. The development of new organizational models such as the Integrated Management Area of Vascular Risk can facilitate the therapeutic harmonization and unification of the health messages offered by different levels of care, based on clinical practice guidelines, in order to provide patient-centred integrated care.

  3. Injuries in professional modern dancers: incidence, risk factors, and management.

    PubMed

    Shah, Selina; Weiss, David S; Burchette, Raoul J

    2012-03-01

    Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing.

  4. Sociological Factors Affecting Agricultural Price Risk Management in Australia

    ERIC Educational Resources Information Center

    Jackson, Elizabeth; Quaddus, Mohammed; Islam, Nazrul; Stanton, John

    2009-01-01

    The highly volatile auction system in Australia accounts for 85 percent of ex-farm wool sales, with the remainder sold by forward contract, futures, and other hedging methods. In this article, against the background of an extensive literature on price risk strategies, we investigate the behavioral factors associated with producers' adoption of…

  5. Sociological Factors Affecting Agricultural Price Risk Management in Australia

    ERIC Educational Resources Information Center

    Jackson, Elizabeth; Quaddus, Mohammed; Islam, Nazrul; Stanton, John

    2009-01-01

    The highly volatile auction system in Australia accounts for 85 percent of ex-farm wool sales, with the remainder sold by forward contract, futures, and other hedging methods. In this article, against the background of an extensive literature on price risk strategies, we investigate the behavioral factors associated with producers' adoption of…

  6. Managing perceived operational risk factors for effective supply-chain management

    NASA Astrophysics Data System (ADS)

    Sylla, Cheickna

    2014-12-01

    This research is part of a large scale comprehensive mathematical and empirical modeling investigation projects aimed at developing a better understanding of supply-chain risk management by offering a comprehensive framework including theoretical elements and empirical evidence based on managers' perception of improved organizational level of preparedness to safeguard against the threats of disruptions, delays and stoppage in the supply chain. More specifically, this paper reports the empirical investigation conducted using 92 companies in several eastern USA regions involved in international trades with global supply chains. Among the 56 general hypotheses investigated, the results support that managers strive to balance their control and decision impacts to mold their responses to risk factors with knowledge of the extent of cost consequences as stated in previous research. However, the results also propose new findings which significantly vary from previous research reports.

  7. Potential impact of single-risk-factor versus total risk management for the prevention of cardiovascular events in Seychelles

    PubMed Central

    Ndindjock, Roger; Gedeon, Jude; Mendis, Shanthi; Paccaud, Fred

    2011-01-01

    Abstract Objective To assess the prevalence of cardiovascular (CV) risk factors in Seychelles, a middle-income African country, and compare the cost-effectiveness of single-risk-factor management (treating individuals with arterial blood pressure ≥ 140/90 mmHg and/or total serum cholesterol ≥ 6.2 mmol/l) with that of management based on total CV risk (treating individuals with a total CV risk ≥ 10% or ≥ 20%). Methods CV risk factor prevalence and a CV risk prediction chart for Africa were used to estimate the 10-year risk of suffering a fatal or non-fatal CV event among individuals aged 40–64 years. These figures were used to compare single-risk-factor management with total risk management in terms of the number of people requiring treatment to avert one CV event and the number of events potentially averted over 10 years. Treatment for patients with high total CV risk (≥ 20%) was assumed to consist of a fixed-dose combination of several drugs (polypill). Cost analyses were limited to medication. Findings A total CV risk of ≥ 10% and ≥ 20% was found among 10.8% and 5.1% of individuals, respectively. With single-risk-factor management, 60% of adults would need to be treated and 157 cardiovascular events per 100 000 population would be averted per year, as opposed to 5% of adults and 92 events with total CV risk management. Management based on high total CV risk optimizes the balance between the number requiring treatment and the number of CV events averted. Conclusion Total CV risk management is much more cost-effective than single-risk-factor management. These findings are relevant for all countries, but especially for those economically and demographically similar to Seychelles. PMID:21479093

  8. Risk factors and management of white spot lesions in orthodontics

    PubMed Central

    Srivastava, Kamna; Tikku, Tripti; Khanna, Rohit; Sachan, Kiran

    2013-01-01

    The formation of white spot lesions or enamel demineralization around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which mars the result of a successfully completed case. This article is a contemporary review of the risk factors, preventive methods and fate of these orthodontics scars. The importance of excellent oral hygiene practice during fixed orthodontic treatment must be explained. Preventive programs must be emphasized to all orthodontic patients. Suggestions are offered in the literature for ways to prevent this condition from manifesting itself. PMID:24987641

  9. Psychological Factors in Risk Assessment and Management of Inappropriate Sexual Behaviour by Men with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Smith, Mark; Willner, Paul

    2004-01-01

    Aim: This study examined the responses of care managers and direct care staff to vignettes of inappropriate sexual behaviour (ISB) by a man with an intellectual disability. The aim was to identify psychological factors that influenced their assessment of risk and the perceived need for risk management strategies. Method: The vignettes varied in…

  10. Cardiovascular Disease in CKD in Children: Update on Risk Factors, Risk Assessment, and Management

    PubMed Central

    Wilson, Amy C; Mitsnefes, Mark M

    2009-01-01

    In young adults with onset of chronic kidney disease in childhood, cardiovascular disease is the most common cause of death. The likely reason for increased cardiovascular disease in these patients is high prevalence of traditional and uremia-related cardiovascular disease risk factors during childhood chronic kidney disease. Early markers of cardiomyopathy, such as left ventricular hypertrophy and left ventricular dysfunction and early markers of atherosclerosis, such as increased carotid artery intima-media thickness, carotid arterial wall stiffness and coronary artery calcification are frequently found in this patient population. The purpose of this review is to provide an update of recent advances in the understanding and management of cardiovascular disease risks in this population. PMID:19619845

  11. Oral Cavity Cancer: Risk Factors, Pathology, and Management.

    PubMed

    Ernani, Vinicius; Saba, Nabil F

    2015-01-01

    Oral cavity cancers are predominantly squamous cell carcinomas, which arise from premalignant lesions through a multistep carcinogenesis process. Tobacco and alcohol are the major etiologic factors, although human papillomavirus has also recently been implicated as a causative agent. The possibility of a second primary malignancy should be considered during the diagnostic evaluation of head and neck cancers, as well as during the posttreatment surveillance phase. The goals of treatment are not only to improve survival outcomes but also to preserve organ function. These cancers are generally treated with a combination of surgery, radiation therapy, and chemotherapy. A multidisciplinary approach, involving surgeons, medical oncologists, and radiation oncologists, as well as dentists, dietitians, and rehabilitation therapists, is generally required for optimal treatment planning and management of patients with head and neck cancer. © 2015 S. Karger AG, Basel.

  12. Cardiovascular risk factors in the Bedouin population: management and compliance.

    PubMed

    Tamir, Oren; Peleg, Roni; Dreiher, Jacob; Abu-Hammad, Talab; Rabia, Yunis Abu; Rashid, Mohammad Abu; Eisenberg, Alex; Sibersky, David; Kazanovich, Alex; Khalil, Elbedour; Vardy, Daniel; Shvartzman, Pesach

    2007-09-01

    Until three decades ago coronary heart disease and stroke were considered rare in the Israeli Bedouin population. Today, this population shows increasing high prevalence compared to the Jewish population. To evaluate the prevalence of diagnosed cardiovascular risk factors among Bedouins (hypertension, diabetes mellitus, dyslipidemia), and to assess compliance with follow-up tests and drug treatment. The study included all listed patients aged 20 years and older in eight clinics in major Bedouin towns, and in two large teaching clinics in Beer Sheva (Jewish population). Risk factor data were extracted from the clinics' computerized databases. For those diagnosed with hypertension, diabetes or dyslipidemia, drug purchasing data were collected from the pharmacy database to determine compliance with treatment, and from the central laboratory mainframe (HbAlc and low density lipoprotein-cholesterol) to evaluate follow-up and control. A significantly higher prevalence of diabetes in all age groups was found in the Bedouin population compared to the Jewish population; age-adjusted results show a prevalence of 12% vs. 8% respectively (P < 0.001). The prevalence of dyslipidemia and age-adjusted hypertension was lower among Bedouins (5.8% vs. 18.2%, P < 0.01 and 17% vs. 21%, P < 0.001 respectively). Two-thirds of hypertensive Bedouin patients and 72.9% of diabetic Bedouin patients were not compliant with treatment. For dyslipidemia only 10.4% of the Bedouins were compliant compared with 28.2% in the Jewish population (P < 0.001). Compliance with drug therapy and follow-up tests was found to be a major problem in the Bedouin population.

  13. Risk factors.

    PubMed

    Robbins, Catherine J; Connors, K C; Sheehan, Timothy J; Vaughan, James S

    2005-06-01

    Minimize surprises on your financial statement by adopting a model for integrated risk management that: Examines interrelationships among operations, investments, and financing. Incorporates concepts of the capital asset pricing model to manage unexpected volatility

  14. Medication-overuse headache: risk factors, pathophysiology and management.

    PubMed

    Diener, Hans-Christoph; Holle, Dagny; Solbach, Kasja; Gaul, Charly

    2016-10-01

    Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder that occurs on ≥15 days per month for >3 months, and is caused by overuse of medication intended for acute or symptomatic headache treatment. The prevalence of MOH in the general population is around 1%, but the condition is much more common in people with headache, in particular chronic migraine. The phenotype of the headache in MOH depends on the initial primary headache and the type of overused acute medication. In this Review, we will discuss the epidemiology, risk factors, pathophysiology, prevention and treatment of MOH. Treatment of MOH is performed in three steps: educating patients about the relationship between frequent intake of acute headache medication and MOH with the aim to reduce intake of acute medication; initiation of migraine prevention (such as topiramate or onabotulinumtoxin A in migraine) in patients who fail step 1; detoxification on an outpatient basis or in a day hospital or inpatient setting, depending on severity and comorbidities. The success rate of treatment is around 50-70%, although patients whose MOH is associated with opioid overuse have higher relapse rates. In all patients with MOH, relapse rates can be reduced by patient education and care in the follow-up period.

  15. Risk management.

    PubMed

    Chambers, David W

    2010-01-01

    Every plan contains risk. To proceed without planning some means of managing that risk is to court failure. The basic logic of risk is explained. It consists in identifying a threshold where some corrective action is necessary, the probability of exceeding that threshold, and the attendant cost should the undesired outcome occur. This is the probable cost of failure. Various risk categories in dentistry are identified, including lack of liquidity; poor quality; equipment or procedure failures; employee slips; competitive environments; new regulations; unreliable suppliers, partners, and patients; and threats to one's reputation. It is prudent to make investments in risk management to the extent that the cost of managing the risk is less than the probable loss due to risk failure and when risk management strategies can be matched to type of risk. Four risk management strategies are discussed: insurance, reducing the probability of failure, reducing the costs of failure, and learning. A risk management accounting of the financial meltdown of October 2008 is provided.

  16. Risk management: Role of societal factors in major industrial accidents

    SciTech Connect

    Hovden, J.; Rausand, M.; Sergeev, G.

    1995-12-31

    The paper discusses factors influencing the occurrence of major accidents in complex technological systems. Societal factors are identified as most significant in this context. Important types of societal factors are pin-pointed and discussed. The safety situation in the former Soviet Union and in today`s Russian is described. The calamities at Chernobyl, Three Mile Island, and partly also Bhopal are discussed, and the role of societal factors identified. A main point of view is that it is not surprising that these catastrophes happened in the then existing conditions. What is surprising is that they did not happen earlier!

  17. Integrating Human Factors into Space Vehicle Processing for Risk Management

    NASA Technical Reports Server (NTRS)

    Woodbury, Sarah; Richards, Kimberly J.

    2008-01-01

    This presentation will discuss the multiple projects performed in United Space Alliance's Human Engineering Modeling and Performance (HEMAP) Lab, improvements that resulted from analysis, and the future applications of the HEMAP Lab for risk assessment by evaluating human/machine interaction and ergonomic designs.

  18. Toxic-Metabolic Risk Factors in Pediatric Pancreatitis: Recommendations for Diagnosis, Management and Future Research

    PubMed Central

    Husain, Sohail Z.; Morinville, Veronique; Pohl, John; Abu-El-Haija, Maisam; Bellin, Melena D.; Freedman, Steve; Hegyi, Peter; Heyman, Melvin B; Himes, Ryan; Ooi, Chee Y.; Schwarzenberg, Sarah Jane; Usatin, Danielle; Uc, Aliye

    2016-01-01

    Objectives Pancreatitis in children can result from metabolic and toxic risk factors, but the evidence linking these factors is sparse. We review the evidence for association or causality of these risk factors in pancreatitis, discuss management strategies and their rationale. Methods We conducted a review of the pediatric pancreatitis literature with respect to the following risk factors: (a) hyperlipidemia, (b) hypercalcemia, (c) chronic renal failure, (d) smoking exposure, (e) alcohol, and (f) medications. Areas of additional research were identified. Results Hypertriglyceridemia of 1000 mg/dl or greater poses an absolute risk for pancreatitis; persistent elevations of calcium are predisposing. Further research is necessary to determine whether end stage renal disease leads to increased pancreatitis in children similar to adults. It is unknown whether cigarette smoking exposure, which clearly increases risk in adults, also increases risk in children. The role of alcohol in pediatric pancreatitis, whether direct or modifying, needs to be elucidated. The evidence supporting most cases of medication-induced pancreatitis is poor. Drug structure, improper handling of drug by host, and by-stander status may be implicated. Other pancreatitis risk factors must be sought in all cases. Conclusions The quality of evidence supporting causative role of various toxic and metabolic factors in pediatric pancreatitis is variable. Careful phenotyping is essential, including search for other etiologic risk factors. Directed therapy includes correction/ removal of any agent identified, and general supportive measures. Further research is necessary to improve our understanding of these pancreatitis risk factors in children. PMID:26594832

  19. Pegfilgrastim-Induced Bone Pain: A Review on Incidence, Risk Factors, and Evidence-Based Management.

    PubMed

    Moore, Donald C; Pellegrino, Annie E

    2017-09-01

    To review the incidence, risk factors, and management of pegfilgrastim-induced bone pain (PIBP). PubMed was searched from 1980 to March 31, 2017, using the terms pegfilgrastim and bone pain. English-language, human studies and reviews assessing the incidence, risk factors, and management of PIBP were incorporated. A total of 3 randomized, prospective studies and 2 retrospective studies evaluated pharmacological management of PIBP. Naproxen compared with placebo demonstrated a reduction in the degree, incidence, and duration of bone pain secondary to pegfilgrastim. Loratadine was not effective in reducing the incidence of bone pain prophylactically, but a retrospective study evaluating dual antihistamine blockade with loratadine and famotidine demonstrated a decreased incidence in bone pain when administered before pegfilgrastim. Naproxen is effective at managing PIBP. Although commonly used, antihistamines have a paucity of data supporting their use. Dose reductions of pegfilgrastim and opioids may also be potential management options; however, data supporting these treatment modalities are scarce.

  20. Importance of risk factor management in diabetic patients and reduction in Stage B heart failure.

    PubMed

    Murtagh, G; O Connell, J; O Connell, E; Tallon, E; Watson, C; Gallagher, J; Baugh, J; Patle, A; O Connell, L; Griffin, J; O'Hanlon, R; Voon, V; Ledwidge, M; O Shea, D; McDonald, K

    2015-04-01

    A number of studies have demonstrated the presence of a diabetic cardiomyopathy, increasing the risk of heart failure development in this population. Improvements in present-day risk factor control may have modified the risk of diabetes-associated cardiomyopathy. We sought to determine the contemporary impact of diabetes mellitus (DM) on the prevalence of cardiomyopathy in at-risk patients with and without adjustment for risk factor control. A cross-sectional study in a population at risk for heart failure. Those with diabetes were compared to those with other cardiovascular risk factors, unmatched, matched for age and gender and then matched for age, gender, body mass index, systolic blood pressure and low density lipoprotein cholesterol. In total, 1399 patients enrolled in the St Vincent's Screening to Prevent Heart Failure (STOP-HF) cohort were included. About 543 participants had an established history of DM. In the whole sample, Stage B heart failure (asymptomatic cardiomyopathy) was not found more frequently among the diabetic cohort compared to those without diabetes [113 (20.8%) vs. 154 (18.0%), P = 0.22], even when matched for age and gender. When controlling for these risk factors and risk factor control Stage B was found to be more prevalent in those with diabetes [88 (22.2%)] compared to those without diabetes [65 (16.4%), P = 0.048]. In this cohort of patients with established risk factors for Stage B heart failure superior risk factor management among the diabetic population appears to dilute the independent diabetic insult to left ventricular structure and function, underlining the importance and benefit of effective risk factor control in this population on cardiovascular outcomes. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Focusing Osteoarthritis Management on Modifiable Risk Factors and Future Therapeutic Prospects

    PubMed Central

    Hunter, David J.

    2009-01-01

    The pathogenesis of osteoarthritis (OA) appears to be the result of a complex interplay between mechanical, cellular, and biochemical forces. Obesity is the strongest risk factor for disease onset and mechanical factors dominate the risk for disease progression. This narrative review focuses on the influence of biomechanics and obesity on the etiology of OA and its symptomatic presentation. We need to revisit the way we currently manage the disease and focus on the modifiable, primarily through nonpharmacologic intervention. Greater therapeutic attention to the important role of mechanical factors and obesity in OA etiopathogenesis is required if we are to find ways of reducing the public health impact of this condition. PMID:22870426

  2. Cardiovascular disease risk factors: prevalence and management in adult hemophilia patients.

    PubMed

    Lim, Ming Y; Pruthi, Rajiv K

    2011-07-01

    With increasing longevity, the prevalence of cardiovascular disease (CVD) risk factors in hemophilia patients is expected to increase; however, evidence-based guidelines on management are lacking. The aim of the study was to determine the prevalence and management of CVD risk factors in hemophilia patients. A retrospective study of 58 adult hemophilia patients (≥35 years) attending Mayo Comprehensive Hemophilia Center between 1 January 2006 and 15 October 2009 were reviewed. The prevalence of CVD risk factors was hypertension 65.5%, diabetes 10.3%, smoking 12.5% and obesity 19.6%. A total of 31% did not have a lipid profile on record. Management of risk factors included antihypertensive medications in 84.2% and lipid-lowering agents in 12.1%. During their medical evaluation, four of seven active smokers received smoking cessation counseling and four of 11 obese patients received lifestyle modification advice. Eight patients (13.8%) experienced a CVD event: myocardial infarction (MI) (n=3), coronary artery disease (n=2), both MI and ischemic stroke (n=1) and hemorrhagic strokes (n=2). Only five of eight patients were on low-dose aspirin, of which aspirin was discontinued in one patient after he was diagnosed with hemophilia following a bleeding work-up. Another patient on dual antiplatelet therapy post stent placement developed epistaxis resulting in clopidogrel cessation. Hemophilia patients are at risk for CVD, similar to the general age-matched male population. Screening for CVD risk factors, with preventive dietary and pharmacologic interventions, play a key role in the prevention and long-term management of CVD. Collaborative efforts between primary care providers, cardiologists and hemophilia center specialists remain essential in managing these complex patients.

  3. Cardiovascular risk factor management in patients with RA compared to matched non-RA patients.

    PubMed

    Alemao, Evo; Cawston, Helene; Bourhis, Francois; Al, Maiwenn; Rutten-van Mölken, Maureen P M H; Liao, Katherine P; Solomon, Daniel H

    2016-05-01

    RA is associated with a 50-60% increase in risk of cardiovascular (CV) death. This study aimed to compare management of CV risk factors in RA and matched non-RA patients. A retrospective cohort study was conducted using UK clinical practice data. Patients presenting with an incident RA diagnosis were matched 1:4 to non-RA patients based on a propensity score for RA, entry year, CV risk category and treatment received at index date (date of RA diagnosis). Patients tested and treated for CV risk factors as well as those attaining CV risk factor management goals were evaluated in both groups. Between 1987 and 2010, 24 859 RA patients were identified and matched to 87 304 non-RA patients. At index date, groups had similar baseline characteristics. Annual blood pressure, lipids and diabetes-related testing were similar in both groups, although CRP and ESR were higher in RA patients at diagnosis and decreased over time. RA patients prescribed antihypertensives increased from 38.2% at diagnosis to 45.7% at 5 years, from 14.0 to 20.6% for lipid-lowering treatments and from 5.1 to 6.4% for antidiabetics. Similar treatment percentages were observed in non-RA patients, although slightly lower for antihypertensives. Modest (2%) but significantly lower attainment of lipid and diabetes goals at 1 year was observed in RA patients. There were no differences between groups in the frequency of testing and treatment of CV risk factors. Higher CV risk in RA patients seems unlikely to be driven by differences in traditional CV risk factor management. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology.

  4. Cardiovascular risk factor management in patients with RA compared to matched non-RA patients

    PubMed Central

    Cawston, Helene; Bourhis, Francois; Al, Maiwenn; Rutten-van Mölken, Maureen P. M. H.; Liao, Katherine P.; Solomon, Daniel H.

    2016-01-01

    Objective. RA is associated with a 50–60% increase in risk of cardiovascular (CV) death. This study aimed to compare management of CV risk factors in RA and matched non-RA patients. Methods. A retrospective cohort study was conducted using UK clinical practice data. Patients presenting with an incident RA diagnosis were matched 1:4 to non-RA patients based on a propensity score for RA, entry year, CV risk category and treatment received at index date (date of RA diagnosis). Patients tested and treated for CV risk factors as well as those attaining CV risk factor management goals were evaluated in both groups. Results. Between 1987 and 2010, 24 859 RA patients were identified and matched to 87 304 non-RA patients. At index date, groups had similar baseline characteristics. Annual blood pressure, lipids and diabetes-related testing were similar in both groups, although CRP and ESR were higher in RA patients at diagnosis and decreased over time. RA patients prescribed antihypertensives increased from 38.2% at diagnosis to 45.7% at 5 years, from 14.0 to 20.6% for lipid-lowering treatments and from 5.1 to 6.4% for antidiabetics. Similar treatment percentages were observed in non-RA patients, although slightly lower for antihypertensives. Modest (2%) but significantly lower attainment of lipid and diabetes goals at 1 year was observed in RA patients. Conclusion. There were no differences between groups in the frequency of testing and treatment of CV risk factors. Higher CV risk in RA patients seems unlikely to be driven by differences in traditional CV risk factor management. PMID:26705329

  5. Risk Management.

    ERIC Educational Resources Information Center

    Rakich, Ronald

    1982-01-01

    Beginning on the front page, this article explains ways of establishing a sound risk management insurance program that can improve a school district's financial position. Organizations that can help are listed. Available from the American Association of School Administrators, 1801 North Moore Street, Arlington, VA 22209. (MLF)

  6. The influence of the risk factor on the abdominal complications in colon injury management

    PubMed Central

    TORBA, M.; GJATA, A.; BUCI, S.; BUSHI, G.; ZENELAJ, A.; KAJO, I.; KOCEKU, S.; KAGJINI, K.; SUBASHI, K.

    2015-01-01

    Introduction The management of colon injuries has distinctly evolved over the last three decades. However, trauma surgeons often find themselves in a dilemma, whether to perform a diversion or to perform a primary repair. The purpose of this study is to evaluate risk factors in colon injury management and their influence on abdominal complications. Patients and methods This is a prospective study conducted at a national level I trauma center in Tirana, Albania from January 2009 to December 2012. The data with respect to demographics, physiological risk factors, intraoperative findings, and surgical procedures were collected. Colonic injury-related morbidity and mortality were analyzed. Multivariate logistic regression analysis was performed by assessing the influence of risk factors on abdominal complications. Results Of the 157 patients treated with colon injury, was performed a primary repair in 107 (68.15%) of the patients and a diversion in the remaining 50 (31.85%). The mean PATI was 18.6, while 37 (23.6%) of patients had PATI greater than 25. The complications and their frequencies according to the surgical technique used (primay repair vs diversion respectively) includes: wound infections (9.3% vs 50%), anastomotic leak (1.8% vs 8.7%), and intra-abdominal abscess (1.8% vs 6.5%). The multivariate analysis identified two independent risk factors for abdominal complications: transfusions of 4 units of blood within the first 24 hours (OR = 1.2 95% CI (1.03 –1.57) p =0.02), and diversion (OR = 9.6, 95% CI 4.4 – 21.3, p<0.001). Conclusion Blood transfusions of more than 4 units within the first 24 hours and diversion during the management of destructive colon injuries are both independent risk factors for abdominal complications. The socioeconomic impact and the need for a subsequent operation in colostomy patients are strong reasons to consider primary repair in the management of colon injuries. PMID:26017103

  7. Management and risk factor control of coronary artery disease in elderly versus nonelderly: a multicenter registry.

    PubMed

    Phrommintikul, Arintaya; Krittayaphong, Rungroj; Wongcharoen, Wanwarang; Boonyaratavej, Smonporn; Wongvipaporn, Chaiyasith; Tiyanon, Woraporn; Dinchuthai, Pakaphan; Kunjara-Na-Ayudhya, Rapeephon; Tatsanavivat, Pyatat; Sritara, Piyamitr

    2016-12-01

    Coronary artery disease (CAD) is a leading cause of death in elderly because aging is the important non-modifiable risk factors of atherosclerosis and also a predictor of poor outcomes. Underuse of guideline directed therapy may contribute to suboptimal risk factor control and worse outcomes in the elderly. We aimed to explore the management of CAD, risk factors control as well as goal attainment in elderly compared to nonelderly CAD patients. The CORE-Thailand is an ongoing multicenter, prospective, observational registry of patients with high atherosclerotic risk in Thailand. The data of 4120 CAD patients enrolled in this cohort was analyzed comparing between the elderly (age ≥ 65 years) vs. nonelderly (age < 65 years). There were 2172 elderly and 1948 nonelderly patients. The elderly CAD patients had higher prevalence of hypertension, dyslipidemia, atrial fibrillation and chronic kidney disease. The proportion of patients who received coronary revascularization was not different between the elderly and nonelderly CAD patients. Antiplatelets were prescribed less in the elderly while statin was prescribed in the similar proportion. Goal attainments of risk factor control of glycemic control, low density lipoprotein cholesterol, and smoking cessation except the blood pressure goal were higher in the elderly CAD patients. The CORE-Thailand registry showed the equity in the treatment of CAD between elderly and non-elderly. Elderly CAD patients had higher rate of goal attainment in risk factor control except blood pressure goal. The effects of goal attainment on cardiovascular outcomes will be demonstrated from ongoing cohort.

  8. Significant factors of aviation insurance and risk management strategy: an empirical study of Taiwanese airline carriers.

    PubMed

    Lin, Yi Hsin; Chang, Yu Hern

    2008-04-01

    Aviation insurance premiums have become a heavy burden for the airline industry since September 11, 2001. Although the industry must constantly balance its operations between profitability and safety, the reality is that airlines are in the business of making money. Therefore, their ability to reduce cost and manage risk is a key factor for success. Unlike past research, which used subjective judgment methods, this study applied quantitative historical data (1999-2000) and gray relation analysis to identify the primary factors influencing ratemaking for aviation insurance premiums. An empirical study of six airlines in Taiwan was conducted to determine these factors and to analyze the management strategies used to deal with them. Results showed that the loss experience and performance of individual airlines were the key elements associated with aviation insurance premiums paid by each airline. By identifying and understanding the primary factors influencing ratemaking for aviation insurance, airlines will better understand their relative operational strengths and weaknesses, and further help top management identify areas for further improvement. Knowledge of these factors combined with effective risk management strategies, may result in lower premiums and operating costs for airline companies.

  9. Management of abdominal aortic aneurysms: which risk factors play a role in decision-making?

    PubMed

    Rutherford, Robert B

    2008-09-01

    There are three choices for management of abdominal aortic aneurysms (AAA), ie, endovascular repair (EVAR), open repair (OR), and continuing surveillance (OBS). The treating physician must weigh the risk of no intervention, in terms of ultimate death from rupture, against the more immediate risk associated with either form of repair, considering in the process those risk factors that directly or indirectly relate to outcome. These risk factors include AAA size and the patient's comorbidities, age, gender, and AAA anatomy, as well as the skills and experience of the treating physicians and the health care environment in which the patient is treated. While individualization is clearly required, a generalizable platform for decision-making derived from past trials and other pertinent observational studies is also useful. This article attempts to present pertinent background information and develop it into generally applicable guidelines.

  10. Physician cardiovascular disease risk factor management: practice analysis in Japan versus the USA.

    PubMed

    Schuster, Richard J; Zhu, Ye; Ogunmoroti, Oluseye; Terwoord, Nancy; Ellison, Sylvia; Fujiyoshi, Akira; Ueshima, Hirotsugu; Muira, Katsuyuki

    2013-01-01

    There is a 42% lower cardiovascular disease (CVD) death rate in Japan compared with the USA. Do physicians report differences in practice management of CVD risk factors in the two countries that might contribute to this difference? CVD risk factor management reported by Japanese versus US primary care physicians was studied. We undertook a descriptive study. An internet-based survey was conducted with physicians from each country. A convenience sample from the Shiga Prefecture in Japan and the state of Ohio in the USA resulted in 48 Japanese and 53 US physicians completing the survey. The survey group may not be representative of a larger sample. The survey demonstrated that 98% of responding Japanese physicians spend <10 minutes performing a patient visit, while 76% of US physicians spend 10 to 20 minutes (P < 0.0001) managing CVD risk factors. Eighty-seven percent of Japanese physicians (vs. 32% of US physicians) see patients in within three months for follow-up (P < 0.0001). Sixty-one percent of Japanese physicians allocate < 30% of visit time to patient education, whereas 60% of US physicians spend > 30% of visit time on patient education (P < 0.0001). Prescriptions are renewed very frequently by Japanese physicians (83% renewing less than monthly) compared with 75% of US physicians who renew medications every one to six months (P < 0.0001). Only 20% of Japanese physicians use practice guidelines routinely compared with 50% of US physicians (P = 0.0413). US physicians report disparities in care more frequently (P < 0.0001). Forty-three percent of Japanese (vs. 10% of US) physicians believe that they have relative freedom to practise medicine (P < 0.0001). Many factors undoubtedly affect CVD in different countries. The dominant ones include social determinants of health, genetics, public health and overall culture (which in turn determine diet, exercise and other factors). Yet the medical care system is an expensive component of society and its role in managing

  11. Demonstration of community pharmacy and managed care organization collaboration on cardiovascular disease risk factor identification using health risk appraisal.

    PubMed

    Dettloff, Rick W; Morse, Jacqueline A

    2009-01-01

    To integrate the resources from a local statewide managed care organization (MCO) and a supermarket pharmacy chain to conduct a comprehensive health risk appraisal (HRA). Collected data were used to assess cardiovascular risk factors and identify disease management opportunities. An analysis to determine the prevalence of risk factors was conducted on a cross-sectional HRA survey. The HRA involved point-of-care cholesterol screening (with a follow-up risk factor questionnaire) conducted by pharmacist employees of the employer group (a regional supermarket chain). Those eligible for the screening were employees of the supermarket chain and their dependents covered by the participating MCO. A total of 12,915 completed HRA questionnaires were received. The mean age of the employees participating was approximately 44 years. Of note, 14%, 24%, 21%, and 69% of questionnaires had abnormal values for total cholesterol, high-density lipoprotein (HDL) cholesterol, blood pressure, and body mass index (BMI), respectively. Compared with national benchmarks, low HDL cholesterol and BMI more than 30 kg/m2 were more common in this cohort. More than one-fourth of the employees in this analysis were identified as being at high risk for a coronary heart disease event. The unique collaboration presented here allowed for an expanded role of pharmacists to implement a quality improvement program. In response, the employer decided to continue the HRA screening and offer a employee contribution reduction-based health incentive to covered members. The employer also is considering offering cardiovascular disease management interventions that will be performed by the supermarket chain's pharmacists and targeted toward the identified risk factor trends.

  12. Conscious worst case definition for risk assessment, part I: a knowledge mapping approach for defining most critical risk factors in integrative risk management of chemicals and nanomaterials.

    PubMed

    Sørensen, Peter B; Thomsen, Marianne; Assmuth, Timo; Grieger, Khara D; Baun, Anders

    2010-08-15

    This paper helps bridge the gap between scientists and other stakeholders in the areas of human and environmental risk management of chemicals and engineered nanomaterials. This connection is needed due to the evolution of stakeholder awareness and scientific progress related to human and environmental health which involves complex methodological demands on risk management. At the same time, the available scientific knowledge is also becoming more scattered across multiple scientific disciplines. Hence, the understanding of potentially risky situations is increasingly multifaceted, which again challenges risk assessors in terms of giving the 'right' relative priority to the multitude of contributing risk factors. A critical issue is therefore to develop procedures that can identify and evaluate worst case risk conditions which may be input to risk level predictions. Therefore, this paper suggests a conceptual modelling procedure that is able to define appropriate worst case conditions in complex risk management. The result of the analysis is an assembly of system models, denoted the Worst Case Definition (WCD) model, to set up and evaluate the conditions of multi-dimensional risk identification and risk quantification. The model can help optimize risk assessment planning by initial screening level analyses and guiding quantitative assessment in relation to knowledge needs for better decision support concerning environmental and human health protection or risk reduction. The WCD model facilitates the evaluation of fundamental uncertainty using knowledge mapping principles and techniques in a way that can improve a complete uncertainty analysis. Ultimately, the WCD is applicable for describing risk contributing factors in relation to many different types of risk management problems since it transparently and effectively handles assumptions and definitions and allows the integration of different forms of knowledge, thereby supporting the inclusion of multifaceted risk

  13. Lifestyle management of erectile dysfunction: the role of cardiovascular and concomitant risk factors.

    PubMed

    Rosen, Raymond C; Friedman, Michael; Kostis, John B

    2005-12-26

    The influence and significance of lifestyle factors in erectile dysfunction (ED) have been demonstrated in cross-sectional and prospective, randomized, controlled trials. Recent epidemiologic studies in several countries have shown that modifiable lifestyle or risk factors, including physical activity in particular, are directly related to the occurrence of ED. In this article, we review several recent observational studies, 2 of which include a longitudinal follow-up component in the study design. The levels of physical activity in both of these studies predicted ED prevalence and incidence. Furthermore, the role of lifestyle changes (weight loss, physical activity) were recently demonstrated to be effective in modifying ED in a prospective, randomized Italian trial in moderately obese, sedentary men. Men without overt diabetes mellitus or cardiovascular disease participated in this landmark study. Other studies have shown that aggressive management of cardiovascular risk factors can increase the effectiveness or outcomes associated with pharmacologic management of ED. Taken together, these studies support the value of risk factor modification and lifestyle change in the clinical management in men with ED and concomitant cardiovascular illness.

  14. Atrial fibrillation in New Zealand primary care: Prevalence, risk factors for stroke and the management of thromboembolic risk.

    PubMed

    Tomlin, Andrew M; Lloyd, Hywel S; Tilyard, Murray W

    2017-02-01

    Background Atrial fibrillation is a major risk factor for stroke and heart disease but there is limited information on its prevalence in New Zealand primary care or the treatment provided to manage thromboembolic risk. Our aim was to estimate the prevalence of atrial fibrillation, assess patient risk for thromboembolism and evaluate the appropriateness of risk reduction using antiplatelet and oral anticoagulation therapy. Design A retrospective cohort study utilising electronic medical records for 739,000 patients registered with 170 general practices in 2014. Methods Patient diagnoses and prescriptions from 2010-2014 were analysed to identify patients with atrial fibrillation in 2014 and co-morbidities included in the CHA2DS2-VASc algorithm. Adjusted prevalence of atrial fibrillation by patient demographic group and the proportion of patients following recommended antithrombotic therapy were calculated. Results 12,712 patients were identified with AF (1.72%, 95% confidence interval 1.69%-1.75%). Prevalence was significantly higher for Maori (odds ratio 1.91, 95% confidence interval 1.80-2.03) than Europeans after adjusting for age, sex, deprivation and clinical risk factors. Stroke risk for Maori and Pacific Island patients was higher than for Europeans across all age groups. Of the 10,406 patients (81.9%) at high risk for thromboembolism, 60.5% were using anticoagulants, 24.1% aspirin monotherapy and 15.4% neither anticoagulants nor aspirin. Oral anticoagulants were used by 31.5% of patients at low risk (CHA2DS2-VASc <2). Conclusions Oral anticoagulants are under-utilised in the management of thromboembolic risk in high risk patients with atrial fibrillation. Better promotion of guideline recommendations for the treatment of patients with atrial fibrillation may be required to improve clinician and patient decision-making.

  15. Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: implications in cardiovascular risk factors management and primary prevention of cardiovascular disease.

    PubMed

    Torres, Tiago; Sales, Rita; Vasconcelos, Carlos; Martins da Silva, Berta; Selores, Manuela

    2013-11-01

    Severe psoriasis has been associated with increase cardiovascular mortality, due to a higher prevalence of traditional cardiovascular risk factors and premature atherosclerosis, as a consequence of its systemic inflammation. Recently, it has been estimated that severe psoriasis may confer an increased 6.2% on long-term risk of cardiovascular disease based on Framingham Risk Score, which can have practical implications in the treatment of cardiovascular risk factors and primary prevention of cardiovascular disease, as treatment guidelines account for the risk of cardiovascular disease in treatment goals. The aim of this study was to analyze the influence of the attributable risk of severe psoriasis on long-term risk of cardiovascular disease and its implication on the correct treatment of cardiovascular risk factors and primary prevention of cardiovascular disease on a real-world cohort of patients. One hundred severe psoriasis patients without psoriatic arthritis or previous cardiovascular disease were evaluated and it was found that more than half of the patients were reclassified to a higher cardiovascular risk category with important clinical implications on the correct management of their cardiovascular risk factors and primary prevention of cardiovascular disease, as a considerable proportion of patients with hypertension, hypercholesterolemia and coronary heart disease equivalent risk were not being correctly managed.

  16. Attitudes, norms and controls influencing lifestyle risk factor management in general practice.

    PubMed

    Ampt, Amanda J; Amoroso, Cheryl; Harris, Mark F; McKenzie, Suzanne H; Rose, Vanessa K; Taggart, Jane R

    2009-08-26

    With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of

  17. Risk factors associated with the incidence of foal mortality in an extensively managed mare herd.

    PubMed Central

    Haas, S D; Bristol, F; Card, C E

    1996-01-01

    The purpose of this study was to determine the incidence of neonatal mortality in a large, extensively managed mare herd and what risk factors were involved in foal mortality. For a 6 wk period between April 18, 1994, and May 31, 1994, 334 foals were born, of which 74 died before reaching 10 d of age, giving an overall mortality of 22% for this period. Seventy four percent of the foal deaths occurred within 48 h of parturition. The major causes of foal mortality included starvation/exposure 27%, septicemia 26%, and dystocia 20%. Weekly incidences varied significantly, ranging from 67% for week 1 to 14% for week 5 (P < 0.01). Other risk factors that were associated with foal death included failure of passive transfer (P < 0.0001), poor mothering ability (P < 0.0001), the presence of dystocia (P < 0.0001), low birth weight (p < 0.05), lack of rainfall (P < 0.01), and low temperatures (P < 0.1). The effect of sire, mare age, mare body condition, and foal sex were not significant risk factors for foal survival (P > 0.1). Further studies are required to determine if changing management procedures will be effective in reducing the incidence of neonatal foal mortality in this extensively managed herd. PMID:8640655

  18. Risk factors and case management of acute diarrhoea in North Gondar Zone, Ethiopia.

    PubMed

    Mediratta, Rishi P; Feleke, Amsalu; Moulton, Lawrence H; Yifru, Sisay; Sack, R Bradley

    2010-06-01

    In Ethiopia, evidence is lacking about maternal care-taking and environmental risk factors that contribute to acute diarrhoea and the case management of diarrhoea. The aim of this study was to identify the risk factors and to understand the management of acute diarrhoea. A pretested structured questionnaire was used for interviewing mothers of 440 children in a prospective, matched, case-control study at the University of Gondar Referral and Teaching Hospital in Gondar, Ethiopia. Results of multivariate analysis demonstrated that children who were breastfed and not completely weaned and mothers who were farmers were protective factors; risk factors for diarrhoea included sharing drinking-water and introducing supplemental foods. Children presented with acute diarrhoea for 3.9 days with 4.3 stools per day. Mothers usually did not increase breastmilk and other fluids during diarrhoea episodes and generally did not take children with diarrhoea to traditional healers. Incorporating messages about the prevention and treatment of acute diarrhoea into child-health interventions will help reduce morbidity and mortality associated with this disease.

  19. Risk Factors and Case Management of Acute Diarrhoea in North Gondar Zone, Ethiopia

    PubMed Central

    Mediratta, Rishi P.; Feleke, Amsalu; Moulton, Lawrence H.; Yifru, Sisay

    2010-01-01

    In Ethiopia, evidence is lacking about maternal care-taking and environmental risk factors that contribute to acute diarrhoea and the case management of diarrhoea. The aim of this study was to identify the risk factors and to understand the management of acute diarrhoea. A pretested structured questionnaire was used for interviewing mothers of 440 children in a prospective, matched, case-control study at the University of Gondar Referral and Teaching Hospital in Gondar, Ethiopia. Results of multivariate analysis demonstrated that children who were breastfed and not completely weaned and mothers who were farmers were protective factors; risk factors for diarrhoea included sharing drinking-water and introducing supplemental foods. Children presented with acute diarrhoea for 3.9 days with 4.3 stools per day. Mothers usually did not increase breastmilk and other fluids during diarrhoea episodes and generally did not take children with diarrhoea to traditional healers. Incorporating messages about the prevention and treatment of acute diarrhoea into child-health interventions will help reduce morbidity and mortality associated with this disease. PMID:20635636

  20. Patients' Adherence to Healthy Behavior in Coronary Heart Disease: Risk Factor Management Among Jordanian Patients.

    PubMed

    Mosleh, Sultan M; Darawad, Muhammad

    2015-01-01

    Poor adherence to risk factor management behaviors for coronary heart disease (CHD) patients increases the risk for a further cardiac event. There is a scarcity of literature about the level of adherence to risk factor management behaviors after CHD diagnosis in Jordan. The aim of this study was to explore which demographic, psychosocial, and clinical factors predict better adherence to risk factor management behaviors, particularly smoking cessation, physical activity, healthy diet, and medication adherence. In addition, we sought to explore the association of poor adherence to hospital readmission. A cross-sectional survey was performed using a sample of 350 patients who visited the outpatient clinics in 4 hospitals in Jordan. Data were obtained from 254 patients (response rate, 73%). Most were overweight (47.8%) or obese (28.5%), and 30% remained smokers after CHD diagnosis; 53 (21.5%) described themselves as ex-smokers. One-third of participants (88, 34.8%) performed regular walking exercise. Only 16% of participants reported that they had been instructed to perform regular activity. Stepwise multiple regressions revealed younger age and lower body mass index as independent predictors for more physical activity. Only 51 (20.9%) reported always following a low-fat dietary regimen, and participants who received dietary recommendation advice were significantly more likely to be on a healthy diet (odds ratio, 10.3; 95% confidence interval, 3.79-30.80; P < .001). Most of the participants (183, 72%) reported low medication adherence (score ≤6), based on the Morisky scale, and only 5 (2%) reported a high adherence score (score = 8). Male gender and having chronic back pain were independent predictors for better medication adherence. About one-third of participants had been hospitalized for cardiac reason at last 2 times in the past 12 months. Rehospitalization was significantly more common among patients who were not following a dietary regimen (Mann-Whitney Z = -2

  1. Incidence, Risk Factors, Management, and Complications of Rectal Injuries During Radical Prostatectomy.

    PubMed

    Mandel, Philipp; Linnemannstöns, Anna; Chun, Felix; Schlomm, Thorsten; Pompe, Raisa; Budäus, Lars; Rosenbaum, Clemens; Ludwig, Tim; Dahlem, Roland; Fisch, Margit; Graefen, Markus; Huland, Hartwig; Tilki, Derya; Steuber, Thomas

    2017-02-07

    Rectal injury (RI) during radical prostatectomy (RP) is a severe complication. So far, only limited data describing the incidence, risk factors, management, and complications of RI are available. In an analysis of data for 24178 patients, we identified 113/24076 patients (0.47%) undergoing open or robotic RP and 7/102 patients (6.86%) after salvage RP who experienced an RI. Besides salvage RP, local tumor stage, Gleason grade, lymph node status, and surgical experience, but not surgical approach (robotic vs open), could be identified as risk factors for RI in univariate and multivariate analysis. Intraoperative management of RI comprised closure with two to three layers. In 13/109 patients (11.9%), a diverting colostomy/ileostomy was carried out. Some 12% of men with closure of an RI developed a recto-anastomosis fistula, and 57% of those who had an additional diverting enterostomy. Thus, the overall incidence of recto-anastomosis fistula after RP was <0.1%. The extent of rectal laceration, prior radiation, and intraoperative signs of rectal infiltration were associated with the development of a subsequent recto-anastomosis fistula. Some 83% of patients with a recto-anastomosis fistula needed further intervention. We analyzed the incidence, risk factors, management, and complications of rectal injury during radical prostatectomy. Overall, the incidence of rectal injury and subsequent development of recto-anastomosis fistulas is low unless the patient has significant risk factors. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  2. Incidental intracardiac thromboemboli during liver transplantation: incidence, risk factors, and management.

    PubMed

    Xia, Victor W; Ho, Jonathan K; Nourmand, Hamid; Wray, Christopher; Busuttil, Ronald W; Steadman, Randolph H

    2010-12-01

    Even though numerous cases of massive thromboemboli have been reported in the literature, intracardiac thromboemboli (ICTs) incidentally found during orthotopic liver transplantation (OLT) have not been examined. In this study, we retrospectively examined the incidence, risk factors, and management of incidental ICTs during OLT. After institutional review board approval, adult patients who underwent OLT between January 2004 and December 2008 at our center were reviewed. ICTs were identified and confirmed by the examination of OLT datasheets, anesthesia records, and recorded transesophageal echocardiography (TEE) clips. The clinical presentation, management, and outcomes of the patients with ICTs were reviewed. Risk factors were analyzed by multivariate logistic regression. During the study period, 426 of the 936 adult OLT patients (45.5%) underwent intraoperative TEE monitoring. Incidental ICTs were identified in 8 of these 426 patients (1.9%). Two ICTs occurred before reperfusion, and 6 ICTs occurred after reperfusion. The treatment was at the discretion of the treating physicians; however, none of the patients received an anticoagulant or thrombolytics. Multivariate analysis identified 2 independent risk factors for intraoperative incidental ICTs: the presence of symptomatic or surgically treated portal hypertension (a history of gastrointestinal bleeding, a transjugular intrahepatic portosystemic shunt procedure, or portocaval shunt surgery) before OLT and intraoperative hemodialysis (odds ratios of 4.05 and 7.29, respectively; P < 0.05 for both). In conclusion, incidental ICTs during OLT occurred at a rate of 1.9% and were associated with several preoperative and intraoperative risk factors. The use of TEE allows early identification, which may be important. Our management for incidental ICTs is described; however, no conclusions can be made about the optimal therapy. Copyright © 2010 American Association for the Study of Liver Diseases.

  3. Work Stress and Risk Factors For Health Management Trainees in Canakkale, Turkey

    PubMed Central

    Tanışman, Beyhan; Cevizci, Sibel; Çelik, Merve; Sevim, Sezgin

    2014-01-01

    Aim: This study aims to investigate the general mental health situation, work-related stress and risk factors of health management trainees. Methods: This cross-sectional study was conducted on Health Management Musters students (N=96) in Canakkale Onsekiz Mart University Health Sciences Institute, May-June 2014. A total of 58 students who voluntarily participated in the study were reached (60.42%). Participants completed a 22-question sociodemographic survey form and a 12-item General Health Questionnaire in a face-to-face interview. Data were analyzed using the SPSS software version 20.0. Results: The average age of participants was 36.4±6.2 (Min:24-Max:62) years. Thirty five of the participants were female (60.3%), 23 were male (39.7%). The number of people using cigarettes and alcohol were 23 (39.7%) and 9 (15.8%) respectively. In our study group according to GHQ scale 32 people (55.2%) were in the group at risk of depression. Eighty-six percent of participants reported experiencing work stress. The most frequently reported sources of stress were superiors (56.8%), work itself (41.3%), and work colleagues (25.8%). There was no significant difference between those at risk of depression and those not at risk in terms of gender, marital status, educational level, age, work-related factors (daily work, computer use, duration of sitting at desk), sleep duration, presence of chronic disease, substance use (cigarettes, alcohol), regular exercise, regular meals, fast-food consumption, sufficient family time and vacations (p>0.05). Conclusions: Our study results indicated that majority of participants reported experiencing work stress with more than half at high risk of developing depression. The most reported risk factors were superiors, the work itself and colleagues in the present study. Psychosocial risk factors at work environment should be investigated in terms of psychological, sociological and ergonomics in more detail to reduce the risk of health management

  4. Management and risk factor control of coronary artery disease in elderly versus nonelderly: a multicenter registry

    PubMed Central

    Phrommintikul, Arintaya; Krittayaphong, Rungroj; Wongcharoen, Wanwarang; Boonyaratavej, Smonporn; Wongvipaporn, Chaiyasith; Tiyanon, Woraporn; Dinchuthai, Pakaphan; Kunjara-Na-Ayudhya, Rapeephon; Tatsanavivat, Pyatat; Sritara, Piyamitr

    2016-01-01

    Background Coronary artery disease (CAD) is a leading cause of death in elderly because aging is the important non-modifiable risk factors of atherosclerosis and also a predictor of poor outcomes. Underuse of guideline directed therapy may contribute to suboptimal risk factor control and worse outcomes in the elderly. We aimed to explore the management of CAD, risk factors control as well as goal attainment in elderly compared to nonelderly CAD patients. Methods The CORE-Thailand is an ongoing multicenter, prospective, observational registry of patients with high atherosclerotic risk in Thailand. The data of 4120 CAD patients enrolled in this cohort was analyzed comparing between the elderly (age ≥ 65 years) vs. nonelderly (age < 65 years). Results There were 2172 elderly and 1948 nonelderly patients. The elderly CAD patients had higher prevalence of hypertension, dyslipidemia, atrial fibrillation and chronic kidney disease. The proportion of patients who received coronary revascularization was not different between the elderly and nonelderly CAD patients. Antiplatelets were prescribed less in the elderly while statin was prescribed in the similar proportion. Goal attainments of risk factor control of glycemic control, low density lipoprotein cholesterol, and smoking cessation except the blood pressure goal were higher in the elderly CAD patients. Conclusions The CORE-Thailand registry showed the equity in the treatment of CAD between elderly and non-elderly. Elderly CAD patients had higher rate of goal attainment in risk factor control except blood pressure goal. The effects of goal attainment on cardiovascular outcomes will be demonstrated from ongoing cohort. PMID:28321237

  5. Pediatric off-label drug use in China: risk factors and management strategies.

    PubMed

    Zhang, Lingli; Li, Youping; Liu, Yi; Zeng, Linan; Hu, Die; Huang, Liang; Chen, Min; Lv, Juan; Yang, Chunsong

    2013-02-01

    To analyze the risk factors of pediatric off-label drug use, and propose management strategies for policy making of the pediatric off-label drug use in China. (i) We applied stratified random sampling to select recipes of children aged 0 to 18 years in pediatric clinics and wards of the West China Second University Hospital in 2010. (ii) All included prescriptions were categorized as off-label use or on-label use, according to the latest package insert licensed by the State Food and Drug Administration. (iii) Risk factors and the weights were calculated using logistic regression. (iv) The correlation between risk factors and the different kinds of off-label prescriptions was presented using adjusted odds ratio, and the impact of the risk factors was measured using standardized partial regression coefficient. (v) SPSS 16.0 was used for statistic analysis. (vi) From the perspective of the medical institutions, pharmaceutical enterprises, professional institutions, and the public, we combined the results of the Evidence-based research on the policy of the off-label drug use in 15 countries and the results of risk factor analysis, in order to propose management strategies for the policy making of pediatric off-label drug use in China. (i) Using the method of sampling, we received 2640 recipes from outpatients and 14,374 prescriptions from 749 inpatients. (ii) The neonates (0 to 27 days) had higher risk in off-label drug use than the other three children age groups. (iii) The dermatological medicines (D), nervous system medicines (N), traditional Chinese medicines, and respiratory drugs (R) were high-risk off-label medicines whose labels should be updated more frequently. (iv) The great factors of off-label drug use are those influence health status and relate to health services (ICD-10:Z00-Z99) (mainly in the clinic of child care and growth development, and in the ward of chemotherapy). (v) Off-label drug use in the ward was 4.4 times than that in clinic service (P < 0

  6. Pancreatic Cancer Risk Factors

    MedlinePlus

    ... Cancer Causes, Risk Factors, and Prevention Pancreatic Cancer Risk Factors A risk factor is anything that affects ... these are risk factors for exocrine pancreatic cancer . Risk factors that can be changed Tobacco use Smoking ...

  7. [Perioperative risk factors and anesthetic management of patients for carotid endarterectomy].

    PubMed

    Niinai, H; Nakagawa, I; Shima, T; Kubota, M; Yamada, K; Kamiya, T; Yoshida, A; Yasuda, T

    1997-05-01

    Data from the records of 142 patients for carotid endarterectomy at Chugoku Rosai General Hospital between 1983 and 1995, were evaluated concerning perioperative risk factors and anesthetic management. As a preoperative anesthetic risk, the incidence of hypertension was the commonest (76%), and there was a significant incidence of ischemic heart disease (18%). Fentanyl and isoflurane have been used for anesthesia recently and the patients were closely observed and cared in the intensive care unit postoperatively. In order to prevent cerebral ischemia during the occlusion of the internal carotid artery, we measured somatosensory evoked potential as well as jugular venous oxygen saturation, and used near infrared spectophotometry. As a result, postoperative mortality and morbidity were 0% and 2%, respectively. The candidates for CEA have potentially high perioperative risks, and it is important to evaluate the coexisting diseases and to select proper anesthetic technic and monitors.

  8. [The status and risk factors of self-health management among community residents in Shenzhen].

    PubMed

    Zhuang, Runsen; Xiang, Yueying; Han, Tieguang; Zhang, Yuan

    2014-07-01

    To analyze the risk factors of the self-health management among Shenzhen's community residents by surveying the status of the self-health management. Multi-stage cluster random sampling was used in this study. The estimated sample size was 6 400 of the study, and the actual number of the subjects was 6 413, who were from 32 communities in Shenzhen. All the subjects were investigated by using a self-devised questionnaire on July 2012. The contents of the questionnaire included sociodemographic characteristics of genders, age, household register, marriage suatus, degrees of education, income, investment of health, family population, the status of self-health management, self-health assessment, illness and injury in the last two weeks, chronic diseases and in hospital last year. Through binary logistic regression, factors influencing the self-health status were analyzed. The proportion of self-health management among the residents was 29.47% (1 890/6 413), and the proportion was 37.26% (392/1 052) among the first ten chronic disease patients. The proportions of diabetes mellitus, anemia, cardiovascular disease, chronic bronchitis and hypertension patients were higher, which were 46.67% (35/75) , 41.94% (26/62), 38.96% (30/77) , 38.95% (37/95) and 38.93% (102/262) respectively. The binary regression analysis results showed that the effect factors of the self-health management were high age (OR = 1.22, 95% CI: 1.15-1.30) , females (OR = 1.20, 95% CI: 1.07-1.34) , high culture (OR = 1.24, 95% CI: 1.15-1.34) , high monthly income (OR = 1.07, 95% CI: 1.00- 1.13) , large family population (OR = 1.23, 95%CI: 1.10-1.38) , household register in Shenzhen (OR = 1.13, 95% CI: 1.00-1.29) , chronic diseases (OR = 1.22, 95% CI: 1.05-1.42). The proportion of self-health management among the community residents in Shenzhen was not high. We should put more effort on construction of health management system, and take action on intervention of the risk factor of health management status.

  9. Management and Outcomes Among Chinese Hospitalized Patients With Established Cardiovascular Disease or Multiple Risk Factors.

    PubMed

    Yang, Jingang; Yang, Yuejin; Gu, Hongqiu; Li, Wei; Hu, Dayi

    2016-02-01

    We assessed the management and outcomes among hospitalized patients with coronary artery disease (CAD), stroke, peripheral artery disease (PAD), or with multiple (≥ 2) cardiovascular (CV) risk factors (multiple risk factors [MRFs]). We retrospectively studied 3732 hospitalized patients of either CV disease or ≥ 2 risk factors for atherothrombosis from October 2004 to January 2005. Outcomes included CV death, myocardial infarction (MI), stroke, and hospitalization for atherothrombotic events. About one-third had disease involving ≥ 1 vascular bed. Medication was more intense in patients with CAD than in others. The lowest use of statins and antiplatelet treatment was in the PAD-only group. Patients with PAD experienced a higher CV mortality (5.1%) than the patients with CAD (3.73%) or stroke (4.1%), P < .001. Cardiovascular death ranged from 1.2% for patients with MRFs, 2.8% for patients with 1-bed disease, 4.7% for patients with 2-bed disease to 6.4% for patients with 3-bed disease (P for trend <.001). For hospitalized patients with established atherosclerotic arterial disease, a substantial increase in CV event rates occurs with increasing numbers of affected arterial beds. Patients with PAD were at an especially high risk.

  10. A novel approach to cardiovascular health by optimizing risk management (ANCHOR): a primary prevention initiative examining the impact of health risk factor assessment and management on cardiac wellness.

    PubMed

    Cox, Jafna L; Carr, Brendan; Vallis, T Michael; Szpilfogel, Claudine; O'Neill, Blair J

    2011-01-01

    Cardiovascular disease (CVD) represents an increasing burden to health care systems. Modifiable risk factors figure prominently in the population-attributable risk for premature coronary artery disease. Primary care is well placed to facilitate CVD risk improvement. We plan to evaluate the ability of a novel primary care intervention providing systematic risk factor screening, risk-weighted behavioural counselling and pharmacological intervention to achieve 2 objectives: (1) optimized management of global CVD risk of patients and (2) increased patient adherence to lifestyle and pharmaceutical interventions aimed at decreasing global CVD risk. A pre-post longitudinal prospective design with a nonrandomized comparison group is being undertaken in 2 geographically diverse primary care practices in Nova Scotia with differing reimbursement models. Participants will complete a readiness to change and pre-post health risk assessment (HRA), that will trigger a 1-year intervention individualized around risk and readiness. The primary outcome will be the proportion of participants with Framingham moderate and high-risk strata that reduce their absolute risk by 10% and 25%, respectively. The secondary outcome will be the proportion of moderate and high-risk participants who reduce their risk category. The impact of the intervention on clinical and behavioural variables will also be examined. Low risk participants will be separately analyzed. Data from participants unable to change from the high risk category because of diabetes mellitus or established atherosclerotic disease will also be analyzed separately, with changes in clinical measures from baseline being assessed. A health economic analysis is planned. Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  11. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

    PubMed Central

    Shaikh, Nissar; Rhaman, M. A.; Raza, Ali; Shabana, Adel; Malstrom, Mahommad Faisal; Al-Sulaiti, Ghanem

    2016-01-01

    Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole

  12. Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland.

    PubMed

    Marques-Vidal, Pedro; Paccaud, Fred

    2012-03-28

    In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the screening and management of cardiovascular risk factors (CVRFs). We thus aimed at assessing geographical levels of CVRFs in Switzerland. Swiss Health Survey for 2007 (N = 17,879). Seven administrative regions were defined: West (Leman), West-Central (Mittelland), Zurich, South (Ticino), North-West, East and Central Switzerland. Obesity, smoking, hypertension, dyslipidemia and diabetes prevalence, treatment and screening within the last 12 months were assessed by interview. After multivariate adjustment for age, gender, educational level, marital status and Swiss citizenship, no significant differences were found between regions regarding prevalence of obesity or current smoking. Similarly, no differences were found regarding hypertension screening and prevalence. Two thirds of subjects who had been told they had high blood pressure were treated, the lowest treatment rates being found in East Switzerland: odds-ratio and [95% confidence interval] 0.65 [0.50-0.85]. Screening for hypercholesterolemia was more frequently reported in French (Leman) and Italian (Ticino) speaking regions. Four out of ten participants who had been told they had high cholesterol levels were treated and the lowest treatment rates were found in German-speaking regions. Screening for diabetes was higher in Ticino (1.24 [1.09 - 1.42]). Six out of ten participants who had been told they had diabetes were treated, the lowest treatment rates were found for German-speaking regions. In Switzerland, cardiovascular risk factor screening and management differ between regions and these differences cannot be accounted for by differences in populations' characteristics. Management of most cardiovascular risk factors could be improved.

  13. Risk factors of mobile phone use while driving in Queensland: Prevalence, attitudes, crash risk perception, and task-management strategies.

    PubMed

    Oviedo-Trespalacios, Oscar; King, Mark; Haque, Md Mazharul; Washington, Simon

    2017-01-01

    Distracted driving is one of the most significant human factor issues in transport safety. Mobile phone interactions while driving may involve a multitude of cognitive and physical resources that result in inferior driving performance and reduced safety margins. The current study investigates characteristics of usage, risk factors, compensatory strategies in use and characteristics of high-frequency offenders of mobile phone use while driving. A series of questions were administered to drivers in Queensland (Australia) using an on-line questionnaire. A total of 484 drivers (34.9% males and 49.8% aged 17-25) participated anonymously. At least one of every two motorists surveyed reported engaging in distracted driving. Drivers were unable to acknowledge the increased crash risk associated with answering and locating a ringing phone in contrast to other tasks such as texting/browsing. Attitudes towards mobile phone usage were more favourable for talking than texting or browsing. Lowering the driving speed and increasing the distance from the vehicle in front were the most popular task-management strategies for talking and texting/browsing while driving. On the other hand, keeping the mobile phone low (e.g. in the driver's lap or on the passenger seat) was the favourite strategy used by drivers to avoid police fines for both talking and texting/browsing. Logistic regression models were fitted to understand differences in risk factors for engaging in mobile phone conversations and browsing/texting while driving. For both tasks, exposure to driving, driving experience, driving history (offences and crashes), and attitudes were significant predictors. Future mobile phone prevention efforts would benefit from development of safe attitudes and increasing risk literacy. Enforcement of mobile phone distraction should be re-engineered, as the use of task-management strategies to evade police enforcement seems to dilute its effect on the prevention of this behaviour. Some

  14. The relationship between microalbuminuria, cardiovascular risk factors and disease management in type 2 diabetes.

    PubMed

    Udenze, I C; Azinge, E C; Ebuehi, O A T; Awolola, N A; Adekola, O O; Menkiti, I; Irurhe, N K

    2012-01-01

    In patients with type 2 diabetes, microalbuminuria is an early clinical sign suggestive of vascular damage to the glomerulus. Microalbuminuria has also been currently reported as an important risk factor for cardiovascular disease and becomes relevant in the management of type 2 diabetes. This study is to determine the prevalence of microalbuminuria, identify the risk factors associated with microalbuminuria in type 2 diabetes, and to asses the achievement of treatment goals for cardiovascular risk reduction in type 2 diabetics. Seventy- two subjects with microalbuminuria were recruited from three hundred consecutively screened type 2 diabetics attending the Diabetic Clinic at the Lagos University Teaching Hospital. Clinical data were obtained by interviewing the participants. Anthropometric measurements were made and blood specimens were collected for analysis. The prevalence of microalbuminuria was twenty-four percent (24%) in type 2 diabetes. Multiple logistic regression identified duration of diabetes (odds ratio 1.3 (95% CI; 0.03-1.58), hypertension(odds ratio 5.2 (95% Cl; 1.24-18.62), Body mass index (BMI) (odds ratio 1.27 (95% CI; 1.0-1.6), waist/hip ratio (WHR) (odds ratio 1.9 (95% Cl; 1.3-3.5), andHbA,c (odds ratio 6.6 (95% Cl; 1.02-27) as independent risk factors associated with microalbuminuria in type 2 diabetics. Optimum blood pressure, glycemic and weight control were achieved in eighty five percent (85%), fifty eight percent (58%) and nineteen percent (19%) of the type 2 diabetes respectively. This study showed that microalbuminuria is common among patients with type 2 diabetes. It also showed improvement in glycemic control and modifiable cardiovascular risk factor control when compared with previous studies.

  15. Risk factors and monitoring for water quality to determine best management practices for splash parks.

    PubMed

    de Man, H; Leenen, E J T M; van Knapen, F; de Roda Husman, A M

    2014-09-01

    Splash parks have been associated with infectious disease outbreaks as a result of exposure to poor water quality. To be able to protect public health, risk factors were identified that determine poor water quality. Samples were taken at seven splash parks where operators were willing to participate in the study. Higher concentrations of Escherichia coli were measured in water of splash parks filled with rainwater or surface water as compared with sites filled with tap water, independent of routine inspection intervals and employed disinfection. Management practices to prevent fecal contamination and guarantee maintaining good water quality at splash parks should include selection of source water of acceptable quality.

  16. Management Status of Cardiovascular Disease Risk Factors for Dyslipidemia among Korean Adults.

    PubMed

    Lee, Jongseok; Son, Heejeong; Ryu, Ohk Hyun

    2017-03-01

    Dyslipidemia, hypertension, and diabetes are well-established risk factors for cardiovascular disease (CVD). This study investigated the prevalence and management status of these factors for dyslipidemia among Korean adults aged 30 years old and older. The prevalence and management status of dyslipidemia, hypertension, and diabetes were analyzed among 12229 subjects (≥30 years) participating in the Korea National Health and Nutrition Survey 2010-2012. Dyslipidemia was defined according to treatment criteria rather than diagnostic criteria in Korea. Therefore, hyper-low-density lipoprotein (LDL) cholesterolemia was defined if LDL cholesterol levels exceeded the appropriate risk-based threshold established by the National Cholesterol Education Program Adult Treatment Panel III. The age-standardized prevalence was highest for dyslipidemia (39.6%), followed by hypertension (32.8%) and diabetes (9.8%). The lowest patient awareness was found for dyslipidemia (27.9%). The treatment rate was 66.5% for diabetes and 57.3% for hypertension, but only 15.7% for dyslipidemia. The control rate among those undergoing treatment was highest for hypertension (64.2%), followed by dyslipidemia (59.2%) and diabetes (22.1%). The higher the risk levels of CVD were, the lower the control rate of dyslipidemia. While the prevalence of dyslipidemia was higher than hypertension and diabetes, awareness and treatment rates thereof were lower. Higher CVD-risk categories showed lower control rates of dyslipidemia. In order to improve awareness and control rates of dyslipidemia, diagnostic criteria should be reconciled with treatment targets based on cardiovascular risk in Korean populations.

  17. Management Status of Cardiovascular Disease Risk Factors for Dyslipidemia among Korean Adults

    PubMed Central

    Lee, Jongseok

    2017-01-01

    Purpose Dyslipidemia, hypertension, and diabetes are well-established risk factors for cardiovascular disease (CVD). This study investigated the prevalence and management status of these factors for dyslipidemia among Korean adults aged 30 years old and older. Materials and Methods The prevalence and management status of dyslipidemia, hypertension, and diabetes were analyzed among 12229 subjects (≥30 years) participating in the Korea National Health and Nutrition Survey 2010–2012. Dyslipidemia was defined according to treatment criteria rather than diagnostic criteria in Korea. Therefore, hyper-low-density lipoprotein (LDL) cholesterolemia was defined if LDL cholesterol levels exceeded the appropriate risk-based threshold established by the National Cholesterol Education Program Adult Treatment Panel III. Results The age-standardized prevalence was highest for dyslipidemia (39.6%), followed by hypertension (32.8%) and diabetes (9.8%). The lowest patient awareness was found for dyslipidemia (27.9%). The treatment rate was 66.5% for diabetes and 57.3% for hypertension, but only 15.7% for dyslipidemia. The control rate among those undergoing treatment was highest for hypertension (64.2%), followed by dyslipidemia (59.2%) and diabetes (22.1%). The higher the risk levels of CVD were, the lower the control rate of dyslipidemia. Conclusion While the prevalence of dyslipidemia was higher than hypertension and diabetes, awareness and treatment rates thereof were lower. Higher CVD-risk categories showed lower control rates of dyslipidemia. In order to improve awareness and control rates of dyslipidemia, diagnostic criteria should be reconciled with treatment targets based on cardiovascular risk in Korean populations. PMID:28120563

  18. Heart disease - risk factors

    MedlinePlus

    Heart disease - prevention; CVD - risk factors; Cardiovascular disease - risk factors; Coronary artery disease - risk factors; CAD - risk ... a certain health condition. Some risk factors for heart disease you cannot change, but some you can. ...

  19. Common risk factors in the management of periodontal and associated systemic diseases: the dental setting and interprofessional collaboration.

    PubMed

    Genco, Robert J; Genco, Frances Doherty

    2014-06-01

    There is a role for dentistry in the interprofessional management of chronic diseases by addressing common risk factors A critical scientific foundation has developed for management of risk factors common to major diseases including periodontal disease, caries, diabetes, heart disease, and cancer. The purpose of this paper is to critically review this scientific literature. This will provide the basis for the current and future role of the dental setting in common risk factor identification and modification; with an emphasis on the role of the dental hygienist. A systematic review of the literature and analysis of the relevant papers was undertaken to support the recommendations. We propose that the appropriate risk factor management procedures be adopted in the dental setting for smoking cessation, reduction of sugar consumption, and weight control in those patients at risk for one or a combination of the following diseases: periodontal disease, caries, diabetes, heart disease and certain cancers. Copyright © 2014. Published by Mosby, Inc.

  20. Low back pain in older adults: risk factors, management options and future directions.

    PubMed

    Wong, Arnold Yl; Karppinen, Jaro; Samartzis, Dino

    2017-01-01

    Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people.

  1. Pancreatic fistula after pancreatectomy: definitions, risk factors, preventive measures, and management-review.

    PubMed

    Machado, Norman Oneil

    2012-01-01

    Resection of pancreas, in particular pancreaticoduodenectomy, is a complex procedure, commonly performed in appropriately selected patients with benign and malignant disease of the pancreas and periampullary region. Despite significant improvements in the safety and efficacy of pancreatic surgery, pancreaticoenteric anastomosis continues to be the "Achilles heel" of pancreaticoduodenectomy, due to its association with a measurable risk of leakage or failure of healing, leading to pancreatic fistula. The morbidity rate after pancreaticoduodenectomy remains high in the range of 30% to 65%, although the mortality has significantly dropped to below 5%. Most of these complications are related to pancreatic fistula, with serious complications of intra-abdominal abscess, postoperative bleeding, and multiorgan failure. Several pharmacological and technical interventions have been suggested to decrease the pancreatic fistula rate, but the results have been controversial. This paper considers definition and classification of pancreatic fistula, risk factors, and preventive approach and offers management strategy when they do occur.

  2. Muscle cramping in athletes--risk factors, clinical assessment, and management.

    PubMed

    Schwellnus, Martin P; Drew, Nichola; Collins, Malcolm

    2008-01-01

    Exercise associated muscle cramping (EAMC) is defined as a painful, spasmodic, and involuntary contraction of skeletal muscle that occurs during or immediately after exercise. There is a high lifetime prevalence of EAMC in athletes, specifically in endurance athletes. The most important risk factors for EAMC in athletes are a previous history of EAMC, and performing exercise at a higher relative exercise intensity or duration, when compared with normal training and participating in hot and humid environmental conditions. The diagnosis of EAMC is made clinically, and the most effective immediate management of EAMC is rest and passive stretching. The key to the prevention of EAMC is to reduce the risk of developing premature muscle fatigue.

  3. A Systematic Review and Meta-Analysis on Self-Management for Improving Risk Factor Control in Stroke Patients.

    PubMed

    Sakakibara, Brodie M; Kim, Amy J; Eng, Janice J

    2017-02-01

    The aims of this review were to describe the self-management interventions used to improve risk factor control in stroke patients and quantitatively assess their effects on the following: 1) overall risk factor control from lifestyle behaviour (i.e. physical activity, diet and nutrition, stress management, smoking, alcohol, and medication adherence), and medical risk factors (i.e. blood pressure, cholesterol, blood glucose) and (2) individual risk factors. We systematically searched the PubMed, PsycINFO, CINAHL and Cochrane Database of Systematic Reviews databases to September 2015 to identify relevant randomized controlled trials investigating self-management to improve stroke risk factors. The self-management interventions were qualitatively described, and the data included in meta-analyses. Fourteen studies were included for review. The model estimating an effect averaged across all stroke risk factors was not significant, but became significant when four low-quality studies were removed (SMD = 0.10 [95 % CI = 0.02 to 0.17], I (2) = 0 %, p = 0.01). Subgroup analyses revealed a significant effect of self-management interventions on lifestyle behaviour risk factors (SMD = 0.15 [95 % CI = 0.04 to 0.25], I (2) = 0 %, p = 0.007) but not medical risk factors. Medication adherence was the only individual risk factor that self-management interventions significantly improved (SMD = 0.31 [95 % CI = 0.07 to 0.56], I (2) = 0 %, p = 0.01). Self-management interventions appear to be effective at improving overall risk factor control; however, more high-quality research is needed to corroborate this observation. Self-management has a greater effect on lifestyle behaviour risk factors than medical risk factors, with the largest effect at improving medication adherence.

  4. Ovarian Hyperstimulation Syndrome: Current Views on Pathophysiology, Risk Factors, Prevention, and Management

    PubMed Central

    Alper, Michael M; Smith, Laura P; Sills, Eric Scott

    2009-01-01

    Objective: To summarize current views on the pathophysiology, risk factors, prevention, clinical features, and management of Ovarian Hyperstimulation Syndrome (OHSS). Design: Literature review Results: OHSS is a condition characterized by increased capillary permeability, and experimental evidence has identified a provocative link to pathologic vasoactive cytokine actions. Although the ultimate physiologic mechanism of OHSS is not yet known, there are well-known risk factors that must be considered during the administration of medications to treat infertility. Clinical features are consequences of third-spaced intravascular fluid, and OHSS may become life-threatening secondary to thromboembolism or compromised pulmonary or cardiovascular function. Cornerstones of prevention have historically included cycle cancellation, coasting, decreased dosing of human chorionic gonadotropin (hCG) trigger, use of an agonist trigger, and cryopreservation of all embryos. Newer methods of prevention include the administration of a dopamine agonist medication. Management options for OHSS include outpatient transvaginal paracentesis, outpatient transabdominal paracentesis, and inpatient hospitalization with or without paracentesis. Conclusions: OHSS continues to be a serious complication of assisted reproductive therapy (ART), with no universally agreed upon best method of prevention. Coasting and cryopreservation of all embryos are the most commonly used approaches in the literature, but cycle cancellation is the only method that can completely prevent the development of OHSS. Dopamine agonists are currently being investigated to both prevent and improve the clinical course in OHSS. Recent publications suggest that outpatient paracentesis both prevents the need for inpatient hospitalization and is a cost-effective strategy. PMID:20485578

  5. Management of cardiovascular risk factors is leaving the office: potential impact of telemedicine.

    PubMed

    Krakoff, Lawrence R

    2011-11-01

    Effective control of hypertension and the other cardiovascular risk factors has been dependent on primary medical care as provided by family practitioners and internists. The progressive reduction in availability of primary care for adult populations in the United States threatens the likelihood of better control of the risk factors and potential loss of opportunity for prevention of cardiovascular disease. Recent progress has been made in the use of home blood pressure monitoring for improvement in classification of risk for hypertensive patients. Several studies establish the feasibility of home pressure monitoring combined with telemedicine for improving control of hypertension. Some studies have explored the role of self-care for adjustment of medication, as well. The potential growth of this strategy for effective control of hypertension with reduced need for face-to-face encounter time in primary care is a promising solution to the reduction in primary care providers. Management of hyperlipidemia and diabetes by telemedicine is also being explored, particularly for rural areas, but may also be effective in urban settings. Development of technology for home monitoring together with electronic communication to providers and mechanisms for education, feedback, and warnings offers a promising solution to the possible crisis in prevention of cardiovascular disease due to the loss of traditional primary care. © 2011 Wiley Periodicals, Inc.

  6. Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality.

    PubMed

    Yumun, Gunduz; Erdolu, Burak; Toktas, Faruk; Eris, Cuneyt; Ay, Derih; Turk, Tamer; As, Ahmet Kagan

    2014-08-01

    Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery. Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated. In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE. Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.

  7. Challenges and Opportunities in the Management of Cardiovascular Risk Factors in Youth with Type 1 Diabetes: Lifestyle and Beyond

    PubMed Central

    Katz, Michelle; Giani, Elisa; Laffel, Lori

    2016-01-01

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in persons with type 1 diabetes (T1D). Specific risk factors associated with diabetes, such as hyperglycemia and kidney disease, have been demonstrated to increase the incidence and progression of CVD. Nevertheless, few data exist on the effects of traditional risk factors such as dyslipidemia, obesity and hypertension on CVD risk in youth with T1D. Improvements in understanding and approaches to the evaluation and management of CVD risk factors, specifically for young persons with T1D, are desirable. Recent advances in non-invasive techniques to detect early vascular damage, such as the evaluation of endothelial dysfunction and aortic or carotid intima media thickness, provide new tools to evaluate the progression of CVD in childhood. In the present review, current CVD risk factor management, challenges, and potential therapeutic interventions in youth with T1D are described. PMID:26520142

  8. Risk factors and management of vaginal mesh erosion after pelvic organ prolapse surgery.

    PubMed

    Cheng, Yung-Wen; Su, Tsung-Hsien; Wang, Hsuan; Huang, Wen-Chu; Lau, Hui-Hsuan

    2017-04-01

    Mesh erosion is a serious and not uncommon complication in women undergoing vaginal mesh repair. We hypothesized that mesh erosion is associated with the patient's comorbidities, surgical procedures, and mesh material. The aims of this study were to identify the risk factors and optimal management for mesh erosion. All women who underwent vaginal mesh repair from 2004 to 2014 were retrospectively reviewed. Data on patients' characteristics, presenting symptoms, treatment and outcomes were collected from their medical records. A total of 741 women underwent vaginal mesh repairs, of whom 47 had mesh erosion. The median follow-up period was 13 months (range 3-84 months). Another nine patients with mesh erosion were referred form other hospitals. Multivariate analysis revealed that concomitant hysterectomy (odds ratio 27.02, 95% confidence interval 12.35-58.82; p < 0.01) and hypertension (odds ratio 5.95, 95% confidence interval 2.43-14.49; p < 0.01) were independent risk factors for mesh erosion. Of these 56 women, 20 (36%) were successfully treated by conservative management, while 36 (64%) required subsequent surgical revision. Compared with surgery, conservative treatment was successful if the size of the erosion was smaller than 0.5 cm (p < 0.01). Six patients (17%) had recurrent erosions after primary revision, but all successfully healed after the second surgery. Concomitant hysterectomy and hypertension were associated with mesh erosion. In the management of mesh erosion, conservative treatment can be tried as the first-line treatment for smaller erosions, while surgical repair for larger erosions. Recurrent erosions could happen and requires repairs several times. Copyright © 2017. Published by Elsevier B.V.

  9. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases.

    PubMed

    Patel, Amit R; Alton, Timothy B; Bransford, Richard J; Lee, Michael J; Bellabarba, Carlo B; Chapman, Jens R

    2014-02-01

    Spinal epidural abscess (SEA) is a rare, serious and increasingly frequent diagnosis. Ideal management (medical vs. surgical) remains controversial. The purpose of this study is to assess the impact of risk factors, organisms, location and extent of SEA on neurologic outcome after medical management or surgery in combination with medical management. Retrospective electronic medical record (EMR) review. We included 128 consecutive, spontaneous SEA from a single tertiary medical center, from January 2005 to September 11. There were 79 male and 49 female with a mean age of 52.9 years (range, 22-83). Patient demographics, presenting complaints, radiographic features, pre/post-treatment neurologic status (ASIA motor score [MS] 0-100), treatment (medical vs. surgical) and clinical follow-up were recorded. Neurologic status was determined before treatment and at last available clinical encounter. Imaging studies reviewed location/extent of pathology. Inclusion criteria were a diagnosis of a bacterial SEA based on radiographs and/or intraoperative findings, age greater than 18 years, and adequate EMR. Exclusion criteria were postinterventional infections, Pott's disease, isolated discitis/osteomyelitis, treatment initiated at an outside facility, and imaging suggestive of a SEA but negative intraoperative findings/cultures. The mean follow-up was 241 days. The presenting chief complaint was site-specific pain (100%), subjective fevers (50%), and weakness (47%). In this cohort, 54.7% had lumbar, 39.1% thoracic, 35.9% cervical, and 23.4% sacral involvement spanning an average of 3.85 disc levels. There were 36% ventral, 41% dorsal, and 23% circumferential infections. Risk factors included a history of IV drug abuse (39.1%), diabetes mellitus (21.9%), and no risk factors (22.7%). Pathogens were methicillin-sensitive Staphylococcus aureus (40%) and methicillin-resistance S aureus (30%). Location, SEA extent, and pathogen did not impact MS recovery. Fifty-one patients were

  10. Risk Factors

    MedlinePlus

    ... has been linked to some cancers: Links between air pollution and cancer risk have been found. These include ... between lung cancer and secondhand tobacco smoke , outdoor air pollution, and asbestos . Drinking water that contains a large ...

  11. SURF - SUrvey of Risk Factor management: first report of an international audit.

    PubMed

    Cooney, Mt; Reiner, Z; Sheu, W; Ryden, L; Sutter, J de; De Bacquer, D; DeBacker, G; Mithal, A; Chung, N; Lim, Yt; Dudina, A; Reynolds, A; Dunney, K; Graham, I

    2014-07-01

    Despite the fact that subjects with established coronary heart disease (CHD) are at high risk of further events and deserve meticulous secondary prevention, current audits such as EUROASPIRE show poor control of major risk factors. Ongoing monitoring is required. We present a new risk factor audit system, SURF (Survey of Risk Factor management), that can be conducted much more quickly and easily than existing audit systems and has the potential to allow hospitals of all sizes to participate in a unified international audit system that will complement EUROASPIRE. Initial experience indicates that SURF is truly simple to undertake in an international setting, and this is illustrated with the results of a substantive pilot project conducted in Europe and Asia. The data collection system was designed to allow rapid and easy data collection as part of routine clinic work. Consecutive patients (aged 18 and over) with established CHD attending outpatient cardiology clinics were included. Information on demographics, previous coronary medical history, smoking history, history of hypertension, dyslipidaemia or diabetes, physical activity, attendance at cardiac rehabilitation, cardiac medications, lipid and glucose levels (and HbA1c in diabetics) if available within the last year, blood pressure, heart rate, body mass index, and waist circumference were collected using a one-page data collection sheet. Years spent in full time education was added as an additional question during the pilot phase. Three European countries - Ireland (n = 251), Belgium (n = 122), and Croatia (n = 124) - and four Asian countries - Singapore (n = 142), Taiwan (n = 334), India (n = 97), and Korea (n = 45) - were included in the pilot study. The results of initial field testing were confirmed in that it proved possible to collect data within 60-90 seconds per subject. There was poor control of several risk factors including high levels of physical inactivity (41

  12. NASA's Risk Management System

    NASA Technical Reports Server (NTRS)

    Perera, Jeevan S.

    2011-01-01

    Leadership is key to success. Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks -- risk office personnel. Each group is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk reporting and communication is an essential element of risk management and will combine both qualitative and quantitative elements. Risk informed decision making should be introduced to all levels of management. Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner. Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

  13. Critical Success Factors for an Effective Security Risk Management Program in an Organization: An Exploratory Case Study

    ERIC Educational Resources Information Center

    Zafar, Humayun

    2010-01-01

    This study investigates differences in perception between layers of management (executive, middle, and lower) and staff with regard to the influence of critical success factors (CSFs) on security risk management (SRM) effectiveness. This is an in-depth case study conducted at a Fortune 500 company. Rockart's (1979) CSF method is modified through…

  14. Critical Success Factors for an Effective Security Risk Management Program in an Organization: An Exploratory Case Study

    ERIC Educational Resources Information Center

    Zafar, Humayun

    2010-01-01

    This study investigates differences in perception between layers of management (executive, middle, and lower) and staff with regard to the influence of critical success factors (CSFs) on security risk management (SRM) effectiveness. This is an in-depth case study conducted at a Fortune 500 company. Rockart's (1979) CSF method is modified through…

  15. Sex differences in risk factor management of coronary heart disease across three regions.

    PubMed

    Zhao, Min; Vaartjes, Ilonca; Graham, Ian; Grobbee, Diederick; Spiering, Wilko; Klipstein-Grobusch, Kerstin; Woodward, Mark; Peters, Sanne Ae

    2017-10-01

    To investigate whether there are sex differences in risk factor management of patients with established coronary heart disease (CHD), and to assess demographic variations of any potential sex differences. Patients with CHD were recruited from Europe, Asia, and the Middle East between 2012-2013. Adherence to guideline-recommended treatment and lifestyle targets was assessed and summarised as a Cardiovascular Health Index Score (CHIS). Age-adjusted regression models were used to estimate odds ratios for women versus men in risk factor management. 10 112 patients (29% women) were included. Compared with men, women were less likely to achieve targets for total cholesterol (OR 0.50, 95% CI 0.43 to 0.59), low-density lipoprotein cholesterol (OR 0.57, 95% CI 0.51 to 0.64), and glucose (OR 0.78, 95% CI 0.70 to 0.87), or to be physically active (OR 0.74, 95% CI 0.68 to 0.81) or non-obese (OR 0.82, 95% CI 0.74 to 0.90). In contrast, women had better control of blood pressure (OR 1.31, 95% CI 1.20 to 1.44) and were more likely to be a non-smoker (OR 1.93, 95% CI 1.67 to 2.22) than men. Overall, women were less likely than men to achieve all treatment targets (OR 0.75, 95% CI 0.60 to 0.93) or obtain an adequate CHIS (OR 0.81, 95% CI 0.73 to 0.91), but no significant differences were found for all lifestyle targets (OR 0.93, 95% CI 0.84 to 1.02). Sex disparities in reaching treatment targets were smaller in Europe than in Asia and the Middle East. Women in Asia were more likely than men to reach lifestyle targets, with opposing results in Europe and the Middle East. Risk factor management for the secondary prevention of CHD was generally worse in women than in men. The magnitude and direction of the sex differences varied by region. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Risk factors of mobile phone use while driving in Queensland: Prevalence, attitudes, crash risk perception, and task-management strategies

    PubMed Central

    King, Mark; Haque, Md. Mazharul; Washington, Simon

    2017-01-01

    Distracted driving is one of the most significant human factor issues in transport safety. Mobile phone interactions while driving may involve a multitude of cognitive and physical resources that result in inferior driving performance and reduced safety margins. The current study investigates characteristics of usage, risk factors, compensatory strategies in use and characteristics of high-frequency offenders of mobile phone use while driving. A series of questions were administered to drivers in Queensland (Australia) using an on-line questionnaire. A total of 484 drivers (34.9% males and 49.8% aged 17–25) participated anonymously. At least one of every two motorists surveyed reported engaging in distracted driving. Drivers were unable to acknowledge the increased crash risk associated with answering and locating a ringing phone in contrast to other tasks such as texting/browsing. Attitudes towards mobile phone usage were more favourable for talking than texting or browsing. Lowering the driving speed and increasing the distance from the vehicle in front were the most popular task-management strategies for talking and texting/browsing while driving. On the other hand, keeping the mobile phone low (e.g. in the driver’s lap or on the passenger seat) was the favourite strategy used by drivers to avoid police fines for both talking and texting/browsing. Logistic regression models were fitted to understand differences in risk factors for engaging in mobile phone conversations and browsing/texting while driving. For both tasks, exposure to driving, driving experience, driving history (offences and crashes), and attitudes were significant predictors. Future mobile phone prevention efforts would benefit from development of safe attitudes and increasing risk literacy. Enforcement of mobile phone distraction should be re-engineered, as the use of task-management strategies to evade police enforcement seems to dilute its effect on the prevention of this behaviour. Some

  17. Bone diseases associated with human immunodeficiency virus infection: pathogenesis, risk factors and clinical management.

    PubMed

    Bongiovanni, Marco; Tincati, Camilla

    2006-06-01

    Bone disorders such as osteopenia and osteoporosis have been recently reported in patients infected with the human immunodeficiency virus (HIV), but their etiology remains still unknown. The prevalence estimates vary widely among the different studies and can be affected by concomitant factors such as the overlapping of other possible conditions inducing bone loss as lypodystrophy, advanced HIV-disease, advanced age, low body weight or concomitant use of other drugs. All the reports at the moment available in the literature showed a higher than expected prevalence of reduced bone mineral density (BMD) in HIV-infected subjects both naïve and receiving potent antiretroviral therapy compared to healthy controls. This controversial can suggest a double role played by both antiretroviral drugs and HIV itself due to immune activation and/or cytokines disregulation. An improved understanding of the pathogenesis of bone disorders can result in better preventative and therapeutic measures. However, the clinical relevance and the risk of fractures remains undefined in HIV-population. The clinical management of osteopenia and osteoporosis in HIV-infected subjects is still being evaluated. Addressing potential underlying bone disease risk factors (e.g., smoking and alcohol intake, use of corticosteroids, advanced age, low body weight), evaluating calcium and vitamin D intake, and performing dual x-ray absorptiometry in HIV-infected individuals who have risk factors for bone disease can be important strategies to prevent osteopenia and osteoporosis in this population. The administration of bisphosphonates (e.g., alendronate), with calcium and vitamin D supplementation, may be a reasonable and effective option to treat osteoporosis in these subjects.

  18. Risk factors and management for pyloric stenosis occurred after endoscopic submucosal dissection adjacent to pylorus

    PubMed Central

    Lee, Jae Un; Park, Moon Sik; Yun, So Hee; Yang, Min A.; Han, Shang Hoon; Lee, Young Jae; Jung, Gum Mo; Kim, Ji Woong; Cho, Yong Keun; Cho, Jin Woong

    2016-01-01

    Abstract Endoscopic submucosal dissection (ESD) has been widely accepted as a curative treatment for gastric neoplasm. Pyloric stenosis is a chronic complication that can be caused by ESD. The aim of this study is to clarify the risk factors and management for pyloric stenosis. From January 2004 to January 2014, a total of 126 patients who underwent ESD adjacent to pylorus were reviewed retrospectively. Pyloric mucosal defect was defined as when any resection margin of ESD was involved in the pyloric ring. Pyloric stenosis was defined as when a conventional endoscope could not be passed to the duodenum. Among the 126 patients, pyloric stenosis was identified in 9. In a univariate analysis, pyloric stenosis was more common in older patients (P < 0.05) and in lesions with resections over 75% of the pyloric ring circumference (P < 0.001). In a multivariate analysis, the factor that was associated with pyloric stenosis was the extent of the pyloric ring dissection (P < 0.001). Four of the 9 patients with pyloric stenosis had mild dyspepsia, and the others had gastric outlet obstruction symptoms. The 5 symptomatic patients underwent endoscopic balloon dilation (EBD), and the frequency of EBD was 1 to 8 times. The asymptomatic patients were treated conservatively. The incidence of pyloric stenosis was higher in lesions with resections over 75% of the pyloric ring circumference. Although EBD was an effective treatment for pyloric stenosis, conservative management was also helpful in patients who had mild symptoms. PMID:27977608

  19. Using risk management files to identify and address causative factors associated with adverse events in pediatrics

    PubMed Central

    Hain, Paul D; Pichert, James W; Hickson, Gerald B; Bledsoe, Sandra H; Hamming, David; Hathaway, Jacob; Nguyen, Carolyn

    2007-01-01

    We report a retrospective analysis of 84 consecutive pediatrics-related internal review files opened by a medical center’s risk managers between 1996 and 2001. The aims were to identify common causative factors associated with adverse events/adverse outcomes (AEs) in a Pediatrics Department, then suggest ways to improve care. The main outcome was identification of any patterns of factors that contributed to AEs so that interventions could be designed to address them. Cases were noted to have at least one apparent contributing problem; the most common were with communication (44% of cases), diagnosis and treatment (37%), medication errors (20%), and IV/Central line issues (17%). 45% of files involved a child with an underlying diagnosis putting her/him at high risk for an adverse outcome. All Pediatrics Departments face multiple challenges in assuring consistent quality care. The extent to which the data generalize to other institutions is unknown. However, the data suggest that systematic analysis of aggregated claims files may help identify and drive opportunities for improvement in care. PMID:18472985

  20. Postoperative Arrhythmias after Cardiac Surgery: Incidence, Risk Factors, and Therapeutic Management

    PubMed Central

    Cianflone, Domenico

    2014-01-01

    Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. In this setting, atrial fibrillation is the most common heart rhythm disorder. Postoperative atrial fibrillation is often self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. However, ventricular arrhythmias and conduction disturbances can also occur. Sustained ventricular arrhythmias in the recovery period after cardiac surgery may warrant acute treatment and long-term preventive strategy in the absence of reversible causes. Transient bradyarrhythmias may be managed with temporary pacing wires placed at surgery, but significant and persistent atrioventricular block or sinus node dysfunction can occur with the need for permanent pacing. We provide a complete and updated review about mechanisms, risk factors, and treatment strategies for the main postoperative arrhythmias. PMID:24511410

  1. Dystocia in labour - risk factors, management and outcome: a retrospective observational study in a Swedish setting.

    PubMed

    Selin, Lotta; Wallin, Gunnar; Berg, Marie

    2008-01-01

    Labour dystocia (LD) is associated with adverse maternal and child outcomes. This study investigated obstetric risk factors, frequency of interventions and delivery outcomes for LD. A retrospective, observational, study of 1,480 deliveries was undertaken in a Swedish district hospital during 2000 and 2001. LD was identified in 21% of deliveries, 16.7% of which ended in caesarean section (CS) compared to 1.7% of deliveries without LD. Multiparity with no previous vaginal delivery (OR=6.0), epidural analgesia (EDA) at cervical dilation < or =5 cm (OR=4.6), primiparity (OR=4.5), gestational age > or =42 weeks (OR=3.1), birth weight >4,000 g (OR=2.7) and EDA at cervical dilation >5 cm (OR=2.0) were major independent risk factors for LD. In delivery management, special attention should be directed to primiparous women and multiparous women with no previous vaginal delivery. Women given EDA, especially at cervical dilation < or =5 cm are also of particular interest. Furthermore, rigorous routines for LD diagnosis and oxytocin augmentation are important.

  2. Local recurrence following mastectomy and autologous breast reconstruction: incidence, risk factors, and management

    PubMed Central

    Wu, Siyu; Mo, Miao; Wang, Yujie; Zhang, Na; Li, Jianwei; Di, Genhong; Shao, Zhimin; Wu, Jiong; Liu, Guangyu

    2016-01-01

    Background Breast reconstruction (BR), including autologous breast reconstruction (ABR) after mastectomy (MST), has been gaining popularity all around the world, especially in the People’s Republic of China during the past decade. However, there is a small proportion, but a significant number, of patients who develop local recurrence (LR) of breast cancer postoperatively. The purpose of this study is to examine the incidence of LR, discuss risk factors associated with LR, and management of LR following MST and ABR. Methods A total of 397 patients who underwent MST and ABR after diagnosis of breast cancer were included in this retrospective study. Data were analyzed by the Kaplan–Meier method, the log-rank statistical test, and Cox proportional hazards model. Results From January 1999 to December 2011, 400 ABRs were performed in 397 patients in Fudan University Shanghai Cancer Center. The median follow-up time in the study was 3.6 years. LR occurred in 11 of 397 patients, with a median time to LR of 2.9 years. In univariate and multivariate analyses, tumor stage, hormonal therapy (yes or no), and tumor type (multifocal or nonmultifocal) were significantly associated with LR after ABR following MST. Conclusion ABR is an oncologically safe surgical procedure with an acceptable LR rate of 2.8%. Risk factors associated with high rate of LR were higher tumor stage, absence of hormonal therapy, and multifocal tumor type. PMID:27853377

  3. Renal artery stenosis: prevalence of, risk factors for, and management of in-stent stenosis.

    PubMed

    Boateng, Frank K; Greco, Barbara A

    2013-01-01

    Atherosclerotic renal artery stenosis is common and is associated with hypertension and chronic kidney disease. More frequent use of percutaneous renal artery stent placement for the treatment of renal artery stenosis during the past 2 decades has increased the number of patients with implanted stents. In-stent stenosis is a serious problem, occurring more frequently than earlier reports suggest and potentially resulting in late complications. Currently, there are no guidelines covering the approach to restenosis after renal artery stent placement. This article reviews data on the prevalence of and risk factors for the development of in-stent stenosis and the clinical manifestations, evaluation, and treatment of in-stent stenosis and suggests a strategy for the management of patients after percutaneous renal artery stent placement. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  4. [Hip Fracture--Epidemiology, Management and Liaison Service. Risk factor for hip fracture].

    PubMed

    Fujiwara, Saeko

    2015-04-01

    Many risk factors have been identified for hip fracture, including female, advanced age, osteoporosis, previous fractures, low body weight or low body mass index, alcohol drinking, smoking, family history of fractures, use of glucocorticoid, factors related to falls, and bone strength. The factors related to falls are number of fall, frail, post stroke, paralysis, muscle weakness, anti-anxiety drugs, anti-depression drugs, and sedatives. Dementia and respiratory disease and others have been reported to be risk factors for secondary hip fracture.

  5. NASA's Risk Management System

    NASA Technical Reports Server (NTRS)

    Perera, Jeevan S.

    2013-01-01

    Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks - not just risk office personnel. Each group/department is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk informed decision making should be introduced to all levels of management. ? Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner. Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

  6. Low back pain in school-age children: risk factors, clinical features and diagnostic managment.

    PubMed

    Boćkowski, L; Sobaniec, W; Kułak, W; Smigielska-Kuzia, J; Sendrowski, K; Roszkowska, M

    2007-01-01

    Low back pain (LBP) is common in adult population, and it is becoming a serious health concern in adolescents. On surveys, about every fifth child in the school-age reports LBP. The study objective was to analysis the natural history, risk factors, clinical symptoms, causes and diagnostic management in school-age children hospitalized with LBP. The study group consisted of 36 patients at the age between 10 and 18 years, 22 girls and 14 boys suffering from LBP hospitalized in our Department of Pediatric Neurology and Rehabilitation in years 2000-2004. The mean age of clinical onset of LBP in our group was 14.7 years, earlier in girls, later in boys. We find the family history of LBP in 50% children. Most frequent factors associated with LBP were: spina bifida (16.7%) and incorrect posture (13.9%). Half of patients pointed the factor initialising LBP: rapid, incoordinated move (39%) or heavy load rise (11%). 58% of patients present the symptoms of ischialgia. Diagnostic imaging showed disc protrusion in 11 children (31%) 6 in computed tomography, 4 in magnetic resonance imaging and 1 in X-Ray examination only. Other causes of LBP included: spondylolysis in 2 patients, Scheuermann disease in one case and juvenile reumatoid arthritis in one case. Some school-age children suffering on low back pain, particulary with sciatic neuralgia symptoms seek medical care in hospital. Althought the main causes are mechanical, associated with lack of physical activity or strenous exercise, serious diagnostic managment is strongly recommended.

  7. Managing Risks

    ERIC Educational Resources Information Center

    Osborn, John E.

    2006-01-01

    Colleges and universities face a wide range of environmental risk. In spite of this, with proper planning, they can avoid emergencies or surprises. Advanced planning, coupled with strategic, technical environmental and legal advice, enable higher-education institutions to keep their environmental budgets under control and predictable. This article…

  8. Managing Risks

    ERIC Educational Resources Information Center

    Osborn, John E.

    2006-01-01

    Colleges and universities face a wide range of environmental risk. In spite of this, with proper planning, they can avoid emergencies or surprises. Advanced planning, coupled with strategic, technical environmental and legal advice, enable higher-education institutions to keep their environmental budgets under control and predictable. This article…

  9. Seasonal infestation of donkeys by lice: phenology, risk factors and management.

    PubMed

    Ellse, L; Burden, F A; Wall, R

    2014-07-14

    A longitudinal study was undertaken over a 21 months period to examine the seasonal abundance of lice infesting donkeys, the risk factors which predispose donkeys to infestation and the effectiveness of louse management. All the lice seen were Bovicola (Werneckiella) ocellatus. A strong seasonal pattern, which was correlated with mean monthly temperature, was observed with higher prevalence and intensity in the cooler, winter months (October-March). Overall infestation in these animals was over-dispersed, suggesting that some individuals are strongly predisposed to infestation. Donkey age and mean hair length were characteristics which affected louse prevalence: older and younger donkeys and donkeys with longer hair harboured the highest numbers of lice. However, the practice of coat-clipping, to reduce the infestation, resulted in a lower louse prevalence only in the summer, suggesting that clipping is not an effective form of louse control in cooler months. Higher louse burdens were associated with larger areas of visible excoriation and hair damage, suggesting that B. ocellatus does adversely impact animal welfare. However, the ability of animal carers to estimate louse presence or absence accurately on an individual donkey was not sufficiently high to allow targeted selective treatment of heavily infested animals to be employed effectively. As animals are housed in closed herds these findings suggest that clipping in the summer and treating all animals with insecticide in late autumn, prior to turn-in may be an effective louse management strategy.

  10. Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death.

    PubMed

    Chisti, Mohammad Jobayer; Ahmed, Tahmeed; Ahmed, A M Shamshir; Sarker, Shafiqul Alam; Faruque, Abu Syed Golam; Islam, Md Munirul; Huq, Sayeeda; Shahrin, Lubaba; Bardhan, Pradip Kumar; Salam, Mohammed Abdus

    2016-06-01

    We sought to investigate the magnitude, clinical features, treatment, and outcome of children suffering from hypernatremic diarrhea and to identify risk factors for fatal outcome among them. We reviewed 2 data sets of children <15 years admitted to the in-patient ward of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) with diarrhea and hypernatremia (serum sodium ≥150 mmol/L): (a) March 2001 to March 2002 (n = 371) and (b) March 2009 to August 2011 (n = 360). We reviewed their records and collected relevant information for analyses. The prevalence of hypernatremia was 5.1% (371/7212) and 2.4% (360/15 219), case fatality rate was 15% and 19%, respectively. In logistic regression analysis, the risk for death significantly increased in association with serum sodium ≥170 mmol/L, nutritional edema, hypoglycemia, respiratory distress, and absent peripheral pulses and reduced with the sole use of oral rehydration salts (ORS) or ORS following intravenous fluid, if indicated (for all, P < .05). Thus, managing children with hypernatremia using only ORS or ORS following intravenous fluid may help reduce the number of deaths. © The Author(s) 2016.

  11. Rules and regulations as potential moderator on the relationship between organizational internal and external factors with effective construction risk management in Nigerian construction companies: A proposed framework

    NASA Astrophysics Data System (ADS)

    Adeleke, A. Q.; Bahaudin, A. Y.; Kamaruddeen, A. M.

    2016-08-01

    Certain organizational internal and external factors have been found to influence effective construction risk management within the construction company which has contributed to massive risk occurrence on the projects. Yet, the influence of the organizational factors such as effective communication, team competency with skills, active leadership, political factor, organizational culture, technology factor and economic factor on effective construction risk management among the construction companies operating in Abuja and Lagos state Nigeria have not received considerable attention. More so, a moderating variable is proposed. This paper proposes rules and regulations as the potential moderator on the relationship between organisational internal factors, external factors and effective construction risk management.

  12. Factors influencing men undertaking active surveillance for the management of low-risk prostate cancer.

    PubMed

    Davison, B Joyce; Oliffe, John L; Pickles, Tom; Mroz, Lawrence

    2009-01-01

    To identify and describe decision-making influences on men who decide to manage their low-risk prostate cancer with active surveillance. Qualitative, semistructured interview. The Prostate Centre at Vancouver General Hospital in Canada. 25 patients diagnosed with low-risk prostate cancer and on active surveillance. An interpretative, descriptive, qualitative design. Factors that influenced men's decisions to take up active surveillance. The specialists' description of the prostate cancer was the most influential factor on men choosing active surveillance. Patients did not consider their prostate cancer to be life threatening and, in general, were relieved that no treatment was required. Avoiding treatment-related suffering and physical dysfunction and side effects such as impotence and incontinence was cited as the major reason to delay treatment. Few men actively sought treatment or health-promotion information following their treatment decision. Female partners played a supportive role in the decision. The need for active treatment if the cancer progressed was acknowledged. Patients were hopeful that new treatments would be available when and if they needed them. Being older and having comorbidities did not preclude the desire for future active treatment. Patients carried on with their lives as usual and did not report having any major distress related to being on active surveillance. The study findings indicate that men are strongly influenced by the treating specialist in taking up active surveillance and planning future active treatments. As such, most men relied on their specialists' recommendation and did not perceive the need for any adjunct therapy or support until the cancer required active treatment. Oncology nurses should work collaborative-ly with specialists to ensure that men receive the information they need to make informed treatment decisions.

  13. A pilot Croatian survey of risk factor (CRO-SURF) management in patients with cardiovascular disease.

    PubMed

    Pećin, Ivan; Milicić, Davor; Jurin, Hrvoje; Reiner, Zeljko

    2012-06-01

    A pilot survey was performed to determine the presence of known risk factors for cardiovascular disease in Croatian patients with diagnosed coronary heart disease (CHD) using a new questionnaire. The idea was to test this new and very simple questionnaire but also to compare the data collected in this pilot survey with the results of the last Croatian national survey (TASPIC-CRO V) and so to obtain the information whether secondary prevention has improved between 2003 and 2010. 122 patients with established CHD (88 men, 34 women, mean age 66.3 years) treated in Zagreb University Hospital Center were included. Data collection was based on filling the SURF questionnaire right after the clinical exam or later using review of medical records. Patients were hospitalized because of CABG (1%), PCI (8%), ACS (35%) or chronic stable angina (56%). The history of arterial hypertension had 95%patients (however, on admission mean systolic pressure was 130.1 mmHg, diastolic 76.8 mmHg), 90% had dyslipidaemia (total cholesterol <4.5 mmol/L had 43%; <4.0 mmol/L 33%; LDL-cholesterol <2.5 mmol/L 49%; <2.0 mmol/L 32%; HDL>1.2 mmol/L (women) or >1.0 mmol/L (men) had 67%), 25% had diabetes which was poorly regulated (mean HbA1c 8.2%), 18% were active smokers. After discharge only 24% performed cardiac rehabilitation. Mean body mass index of the patients was 28.3 kg/m2 (32% were obese, 72% overweight). Compared to TASPIC-CRO V there was lower usage of aspirin than recommended on discharge. This was also true for statin therapy. More patients were taking beta blockers, calcium antagonists and diuretics than 7 years ago. This pilot survey showed that CRO-SURF questionnaire is short, quick, effective and simple to use. It is a good and cost effective tool to collect data on CVD risk factors and their management. The results obtained by using it indicate that there is still a high prevalence of modifiable risk factors in Croatian patients with CHD.

  14. Risk Management for Schools.

    ERIC Educational Resources Information Center

    National Association of Independent Schools, Boston, MA.

    This manual focuses on the promotion of good risk management practices. The first of four sections presents an overview of risk management in terms of risk management concepts and avoiding, transferring, controlling, and financing risk. Second, the manual present methods for identifying and assessing risk. The third section discusses different…

  15. Risk Management for Schools.

    ERIC Educational Resources Information Center

    National Association of Independent Schools, Boston, MA.

    This manual focuses on the promotion of good risk management practices. The first of four sections presents an overview of risk management in terms of risk management concepts and avoiding, transferring, controlling, and financing risk. Second, the manual present methods for identifying and assessing risk. The third section discusses different…

  16. Risk Factors and Prevention

    MedlinePlus

    ... Resources Risk Factors & Prevention Back to Patient Resources Risk Factors & Prevention Even people who look healthy and ... Blood Pressure , high cholesterol, diabetes, and thyroid disease. Risk Factors For Arrhythmias and Heart Disease The following ...

  17. Associated risk factors and management of chronic diabetic foot ulcers exceeding 6 months’ duration

    PubMed Central

    Musa, Hassan Gubara; Ahmed, Mohamed ElMakki

    2012-01-01

    Background The management of chronic diabetic foot ulcers (DFU) poses a great challenge to the treating physician and surgeon. The aim of this study was to identify the risk factors, clinical presentation, and outcomes associated with chronic DFU>6 months’ duration. Methods This prospective study was performed in Jabir Abu Eliz Diabetic Centre (JADC), Khartoum, Sudan. A total of 108 patients who had DFU for >6 months were included. Recorded data included patient's demographics, DFU presentation, associated comorbidities, and outcomes. DFU description included size, depth, protective sensation, perfusion, and presence of infection. Comorbidities assessed included eye impairment, renal and heart disease. All patients received necessary local wound care with sharp debridement of any concomitant necrotic and infected tissues and off-loading with appropriate shoe gear and therapeutic devices. Results The mean age of the studied patients was 56+SD 9 years with a male to female ratio of 3:3.3. The mean duration of DFU was 18±SD 17 months (ranging from 6 to 84 months). Ulcer healing was significantly associated with off-loading, mainly the use of total contact cast (TCC) (p=0.013). Non-healing ulcerations were significantly associated with longer duration of the chronic DFU>12 months (p=0.002), smoking (p=0.000), poor glycemic control as evidenced by an elevated HbA1c (>7%), large size (mean SD 8+4 cm), increased depth (p<0.001), presence of skin callus (p<0.000), impaired limb perfusion (p=0.001), impaired protective sensation as measured by 10 g monofilament (p=0.002), neuroischemia (p=0.002), and Charcot neuroarthropathy (p=0.017). Discussion Risk factors associated with chronic DFU of>6 months’ duration included the presentation of an ulcer with increased size and depth, with associated skin callus and neuroischemia, in a diabetic patient with a history of smoking and increased HbA1c >7%. Off-loading mainly with the use of TCC is an effective method of managing

  18. Occupational health hazards in a prosthodontic practice: review of risk factors and management strategies

    PubMed Central

    Arunachalam, Kuthalingam Subbiah; Solomon, EGR

    2012-01-01

    The intent of this article was to analyze the potential hazards and risks involved in persons exposed to prosthodontic practice. These risks include exposure to physical and chemical hazards, dental materials, infectious environment, inappropriate working pattern and psychosocial stress. The potential harm of these hazards and its prevention is highlighted. Prosthodontists, students, dental technicians, and others working in the prosthodontic clinics and laboratory should be aware of the specific risk factors and take measures to prevent and overcome these hazards. PMID:23236581

  19. The "Problems Behind the Problems:" Systems Engineering and Program Management Risk Factors in Acquisition Programs

    DTIC Science & Technology

    2004-08-01

    Acquisition, Technology, and Logistics), Office of Enterprise Development in the Office of Systems Engineering . The publication of this IDA document does not...Defense (Acquisition, Technology, and Logistics), Office of Enterprise Development in the Office of Systems Engineering (SE). This paper responds to... development process, and open systems.6 2. Category II: Systems Engineering and Program Management Process Risk Factors Systems engineering and program

  20. Project Risk Management

    NASA Technical Reports Server (NTRS)

    Jr., R. F. Miles

    1995-01-01

    Project risk management is primarily concerned with performance, reliability, cost, and schedule. Environmental risk management is primarily concerned with human health and ecological hazards and likelihoods. This paper discusses project risk management and compares it to environmental risk management, both with respect to goals and implementation. The approach of the Jet Propulsion Laboratory to risk management is presented as an example of a project risk management approach that is an extension to NASA NHB 7120.5: Management of Major System Programs and Projects.

  1. Project Risk Management

    NASA Technical Reports Server (NTRS)

    Jr., R. F. Miles

    1995-01-01

    Project risk management is primarily concerned with performance, reliability, cost, and schedule. Environmental risk management is primarily concerned with human health and ecological hazards and likelihoods. This paper discusses project risk management and compares it to environmental risk management, both with respect to goals and implementation. The approach of the Jet Propulsion Laboratory to risk management is presented as an example of a project risk management approach that is an extension to NASA NHB 7120.5: Management of Major System Programs and Projects.

  2. Turkish assessment of SURF (SUrvey of Risk Factor Management) study: Control rates of cardiovascular risk factors derived from databases of 15 different levels of health centers in Turkey.

    PubMed

    Tokgözoğlu, Lale; Oğuz, Aytekin; Balcı, Mustafa Kemal; Temizhan, Ahmet; Güldal Altunoğlu, Esma; Bektaş, Osman; Aslan, Güler; Iyigün, Özgün; Kara, Ahmet; Tanrıverdi Pınar, Handan; Yavuz, Saffet; Tekin, Murat; Ercan, Saffet; Çelik, Selda; Sezgin Meriçliler, Özlem; Bozkurt Çakır, İrem

    2017-07-01

    The aim of this study was to evaluate the adherence to recommendations for secondary prevention and the achievement of treatment targets for the control of risk factors in patients with established coronary heart disease (CHD) who were followed-up at various healthcare facilities in Turkey. According to the protocol of the international Survey of Risk Factor Management study, questionnaire forms were completed and demographic, anthropometric, and laboratory data of CHD patients who were followed-up at a total of 15 selected primary, secondary, and tertiary healthcare centers were recorded. Among a total of 724 CHD patients (69.8% male; mean age: 63.3±10.7 years) included in the study, 18.4% were current smokers, only 19.1% had normal body mass index, and 22.1% had waist circumference below the limit of abdominal obesity. Physical activity was insufficient in 53% of the patients, 47.3% had low high-density lipoprotein cholesterol value, 46% had triglyceride level above 150 mg/dL, and 67% had glycated hemoglobin value of 6.5% or above. Of all the patients, 88.1% were using antiplatelet drugs, 71.4% were using beta-blockers, 55.7% were using statins, and 41.9% were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Blood pressure was under control in 56.7% of the hypertensive patients using antihypertensive drugs, and the proportion of diabetic patients who reached glycemic control targets using antidiabetic drugs was 35.9%. Low-density lipoprotein cholesterol was below 70 mg/dL in 12.2% of the patients using statins. According to the data obtained, among Turkish CHD patients, the control rate of cardiovascular risk factors is low, and implementation of the recommendations regarding lifestyle modification and medication use for secondary prevention in the current guidelines are insufficient.

  3. Risk factors for persistent cervical intraepithelial neoplasia grades 1 and 2: managed by watchful waiting.

    PubMed

    Ho, Gloria Y F; Einstein, Mark H; Romney, Seymour L; Kadish, Anna S; Abadi, Maria; Mikhail, Magdy; Basu, Jayasri; Thysen, Benjamin; Reimers, Laura; Palan, Prabhudas R; Trim, Shelly; Soroudi, Nafisseh; Burk, Robert D

    2011-10-01

    : This study examines risk factors for persistent cervical intraepithelial neoplasia (CIN) and examines whether human papillomavirus (HPV) testing predicts persistent lesions. : Women with histologically diagnosed CIN 1 or CIN 2 (n = 206) were followed up every 3 months without treatment. Human papillomavirus genotyping, plasma levels of ascorbic acid, and red blood cell folate levels were obtained. Cervical biopsy at 12 months determined the presence of CIN. Relative risk (RR) was estimated by log-linked binomial regression models. : At 12 months, 70% of CIN 1 versus 54% of CIN 2 lesions spontaneously regressed (p < .001). Levels of folate or ascorbic acid were not associated with persistent CIN at 12 months. Compared with HPV-negative women, those with multiple HPV types (RRs ranged from 1.68 to 2.17 at each follow-up visit) or high-risk types (RRs range = 1.74-2.09) were at increased risk for persistent CIN; women with HPV-16/18 had the highest risk (RRs range = 1.91-2.21). Persistent infection with a high-risk type was also associated with persistent CIN (RRs range = 1.50-2.35). Typing for high-risk HPVs at 6 months only had a sensitivity of 46% in predicting persistence of any lesions at 12 months. : Spontaneous regression of CIN 1 and 2 occurs frequently within 12 months. Human papillomavirus infection is the major risk factor for persistent CIN. However, HPV testing cannot reliably predict persistence of any lesion.

  4. Suboptimal management of cardiovascular risk factors in coronary heart disease patients in primary care occurs particularly in women.

    PubMed

    Driscoll, A; Beauchamp, A; Lyubomirsky, G; Demos, L; McNeil, J; Tonkin, A

    2011-10-01

    Patients with established coronary heart disease (CHD) are at the highest risk of further events. Despite proven therapies, secondary prevention is often suboptimal. General practitioners (GPs) are in an ideal position to improve secondary prevention. To contrast management of cardiovascular risk factors in patients with established CHD in primary care to those in clinical guidelines and according to gender. GPs throughout Australia were approached to participate in a programme incorporating a disease management software (mdCare) program. Participating practitioners (1258 GPs) recruited individual patients whose cardiovascular risk factor levels were measured. The mdCare programme included 12,509 patients (58% male) diagnosed with CHD. Their mean age was 71.7years (intra-quartile range 66-78) for men and 74years (intra-quartile range 68-80) for women. Low-density-lipoprotein cholesterol was above target levels in 69% (2032) of women compared with 58% (2487) in men (P < 0.0001). There was also a higher proportion of women with total cholesterol above target levels (76%, 3592) compared with men (57%, 3787) (P < 0.0001). In patients who were prescribed lipid-lowering medication, 53% (2504) of men and 72% (2285) of women continued to have a total cholesterol higher than recommended target levels (P < 0.0001). Overall, over half (52%, 6538) had at least five cardiovascular risk factors (55% (2914) in women and 50% (3624) in men, P < 0.0001). This study found less intensive management of cardiovascular risk factors in CHD patients, particularly among women, despite equivalent cardiovascular risk. This study has shown that these patients have multiple risk factors where gender also plays a role. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

  5. Managing the risks of risk management on large fires

    Treesearch

    Donald G. MacGregor; Armando. González-Cabán

    2013-01-01

    Large fires pose risks to a number of important values, including the ecology, property and the lives of incident responders. A relatively unstudied aspect of fire management is the risks to which incident managers are exposed due to organizational and sociopolitical factors that put them in a position of, for example, potential liability or degradation of their image...

  6. Modifying Risk Factors in the Management of Erectile Dysfunction: A Review

    PubMed Central

    DeLay, Kenneth J; Haney, Nora

    2016-01-01

    Erectile dysfunction (ED) is prevalent among men and its presence is often an indicator of systemic disease. Risk factors for ED include cardiovascular disease, hypertension, diabetes mellitus (DM), tobacco use, hyperlipidemia, hypogonadism, lower urinary tract symptoms, metabolic syndrome, and depression. Addressing the modifiable risk factors frequently improves a patient's overall health and increases lifespan. The literature suggests that smoking cessation, treatment of hyperlipidemia, and increasing physical activity will improve erectile function in many patients. How the treatment of DM, depression, and hypogonadism impacts erectile function is less clear. Clinicians need to be aware that certain antihypertensive agents can adversely impact erectile function. The treatment of men with ED needs to address the underlying risk factors to ameliorate the disease process. PMID:27574592

  7. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I - Assessment and Management of Various Cardiovascular Risk Factors.

    PubMed

    Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto

    2015-01-01

    Cardiovascular disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous cardiovascular risk factors play important roles in the development of various cardiovascular complications. Of these, loss of residual renal function is regarded as one of the key cardiovascular risk factors and is associated with an increased mortality and cardiovascular death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various cardiovascular risk factors, as well as management of the various cardiovascular complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed.

  8. Assessment of management-related risk factors for paratuberculosis in Danish dairy herds using Bayesian mixture models.

    PubMed

    Nielsen, S S; Toft, N

    2007-10-16

    Transmission of Mycobacterium avium subsp. paratuberculosis (Map) to susceptible animals is primarily considered to occur via faeces and milk originating from infectious cows. However, studies of factors resulting in increased transmission of Map are difficult to perform due to a long and unpredictable incubation period and inaccurate diagnostic tests. A multi-level Bayesian mixture model has been shown to predict the infection status of an individual cow more precisely than traditional cut-off based methods used for interpretation of diagnostic test-information, thereby increasing the precision of the diagnostic information. The objective of our study was to assess management-related risk factors for within-herd transmission of Map. Management-related risk factors were recorded in 97 Danish dairy herds. Twenty-six months following that recording, the antibody status of all lactating cows (n=7,410) in the same herds was measured by the use of an ELISA. A multi-level Bayesian mixture model was used to assess the association between the probability of infection of individual cows and 41 herd-level management-related risk factors using univariable analyses. In this model, the continuous OD value was used to estimate the probability of infection, corrected for known animal covariates and laboratory factors. The statistical significance of the potential risk factors was assessed by calculating odds ratios and their 95% credibility posterior intervals. Four significant risk factors were identified: housing of cows in bed stalls compared to housing in tie stalls; low level of hygiene in the feeding area of calving areas; low amounts of straw in the bedding of the calving area; high animal density among young stock >12 months of age. Surprisingly, the hygiene level in the calving area was not found to affect the odds of infection.

  9. Quality assurance and risk management: Perspectives on Human Factors Certification of Advanced Aviation Systems

    NASA Technical Reports Server (NTRS)

    Taylor, Robert M.; Macleod, Iain S.

    1994-01-01

    This paper is based on the experience of engineering psychologists advising the U.K. Ministry of Defense (MoD) on the procurement of advanced aviation systems that conform to good human engineering (HE) practice. Traditional approaches to HE in systems procurement focus on the physical nature of the human-machine interface. Advanced aviation systems present increasingly complex design requirements for human functional integration, information processing, and cognitive task performance effectiveness. These developing requirements present new challenges for HE quality assurance (QA) and risk management, requiring focus on design processes as well as on design content or product. A new approach to the application of HE, recently adopted by NATO, provides more systematic ordering and control of HE processes and activities to meet the challenges of advanced aircrew systems design. This systematic approach to HE has been applied by MoD to the procurement of mission systems for the Royal Navy Merlin helicopter. In MoD procurement, certification is a judicial function, essentially independent of the service customer and industry contractor. Certification decisions are based on advice from MoD's appointed Acceptance Agency. Test and evaluation (T&E) conducted by the contractor and by the Acceptance Agency provide evidence for certification. Certification identifies limitations of systems upon release to the service. Evidence of compliance with HE standards traditionally forms the main basis of HE certification and significant non-compliance could restrict release. The systems HE approach shows concern for the quality of processes as well as for the content of the product. Human factors certification should be concerned with the quality of HE processes as well as products. Certification should require proof of process as well as proof of content and performance. QA criteria such as completeness, consistency, timeliness, and compatibility provide generic guidelines for

  10. Violent Children in the Schoolhouse: One Elementary Principal's Experience with Risk Factors and Management.

    ERIC Educational Resources Information Center

    West, Cathie E.

    2002-01-01

    Elementary principal describes experience working with violent-prone children. Describes steps in dealing with violence-prone children: Create a support team, schedule a transition meeting, evaluate risk factors, prepare a transition plan, notify staff members, and create a behavior plan, the components of which include behavior, levels plan,…

  11. Managing Multiple Risk Factors for Cardiovascular Disease Through Anger/Hostility Control and Medicine

    DTIC Science & Technology

    2001-03-01

    of death in men and women. Cardiovascular disease , including CHD, kills nearly 500,000 American women each year and black women generally have a...and 30% of women reported having two or more of the following risk factors for cardiovascular disease : hypertension, high blood cholesterol, diabetes

  12. Integrated risk management

    NASA Technical Reports Server (NTRS)

    Hunsucker, J. L.

    1993-01-01

    The purpose of this report is to first present a basis or foundation for the building of an integrated risk management plan and them to present the plan. The integration referred to is across both the temporal and the hierarchical dimensions. Complexity, consequence, and credibility seem to be driving the need for the consideration of risk. Reduction of personal bias and reproducibility of the decision making process seem to be driving the consideration of a formal risk plan. While risk can be used as either a selection tool or a control tool, this paper concentrates on the selection usage. Risk relies on stated purpose. The tightness of the definition of purpose and success is directly reflected in the definition and control of risk. Much of a risk management plan could be designed by the answers to the questions of why, what, who, when, and where. However, any plan must provide the following information about a threat or risk: likelihood, consequence, predictability, reliability, and reproducibility. While the environment at NASA is seen as warm, but not hot, for the introduction of a risk program, some encouragement is seen if the following problems are addressed: no champion, no commitment of resource, confused definitions, lack of direction and focus, a hard sell, NASA culture, many choices of assessment methods, and cost. The plan is designed to follow the normal method of doing work and is structured to follow either the work break down structure or a functional structure very well. The parts of the plan include: defining purpose and success, initial threat assessment, initial risk assessment, reconciling threats and parameters, putting part of the information down and factoring the information back into the decision process as it comes back up, and developing inferences. Two major suggestions are presented. One is to build an office of risk management to be used as a resource by managers in doing the risk process. Another is to form a pilot program to try

  13. Risk Management in EVA

    NASA Technical Reports Server (NTRS)

    Hall, Jonathan; Lutomski, M.

    2006-01-01

    This viewgraph presentation reviews the use of risk management in Extravehicular Activities (EVA). The contents include: 1) EVA Office at NASA - JSC; 2) EVA Project Risk Management: Why and When; 3) EVA Office Risk Management: How; 4) Criteria for Closing a Risk; 5) Criteria for Accepting a Risk; 6) ISS IRMA Reference Card Data Entry Requirement s; 7) XA/ EVA Office Risk Activity Summary; 8) EVA Significant Change Summary; 9) Integrated Risk Management Application (XA) Matrix, March 31, 2004; 10) ISS Watch Item: 50XX Summary Report; and 11) EVA Project RM Usefulness

  14. Preventing cardiovascular disease in primary care: role of a national risk factor management program.

    PubMed

    McGrath, Emer R; Glynn, Liam G; Murphy, Andrew W; O Conghaile, Aengus; Canavan, Michelle; Reid, Claire; Moloney, Brian; O'Donnell, Martin J

    2012-04-01

    Heartwatch, a structured risk factor modification program for secondary prevention of cardiovascular (CV) disease (CVD) in primary care, is associated with improvements in CV risk factors in participating patients. However, it is not known whether Heartwatch translates into reductions in clinically important CV events. The aim of the study was to determine the association between participation in Heartwatch and future risk of CV events in patients with CVD. The study consisted of a prospective cohort of 1,609 patients with CVD in primary care practices. Of these, 97.5% had data available on Heartwatch participation status, of whom 15.2% were Heartwatch participants. Cox proportional hazards models were used to determine the association between Heartwatch participation and risk of the CV composite (CV death, nonfatal myocardial infarction, heart failure, and nonfatal stroke). All-cause mortality and CV mortality were secondary outcome measures. During follow-up, the CV composite occurred in 208 patients (13.6%). Of Heartwatch participants, 8.4% experienced the CV composite compared with 14.5% of nonparticipants (P = .003). Participation in Heartwatch was associated with a significantly reduced risk of the CV composite (hazard ratio [HR] 0.52, 95% CI, 0.31-0.87), CV mortality (HR 0.31, 95% CI, 0.11-0.89), and all-cause mortality (HR 0.32, 95% CI, 0.15-0.68). Heartwatch participation was also associated with greater reductions in mean systolic blood pressure (P = .047), mean diastolic blood pressure (P < .001), and greater use of secondary preventative therapies for CVD, such as lipid-lowering agents (P < .001), β-blockers (P < .001), and angiotensin-converting enzyme inhibitors (P < .001). Heartwatch is associated with a reduced risk of major vascular events and improved risk factor modification, supporting its potential as a nationwide program for secondary prevention of CVD. Copyright © 2012 Mosby, Inc. All rights reserved.

  15. Environmental risk factors and their role in the management of atopic dermatitis.

    PubMed

    Kantor, Robert; Silverberg, Jonathan I

    2017-01-01

    The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors. Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD. Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.

  16. Risk Management and Prevention.

    ERIC Educational Resources Information Center

    Letzring, Timothy D.

    1999-01-01

    Schools cannot eliminate all risks but can manage them so they minimally affect the "bottom line." A sound risk-management program has four categories: risk avoidance, control, transfer, and retention. Schools retain some risk in situations when insurance is unavailable, costs are negligible, or loss probabilities are remote. (MLH)

  17. Risk Management and Prevention.

    ERIC Educational Resources Information Center

    Letzring, Timothy D.

    1999-01-01

    Schools cannot eliminate all risks but can manage them so they minimally affect the "bottom line." A sound risk-management program has four categories: risk avoidance, control, transfer, and retention. Schools retain some risk in situations when insurance is unavailable, costs are negligible, or loss probabilities are remote. (MLH)

  18. An Internet-based health management platform may effectively reduce the risk factors of metabolic syndrome among career women.

    PubMed

    Chen, Yi-Ching; Tsao, Lee-Ing; Huang, Chih-Hsung; Yu, Yi-Yen; Liu, I-Li; Jou, Hei-Jen

    2013-06-01

    The purpose of this study is to target career women with metabolic syndrome (Mets) risk factors and investigate the effectiveness of using a health management platform (HMP) to improve health behavior and reduce Mets risk factors. This study adopted the structure of a randomized control trial, and targeted full-time career women aged ≥ 20 years, who possessed Mets risk factors. Intervention was performed via an Internet-based HMP, and changes in health behavior 1.5 months and 3 months after intervention and Mets risk factors 3 months after intervention were analyzed. A total of 66 career women participated in this study. At 3 months, the HMP group displayed better results than the control group in terms of waist circumference, fasting glucose, and the mean number of Mets components. In terms of the group and time interaction analysis on health behavior, the HMP group only displayed significantly better results in exercise scores than the control group at 1.5 months. The application of an Internet-based tailored HMP can facilitate an effective improvement in Mets components of career women with Mets risk factors. Copyright © 2013. Published by Elsevier B.V.

  19. Updates on the risk factors for latent tuberculosis reactivation and their managements

    PubMed Central

    Ai, Jing-Wen; Ruan, Qiao-Ling; Liu, Qi-Hui; Zhang, Wen-Hong

    2016-01-01

    The preventive treatment of latent tuberculosis infection (LTBI) is of great importance for the elimination and control of tuberculosis (TB) worldwide, but existing screening methods for LTBI are still limited in predicting the onset of TB. Previous studies have found that some high-risk factors (including human immunodeficiency virus (HIV), organ transplantation, silicosis, tumor necrosis factor-alpha blockers, close contacts and kidney dialysis) contribute to a significantly increased TB reactivation rate. This article reviews each risk factor's association with TB and approaches to address those factors. Five regimens are currently recommended by the World Health Organization, and no regimen has shown superiority over others. In recent years, studies have gradually narrowed down to the preventive treatment of LTBI for high-risk target groups, such as silicosis patients, organ-transplantation recipients and HIV-infected patients. This review discusses regimens for each target group and compares the efficacy of different regimens. For HIV patients and transplant recipients, isoniazid monotherapy is effective in treating LTBI, but for others, little evidence is available at present. PMID:26839146

  20. A novel community-based model to enhance health promotion, risk factor management and chronic disease prevention.

    PubMed

    Carson, Shannon Ryan; Carr, Caroline; Kohler, Graeme; Edwards, Lynn; Gibson, Rick; Sampalli, Tara

    2014-01-01

    Chronic disease is a highly expensive but preventable problem to the healthcare system. Evidence suggests that impacting modifiable behaviours and risk management factors in the areas of physical inactivity, unhealthy diet, stress and obesity can alleviate the burden of chronic disease problem to a large extent. Despite this recognition, the challenge is embedding these recognized priorities into the community and in primary care in a sustainable and meaningful manner. Primary Health Care in Capital Health responded to this challenge by developing and implementing a free, interprofessional and community-based service, namely, the Community Health Teams (CHTs), that offers health and wellness, risk factor management, wellness navigation and behaviour-based programming. In this paper, the development and implementation of the CHTs are discussed. Preliminary outcomes for the model are significant and promising. Formal and large-scale studies are planned to validate these outcomes with additional research rigour. Copyright © 2014 Longwoods Publishing.

  1. Assessing risks for integrated water resource management: coping with uncertainty and the human factor

    NASA Astrophysics Data System (ADS)

    Polo, M. J.; Aguilar, C.; Millares, A.; Herrero, J.; Gómez-Beas, R.; Contreras, E.; Losada, M. A.

    2014-09-01

    Risk assessment for water resource planning must deal with the uncertainty associated with excess/scarcity situations and their costs. The projected actions for increasing water security usually involve an indirect "call-effect": the territory occupation/water use is increased following the achieved protection. In this work, flood and water demand in a mountainous semi-arid watershed in southern Spain are assessed by means of the stochastic simulation of extremes, when this human factor is/is not considered. The results show how not including this call-effect induced an underestimation of flood risk after protecting the floodplain of between 35 and 78 % in a 35-year planning horizon. Similarly, the pursued water availability of a new reservoir resulted in a 10-year scarcity risk increase up to 38 % when the trend of expanding the irrigated area was included in the simulations. These results highlight the need for including this interaction in the decision-making assessment.

  2. Rimonabant: a cannabinoid receptor type 1 blocker for management of multiple cardiometabolic risk factors.

    PubMed

    Gelfand, Eli V; Cannon, Christopher P

    2006-05-16

    Rimonabant is a first selective blocker of the cannabinoid receptor type 1 (CB1) being developed for the treatment of multiple cardiometabolic risk factors, including abdominal obesity and smoking. In four large trials, after one year of treatment, rimonabant 20 mg led to greater weight loss and reduction in waist circumference compared with placebo. Therapy with rimonabant is also associated with favorable changes in serum lipid levels and an improvement in glycemic control in prediabetes patients and in type 2 diabetic patients. At the same dose, rimonabant significantly increased cigarette smoking quit rates as compared with placebo. Rimonabant seems to be well tolerated, with a primary side effect of mild nausea. As an agent with a novel mechanism of action, rimonabant has a potential to be a useful adjunct to lifestyle and behavior modification in treatment of multiple cardiometabolic risk factors, including abdominal obesity and smoking.

  3. [Global risk management].

    PubMed

    Sghaier, W; Hergon, E; Desroches, A

    2015-08-01

    Risk management is a fundamental component of any successful company, whether it is in economic, societal or environmental aspect. Risk management is an especially important activity for companies that optimal security challenge of products and services is great. This is the case especially for the health sector institutions. Risk management is therefore a decision support tool and a means to ensure the sustainability of an organization. In this context, what methods and approaches implemented to manage the risks? Through this state of the art, we are interested in the concept of risk and risk management processes. Then we focus on the different methods of risk management and the criteria for choosing among these methods. Finally we highlight the need to supplement these methods by a systemic and global approach including through risk assessment by the audits.

  4. National trends in the management of cardiovascular disease risk factors in children: second NHLBI survey of primary care physicians.

    PubMed

    Kimm, S Y; Payne, G H; Stylianou, M P; Waclawiw, M A; Lichtenstein, C

    1998-11-01

    The evidence that atherosclerosis begins during adolescence has led to the belief that primary prevention of cardiovascular disease (CHD) should commence in childhood. Although several national guidelines have been issued for the detection and treatment of CHD risk factors in children, concerns continue to be expressed regarding what constitutes appropriate measures and when to institute such measures in children. A 1988 national survey of primary care physicians revealed variation in the management of CHD risk factors in children by physician categories, which suggested the underlying quandary among physicians regarding CHD risk factors in children. To assess current clinical management of pediatric CHD risk factors in the primary care setting and also to evaluate time trends between the current and 1988 surveys. A 25-minute telephone survey was conducted with 1036 of eligible physicians (ie, >20 hours per week direct patient care including at least five pediatric patient contacts) selected from a national probability sample in three practice categories (family practitioners, pediatricians, and general practitioners). The questionnaire assessed the current practice of these physicians in the primary care setting regarding cholesterol and blood pressure (BP) screening and treatment, both nonpharmacologic and pharmacologic, and physician attitude and knowledge. Cholesterol screening in children was performed by 75.7% of all physicians. Nonscreening was highest among general practitioners (38%) and lowest among pediatricians (12%). BP was measured by almost all physicians. The majority of physicians (71%) prescribed diet as the first cholesterol-lowering step, but approximately 16% also used pharmacologic therapy. Cholesterol synthesis inhibitors and bile acid sequestrants were the drugs used most commonly. Approximately 25% of physicians have used drugs in children to treat high BP. Diuretics and beta-blockers were used most frequently. More than one fourth of the

  5. Assessment of risk factors for oro-facial pain and recent developments in classification: implications for management.

    PubMed

    Svensson, P; Kumar, A

    2016-12-01

    Oro-facial pain research has during the last decades provided important novel insights into the basic underlying mechanisms, the need for standardised diagnostic procedures and classification systems, and multiple treatment options for successful rehabilitation of the patient in pain. Notwithstanding the significant progress in our knowledge spanning from molecules to chair, there may also be limitations in our ability to integrate and interpret the tremendous amount of new data and information, in particular in terms of the clinical implications and overriding conceptual models for oro-facial pain. The aim of the present narrative review is to briefly summarise some of the current thoughts on oro-facial pain mechanisms and recent attempts to identify biomarkers and risk factors leading to the proposal of a new risk assessment diagram for oro-facial pain (RADOP) and a provocative new concept based on stochastic variation between multiple risk factors. Finally, the implications for novel management strategies will briefly be discussed.

  6. Risk Factors for Scleroderma

    MedlinePlus

    ... Home For Patients Risk Factors Risk Factors for Scleroderma The cause of scleroderma is still unknown. Scientists ... help find improved therapies and a cure for scleroderma! Your gift today will be matched to have ...

  7. Combining antihypertensive and antihyperlipidemic agents – optimizing cardiovascular risk factor management

    PubMed Central

    Zamorano, José; Edwards, Jonathan

    2011-01-01

    Clinical guidelines now recognize the importance of a multifactorial approach to managing cardiovascular (CV) risk. This idea was taken a step further with the concept of the Polypill™. There are, however, considerable patent, pharmacokinetic, pharmacodynamic, registration, and cost implications that will need to be overcome before the Polypill™ or other single-pill combinations of CV medications become widely available. However, a medication targeting blood pressure (BP) and lipids provides much of the proposed benefits of the Polypill™. A single-pill combination of the antihypertensive amlodipine besylate and the lipid-lowering medication atorvastatin calcium (SPAA) is currently available in many parts of the world. This review describes the rationale for this combination therapy and the clinical trials that have demonstrated that these two agents can be combined without the loss of efficacy for either agent or an increase in the incidence of adverse events. The recently completed Cluster Randomized Usual Care vs Caduet Investigation Assessing Long-term-risk (CRUCIAL trial) is discussed in detail. CRUCIAL was a 12-month, international, multicenter, prospective, open-label, parallel design, cluster-randomized trial, which demonstrated that a proactive intervention strategy based on SPAA in addition to usual care (UC) had substantial benefits on estimated CV risk, BP, and lipids over continued UC alone. Adherence with antihypertensive and lipid-lowering therapies outside of the controlled environment of clinical trials is very low (~30%–40% at 12 months). Observational studies have demonstrated that improving adherence to lipid-lowering and antihypertensive medications may reduce CV events. One means of improving adherence is the use of single-pill combinations. Real-world observational studies have demonstrated that patients are more adherent to SPAA than co-administered antihypertensive and lipid-lowering therapy, and this improved adherence translated to

  8. Clinical update on screening, diagnosis and management of metabolic disorders and cardiovascular risk factors associated with polycystic ovary syndrome.

    PubMed

    Huang, Grace; Coviello, Andrea

    2012-12-01

    Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy in premenopausal women. This review discusses the screening, diagnosis and management of metabolic disorders and cardiovascular risk factors associated with PCOS, highlighting significant recent developments. PCOS is a complex genetic disorder with multiple susceptibility genes as well as environmental factors influencing the expression of various PCOS phenotypes. The first genome-wide association study of PCOS identified susceptibility loci on chromosome 2 near the luteinizing hormone receptor gene LHCGR and chromosome 9 near the obesity gene DEEND1A. Women with PCOS are affected by a variety of metabolic disorders, including insulin resistance, metabolic syndrome, type-2 diabetes, dyslipidemia and obesity. Recently, it has been established that women with PCOS have a high risk of nonalcoholic fatty liver disease. These metabolic disturbances are associated with an increased risk of cardiovascular disease (CVD). Although women with PCOS have higher rates of cardiovascular risk factors and intermediate markers of CVD, studies definitively documenting increased CVD are lacking. The high prevalence of metabolic disorders and CVD risk factors in women with PCOS highlights the need for early screening, diagnosis and treatment of these disorders to promote long-term health and possibly prevent CVD.

  9. Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy.

    PubMed

    Bhatt, Nikita R; Gillis, Amy; Smoothey, Craig O; Awan, Faisal N; Ridgway, Paul F

    2016-10-01

    There are no evidence-based guidelines to dictate when Gallbladder Polyps (GBPs) of varying sizes should be resected. To identify factors that accurately predict malignant disease in GBP; to provide an evidence-based algorithm for management. A systematic review following PRISMA guidelines was performed using terms "gallbladder polyps" AND "polypoid lesion of gallbladder", from January 1993 and September 2013. Inclusion criteria required histopathological report or follow-up of 2 years. RTI-IB tool was used for quality analysis. Correlation with GBP size and malignant potential was analysed using Euclidean distance; a logistics mixed effects model was used for assessing independent risk factors for malignancy. Fifty-three articles were included in review. Data from 21 studies was pooled for analysis. Optimum size cut-off for resection of GBPs was 10 mm. Probability of malignancy is approximately zero at size <4.15 mm. Patient age >50 years, sessile and single polyps were independent risk factors for malignancy. For polyps sized 4 mm-10 mm, a risk assessment model was formulated. This review and analysis has provided an evidence-based algorithm for the management of GBPs. Longitudinal studies are needed to better understand the behaviour of polyps <10 mm, that are not at a high risk of malignancy, but may change over time. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  10. Incidence and risk factors for failed medical management of spinal epidural abscess: a systematic review and meta-analysis.

    PubMed

    Stratton, Alexandra; Gustafson, Karla; Thomas, Kenneth; James, Matthew T

    2017-01-01

    OBJECTIVE Spinal epidural abscess (SEA) is a life-threatening infection. It is uncertain whether medical versus surgical treatment is the ideal initial approach for neurologically intact patients with SEA. Recent evidence demonstrates that initial medical management is increasingly common; however, patients who ultimately require surgery after failed medical management may have a worse prognosis than those whose treatment was initially surgical. The primary objective of this study was to establish the current incidence of failed medical management for SEA. The secondary aim was to identify risk factors associated with the failure of medical management. METHODS The authors conducted a systematic review and meta-analysis by searching electronic databases (MEDLINE, Embase, CINAHL, and PubMed), recent conference proceedings, and reference lists of relevant articles. Studies that reported original data on consecutive adult patients with SEA treated medically were eligible for inclusion. RESULTS Twelve studies met the inclusion criteria, which included a total of 489 medically treated patients with SEA. Agreement on articles for study inclusion was very high between the reviewers (kappa 0.86). In a meta-analysis, the overall pooled risk of failed medical management was 29.3% (95% CI 21.4%-37.2%) and when medical to surgical crossover was used to define failure the rate was 26.3% (95% CI 13.0%-39.7%). Only 6 studies provided data for analysis by intended treatment, with a pooled estimate of 35.1% (95% CI 15.7%-54.4%) of failed medical management. Two studies reported predictors of the failure of medical management. CONCLUSIONS Although the incidence of failed medical management of SEA was relatively common in published reports, estimates were highly heterogeneous between studies, thus introducing uncertainty about the frequency of this risk. A consensus definition of failure is required to facilitate comparison of failure rates across studies.

  11. Risk Management Implementation Tool

    NASA Technical Reports Server (NTRS)

    Wright, Shayla L.

    2004-01-01

    Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.

  12. Risk Management Implementation Tool

    NASA Technical Reports Server (NTRS)

    Wright, Shayla L.

    2004-01-01

    Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.

  13. Risk and crisis management in intraoperative hemorrhage: Human factors in hemorrhagic critical events

    PubMed Central

    2011-01-01

    Hemorrhage is the major cause of cardiac arrest developing in the operating room. Many human factors including surgical procedures, transfusion practices, blood supply, and anesthetic management are involved in the process that leads to hemorrhage developing into a critical situation. It is desirable for hospital transfusion committees to prepare hospital regulations on 'actions to be taken to manage critical hemorrhage', and practice the implementation of these regulations by simulated drills. If intraoperative hemorrhage seems to be critical, a state of emergency should immediately be declared to the operating room staff, the blood transfusion service staff, and blood bank staff in order to organize a systematic approach to the ongoing problem and keep all responsible staff working outside the operating room informed of events developing in the operating room. To rapidly deal with critical hemorrhage, not only cooperation between anesthesiologists and surgeons but also linkage of operating rooms with blood transfusion services and a blood bank are important. When time is short, cross-matching tests are omitted, and ABO-identical red blood cells are used. When supplies of ABO-identical red blood cells are not available, ABO-compatible, non-identical red blood cells are used. Because a systematic, not individual, approach is required to prevent and manage critical hemorrhage, whether a hospital can establish a procedure to deal with it or not depends on the overall capability of critical and crisis management of the hospital. PMID:21490815

  14. Non-genetic risk factors in haemophilia A inhibitor management - the danger theory and the use of animal models.

    PubMed

    Lövgren, K M; Søndergaard, H; Skov, S; Wiinberg, B

    2016-09-01

    In haemophilia A (HA) management, antidrug antibodies, or inhibitors, are a serious complication that renders factor VIII (FVIII) replacement therapy ineffective, increases morbidity and reduces quality of life for affected patients. Inhibitor development aetiology is multifactorial and covers both genetic and therapy related risk factors. Many therapy-related risk factors have proven difficult to confirm due to several confounding factors and the small study populations available. However, clinical studies indicate that e.g. on-demand treatment and surgery affect inhibitor development, and explanations for this association are being investigated. A potential explanation is the danger signal effect, where the immune response is activated by endogenous or exogenous danger or damage signals present at the time and site of FVIII administration. The danger theory explains how alarm signals from stressed, injured or dying cells can activate an immune reaction, without the involvement of foreign antigens. Bleeds, trauma, surgery or concomitant infection could be events initiating danger signalling in HA patients, resulting in an immune reaction towards administered FVIII that otherwise would pass unnoticed. This role of danger in HA inhibitor formation has previously been suggested, but a thorough discussion of this subject is lacking. The present review will discuss the potential role of danger signals in haemophilia and inhibitor development, with focus on treatment related risk factors with a suspected danger signal aetiology; on-demand treatment, treatment during major bleeds or surgery, and treatment during infection or vaccination. Clinical studies as well as animal experiments addressing these factors will be reviewed.

  15. [Preeclampsia as cardiovascular risk factor].

    PubMed

    Heida, Karst Y; Franx, Arie; Bots, Michiel L

    2013-01-01

    Cardiovascular diseases (CVD) are the primary cause of death in women. Guidelines for identifying high-risk individuals have been developed, e.g. the Dutch Guideline on Cardiovascular Risk Management. In the most recent version of this guideline, diabetes mellitus (DM) and rheumatoid arthritis (RA) are cited as cardiovascular risk factors; therefore, individuals with these conditions are identified as being at high risk. As with DM and RA, there is strong evidence that the experience of having a hypertensive disorder during pregnancy is a cardiovascular risk factor. This is particularly the case for early preeclampsia, which constitutes a 7-fold increased risk of ischemic heart disease. However, in the Netherlands, there are no guidelines and there is no consensus on how to screen or treat these women. Trial evidence is therefore urgently needed to substantiate the value of cardiovascular risk management for those women with a history of hypertension during pregnancy.

  16. Risk Factors and Management of Incidental Durotomy in Lumbar Interbody Fusion Surgery.

    PubMed

    Enders, Frederik; Ackemann, Amelie; Müller, Simon; Kiening, Karl; Orakcioglu, Berk

    2017-08-28

    This is a retrospective study analysis. In this retrospective study we evaluated risk factors for incidental durotomy and its impact on the postoperative course. Lumbar interbody fusion (LIF) is increasingly applied for the treatment of degenerative instability. A known complication is incidental durotomy. A cohort of 541 patients who underwent primary LIF surgery between 2005 and 2015 was analyzed. Previous lumbar surgery, age, surgeon's experience, intraoperative use of a microscope, and the number of operated levels were assessed and the risk for incidental durotomy was estimated using the Log-likelihood test and Wald test, respectively. The association of incidental durotomy and outcome parameters was analyzed using the quantile regression model. In 77 (14.2%) patients intraoperative cerebrospinal fluid (CSF) fistula was observed. Previous lumbar surgery (P<0.001), number of operated levels (P=0.03), and surgeon's experience (P=0.01) were significantly associated with incidental durotomy. Incidental durotomy was significantly associated with a prolonged bed rest (P<0.001), hospital stay (P=0.041), and an increased use of postoperative antibiotics (P<0.001). Eleven of 77 patients with incidental durotomy (14.3%) developed postoperative CSF fistula of whom 10 (91%) needed revision surgery for dural repair. We could identify important risk factors for incidental durotomy in LIF surgery. In patients who had undergone previous lumbar surgery and those with multilevel disease particular precaution is required. Furthermore, we were able to verify the morbidity associated with CSF fistula as shown by increased immobilization and follow-up surgeries for postoperative CSF fistula which emphasizes the importance to develop strategies to minimize the risk for incidental durotomy.

  17. Hyperphosphataemia as a cardiovascular risk factor -- how to manage the problem.

    PubMed

    Cannata-Andía, Jorge B; Rodríguez-García, Minerva

    2002-01-01

    Hyperphosphataemia is a frequent and important cardiovascular risk factor in patients with chronic kidney disease (CKD). High phosphate levels may influence vascular calcifications by two separate mechanisms: by worsening secondary hyperparathyroidism, which in turn facilitates calcification, and by promoting calcium phosphate deposition in pre-formed endothelial plaques and in the arterial wall. Recent studies have shown that hyperphosphataemia induces the proliferation and differentiation of endothelial vascular cells into osteoblast-like cells, promoting vascular calcification. High phosphate levels also increase the risk of mortality in patients with CKD. To reduce the negative impact of high phosphate, serum phosphate levels should be <5 mg/dl and serum calcium <10 mg/dl. This allows the calcium x phosphate product to be maintained at < or =50 mg(2)/dl(2), reducing the risk of vascular, valvular, and extraskeletal calcification. A multiple-factor approach can be used to reduce serum phosphate: (i). decrease bone resorption by maintaining adequate serum parathyroid hormone levels; (ii). reduce phosphorous intake in the diet, (iii). use phosphate binders efficiently; and (iv). avoid under-dialysis. The patient's diet should be high in nutrition but with the lowest possible phosphorous content. Doses of phosphate binders should be tailored to individual dietary habits and must be taken during meals in a dose proportional to the phosphorous content of the meal. Because of the risk of increased extraskeletal calcification, calcium-containing phosphate-binder intake should not exceed 2-3 g/day. Sevelamer hydrochloride, a non-calcium and non-aluminium phosphate binder with a potency similar to that of calcium salts has shown beneficial effects on lipid profiles. Better control of serum phosphate is achieved in patients on continuous ambulatory peritoneal dialysis than in those on haemodialysis. Removal of phosphate is directly correlated with duration and frequency

  18. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management.

    PubMed Central

    Elliott, D C; Kufera, J A; Myers, R A

    1996-01-01

    OBJECTIVE: The authors evaluate in a retrospective fashion the factors influencing outcome in a large group of patients presenting with necrotizing soft tissue infections, and, based on this analysis, propose a plan for optimal care of such patients. SUMMARY BACKGROUND DATA: In many smaller series of patients with necrotizing soft tissue infections, similar analyses of risk factors for mortality have been performed, producing conflicting conclusions regarding optimal care. In particular, debate exists regarding the impact of concurrent physiologic derangements, type and extent of infection, and the role of hyperbaric oxygen in treatment. METHODS: A retrospective chart review of 198 consecutive patients with documented necrotizing soft tissue infections, treated at a single institution during an 8-year period, was conducted. Using a model for logistic regression analysis, characteristics of each patient and his/her clinical course were tested for impact on outcome. RESULTS: The mortality rate among the 198 patients was 25.3%. The most common sites of origin of infection were the perineum (Fournier's disease; 36% of cases) and the foot (in diabetics; 15.2%). By logistic regression analysis, risk factors for death included age, female gender, extent of infection, delay in first debridement, elevated serum creatinine level, elevated blood lactate level, and degree of organ system dysfunction at admission. Diabetes mellitus did not predispose patients to death, except in conjunction with renal dysfunction or peripheral vascular disease. Myonecrosis, noted in 41.4% of the patients who underwent surgery, did not influence mortality. CONCLUSIONS: Necrotizing soft tissue infections represent a group of highly lethal infections best treated by early and repeated extensive debridement and broad-spectrum antibiotics. Hyperbaric oxygen appears to offer the advantage of early wound closure. Certain markers predict those individuals at increased risk for multiple-organ failure

  19. A comparative study of pre- and post-menopausal breast cancer: Risk factors, presentation, characteristics and management

    PubMed Central

    Surakasula, Aruna; Nagarjunapu, Govardhana Chary; Raghavaiah, K. V.

    2014-01-01

    Objective: Breast cancer is the most common female cancer worldwide and is the second most commonly diagnosed cancer in Indian women. This study evaluates the differences between pre- and post-menopausal breast cancer women regarding risk factors, nature of disease presentation, tumor characteristics, and management. Methods: This is a prospective observational study, conducted in the Oncology Department of St. Ann's Cancer Hospital, for a period of 6 months from January to August 2012. Data on basic demography, clinical and pathological tumor profile, and treatment details were collected prospectively for each patient based on patient interviews and medical records. Findings: Among 100 female patients taken up for the study, 48 were premenopausal and 52 had reached menopause. The mean age of presentation for breast carcinoma was a decade earlier in these patients compared with western patients. The risk factors for both pre-and post-menopausal breast cancer were found similar other than late menopause in postmenopausal patients. Having dense breast tissue was a predominant risk factor among all women. Late presentation was the common phenomenon in almost all patients. The treatment given was not based on any standard guidelines due to inadequate public health policies. Conclusion: Late stage at presentation of breast cancer is the main problem and possesses a challenge to the health care community. In order to reduce the burden of breast cancer, a multi-sectorial approach and evidence-based strategies aiming at early detection and effective management of the disease are required. PMID:24991630

  20. Prevalence, awareness, and management of CKD and cardiovascular risk factors in publicly funded health care.

    PubMed

    Verhave, Jacobien C; Troyanov, Stéphan; Mongeau, Frédéric; Fradette, Lorraine; Bouchard, Josée; Awadalla, Philip; Madore, François

    2014-04-01

    It is uncertain how many patients with CKD and cardiovascular risk factors in publicly funded universal health care systems are aware of their disease and how to achieve their treatment targets. The CARTaGENE study evaluated BP, lipid, and diabetes profiles as well as corresponding treatments in 20,004 random individuals between 40 and 69 years of age. Participants had free access to health care and were recruited from four regions within the province of Quebec, Canada in 2009 and 2010. CKD (Chronic Kidney Disease Epidemiology Collaboration equation; <60 ml/min per 1.73 m(2)) was present in 4.0% of the respondents, and hypertension, diabetes, and hypercholesterolemia were reported by 25%, 7.4%, and 28% of participants, respectively. Self-awareness was low: 8% for CKD, 73% for diabetes, and 45% for hypercholesterolemia. Overall, 31% of patients with hypertension did not meet BP goals, and many received fewer antihypertensive drugs than appropriately controlled individuals; 41% of patients with diabetes failed to meet treatment targets. Among those patients with a moderate or high Framingham risk score, 53% of patients had LDL levels above the recommended levels, and many patients were not receiving a statin. Physician checkups were not associated with greater awareness but did increase the achievement of targets. In this population with access to publicly funded health care, CKD and cardiovascular risk factors are common, and self-awareness of these conditions is low. Recommended targets were frequently not achieved, and treatments were less intensive in those patients who failed to reach goals. New strategies to enhance public awareness and reach guideline targets should be developed.

  1. [Cardiac and metabolic risk factors in severe mental disorders. Task of a prevention manager].

    PubMed

    Lederbogen, F; Schwarz, P; Häfner, S; Schweiger, U; Bohus, M; Deuschle, M

    2015-07-01

    People with severe mental disorders have a reduction in life expectancy of 13-30 % compared with the general population. This severe disadvantage is primarily due to an increased prevalence of cardiac and metabolic disorders, especially coronary heart disease (CHD) and type 2 diabetes mellitus and are the result of untoward health behavior characterized by smoking, low levels of physical activity and unhealthy dietary habits. Obesity, arterial hypertension and lipid disorders are also associated with this behavior and further increase the risk of CHD and type 2 diabetes. Thus, people with mental disorders constitute a population with a high risk of cardiovascular events. Appropriate measures for prevention and therapy are urgently indicated but rarely applied. This article presents new organizational structures to overcome this deficit with a prevention manager playing a central role in organizing and applying preventive and therapeutic care. Results from cardiology and diabetic medicine have shown the effectiveness of pooling this responsibility. The measure has the potential to reduce the increased mortality of people with severe mental disorders.

  2. Proactive multiple cardiovascular risk factor management compared with usual care in patients with hypertension and additional risk factors: the CRUCIAL trial.

    PubMed

    Zamorano, José; Erdine, Serap; Pavia, Abel; Kim, Jae-Hyung; Al-Khadra, Ayman; Westergaard, Mogens; Sutradhar, Santosh; Yunis, Carla

    2011-04-01

    To investigate whether a proactive multifactorial risk factor intervention strategy using single-pill amlodipine/atorvastatin (5/10, 10/10 mg) in addition to other antihypertensive and lipid-lowering therapy, as required, resulted in greater reduction in calculated Framingham 10-year coronary heart disease (CHD) risk compared with usual care (UC) after 52-weeks treatment. Prospective, multinational, open-label, cluster randomized trial, with the investigator as the unit of randomization. Eligible hypertensive patients were 35-79 years of age, with ≥3 additional cardiovascular risk factors, but no history of CHD and baseline total cholesterol (TC) ≤6.5 mmol/l. www.ClinicalTrials.gov ; trial identifier NCT00407537. The primary endpoint was calculated Framingham 10-year CHD risk at 52 weeks. Of the 140 randomized sites, 136 sites contributed 1461 patients. Mean baseline age and low-density lipoprotein cholesterol (LDL-C) were comparable between treatment arms. Mean baseline BP (150.3/89.7 vs. 144.3/86.5 mmHg) and Framingham CHD risk (20.0 vs. 18.1%) were higher in the proactive intervention versus the UC arm (p < 0.002 for both). At week 52, mean CHD risk was 12.5% in the proactive intervention arm and 16.3% in the UC arm (p < 0.001). The difference, observed at weeks 16 and 52, was primarily driven by significant differences in systolic BP and in TC between the two arms. Overall, adverse events (AEs) were reported in 48.8% and 44.0% of patients in the proactive intervention and the UC arm, respectively. Although there were differences in the incidence of AEs between the treatment arms, the AE profile in the proactive intervention arm was consistent with previous safety experience for this medication. A proactive multifactorial risk factor intervention strategy that simultaneously treated both BP and cholesterol regardless of individual risk factors per se, is more effective in reducing calculated Framingham 10-year CHD risk than UC in patients with

  3. Impact Assessment of Pharmaceutical Care in the Management of Hypertension and Coronary Risk Factors after Discharge

    PubMed Central

    de Freitas, Osvaldo; Penaforte, Thais Rodrigues; Achcar, Angela; Pereira, Leonardo Régis Leira

    2016-01-01

    Introduction Almost 50% of the 17.5 million deaths worldwide from cardiovascular disease have been associated with systemic arterial hypertension (SAH). Into this scenario, Pharmaceutical Care (PC) has been inserted in order to improve the management of SAH and reduce its risks. Objective To evaluate the outcomes and healthcare assistance achieved after discharge of hypertension patients from the PC program. Methods This is a quasi-experimental study with historical controls. Retrospective data collection from 2006 to 2012 was begun in 2013 and included a PC program performed over one year. PC was performed in two basic units of the public health system in Ribeirão Preto-SP, Brazil, where the pharmacist followed up 104 hypertensive patients. The clinical indicators of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total-cholesterol, high and low density lipoprotein cholesterol were collected, as well as care indicators related to the number of consultations (basic, specialized and emergency care) and antihypertensive drugs used. The coronary risk of patients by the Framingham risk score was also calculated. For the analysis, the data were divided into three periods, 2006–2008 as pre-PC, 2009 as PC and 2010–2012 as post-PC. Results In the pre-PC period, 54.4%, 79.0% and 27.3% of patients presented satisfactory levels of SBP, DBP and total-cholesterol, respectively. In the post-PC period, the percentages were 93.0% for SBP and DBP [p <0.001] and 60.6% for total-cholesterol [p <0.001]. The average number of consultations per patient/year in primary care was 1.66 ± 1.43 and 2.36 ± 1.73, [p = 0.012]; and for emergency care was 1.70 ± 1.43 and 1.06 ± 0.81, [p = 0.002] in the pre-PC and post-PC periods, respectively. The pre-PC Framingham risk in the last year was 14.3% ± 10.6 and the average post-PC was 10.9% ± 7.9. Conclusion PC was effective in the control of blood pressure and total-cholesterolafter discharge of the hypertensive patients

  4. Cardiovascular Risk Factor Management Performance in Canada and the United States: A Systematic Review.

    PubMed

    Alabousi, Mostafa; Abdullah, Peri; Alter, David A; Booth, Gillian L; Hogg, William; Ko, Dennis T; Manuel, Douglas G; Farkouh, Michael E; Tu, Jack V; Udell, Jacob A

    2017-03-01

    Comparative cardiovascular risk factor care across North America is unknown. We aimed to determine current performance in Canada and the United States (US). A systematic review was conducted of Medline and EMBASE (to June 1, 2014). Eligible studies reported on screening, awareness, treatment, or control rates for hypertension, dyslipidemia, diabetes, and smoking. Categorical performance 'ratings' on the basis of the most successful US health plans were used to classify rates as suboptimal (< 50%), below target (50%-70%), above target (70%-90%), or optimal (> 90%). A total of 127 studies reporting on 10,510,324 individuals across North America were included. Hypertension awareness (84.3%) and treatment (82.0%) rates in Canada and the US (82.7% and 75.6%, respectively) were above target, whereas control in both nations was below target (68.1% vs 51.8%, respectively). Canadian awareness, treatment, and control rates for dyslipidemia (42.7%, 40.9%, and 41.5%, respectively) were suboptimal, and American indicators were generally below target (61.5%, 43.0%, and 63.6%, respectively). Canada and the US showed diabetes awareness (88.2% vs 86.8%) and treatment rates (82.3% vs 82.5%) above target. However, glucose control was suboptimal in Canada (35.3%), and below target in the US (58.8%). There was a modest decline in absolute smoking prevalence rates in Canada from 1999 to 2013 (25.2% to 14.6%). Screening for tobacco use (72.2%) and counselling rates (73.8%) in the US were above target. Substantial variation exists in cardiovascular risk factor care across North America. Standardized reporting, dissemination of practice guidelines, and setting explicit goal-directed targets for performance might facilitate improvement. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  5. Perspectives: Intellectual Risk Management

    ERIC Educational Resources Information Center

    Hall, James C.

    2013-01-01

    Ask a college administrator about students and risk management, and you're likely to get a quick and agitated speech about alcohol consumption and bad behavior or a meditation on mental health and campus safety. But in colleges and universities, we manage intellectual risk-taking too. Bring that up, and you'll probably get little out of that same…

  6. Perspectives: Intellectual Risk Management

    ERIC Educational Resources Information Center

    Hall, James C.

    2013-01-01

    Ask a college administrator about students and risk management, and you're likely to get a quick and agitated speech about alcohol consumption and bad behavior or a meditation on mental health and campus safety. But in colleges and universities, we manage intellectual risk-taking too. Bring that up, and you'll probably get little out of that same…

  7. Impact of a standardized management protocol on mortality of children with diarrhoea: an update of risk factors for childhood death.

    PubMed

    Durley, Alison; Shenoy, Akhil; Faruque, A S G; Suskind, Robert; Ahmed, Tahmeed

    2004-10-01

    In the developing world, diarrhoeal disease is a significant cause of childhood morbidity especially amongst severely malnourished children. As a direct result of improved acute-phase management of this group of patients, there has been a 47 per cent reduction in the death rate among severely malnourished children hospitalized at the ICDDR,B in Bangladesh. The change in the risk factors for death among children aged under 5 years presenting with diarrhoea was reassessed. The charts of 366 children under 5 years of age who were hospitalized for diarrhoeal disease in the year 1998 were retrospectively analysed. One hundred and eighty-three of these patients died and 183 of those who survived acted as controls. Univariate analysis found 12 significant risk factors on admission that impacted outcome. Only two factors, female sex and positive blood culture, remained significant in the multivariate analysis with odds ratios (95 per cent CI) of 2.05 (1.1-4.0) and 4.6 (1.7-12.4), respectively. Prior to the change in the protocol involving the management of severely malnourished children, only severe malnutrition and non-breastfeeding were found to be significant predictors of mortality.

  8. Management of Ventriculoperitoneal Shunt Infections in Adults: Analysis of Risk Factors Associated With Treatment Failure.

    PubMed

    Pelegrín, Iván; Lora-Tamayo, Jaime; Gómez-Junyent, Joan; Sabé, Nuria; García-Somoza, Dolors; Gabarrós, Andreu; Ariza, Javier; Viladrich, Pedro Fernández; Cabellos, Carmen

    2017-04-15

    Little is known regarding the optimal treatment of ventriculoperitoneal (VP) shunt infections in adults. Our aim was to assess the efficacy of treatment strategies and to identify factors that predict failure. Retrospective, observational study of patients aged ≥12 years with VP shunt infections (1980 -2014). Therapeutic approaches were classified under 4 headings: only antibiotics (OA), one-stage shunt replacement (OSSR), two-stage shunt replacement (TSSR), and shunt removal without replacement (SR). The primary endpoint was failure of the treatment strategy, defined as the absence of definite cerebrospinal fluid (CSF) sterilization or related mortality. The parameters that predicted failure were analyzed using logistic regression. Of 108 episodes (51% male, median age 50 years), 86 were analyzed. Intravenous antibiotics were administered for a median of 19 days. Eighty episodes were treated using strategies that combined antibiotic and surgical treatment (37 TSSR, 24 SR, 19 OSSR) and 6 with OA. Failure occurred in 30% of episodes, mostly due to lack of CSF sterilization in OSSR and OA groups. Twelve percent died of related causes and 10% presented superinfection of the CSF temporary drainage/externalized peritoneal catheter. TSSR was the most effective strategy when VP shunt replacement was attempted. The only independent risk factor that predicted failure was retention of the VP shunt, regardless of the strategy. This is the largest series of VP shunt infections in adults reported to date. VP shunt removal, particularly TSSR when the patient is shunt dependent, remains the optimal choice of treatment and does not increase morbidity.

  9. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors

    PubMed Central

    Kalaria, Raj N; Maestre, Gladys E; Arizaga, Raul; Friedland, Robert P; Galasko, Doug; Hall, Kathleen; Luchsinger, José A; Ogunniyi, Adesola; Perry, Elaine K; Potocnik, Felix; Prince, Martin; Stewart, Robert; Wimo, Anders; Zhang, Zhen-Xin; Antuono, Piero

    2010-01-01

    Despite mortality due to communicable diseases, poverty, and human conflicts, dementia incidence is destined to increase in the developing world in tandem with the ageing population. Current data from developing countries suggest that age-adjusted dementia prevalence estimates in 65 year olds are high (≥5%) in certain Asian and Latin American countries, but consistently low (1–3%) in India and sub-Saharan Africa; Alzheimer's disease accounts for 60% whereas vascular dementia accounts for ∼30% of the prevalence. Early-onset familial forms of dementia with single-gene defects occur in Latin America, Asia, and Africa. Illiteracy remains a risk factor for dementia. The APOE ε4 allele does not influence dementia progression in sub-Saharan Africans. Vascular factors, such as hypertension and type 2 diabetes, are likely to increase the burden of dementia. Use of traditional diets and medicinal plant extracts might aid prevention and treatment. Dementia costs in developing countries are estimated to be US$73 billion yearly, but care demands social protection, which seems scarce in these regions. PMID:18667359

  10. Risk factors for liver abscess formation in patients with blunt hepatic injury after non-operative management.

    PubMed

    Hsu, C-P; Wang, S-Y; Hsu, Y-P; Chen, H-W; Lin, B-C; Kang, S-C; Yuan, K-C; Liu, E-H; Kuo, I-M; Liao, C-H; Ouyang, C-H; Yang, S-J

    2014-10-01

    To identify risk factors for liver abscess formation in patients with blunt hepatic injury who underwent non-operative management (NOM). From January 2004 to October 2008, retrospective data were collected from a single level I trauma center. Clinical data, hospital course, and outcome were all extracted from patient medical records for further analysis. A total of 358 patients were enrolled for analysis. There were 13 patients with liver abscess after blunt hepatic injury. Patients with abscess had a significant increase in glutamic oxaloacetic transaminase (GOT, p = 0.006) and glutamic pyruvic transaminase (GPT, p < 0.0001), and a decrease in arterial blood pH (p = 0.023) compared to patients without abscess in the univariate analyses. In addition, high-grade hepatic injury and transarterial embolization (TAE, p < 0.001) were also risk factors for liver abscess formation. Five factors (GOT, GPT, pH level in the arterial blood sample, TAE, and high-grade hepatic injury) were included in the multivariate analysis. TAE, high-grade hepatic injury, and GPT level were statistically significant. The odds ratios of TAE and high-grade hepatic injury were 15.41 and 16.08, respectively. A receiver operating characteristic (ROC) analysis was used for GPT, and it suggested cutoff values of 372.5 U/L. A prediction model based on the ROC analysis had 100 % sensitivity and 86.7 % specificity to predict liver abscess formation in patients with two of the three independent risk factors. TAE, high-grade hepatic injury, and a high GPT level are independent risk factors for liver abscess formation.

  11. Fatigue risk management: Organizational factors at the regulatory and industry/company level.

    PubMed

    Gander, Philippa; Hartley, Laurence; Powell, David; Cabon, Philippe; Hitchcock, Edward; Mills, Ann; Popkin, Stephen

    2011-03-01

    This paper focuses on the development of fatigue risk management systems (FRMS) in the transport sector. The evolution of regulatory frameworks is traced, from uni-dimensional hours of service regulations through to frameworks that enable multi-dimensional FRMS. These regulatory changes reflect advances in understanding of human error in the aetiology of accidents, and in fatigue and safety science. Implementation of FRMS shifts the locus of responsibility for safety away from the regulator towards companies and individuals, and requires changes in traditional roles. Organizational, ethnic, and national culture need to be considered. Recent trends in the work environment have potential to adversely affect FRMS, including precarious employment and shortages of skilled labour. Essential components of an FRMS, and examples of FRMS in different transport modes, are described. It is vital that regulators, employer, and employees have an understanding of the causes and consequences of fatigue that is sufficient for them to meet their responsibilities in relation to FRMS. While there is a strong evidence base supporting the principles of FRMS, experience with implementation is more limited. The evidence base for effective implementation will expand, since FRMS is data-driven, and ongoing evaluation is integral. We strongly advocate that experience be shared wherever possible.

  12. Biliary complications after pediatric liver transplantation: Risk factors, diagnosis and management

    PubMed Central

    Feier, Flavia H; da Fonseca, Eduardo A; Seda-Neto, Joao; Chapchap, Paulo

    2015-01-01

    The expanded indications of partial grafts in pediatric liver transplantation have reduced waiting list mortality. However, a higher morbidity is observed, including an increased rate of biliary complications (BCs). Factors such as the type of graft, the preservation methods applied, the donor characteristics, the type of biliary reconstruction, and the number of bile ducts in the liver graft influences the occurrence of these complications. Bile leaks and strictures comprise the majority of post-transplant BCs. Biliary strictures require a high grade of suspicion, and because most children have a bileo-enteric anastomosis, its diagnosis and management rely on percutaneous hepatic cholangiography and percutaneous biliary interventions (PBI). The success rates with PBI range from 70% to 90%. Surgery is reserved for patients who have failed PBI. BCs in children after liver transplantation have a prolonged treatment and are associated with a longer length of stay and higher hospital costs. However, with early diagnosis and aggressive treatment, patient and graft survival are not significantly compromised. PMID:26328028

  13. Risk Factors: Colleges Look to Manage Threats Ranging from Fraud to Data Breaches

    ERIC Educational Resources Information Center

    Wills, Lisa M.

    2011-01-01

    When an individual hears the term risk, he/she usually thinks of the financial institutions whose mismanagement of risk was instrumental in causing the 2008 financial crash. But all organizations, including colleges and universities, face various types and levels of risk, which threaten to harm the institutions and their ability to fulfill their…

  14. Risk Factors: Colleges Look to Manage Threats Ranging from Fraud to Data Breaches

    ERIC Educational Resources Information Center

    Wills, Lisa M.

    2011-01-01

    When an individual hears the term risk, he/she usually thinks of the financial institutions whose mismanagement of risk was instrumental in causing the 2008 financial crash. But all organizations, including colleges and universities, face various types and levels of risk, which threaten to harm the institutions and their ability to fulfill their…

  15. Risk factors for periodontal disease.

    PubMed

    Genco, Robert J; Borgnakke, Wenche S

    2013-06-01

    Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors

  16. Current state of cardiac rehabilitation in Germany: patient characteristics, risk factor management and control status, by education level

    PubMed Central

    Bestehorn, Kurt; Jannowitz, Christina; Horack, Martin; Karmann, Barbara; Halle, Martin; Völler, Heinz

    2011-01-01

    Background After the acute hospital stay, most cardiac patients in Germany are transferred for a 3–4-week period of inpatient cardiac rehabilitation. We aim to describe patient characteristics and risk factor management of cardiac rehabilitation patients with a focus on drug treatment and control status, differentiated by education level (low level, elementary school; intermediate level, secondary modern school; high level, grammar school/university). Methods Data covering a time period between 2003 and 2008 from 68,191 hospitalized patients in cardiac rehabilitation from a large-scale registry (Transparency Registry to Objectify Guideline- Oriented Risk Factor Management) were analyzed descriptively. Further, a multivariate model was applied to assess factors associated with good control of risk factors. Results In the total cohort, patients with a manifestation of coronary artery disease (mean age 63.7 years, males 71.7%) were referred to cardiac rehabilitation after having received percutaneous coronary intervention (51.6%) or coronary bypass surgery (39.5%). Statin therapy increased from 76.3% at entry to 88.9% at discharge, and low density lipoprotein cholesterol < 100 mg/dL rates increased from 31.1% to 69.6%. Mean fasting blood glucose decreased from 108 mg/dL to 104 mg/dL, and mean exercise capacity increased from 78 W to 95 W. Age and gender did not differ by education. In contrast with patients having high education, those with low education had more diabetes, hypertension, and peripheral arterial disease, had lower exercise capacity, and received less treatment with statins and guideline-orientated therapy in general. In the multivariate model, good control was significantly more likely in men (odds ratio 1.38; 95% confidence interval 1.30–1.46), less likely in patients of higher age (0.99; 0.99–0.99), with diabetes (0.90; 0.85–0.95), or peripheral arterial disease (0.88; 0.82–0.95). Compared with a low level education, a mid level education

  17. Current state of cardiac rehabilitation in Germany: patient characteristics, risk factor management and control status, by education level.

    PubMed

    Bestehorn, Kurt; Jannowitz, Christina; Horack, Martin; Karmann, Barbara; Halle, Martin; Völler, Heinz

    2011-01-01

    After the acute hospital stay, most cardiac patients in Germany are transferred for a 3-4-week period of inpatient cardiac rehabilitation. We aim to describe patient characteristics and risk factor management of cardiac rehabilitation patients with a focus on drug treatment and control status, differentiated by education level (low level, elementary school; intermediate level, secondary modern school; high level, grammar school/university). Data covering a time period between 2003 and 2008 from 68,191 hospitalized patients in cardiac rehabilitation from a large-scale registry (Transparency Registry to Objectify Guideline- Oriented Risk Factor Management) were analyzed descriptively. Further, a multivariate model was applied to assess factors associated with good control of risk factors. In the total cohort, patients with a manifestation of coronary artery disease (mean age 63.7 years, males 71.7%) were referred to cardiac rehabilitation after having received percutaneous coronary intervention (51.6%) or coronary bypass surgery (39.5%). Statin therapy increased from 76.3% at entry to 88.9% at discharge, and low density lipoprotein cholesterol < 100 mg/dL rates increased from 31.1% to 69.6%. Mean fasting blood glucose decreased from 108 mg/dL to 104 mg/dL, and mean exercise capacity increased from 78 W to 95 W. Age and gender did not differ by education. In contrast with patients having high education, those with low education had more diabetes, hypertension, and peripheral arterial disease, had lower exercise capacity, and received less treatment with statins and guideline-orientated therapy in general. In the multivariate model, good control was significantly more likely in men (odds ratio 1.38; 95% confidence interval 1.30-1.46), less likely in patients of higher age (0.99; 0.99-0.99), with diabetes (0.90; 0.85-0.95), or peripheral arterial disease (0.88; 0.82-0.95). Compared with a low level education, a mid level education was associated with poor control (0

  18. Managing demographic risk.

    PubMed

    Strack, Rainer; Baier, Jens; Fahlander, Anders

    2008-02-01

    In developed nations, the workforce is aging rapidly. That trend has serious implications. Companies could face severe labor shortages in a few years as workers retire, taking critical knowledge with them. Businesses may also see productivity decline among older employees, especially in physically demanding jobs. The authors, partners at Boston Consulting Group, offer managers a systematic way to assess these dual threats--capacity risk and productivity risk--at their companies. It involves studying the age distribution of their employees to see if large percentages fall within high age brackets and then projecting--by location, unit, and job category--how the distribution will change over the next 15 years. Managers must also factor in both the impact of strategic moves on personnel needs and the future supply of workers in the market. When RWE Power analyzed its trends, the company learned that in 2018 almost 80% of its workers would be over 50. What's more, in certain critical areas its labor surplus was about to become a sizable shortfall. For instance, a shortage of specialized engineers would develop in the company just as their ranks in the job market thinned and competition to hire them intensified. Reversing its downsizing course, RWE Power took steps to increase its supply of workers in those key positions. The authors show how companies that face talent gaps, as RWE Power did, can close them through training, transfers, recruitment, retention, productivity improvements, and outsourcing. They also describe measures that companies can take to keep older workers productive, including workplace accommodations, revised compensation structures, performance incentives, and targeted health care management. The key is to identify and address potential problems early. Firms that do so will gain an edge on rivals that are still relentlessly focused on reducing head count.

  19. Acrokeratosis paraneoplastica (Bazex syndrome) - a systematic review on risk factors, diagnosis, prognosis and management.

    PubMed

    Räßler, Franziska; Goetze, Steven; Elsner, Peter

    2017-03-08

    Acrokeratosis paraneoplastica Bazex (Bazex syndrome) is a rare paraneoplastic skin disease defined by erythematous, violaceous, scaly plaques on the hands and feet and on other acral locations such as nose and ears. Bazex syndrome is linked to a variety of underlying malignancies. Usually the skin lesions develop prior to the diagnosis of an internal malignant neoplasm with spontaneous remission after tumor removal. The objective of this study was to review the so far reported risk factors, diagnostic work up, prognosis and treatment options for Bazex syndrome in a systematic manner. This systematic review is based on a search in Medline, Embase and Cochrane Central Register for English and German articles from 1990 to 2015. Evidence on the diagnosis and treatment of Bazex syndrome is limited predominately to case reports or to small case series. There are no randomized controlled trials. A number of underlying tumor entities, predominately oropharyngeal neoplasms and tumors of the gastroenterological tract, but other malignancies were reported. Treatment modalities including topical and systemic corticosteroids, salicylic acid, topical vitamin D analogues, etretinate and PUVA therapy are often ineffective. Due to the small number of patients and the frequent misdiagnosis of this clinical entity, the aim of this systematic review is to call attention to this rare condition and to help clinicians to diagnose and treat Bazex syndrome effectively. Due to the good prognosis of the skin lesions and the tendency to resolve spontaneously if the underlying tumor is treated early, the differential diagnosis of Bazex syndrome should be taken into consideration when dealing with atypical psoriasiform cutaneous lesions. An early diagnosis may improve the patient's prognosis substantially. This article is protected by copyright. All rights reserved.

  20. Risk Management Certainty Act

    THOMAS, 113th Congress

    Rep. Hudson, Richard [R-NC-8

    2014-01-07

    House - 02/12/2014 Referred to the Subcommittee on General Farm Commodities and Risk Management. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  1. Risk Management Plan Rule

    EPA Pesticide Factsheets

    RMP implements Section 112(r) of the 1990 Clean Air Act amendments, and requires facilities that use extremely hazardous substances to develop a Risk Management Plan and revise/resubmit every five years. Find guidance, factsheets, training, and assistance.

  2. Groundwater Risk Management Handbook

    DTIC Science & Technology

    2008-01-01

    management approach. • Section 6.0 Case Studies : Provides examples of two sites where risk management approaches were employed to develop...unacceptable risk, but in some cases the remedy can be limited to land use controls (LUCs) with limited long- term monitoring, as discussed in the case study ...cost avoidance of $1,250,000 over active remediation. For more information on this equipment and additional case studies , view the Web tool at http

  3. Acute diarrhea in adults consulting a general practitioner in France during winter: incidence, clinical characteristics, management and risk factors.

    PubMed

    Arena, Christophe; Amoros, Jean Pierre; Vaillant, Véronique; Ambert-Balay, Katia; Chikhi-Brachet, Roxane; Jourdan-Da Silva, Nathalie; Varesi, Laurent; Arrighi, Jean; Souty, Cécile; Blanchon, Thierry; Falchi, Alessandra; Hanslik, Thomas

    2014-10-30

    Data describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant. The objective of this study was to identify the incidence, clinical characteristics, management and risk factors of winter viral AD in adults. The incidence of AD in adults during two consecutive winters (from December 2010 to April 2011 and from December 2011 to April 2012) was estimated from the French Sentinelles network. During these two winters, a subset of Sentinelles general practitioners (GPs) identified and included adult patients who presented with AD and who filled out a questionnaire and returned a stool specimen for virological examination. All stool specimens were tested for astrovirus, group A rotavirus, human enteric adenovirus, and norovirus of genogroup I and genogroup II. Age- and sex-matched controls were included to permit a case-control analysis with the aim of identifying risk factors for viral AD. During the studied winters, the average incidence of AD in adults was estimated to be 3,158 per 100,000 French adults (95% CI [2,321 - 3,997]). The most reported clinical signs were abdominal pain (91.1%), watery diarrhea (88.5%), and nausea (83.3%). GPs prescribed a treatment in 95% of the patients with AD, and 80% of the working patients with AD could not go to work. Stool examinations were positive for at least one enteric virus in 65% (95% CI [57 - 73]) of patients with AD with a predominance of noroviruses (49%). Having been in contact with a person who has suffered from AD in the last 7 days, whether within or outside the household, and having a job (or being a student) were risk factors significantly associated with acquiring viral AD. During the winter, AD of viral origin is a frequent disease in adults, and noroviruses are most often the cause. No preventable risk factor was identified other than contact with a person with AD. Thus, at the present time, reinforcement of education related to hand hygiene remains the only way to reduce the

  4. Diabetes mellitus in Zambia and the Western Cape province of South Africa: Prevalence, risk factors, diagnosis and management.

    PubMed

    Bailey, Sarah Lou; Ayles, Helen; Beyers, Nulda; Godfrey-Faussett, Peter; Muyoyeta, Monde; du Toit, Elizabeth; Yudkin, John S; Floyd, Sian

    2016-08-01

    To determine the prevalence of and risk factors for diabetes mellitus and examine its diagnosis and management in the study communities. This is a population-based cross-sectional study among adults in 24 communities from Zambia and the Western Cape (WC) province of South Africa. Diabetes is defined as a random blood glucose concentration (RBG)⩾11.1mmol/L, or RBG<11.1mmol/L but with a self-reported prior diabetes diagnosis. For individuals with a prior diagnosis of diabetes, RBG<7.8mmol/L was considered to be an acceptable level of glycaemia. Among 45,767 Zambian and 12,496 WC participants the age-standardised prevalence of diabetes was 3.5% and 7.2% respectively. The highest risk groups identified were those of older age and those with obesity. Of those identified to have diabetes, 34.5% in Zambia and 12.7% in WC were previously unaware of their diagnosis. Among Zambian participants with diabetes, this proportion was lower among individuals with better education or with higher household socio-economic position. Of all those with previously diagnosed diabetes, 66.0% in Zambia and 59.4% in WC were not on any diabetes treatment, and 34.4% in Zambia and 32.7% in WC had a RBG concentration beyond the recommended level, ⩾7.8mmol/L. The diabetes risk factor profile for our study communities is similar to that seen in high-income populations. A high proportion of individuals with diabetes are not on diabetes treatment and of those on treatment a high proportion have high glycaemic concentrations. Such data may assist in healthcare planning to ensure timely diagnosis and management of diabetes. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  5. A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease.

    PubMed

    Keith, Mary; Kuliszewski, Michael A; Liao, Christine; Peeva, Valentina; Ahmed, Mavra; Tran, Susan; Sorokin, Kevin; Jenkins, David J; Errett, Lee; Leong-Poi, Howard

    2015-06-01

    Secondary prevention can improve outcomes in high risk patients. This study investigated the magnitude of cardiovascular risk reduction associated with consumption of a modified portfolio diet in parallel with medical management. 30 patients with type II diabetes, 6 weeks post bypass surgery received dietary counseling on a Modified Portfolio Diet (MPD) (low fat, 8 g/1000 kcal viscous fibres, 17 g/1000 kcal soy protein and 22 g/1000 kcal almonds). Lipid profiles, endothelial function and markers of glycemic control, oxidative stress and inflammation were measured at baseline and following two and four weeks of intervention. Seven patients with no diet therapy served as time controls. Consumption of the MPD resulted in a 19% relative reduction in LDL (1.9 ± 0.8 vs 1.6 ± 0.6 mmol/L, p < 0.001) with no change in HDL cholesterol. Homocysteine levels dropped significantly (10.1 ± 2.7 vs 7.9 ± 4 μmol/L, p = 0.006) over the study period. Flow mediated dilatation increased significantly in treated patients (3.8 ± 3.8% to 6.5 ± 3.6%, p = 0.004) while remaining constant in controls (p = 0.6). Endothelial progenitor cells numbers (CD34+, CD 133+ and UEA-1+) increased significantly following MPD consumption (p < 0.02) with no difference in migratory capacity. In contrast, time controls showed no significant changes. Dietary intervention in medically managed, high risk patients resulted in important reductions in risk factors. Clinical Trials registry number NCT00462436. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  6. Today's School Risk Manager

    ERIC Educational Resources Information Center

    Johnson, Cheryl P.; Levering, Steve

    2009-01-01

    School districts are held accountable not only for the monies that contribute to the education system but also for mitigating any issues that threaten student learning. Some school districts are fortunate to have professional risk managers on staff who can identify and control the many risks that are unique to school systems. Most schools,…

  7. [Delivery management for the prevention of shoulder dystocia in case of identified risk factors].

    PubMed

    Schmitz, T

    2015-12-01

    To determine the impact of (i) computed tomographic (CT) pelvimetry for the choice of the mode of delivery, (ii) cesarean, (iii) induction of labor, and of (iv) various delivery managements on the risk of shoulder dystocia in case of fetal macrosomia, with or without maternal diabetes, and in women with previous history of shoulder dystocia. The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. In case of clinically suspected macrosomia, a sonography should be performed to increase diagnostic performances and to assist in decision-making (Professional consensus). Because CT pelvimetry is associated with high false positive rates and increases cesarean deliveries, its use is not recommended to prevent shoulder dystocia in case of fetal macrosomia (Professional consensus). To avoid the neonatal complications of shoulder dystocia, mainly permanent brachial plexus palsy, cesarean delivery is recommended in case of estimated fetal weight (EFW) greater than 4500 g if associated with maternal diabetes (grade C), and greater than 5000 g in the absence of maternal diabetes (grade C). The published data do not provide definitive evidences to recommend systematic labor induction in case of impending fetal macrosomia (Professional consensus). In case of favourable cervix and gestational age greater than 39 weeks of gestation, labor induction should be promoted (Professional consensus). Prophylactic McRoberts maneuver is not recommended to prevent shoulder dystocia in case of fetal macrosomia (grade C). Because data are lacking, no recommendation is possible regarding the use of episiotomy. In case of fetal macrosomia and failure to progress in the second stage of labor, midpelvic and higher instrumental deliveries are not recommended and a cesarean delivery should be preferred (grade C), if the fetal head is at or lower than a +2 station, cesarean delivery is not recommended and an

  8. ARDS: Risk Factors, Prognostic Factors, Management and Outcomes. Incidence and Mortality of ARDS in Combat Casualty Care

    DTIC Science & Technology

    2009-07-01

    with their associated risk of transfusion-associated acute lung injury ( TRALI ) and this issue warrants further study. Fluid amounts for...numbers of patients are now exposed to plasma products, with their associated risk of transfusion-associated acute lung injury ( TRALI ) and this issue

  9. Changes in elevated cholesterol in the era of tenofovir in South Africa: risk factors, clinical management and outcomes.

    PubMed

    Jamieson, L; Evans, D; Brennan, A T; Moyo, F; Spencer, D; Mahomed, K; Maskew, M; Long, L; Rosen, S; Fox, M P

    2017-09-01

    Antiretroviral therapy (ART) has been associated with unfavourable lipid profile changes and increased risk of cardiovascular disease (CVD). With a growing population on ART in South Africa, there has been concern about the increase in noncommunicable diseases such as CVD. We determined risk factors associated with increased total cholesterol (TC) in a large cohort on ART and describe the clinical management thereof. We conducted an observational cohort study of ART-naïve adults initiating standard first-line ART in a large urban clinic in Johannesburg, South Africa. TC was measured annually for most patients. A proportional hazards regression model was used to determine risk factors associated with incident high TC (≥ 6 mmol/L). Significant risk factors included initial regimen non-tenofovir vs. tenofovir [hazard ratio (HR) 1.54; 95% confidence interval (CI) 1.14-2.08], age ≥40 vs. <30 years (HR 3.22; 95% CI 2.07-4.99), body mass index (BMI) ≥ 30 kg/m(2) (HR 1.65; 95% CI 1.18-2.31) and BMI 25-29.9 kg/m(2) (HR 1.70; 95% CI 1.30-2.23) vs. 18-24.9 kg/m(2) , and baseline CD4 count < 50 cells/μL (HR 1.55; 95% CI 1.10-2.20) and 50-99 cells/μL (HR 1.40; 95% CI 1.00-1.97) vs. > 200 cells/μL. Two-thirds of patients with high TC were given cholesterol-lowering drugs, after repeat TC measurements about 12 months apart, while 31.8% were likely to have received dietary counselling only. Older age, higher BMI, lower CD4 count and a non-tenofovir regimen were risk factors for incident elevated TC. Current guidelines do not indicate regular cholesterol testing at ART clinic visits, which are the main exposure to regular clinical monitoring for most HIV-positive individuals. If regular cholesterol monitoring is conducted, improvements can be made to identify and treat patients sooner. © 2017 British HIV Association.

  10. Risks and Protective Factors for Stress Self-Management in Parents of Children With Autism Spectrum Disorder: An Integrated Review of the Literature.

    PubMed

    Bonis, Susan A; Sawin, Kathleen J

    Stress in parents of children with autism spectrum disorder (ASD) has been reported to be very high. However, little is known about what risk and protective factors influence parental stress self-management in this population. Accordingly, this manuscript is a synthesis of the risk and protective factors that impact self-management of stress in these parents. The concepts in the individual and family self-management theory context domain were used as a framework to guide data collection and analysis. Searches were conducted using CINAHL, MedLine and PsychInfo. Studies were included if they addressed context factors in parents of children with ASD and were written in English. Ninety-eight studies met review criteria. This review highlighted risk factors to parental stress self-management within the context of condition-specific factors, physical and social environment, and individual and family. The most concerning of these findings is that parents struggle accessing a diagnosis and services for their child and are frustrated with health care providers' knowledge of ASD and lack of communication. The risks parents experience as they care for their child with ASD far outweigh the protective factors for self-management of parental stress. Nurses who are aware of these issues can make important changes to their practice and have a significant impact on parental stress self-management and the care of children with ASD. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Adaptation and risk management

    SciTech Connect

    Preston, Benjamin L

    2011-01-01

    Adaptation assessment methods are compatible with the international risk management standard ISO:31000. Risk management approaches are increasingly being recommended for adaptation assessments at both national and local levels. Two orientations to assessments can commonly be identified: top-down and bottom-up, and prescriptive and diagnostic. Combinations of these orientations favor different types of assessments. The choice of orientation can be related to uncertainties in prediction and taking action, in the type of adaptation and in the degree of system stress. Adopting multiple viewpoints is to be encouraged, especially in complex situations. The bulk of current guidance material is consistent with top-down and predictive approaches, thus is most suitable for risk scoping and identification. Abroad range ofmaterial fromwithin and beyond the climate change literature can be used to select methods to be used in assessing and implementing adaptation. The framing of risk, correct formulation of the questions being investigated and assessment methodology are critical aspects of the scoping phase. Only when these issues have been addressed should be issue of specific methods and tools be addressed. The reorientation of adaptation from an assessment focused solely on anthropogenic climate change to broader issues of vulnerability/resilience, sustainable development and disaster risk, especially through a risk management framework, can draw from existing policy and management understanding in communities, professions and agencies, incorporating existing agendas, knowledge, risks, and issues they already face.

  12. The Global Asthma Network rationale and methods for Phase I global surveillance: prevalence, severity, management and risk factors.

    PubMed

    Ellwood, Philippa; Asher, M Innes; Billo, Nils E; Bissell, Karen; Chiang, Chen-Yuan; Ellwood, Eamon M; El-Sony, Asma; García-Marcos, Luis; Mallol, Javier; Marks, Guy B; Pearce, Neil E; Strachan, David P

    2017-01-01

    The Global Asthma Network (GAN), established in 2012, followed the International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Phase One involved over 700 000 adolescents and children from 156 centres in 56 countries; it found marked worldwide variation in symptom prevalence of asthma, rhinitis and eczema that was not explained by the current understanding of these diseases; ISAAC Phase Three involved over 1 187 496 adolescents and children (237 centres in 98 countries). It found that asthma symptom prevalence was increasing in many locations especially in low- and middle-income countries where severity was also high, and identified several environmental factors that required further investigation.GAN Phase I, described in this article, builds on the ISAAC findings by collecting further information on asthma, rhinitis and eczema prevalence, severity, diagnoses, asthma emergency room visits, hospital admissions, management and use of asthma essential medicines. The subjects will be the same age groups as ISAAC, and their parents. In this first global monitoring of asthma in children and adults since 2003, further evidence will be obtained to understand asthma, management practices and risk factors, leading to further recognition that asthma is an important non-communicable disease and to reduce its global burden.

  13. Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters.

    PubMed

    Linnemann, Birgit; Lindhoff-Last, Edelgard

    2012-09-01

    An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications.

  14. Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery: optimal management of patients on antiplatelet therapy.

    PubMed

    Okano, Atsushi; Oya, Soichi; Fujisawa, Naoaki; Tsuchiya, Tsukasa; Indo, Masahiro; Nakamura, Takumi; Chang, Han Soo; Matsui, Toru

    2014-04-01

    OBJECTIVE. Not much is known about surgical management of patients with chronic subdural haematoma (CSDH) treated with antiplatelet or anticoagulant therapy. The aims of this study were to review the surgical outcomes of patients with CSDH and assess the risks of antiplatelet in their surgical management. METHODS. We retrospectively analysed 448 consecutive patients with CSDH treated by one burr hole surgery at our institution. Among them, 58 patients had been on antiplatelet therapy. We discontinued the antiplatelet agents before surgery for all 58 patients. For 51 of these 58 patients (87.9%), early surgery was performed within 0-2 days from admission. We analysed the association between recurrence and patient characteristics, including history of antiplatelet or anticoagulant therapy; age (< 70 years or ≥ 70 years); side; history of angiotensin receptor II blocker, angiotensin converting enzyme blocker, or statin therapy; and previous medical history of head trauma, infarction, hypertension, diabetes mellitus, haemodialysis, seizure, cancer, or liver cirrhosis. RESULTS. Recurrence occurred in 40 patients (8.9%), which was one of the lowest rates in the literature. Univariate analysis showed that only the presence of bilateral haematomas was associated with increased recurrence rate while antiplatelet or anticoagulant therapy did not significantly increase recurrence risk. Also, the recurrence rate from early surgery (0-2 days from drug cessation) for patients on antiplatelet therapy was not significantly higher than that from elective surgery (5 days or more after drug cessation). However, multivariate analysis revealed that previous history of cerebral infarction was an independent risk factor for CSDH recurrence. CONCLUSIOns. Our overall data support the safety of early surgery for patients on the preoperative antiplatelet therapy without drug cessation or platelet infusion. Patients with a previous history of infarction may need to be closely followed

  15. Cryptosporidium and Giardia in different age groups of Danish cattle and pigs--occurrence and management associated risk factors.

    PubMed

    Maddox-Hyttel, Charlotte; Langkjaer, Rikke B; Enemark, Heidi L; Vigre, Håkan

    2006-10-10

    To obtain information both about the prevalence of Giardia and Cryptosporidium in Danish cattle and pigs as well as the possible influence of different management systems on the occurrence and intensity of infection, we conducted an epidemiological survey comprising 50 randomly selected dairy and sow herds, respectively. Each herd was visited once for the collection of faecal samples and registration of basic management parameters. Faecal samples were collected from three different age groups of animals, i.e. 5 sows/cows, 10 nursing piglets/calves less than 1 month, and 10 weaner pigs 8-45 kg/calves 1-12 months. The faecal samples were purified and the number of (oo)cysts quantified. The study revealed an age-specific herd prevalence of Cryptosporidium of 16, 31 and 100% for sows, piglets and weaners, respectively, and of 14, 96 and 84% for cows, young calves and older calves, respectively. For Giardia the age-specific herd prevalence was 18, 22 and 84% for the sows, piglets and weaners, while for cattle herds the prevalence was 60, 82 and 100% for cows, young calves and older calves, correspondingly. The (oo)cyst excretion levels varied considerably both within and between herds for all age groups. Risk factors were evaluated by using proportional odds models with (oo)cyst excretion levels divided into four categories as response. Among the numerous risk factors examined, only a few were demonstrated to have a statistically significant influence, e.g. the use of an empty period in the calf pen between introduction of calves for both parasites had a protective effect in young calves. For weaners, use of straw in the pen and high pressure cleaning between batches of weaners had a preventive effect against higher Cryptosporidium oocyst excretion levels.

  16. Air quality risk management.

    PubMed

    Williams, Martin L

    2008-01-01

    Rather than attempt to provide a comprehensive account of air quality risk assessment, as might be found in a textbook or manual, this article discusses some issues that are of current importance in the United Kingdom and the rest of Europe, with special emphasis on risk assessment in the context of policy formulation, and emerging scientific knowledge. There are two pollutants of particular concern and that both pose challenges for risk assessment and policy, and they are particulate matter (PM) and ozone. The article describes some issues for health risk assessment and finally some forward-looking suggestions for future approaches to air quality management.

  17. Research on culturally tailored interventions aimed at improving chronic disease risk factors and management.

    PubMed

    Dorrejo, Xiomara M; Wilson, Paula

    2012-10-01

    High blood pressure (HBP) is a worldwide epidemic with health and economic consequences. Although there is a growing body of knowledge, treatment options, and clinical guidelines, a small percentage of people with hypertension (HTN) achieve optimal control. In addition, HBP disproportionately affects racial and ethnic minorities. Strategies to address the management of HTN among specific populations remain scarce. Evidence shows that successful management of HTN requires pharmacological, educational, and self-care approaches. The first 3 summaries here profile research addressing this issue. The research focuses on the tailoring of interventions for racial and ethnic minority groups, specifically African Americans and Korean Americans. The fourth summary profiles an intervention targeted at a low-literacy group to improve diet. Readers are encouraged to access the full articles to learn more details about the intervention strategies and outcomes of these initiatives.

  18. Identifying and managing risk factors for salt-affected soils: a case study in a semi-arid region in China.

    PubMed

    Zhou, De; Xu, Jianchun; Wang, Li; Lin, Zhulu; Liu, Liming

    2015-07-01

    Soil salinization and desalinization are complex processes caused by natural conditions and human-induced risk factors. Conventional salinity risk identification and management methods have limitations in spatial data analysis and often provide an inadequate description of the problem. The objectives of this study were to identify controllable risk factors, to provide response measures, and to design management strategies for salt-affected soils. We proposed to integrate spatial autoregressive (SAR) model, multi-attribute decision making (MADM), and analytic hierarchy process (AHP) for these purposes. Our proposed method was demonstrated through a case study of managing soil salinization in a semi-arid region in China. The results clearly indicated that the SAR model is superior to the OLS model in terms of risk factor identification. These factors include groundwater salinity, paddy area, corn area, aquaculture (i.e., ponds and lakes) area, distance to drainage ditches and irrigation channels, organic fertilizer input, and cropping index, among which the factors related to human land use activities are dominant risk factors that drive the soil salinization processes. We also showed that ecological irrigation and sustainable land use are acceptable strategies for soil salinity management.

  19. Risk Factors for Tuberculosis

    PubMed Central

    Narasimhan, Padmanesan; Wood, James; MacIntyre, Chandini Raina; Mathai, Dilip

    2013-01-01

    The risk of progression from exposure to the tuberculosis bacilli to the development of active disease is a two-stage process governed by both exogenous and endogenous risk factors. Exogenous factors play a key role in accentuating the progression from exposure to infection among which the bacillary load in the sputum and the proximity of an individual to an infectious TB case are key factors. Similarly endogenous factors lead in progression from infection to active TB disease. Along with well-established risk factors (such as human immunodeficiency virus (HIV), malnutrition, and young age), emerging variables such as diabetes, indoor air pollution, alcohol, use of immunosuppressive drugs, and tobacco smoke play a significant role at both the individual and population level. Socioeconomic and behavioral factors are also shown to increase the susceptibility to infection. Specific groups such as health care workers and indigenous population are also at an increased risk of TB infection and disease. This paper summarizes these factors along with health system issues such as the effects of delay in diagnosis of TB in the transmission of the bacilli. PMID:23476764

  20. Risk management in surgery

    PubMed Central

    MESSANO, G.A.; SPAZIANI, E.; TURCHETTA, F.; CECI, F.; CORELLI, S.; CASCIARO, G.; MARTELLUCCI, A.; COSTANTINO, A.; NAPOLEONI, A.; CIPRIANI, B.; NICODEMI, S.; DI GRAZIA, C.; MOSILLO, R.; AVALLONE, M.; ORSINI, S.; TUDISCO, A.; AIUTI, F.; STAGNITTI, F.

    2013-01-01

    Summary Malpractice is the responsible for the greatest number of legal claims. At the present time, legal actions against physicians in Italy are 15,000 per year, and a stunning increase about costs to refund patients injured by therapeutic and diagnostic errors is expected. The method for the medical prevention is “Risk Management”, that is the setting-up of organizational instruments, methods and actions that enable the measurement or estimation of medical risk; it allows to develop strategies to govern and reduce medical error. In the present work, the reconstruction about the history of risk management in Italy was carried out. After then the latest initiatives undertaken by Italy about the issue of risk management were examined. PMID:24091181

  1. Gemcitabine-Related Pneumonitis in Pancreas Adenocarcinoma--An Infrequent Event: Elucidation of Risk Factors and Management Implications.

    PubMed

    Sahin, Ibrahim Halil; Geyer, Alexander I; Kelly, Daniel W; O'Reilly, Eileen Mary

    2016-03-01

    Gemcitabine-related pneumonitis (GRP) has been reported relatively frequently for pancreas cancer in the literature; however, underlying risk factors and optimal management remain to be defined. We studied a cohort of patients with GRP and investigated potential predisposing factors in pancreatic cancer patients. A total 2440 patients at Memorial Sloan Kettering Cancer Center were identified between January 1, 2000, and December 31, 2012, and were screened for grade 2 or higher GRP in an institutional tumor registry and using an ICD billing code database. Demographic and clinical information was extracted by electronic chart review. A total of 28 patients (1.1%) with GRP were identified. Incidence of grade 2, 3, and 4 reactions were 7 (25%), 18 (64%), and 3 (11%), respectively. No GRP-related mortality was observed. Twenty-one patients (75%) reported a history of cigarette smoking. Seventeen patients (61%) were alcohol users. Six patients (21%) were either regular or heavy drinkers. Most patients (93%) had either locally advanced or metastatic disease. Three patients (11%) underwent a diagnostic bronchoscopy, and in 1 patient a diagnosis of organizing pneumonia was established. Morbidity was significant; 3 patients (11%) required treatment in the intensive care unit. All hospitalized patients received steroid treatment. GRP is relatively uncommon but incurs significant morbidity. Potential risk factors include advanced-stage disease, along with smoking and alcohol consumption and possibly underlying lung disease. We recommend a high level of clinical alertness regarding the diagnosis, early pulmonary referral, and cessation of gemcitabine on suspicion of GRP. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Bleeding in patients using new anticoagulants or antiplatelet agents: risk factors and management.

    PubMed

    Levi, M M; Eerenberg, E; Löwenberg, E; Kamphuisen, P W

    2010-02-01

    The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. In case of serious or even life-threatening bleeding in a patient who uses anticoagulant agents or when patient on anticoagulants needs to undergo an urgent invasive procedure, anticoagulant treatment can be reversed by various specific strategies. Heparin and heparin derivatives can be counteracted by protamine sulphate, whereas the anticoagulant effect of vitamin K antagonists may be neutralised by administration of vitamin K or prothrombin complex concentrates. The antihaemostatic effect of aspirin and other antiplatelet strategies can be corrected by the administration of platelet concentrate and/or desmopressin, if needed. Recently, a new generation of anticoagulants with a greater specificity towards activated coagulation factors has been introduced and most of these agents are currently being evaluated in clinical studies, showing promising results. The new-generation anticoagulants include specific inhibitors of factor IIa or factor Xa (including pentasaccharides) and antiplatelet agents belonging to the class of thienopyridine derivatives. A limitation of the new class of anti-IIa and anti-Xa agents may be the lack of an appropriate strategy to reverse the effect if a bleeding event occurs, although in some cases the administration of recombinant factor VIIa may be an option.

  3. Management- and housing-related risk factors of respiratory disorders in non-weaned French Charolais calves.

    PubMed

    Assié, Sébastien; Bareille, Nathalie; Beaudeau, François; Seegers, Henri

    2009-10-01

    Our aim was to determine at calf-batch level the management- and housing-related risk factors of respiratory disorders in non-weaned Charolais calves. Farmers recorded cases according to the definition provided i.e. the association of at least one respiratory sign and, in the same calf or another calf of the same batch, at least one general sign on the same day or the day before. During farm visits, quality of farmers' records was checked and questionnaires were applied to gather farm and herd characteristics and to describe farming practices and housing facilities. Data were suitable for analysis for 172 batches where no metaphylactic treatment was implemented. Batches had great disparity in incidence of respiratory disorders. In the 120 batches with at least one case, the quartiles of incidence rate were, respectively, 0.95, 2.15 and 3.59 cases per 1000 calf-days at-risk. For risk-factor analysis, the statistical unit was the calf-batch located in a given batch. We used a ZINB model because (i) there was significant overdispersion of incidence rates of respiratory disorders (overdispersion test statistic of O=1049 (P<0.001)), (ii) probability was high that a two-group modelling process existed (Vuong statistic of V=2.44 (P=0.0073)) and (iii) the ZINB model fit significantly better than the ZIP model (likelihood-ratio statistic of 340.14 (P<0.001)). The risk was higher in open-fronted barns or in open barns compared to closed ones (incidence-rate ratios (IRRs): 1.9 and 1.8), in barns where no annual disinfection was implemented (IRR: 1.5) and in part slope with straw/part scraped and in part straw-bedded/part scraped barns compared to completely straw-bedded barns (IRRs: 1.9 and 1.6). Larger calf-batches were more at-risk than smaller batches (OR for the effect of an increase of 10 calves on the probability of a 0 count: 0.5).

  4. An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

    PubMed Central

    Laws, Rachel A; Kemp, Lynn A; Harris, Mark F; Davies, Gawaine Powell; Williams, Anna M; Eames-Brown, Rosslyn

    2009-01-01

    Background Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed. Methods The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data. Results The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These

  5. Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes: the ACCORD randomized trial.

    PubMed

    Margolis, Karen L; O'Connor, Patrick J; Morgan, Timothy M; Buse, John B; Cohen, Robert M; Cushman, William C; Cutler, Jeffrey A; Evans, Gregory W; Gerstein, Hertzel C; Grimm, Richard H; Lipkin, Edward W; Narayan, K M Venkat; Riddle, Matthew C; Sood, Ajay; Goff, David C

    2014-06-01

    To compare effects of combinations of standard and intensive treatment of glycemia and either blood pressure (BP) or lipids in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. ACCORD enrolled 10,251 type 2 diabetes patients aged 40-79 years at high risk for cardiovascular disease (CVD) events. Participants were randomly assigned to hemoglobin A1c goals of <6.0% (<42 mmol/mol; intensive glycemia) or 7.0-7.9% (53-63 mmol/mol; standard glycemia) and then randomized a second time to either 1) systolic BP goals of <120 mmHg (intensive BP) or <140 mmHg (standard BP) or 2) simvastatin plus fenofibrate (intensive lipid) or simvastatin plus placebo (standard lipid). Proportional hazards models were used to assess combinations of treatment assignments on the composite primary (deaths due to CVD, nonfatal myocardial infarction [MI], and nonfatal stroke) and secondary outcomes. In the BP trial, risk of the primary outcome was lower in the groups intensively treated for glycemia (hazard ratio [HR] 0.67; 95% CI 0.50-0.91), BP (HR 0.74; 95% CI 0.55-1.00), or both (HR 0.71; 95% CI 0.52-0.96) compared with combined standard BP and glycemia treatment. For secondary outcomes, MI was significantly reduced by intensive glycemia treatment and stroke by intensive BP treatment; most other HRs were neutral or favored intensive treatment groups. In the lipid trial, the general pattern of results showed no evidence of benefit of intensive regimens (whether single or combined) compared with combined standard lipid and glycemia treatment. The mortality HR was 1.33 (95% CI 1.02-1.74) in the standard lipid/intensive glycemia group compared with the standard lipid/standard glycemia group. In the ACCORD BP trial, compared with combined standard treatment, intensive BP or intensive glycemia treatment alone improved major CVD outcomes, without additional benefit from combining the two. In the ACCORD lipid trial, neither intensive lipid nor glycemia treatment produced an overall

  6. Screening and management of risk factors for cardiovascular disease in HIV-positive patients attending an Australian urban sexual health clinic.

    PubMed

    Kakar, Sheena; Drak, Douglas; Amin, Tahiya; Cheung, Jason; O'Connor, Catherine; Gracey, David

    2016-11-11

    Background: Few data exist regarding cardiovascular risk among HIV-infected patients attending sexual health clinics (SHC) in Australia. Methods: The medical records of 188 patients attending an inner-city SHC between August 2013 and July 2014 were retrospectively reviewed for cardiovascular risk factors and associated screening and management practices. Results: Cardiovascular risk factors were common among attendees of the SHC, including smoking (38%), hypertension (14%) and dyslipidaemia (11%). Of the 188 patients, 23% reported using potentially cardiotoxic recreational drugs, 25% of dyslipidaemic patients were not on therapy and 10% of patients were hypertensive; none were prescribed treatment. A smoking cessation program was offered to all patients. Conclusion: A high prevalence of risk factors for cardiovascular disease was demonstrated. Modification of risk factors could be improved.

  7. Retrospective assessment of osteomyelitis. Etiology, demographics, risk factors, and management in 35 cases.

    PubMed

    Koorbusch, G F; Fotos, P; Goll, K T

    1992-08-01

    A retrospective review and analysis of the management of osteomyelitis in 35 patients at a major hospital complex has been made. In this patient population sample, trauma and odontogenic sources were determined to be the most prevalent causes of osteomyelitis of the jaws, which in the vast majority of cases affected the mandible. Alcohol and/or tobacco use was reported in at least one half of the cases surveyed. Surgical exploration and debridement were most frequently used during the treatment of these cases. The microbial causes of these lesions were most frequently mixed infections that originated from the oral cavity. Antimicrobial therapy most often used beta-lactam-bearing antibiotics, although combinations with other agents were often included. These and other data obtained through this study underscore the multifactored causes and therapeutic approaches found in osteomyelitis of the jaws.

  8. [Risk factors for stroke].

    PubMed

    Mandić, Milan; Rancić, Natasa

    2011-01-01

    Stroke is the third cause of mortality both in men and in women throughout the world. In Serbia, stroke is the first cause of mortality in women older than 55 years of age and the second cause of death in men of the same age. Both ischemic heart diseases and ischemic stroke correlate with the same predisposing, potentially modifiable risk factors (hypertension, abnormal blood lipids and lipoproteins, cigarette smoking, physical inactivity, obesity, diabetes mellitus). Stroke does not usually occur on its own. Patients with stroke have a high prevalence of associated medical problems. These conditions may predict the stroke ("preexisting conditions"), occur for the first time after stroke ("post-stroke complications"), or present as manifestations of preexisting medical conditions after stroke. Risk factors for stroke are divided into the three groups: risk factors which cannot be influenced on such as: age, gender, positive family history of stroke, race: those which are modifiable such as: hypertension, diabetes mellitus, smoking cigarettes, obesity, physical inactivity and the third group consists of potential risk factors for stroke (consumption of alcohol, hormones, changes in fibrinolysis, changes in blood. Stroke remains a leading cause of long-term disability and premature death of both men and women. Consequently, stroke survivors are often handicapped and doomed to sedentary lifestyle which restrains performance of activities of daily living, increases the risk for falls, and may contribute to a higher risk for recurrent stroke and cardiovascular disease. Prevention of stroke is still a great medical and social problem. Further studies are required to investigate potential risk factors for the occurrence of stroke as well as the measures of primary and secondary prevention.

  9. Isometric Exercise Training for Managing Vascular Risk Factors in Mild Cognitive Impairment and Alzheimer’s Disease

    PubMed Central

    Hess, Nicole C. L.; Smart, Neil A.

    2017-01-01

    Alzheimer’s disease (AD) is the most common form of dementia diagnosed amongst the elderly. Mild cognitive impairment (MCI) is a condition often indicative of the earliest symptomatology of AD with 10%–15% of MCI patients reportedly progressing to a diagnosis of AD. Individuals with a history of vascular risk factors (VRF’s) are considered high risk candidates for developing cognitive impairment in later life. Evidence suggests that vascular injury resulting from untreated VRF’s promotes progression from MCI to AD and exacerbates the severity of dementia in AD, and neuroimaging studies have found that the neurodegenerative processes associated with AD are heavily driven by VRF’s that promote cerebral hypoperfusion. Subsequently, common links between vascular disorders such as hypertension and neurodegenerative disorders such as AD include compromised vasculature, cerebral hypoperfusion and chronic low grade inflammation (a hallmark of both hypertension and AD). Exercise has been demonstrated to be an effective intervention for blood pressure management, chronic low grade inflammation and improvements in cognition. Data from recent analyses suggests that isometric exercise training (IET) may improve vascular integrity and elicit blood pressure reductions in hypertensives greater than those seen with dynamic aerobic and resistance exercise. IET may also play an effective role in the management of VRF’s at the MCI stage of AD and may prove to be a significant strategy in the prevention, attenuation or delay of progression to AD. A plausible hypothesis is that the reactive hyperemia stimulated by IET initiates a cascade of vascular, neurotrophic and neuro-endocrine events that lead to improvements in cognitive function. PMID:28316570

  10. Navigator program risk management

    NASA Technical Reports Server (NTRS)

    Wessen, Randii R.; Padilla, Deborah A.

    2004-01-01

    In this paper, program risk management as applied to the Navigator Program: In Search of New Worlds will be discussed. The Navigator Program's goals are to learn how planetary systems form and to search for those worlds that could or do harbor life.

  11. Navigator program risk management

    NASA Technical Reports Server (NTRS)

    Wessen, Randii R.; Padilla, Deborah A.

    2004-01-01

    In this paper, program risk management as applied to the Navigator Program: In Search of New Worlds will be discussed. The Navigator Program's goals are to learn how planetary systems form and to search for those worlds that could or do harbor life.

  12. Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey.

    PubMed

    Alam, Mahbub-Ul; Luby, Stephen P; Halder, Amal K; Islam, Khairul; Opel, Aftab; Shoab, Abul K; Ghosh, Probir K; Rahman, Mahbubur; Mahon, Therese; Unicomb, Leanne

    2017-07-09

    Many adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation. Little research has been conducted on how menstruation affects school absence. This study examines the association of menstrual hygiene management knowledge, facilities and practice with absence from school during menstruation among Bangladeshi schoolgirls. We conducted a nationally representative, cross-sectional study in Bangladeshi schools from March to June 2013 among girls 11 to 17 years old who reached menarche. We sampled 700 schools from 50 urban and 50 rural clusters using a probability proportional to size technique. We interviewed 2332 schoolgirls and conducted spot checks in each school for menstrual hygiene facilities. To assess factors associated with reported school absence, we estimated adjusted prevalence difference (APD) for controlling confounders' effect using generalised estimating equations to account for school-level clustering. Among schoolgirls who reached menarche, 41% (931) reported missing school, an average of 2.8 missed days per menstrual cycle. Students who felt uncomfortable at school during menstruation (99% vs 32%; APD=58%; CI 54 to 63) and who believed menstrual problems interfere with school performance (64% vs 30%; APD=27; CI 20 to 33) were more likely to miss school during menstruation than those who did not. School absence during menstruation was less common among girls attending schools with unlocked toilet for girls (35% vs 43%; APD=-5.4; CI -10 to -1.6). School absence was more common among girls who were forbidden from any activities during menstruation (41% vs 33%; APD=9.1; CI 3.3 to 14). Risk factors for school absence included girl's attitude, misconceptions about menstruation, insufficient and inadequate facilities at school, and family restriction. Enabling girls to manage menstruation at school by providing knowledge and management methods prior to menarche, privacy and a

  13. Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey

    PubMed Central

    Luby, Stephen P; Halder, Amal K; Islam, Khairul; Opel, Aftab; Shoab, Abul K; Ghosh, Probir K; Rahman, Mahbubur; Mahon, Therese; Unicomb, Leanne

    2017-01-01

    Background Many adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation. Little research has been conducted on how menstruation affects school absence. This study examines the association of menstrual hygiene management knowledge, facilities and practice with absence from school during menstruation among Bangladeshi schoolgirls. Methods We conducted a nationally representative, cross-sectional study in Bangladeshi schools from March to June 2013 among girls 11 to 17 years old who reached menarche. We sampled 700 schools from 50 urban and 50 rural clusters using a probability proportional to size technique. We interviewed 2332 schoolgirls and conducted spot checks in each school for menstrual hygiene facilities. To assess factors associated with reported school absence, we estimated adjusted prevalence difference (APD) for controlling confounders’ effect using generalised estimating equations to account for school-level clustering. Results Among schoolgirls who reached menarche, 41% (931) reported missing school, an average of 2.8 missed days per menstrual cycle. Students who felt uncomfortable at school during menstruation (99% vs 32%; APD=58%; CI 54 to 63) and who believed menstrual problems interfere with school performance (64% vs 30%; APD=27; CI 20 to 33) were more likely to miss school during menstruation than those who did not. School absence during menstruation was less common among girls attending schools with unlocked toilet for girls (35% vs 43%; APD=−5.4; CI −10 to –1.6). School absence was more common among girls who were forbidden from any activities during menstruation (41% vs 33%; APD=9.1; CI 3.3 to 14). Conclusion Risk factors for school absence included girl’s attitude, misconceptions about menstruation, insufficient and inadequate facilities at school, and family restriction. Enabling girls to manage menstruation at school by providing knowledge and management

  14. Clinical Variability in Cardiovascular Disease Risk Factor Screening and Management in Adolescent and Young Adult Women with Polycystic Ovary Syndrome.

    PubMed

    Baer, Tamara E; Milliren, Carly E; Walls, Courtney; DiVasta, Amy D

    2015-10-01

    To review the clinical presentation, evaluation, and management of normal-weight (NW), overweight (OW), and obese (OB) adolescent and young adult women with polycystic ovary syndrome (PCOS) during a 2-year follow-up. Retrospective chart review. One hundred seventy-three adolescent and young adult women, aged 12-22 years, diagnosed with PCOS. Demographic, health data, and laboratory measures were abstracted from 3 clinic visits: baseline and 1- and 2-year follow-up. Subjects were classified as NW, OW, or OB. Longitudinal data were analyzed using repeated-measures analysis of variance. Body mass index, self-reported concerns, and lifestyle changes. Most patients (73%) were OW or OB. Family history of type 2 diabetes was greater in OW (38%) and OB (53%) patients compared with NW (22%) patients (P = .002). Acanthosis nigricans was identified in OW (62%) and OB (21%) patients but not in NW patients (0%; P < .001). OW and OB patients had higher fasting insulin (P < .001) and lower high-density lipoprotein cholesterol (P = .005) levels than NW patients, although screening rates were low. Body mass index Z-scores decreased in both OW and OB patients over time (0.07 unit/yr, P < .001). Most patients with PCOS were OW or OB. Substantial clinical variability existed in cardiovascular disease (CVD) screening; among those screened, OW and OB patients had greater CVD risk factors. Despite self-reported concerns about weight and diabetes risk among OW and OB patients, no clinically significant change in body mass index percentile occurred. Evidence-based interventions and recommendations for screening tests are needed to address CVD risk in adolescents and young adults with PCOS. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  15. Clinical variability in cardiovascular disease risk factor screening and management in adolescent and young adult women with polycystic ovary syndrome

    PubMed Central

    Baer, Tamara E.; Milliren, Carly E.; Walls, Courtney; DiVasta, Amy D.

    2014-01-01

    Study Objectives To review the clinical presentation, evaluation and management of normal-weight, overweight and obese adolescent and young adult women with PCOS over 2-year follow-up. Design Retrospective chart review Participants 173 adolescent and young adult women, aged 12–22 years, diagnosed with PCOS Interventions Demographic, health data, and laboratory measures were abstracted from 3 clinic visits: baseline and 1- and 2- year follow-up. Subjects were classified as normal-weight (NW), overweight (OW) or obese (OB). Longitudinal data were analyzed using repeated measures ANOVA. Main Outcome Measures BMI, self-reported concerns, lifestyle changes. Results Most patients (73%) were OW or OB. Family history of type II diabetes was greater in OW (38%) and OB (53%) as compared to NW (22%) patients (p=0.002). Acanthosis nigricans was identified in OW (62%) and OB (21%) patients, but not NW patients (0%; p <0.001). OW and OB patients had higher fasting insulin (p<0.001) and lower HDL cholesterol (p=0.005) than NW patients, although screening rates were low. BMI Z-scores decreased in both OW and OB patients over time (0.07 units/year; p<0.001). Conclusions Most patients with PCOS were OW/OB. Substantial clinical variability existed in CVD screening; among those screened, OW and OB patients had greater CVD risk factors. Despite self-reported concerns about weight and diabetes risk among OW/OB patients, no clinically significant change in BMI percentile occurred. Evidence-based interventions and recommendations for screening tests are needed to address CVD risk in adolescents and young adults with PCOS. PMID:26081478

  16. Prevalence and risk factors for central diabetes insipidus in cardiac arrest survivor treated with targeted temperature management.

    PubMed

    Lee, Dong Hun; Lee, Byung Kook; Song, Kyoung Hwan; Jung, Yong Hun; Park, Jung Soo; Lee, Sung Min; Cho, Yong Soo; Kim, Jin Woong; Jeung, Kyung Woon

    2016-08-01

    Central diabetes insipidus (CDI) is a marker of severe brain injury. Here we aimed to investigate the prevalence and risk factors of CDI in cardiac arrest survivors treated with targeted temperature management (TTM). This retrospective observational study included consecutive adult cardiac arrest survivors treated with TTM between 2008 and 2014. Central diabetes insipidus was confirmed if all of the following criteria were met: urine volume >50 cc kg(-1) d(-1), serum osmolarity >300 mmol/L, urine osmolarity <300 mmol/L, and serum sodium >145 mEq/L. The primary outcome was the incidence of CDI. Of the 385 included patients, 45 (11.7%) had confirmed central CDI. Univariate analysis showed that younger age, nonwitness of collapse, nonshockable rhythm, a high incidence of asphyxia arrest, longer downtime, and lower initial core temperature were associated with CDI development. Patients with CDI had a higher incidence of poor neurologic outcomes at discharge and higher in-hospital mortality rate (20/45 vs 76/340, P= .001) as well as 180-day mortality (44/45 vs 174/340, P< .001). Multivariate analysis revealed that age (odds ratio [OR], 0.963; 95% confidence interval [CI], 0.942-0.984), shockable rhythm (OR, 0.077; 95% CI, 0.009-0.662), downtime (OR, 1.025; 95% CI, 1.006-1.044), and asphyxia etiology (OR, 6.815; 95% CI, 2.457-18.899) were independently associated with CDI development. Central diabetes insipidus developed in 12% of cardiac arrest survivors treated with TTM, and those with CDI showed poor neurologic outcomes and high mortality rates. Younger age, nonshockable rhythm, long downtime, and asphyxia arrest were significant risk factors for development of CDI. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. A survey of temporomandibular joint dislocation: aetiology, demographics, risk factors and management in 96 Nigerian cases.

    PubMed

    Ugboko, V I; Oginni, F O; Ajike, S O; Olasoji, H O; Adebayo, E T

    2005-07-01

    A retrospective study of 96 cases of temporomandibular joint dislocation was undertaken. Patients' ages ranged from 9 to 85 years (mean+/-SD, 35.3+/-17.4 years) and peak incidence was at 20-29 years. Mean duration was 7.9 weeks (range, 1h to 3 years). Acute, chronic and recurrent dislocations were seen in 46 (47.9%), 29 (30.2%) and 21 (21.9%) patients, respectively. Males dominated in all three categories but this was not statistically significant (P = 0.8). Excessive mouth opening while yawning (44 cases) was the commonest cause of dislocation, followed by road traffic accidents (13 cases). Ten patients (10.4%) had an underlying systemic disease, the commonest being epilepsy (four cases); those with acute dislocation recorded the highest incidence of underlying illness. Bilateral anterior (86 cases) dislocations were the most frequent. Of the 96 patients, 89 (92.7%) were available for treatment. Manual reduction with or without anaesthesia proved effective for 38/45 acute, 5/24 chronic and 14/20 recurrent cases. Chronic dislocations were treated mainly by surgical osteotomy (13/24). Vertical subsigmoid and oblique ramus osteotomies were the commonest surgical techniques recorded. Treatment was satisfactory for all patients surgically handled except for one case of anterior open bite postoperatively. This study has shown that excessive mouth opening while yawning is the commonest cause of temporomandibular joint dislocation in Nigerians, and conservative approaches to management remain quite effective irrespective of the duration and clinical subtype. The best choice of surgical technique should be determined by proper clinical evaluation and the need to avoid or minimize postoperative morbidity.

  18. Continuous Risk Management: An Overview

    NASA Technical Reports Server (NTRS)

    Rosenberg, Linda; Hammer, Theodore F.

    1999-01-01

    Software risk management is important because it helps avoid disasters, rework, and overkill, but more importantly because it stimulates win-win situations. The objectives of software risk management are to identify, address, and eliminate software risk items before they become threats to success or major sources of rework. In general, good project managers are also good managers of risk. It makes good business sense for all software development projects to incorporate risk management as part of project management. The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to implement risk management. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This is an introductory tutorial to continuous risk management based on this course. The rational for continuous risk management and how it is incorporated into project management are discussed. The risk management structure of six functions is discussed in sufficient depth for managers to understand what is involved in risk management and how it is implemented. These functions include: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

  19. A survey of management practices on Irish dairy farms with emphasis on risk factors for Johne's disease transmission.

    PubMed

    Kennedy, Aideen E; O'Doherty, Eugene F; Byrne, Noel; O'Mahony, Jim; Kennedy, E M; Sayers, Riona G

    2014-01-01

    Johne's disease (JD) is a chronic granulomatous enteritis affecting ruminants. A number of farm management practices are associated with increased risk of JD transmission. The aim of the current study was to document JD-related management practices currently employed on Irish dairy farms. Survey questions focused on calving area (CA), calf and manure management. Independent variables (region, calving-season, enterprise type, herd size and biosecurity status) were used to examine influences on JD associated dependent variables (survey questions). Additionally general biosecurity practices were also examined. Results showed management practices implemented by Irish dairy farmers pose a high risk of JD transmission. Of the farmers surveyed, 97% used the CA for more than one calving, 73.5% and 87.8% pooled colostrum and milk respectively, 33.7% never cleaned the CA between calving's, and 56.6% used the CA for isolating sick cows. Survey results also highlighted that larger herds were more likely to engage in high risk practices for JD transmission, such as pooling colostrum (OR 4.8) and overcrowding the CA (OR 7.8). Larger herds were also less likely than smaller herds to clean the CA (OR 0.28), a practice also considered of risk in the transmission of JD. Many management practices associated with risk of JD transmission were commonly applied on Irish dairy farms. Larger herds were more likely to engage in high risk practices for JD transmission. Control programmes should incorporate educational tools outlining the pathogenesis and transmission of JD to highlight the risks associated with implementing certain management practices with regard to JD transmission.

  20. Postoperative Urinary Leakage Following Partial Nephrectomy for Renal Mass: Risk Factors and a Proposed Algorithm for the Diagnosis and Management.

    PubMed

    Erlich, T; Abu-Ghanem, Y; Ramon, J; Mor, Y; Rosenzweig, B; Dotan, Z

    2017-06-01

    To evaluate the current incidence, risk factors, management, and long-term follow-up of urinary leakage following partial nephrectomy, in order to propose an algorithm for diagnosis and evaluation of postoperative urinary leakage. The study included 752 patients who underwent elective partial nephrectomies for renal masses between the years 1988 and 2013. Patients' demographics, clinico-pathologic variables, and operative details were collected retrospectively. The associations between urinary leakage and patients' variables were assessed by univariate and multivariate analyses. Of the 752 patients, 21 (2.8%) experienced urinary leakage; 4 of the 21 patients with urinary leakage had spontaneous resolution, 1 patient underwent nephrectomy, and 16 patients were treated by retrograde ureteral stents insertion. One of them necessitated insertion of an additional percutaneous nephrostomy and another one deserved concomitant percutaneous drainage of a perirenal urinoma. The average period of time that elapsed from the operation until the insertion of stent was 8.5 ± 4.5 days. Stents were removed 68 ± 20.5 days postoperatively. None of the patients had either persistent or repeated leakage. On univariate analysis, hilar renal masses (p < 0.04) and higher preoperative creatinine levels (p < 0.01) were found to be associated with higher rates of urinary leakage. None of these variables was significant on a multivariate analysis. Review of the urinary leakage rate over time revealed it has been constantly decreasing over time, from 4% in early cases to 1.3% among the most recent ones. None of the preoperative variables that were examined in this study was significantly associated with increased risk of urinary leakage. However, cumulative surgical experience was associated with lower rates of urinary leakage, suggesting that the decrease in its incidence is related to the improved surgical skills, rather than to differences in tumors' or patients

  1. [Pathological gambling: risk factors].

    PubMed

    Bouju, G; Grall-Bronnec, M; Landreat-Guillou, M; Venisse, J-L

    2011-09-01

    In France, consumption of gambling games increased by 148% between 1960 and 2005. In 2004, gamblers lost approximately 0.9% of household income, compared to 0.4% in 1960. This represents approximately 134 Euros per year and per head. In spite of this important increase, the level remains lower than the European average (1%). However, gambling practices may continue to escalate in France in the next few years, particularly with the recent announce of the legalisation of online games and sports betting. With the spread of legalised gambling, pathological gambling rates may increase in France in the next years, in response to more widely available and more attractive gambling opportunities. In this context, there is a need for better understanding of the risk factors that are implicated in the development and maintenance of pathological gambling. This paper briefly describes the major risk factors for pathological gambling by examining the recent published literature available during the first quarter of 2008. This documentary basis was collected by Inserm for the collective expert report procedure on Gambling (contexts and addictions). Seventy-two articles focusing on risk factors for pathological gambling were considered in this review. Only 47 of them were taken into account for analysis. The selection of these 47 publications was based on the guide on literature analysis established by the French National Agency for Accreditation and Assessment in Health (ANAES, 2000). Some publications from more recent literature have also been added, mostly about Internet gambling. We identify three major types of risk factors implicated in gambling problems: some of them are related to the subject (individual factors), others are related to the object of the addiction, here the gambling activity by itself (structural factors), and the last are related to environment (contextual or situational factors). Thus, the development and maintenance of pathological gambling seems to be

  2. Modifications of Coronary Risk Factors

    PubMed Central

    Albu, Jeanine; Gottlieb, Sheldon H.; August, Phyllis; Nesto, Richard W.; Orchard, Trevor J.

    2009-01-01

    In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.59 mmol/L (<100 mg/dL) with an optional goal of <1.81 mmol/L (<70 mg/dL); plasma triglyceride level <1.70 mmol/L (<150 mg/dL); blood pressure level <130 mm Hg systolic and <80 mm Hg diastolic; and smoking cessation treatment for all active smokers. Algorithms were developed for the pharmacologic management of dyslipidemia and hypertension. Dietary prescriptions for the management of glycemia, plasma lipid profiles, and blood pressure levels were adapted from existing clinical practice guidelines. Patients with a body mass index >25 were prescribed moderate caloric restriction; after the trial was under way, a lifestyle weight-management program was instituted. All patients were formally prescribed both endurance and resistance/flexibility exercises, individually adapted to their level of disability and fitness. Pedometers were distributed as a biofeedback strategy. Strategies to achieve the goals for risk factors were designed by BARI 2D working groups (lipid, cardiovascular and hypertension, and nonpharmacologic intervention) and the ongoing implementation of the strategies is monitored by lipid, hypertension, and lifestyle intervention management centers. PMID:16813737

  3. Prevalence, management and control of diabetes mellitus and associated risk factors in primary health care in Portugal.

    PubMed

    Cortez-Dias, Nuno; Martins, Susana; Belo, Adriana; Fiuza, Manuela

    2010-04-01

    antihypertensive medication, but only 9.8% had controlled BP (M: 13.7%; F: 6.1%). Although 59% of the diabetic population were being treated with statins, only 6.7% had total cholesterol < 200 mg/dl, triglycerides < 150 mg/dl and HDL-cholesterol > 60 mg/dl. Of diabetic patients with CAD, 76.5% were being treated with statins, but only 29.4% had total cholesterol < 175 mg/dl (M: 34.2%; F: 24.1%). The management of DM in a primary care setting in Portugal can and should be improved, since 9.8% of patients are not treated and 48.3% are not controlled. DM has a considerable clinical impact due to its strong association with CAD and stroke. The risk of stroke and CAD is much higher in diabetic women, due firstly to a stronger association of DM with other risk factors in women, and secondly to less aggressive treatment.

  4. Prevalence and management of cardiovascular risk factors in Portuguese living in Portugal and Portuguese who migrated to Switzerland.

    PubMed

    Alves, Luís; Azevedo, Ana; Barros, Henrique; Vollenweider, Peter; Waeber, Gérard; Marques-Vidal, Pedro

    2015-03-31

    Information regarding the health status of migrants compared to subjects who remain in the country of origin is scarce. We compared the levels and management of the main cardiovascular risk factors between Portuguese living in Porto (Portugal) and Portuguese migrants living in Lausanne (Switzerland). Cross-sectional studies conducted in Porto (EPIPorto, 1999 to 2003, n = 1150) and Lausanne (CoLaus, 2003 to 2006, n = 388) among subjects aged 35-65 years. Educational level, medical history and time since migration were collected using structured questionnaires. Body mass index, blood pressure, cholesterol and glucose levels were measured using standardized procedures. Portuguese living in Lausanne were younger, more frequently male and had lower education than Portuguese living in Porto. After multivariate adjustment using Poisson regression, no differences were found between Portuguese living in Porto or in Lausanne: prevalence rate ratio (PRR) and (95% confidence interval) for Portuguese living in Lausanne relative to Portuguese living in Porto: 0.92 (0.71 - 1.18) for current smoking; 0.78 (0.59 - 1.04) for obesity; 0.81 (0.62 - 1.05) for abdominal obesity; 0.82 (0.64 - 1.06) for hypertension; 0.88 (0.75 - 1.04) for hypercholesterolemia and 0.92 (0.49 - 1.73) for diabetes. Treatment and control rates for hypercholesterolemia were higher among Portuguese living in Lausanne: PRR = 1.91 (1.15 - 3.19) and 3.98 (1.59 - 9.99) for treatment and control, respectively. Conversely, no differences were found regarding hypertension treatment and control rates: PRR = 0.98 (0.66 - 1.46) and 0.97 (0.49 - 1.91), respectively, and for treatment rates of diabetes: PRR = 1.51 (0.70 - 3.25). Portuguese living in Lausanne, Switzerland, present a similar cardiovascular risk profile but tend to be better managed regarding hypercholesterolemia than Portuguese living in Porto, Portugal.

  5. Breast cancer risk factors

    PubMed Central

    Ciszewski, Tomasz; Łopacka-Szatan, Karolina; Miotła, Paweł; Starosławska, Elżbieta

    2015-01-01

    Breast cancer is the most frequently diagnosed neoplastic disease in women around menopause often leading to a significant reduction of these women's ability to function normally in everyday life. The increased breast cancer incidence observed in epidemiological studies in a group of women actively participating in social and professional life implicates the necessity of conducting multidirectional studies in order to identify risk factors associated with the occurrence of this type of neoplasm. Taking the possibility of influencing the neoplastic transformation process in individuals as a criterion, all the risk factors initiating the process can be divided into two groups. The first group would include inherent factors such as age, sex, race, genetic makeup promoting familial occurrence of the neoplastic disease or the occurrence of benign proliferative lesions of the mammary gland. They all constitute independent parameters and do not undergo simple modification in the course of an individual's life. The second group would include extrinsic factors conditioned by lifestyle, diet or long-term medical intervention such as using oral hormonal contraceptives or hormonal replacement therapy and their influence on the neoplastic process may be modified to a certain degree. Identification of modifiable factors may contribute to development of prevention strategies decreasing breast cancer incidence. PMID:26528110

  6. Therapeutic and optical keratoplasty in the management of Acanthamoeba keratitis: risk factors, outcomes, and summary of the literature.

    PubMed

    Robaei, Dana; Carnt, Nicole; Minassian, Darwin C; Dart, John K G

    2015-01-01

    To report the risk factors for and outcomes of therapeutic and optical keratoplasty in the management of Acanthamoeba keratitis (AK). Retrospective case series. A total of 50 eyes of 196 patients with retrievable medical records, diagnosed with AK at Moorfields Eye Hospital, London, underwent keratoplasty between January 1991 and April 2012. Patient demographics, initial clinical examination findings, and management details were collected. The ophthalmic characteristics of patients who underwent keratoplasty for AK were compared with those who did not. Patients undergoing therapeutic keratoplasty were compared with those undergoing optical keratoplasty for baseline characteristics, management details, and visual outcomes. A multivariate logistic model was used to derive the odds ratios of a poor visual outcome in all keratoplasty patients. Poor visual outcome was defined as final visual acuity of 20/200 or worse. Secondary outcomes of interest included number of clinic visits and the need for additional intraocular surgery. Of the 196 AK patients, a total of 50 patients (25.5%) underwent penetrating or anterior lamellar keratoplasty, 10 of whom (20%) underwent repeat procedures. Of these 50 patients, 26 (52%) had therapeutic keratoplasty, predominantly for corneal perforation. The remaining 24 patients (48%) underwent optical keratoplasty for visual rehabilitation. Thirty-seven (80.4%) patients in the keratoplasty group initially were misdiagnosed as having herpes simplex keratitis versus 59 (41.8%) patients who did not require a keratoplasty (P < 0.001). Final visual outcomes were significantly better in the optical group compared with the therapeutic group, with 13 (54.2%) achieving visual acuity of 20/30 or better versus 7 (26.9%), respectively. On multivariate analysis, beginning therapy at a hospital other than Moorfields and undergoing a therapeutic, rather than an optical, keratoplasty were associated significantly with a poor visual outcome from

  7. Manageable risk factors associated with the lactational incidence, elimination, and prevalence of Staphylococcus aureus intramammary infections in dairy cows.

    PubMed

    Dufour, S; Dohoo, I R; Barkema, H W; Descôteaux, L; Devries, T J; Reyher, K K; Roy, J-P; Scholl, D T

    2012-03-01

    Staphylococcus aureus intramammary infections (IMI) are a major cause of mastitis on farms worldwide. Incidence and elimination rates are the key determinants of prevalence of Staph. aureus, and risk factors associated with these rates must be identified, prioritized, and controlled to obtain long-term reduction in prevalence. The objectives of this study were to identify manageable risk factors associated with the lactational incidence, elimination, and prevalence of Staph. aureus IMI. A cohort of 90 Canadian dairy farms was recruited and followed in 2007 and 2008. Quarter milk samples were collected repeatedly from a selection of cows, and bacteriological culture was realized to assess incidence, elimination, and prevalence of Staph. aureus IMI. Practices used on farms were measured using direct observations and a validated questionnaire. A linear regression model was used to explore the relationship between herd IMI prevalence and incidence and elimination rates. Multilevel logistic regression models were used to compute measures of associations between practices used on farms and IMI incidence, elimination, and prevalence. The herd incidence rate was the most important predictor of herd IMI prevalence: a reduction of the incidence rate equivalent to its interquartile range (0.011 new IMI/quarter-month) was associated with a prevalence reduction of 2.2 percentage points; in comparison, an equivalent increase of the elimination rate by its interquartile range (0.36 eliminated IMI/quarter-month) resulted in a prevalence reduction of 0.4 percentage points. Postmilking teat disinfection and blanket dry-cow therapy were already implemented by most herds. Most of the practices associated with Staph. aureus IMI incidence were related to milking procedures. Among these, wearing gloves during milking showed desirable associations with IMI incidence, elimination, and prevalence. Similarly, adequate teat-end condition and use of premilking teat disinfection were associated

  8. Continuous Risk Management Course. Revised

    NASA Technical Reports Server (NTRS)

    Hammer, Theodore F.

    1999-01-01

    This document includes a course plan for Continuous Risk Management taught by the Software Assurance Technology Center along with the Continuous Risk Management Guidebook of the Software Engineering Institute of Carnegie Mellon University and a description of Continuous Risk Management at NASA.

  9. Manual of Educational Risk Management.

    ERIC Educational Resources Information Center

    Cody, Frank J.; Dise, John H., Jr.

    This is the first risk management publication for school administrators that attempts to be comprehensive by addressing all potential areas of risk to school districts and offering specific guidelines on how to manage those areas. Chapter 1 gives directions on how to use the manual. Chapter 2 contains a complete overview of risk management,…

  10. Manual of Educational Risk Management.

    ERIC Educational Resources Information Center

    Cody, Frank J.; Dise, John H., Jr.

    This is the first risk management publication for school administrators that attempts to be comprehensive by addressing all potential areas of risk to school districts and offering specific guidelines on how to manage those areas. Chapter 1 gives directions on how to use the manual. Chapter 2 contains a complete overview of risk management,…

  11. Risk management of nanomaterials.

    PubMed

    Gwinn, Maureen R; Tran, Lang

    2010-01-01

    Nanotechnology has become the focus of a large amount of scientific, political, and financial interest. Limited information on the exposure to nanomaterials is available, with only a few occupational exposure studies having been performed. While laboratory animal studies on the biological effects of some nanomaterials have been published, no epidemiological studies have been reported to date. This lack of data on exposure and human health effects hinders risk assessment of these materials. As the use of nanomaterials increases rapidly, it is of vital importance that the risk assessment community understands the complexities of the issues surrounding the manufacture, use and disposal of nanomaterials, the potential of environmental and occupational exposure to human populations, as well as adverse health outcomes. For this to happen, it is in many ways necessary for the scientific community to also understand what questions risk assessors need to ask, and what research will best answer them. Risk management of nanomaterials requires more information as to the human and ecological effects of exposure to various nanomaterials. At this time, there are no specific regulations for nanomaterials, but a few efforts to include nanomaterials under existing environmental regulations have begun. The purpose of this article is to describe the potential regulations for nanomaterials, and the current issues related to the risk assessment of nanomaterials.

  12. Educational interventions for general practitioners to identify and manage depression as a suicide risk factor in young people: a systematic review and meta-analysis protocol.

    PubMed

    Tait, Lynda; Michail, Maria

    2014-12-15

    Suicide is a major public health problem and globally is the second leading cause of death in young adults. Globally, there are 164,000 suicides per year in young people under 25 years. Depression is a strong risk factor for suicide. Evidence shows that 45% of those completing suicide, including young adults, contact their general practitioner rather than a mental health professional in the month before their death. Further evidence indicates that risk factors or early warning signs of suicide in young people go undetected and untreated by general practitioners. Healthcare-based suicide prevention interventions targeted at general practitioners are designed to increase identification of at-risk young people. The rationale of this type of intervention is that early identification and improved clinical management of at-risk individuals will reduce morbidity and mortality. This systematic review will synthesise evidence on the effectiveness of education interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people. We shall conduct a systematic review and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions guidelines and conform to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases will be systematically searched for randomised controlled trials and quasi-experimental studies investigating the effectiveness of interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people in comparison to any other intervention, no intervention, usual care or waiting list. Grey literature will be searched by screening trial registers. Only studies published in English will be included. No date restrictions will be applied. Two authors will independently screen titles and abstracts of potential studies. The primary outcome is

  13. Human parainfluenza virus infection after hematopoietic stem cell transplantation: risk factors, management, mortality, and changes over time.

    PubMed

    Ustun, Celalettin; Slabý, Jiří; Shanley, Ryan M; Vydra, Jan; Smith, Angela R; Wagner, John E; Weisdorf, Daniel J; Young, Jo-Anne H

    2012-10-01

    Human parainfluenza viruses (HPIVs) are uncommon, yet high-risk pathogens after hematopoietic stem cell transplant (HCT). We evaluated 5178 pediatric and adult patients undergoing HCT between 1974 and 2010 to determine the incidence, risk factors, response to treatment, and outcome of HPIV infection as well as any change in frequency or character of HPIV infection over time. HPIV was identified in 173 patients (3.3%); type 3 was most common (66%). HPIV involved upper respiratory tract infection (URTI; 57%), lower respiratory tract infection (LRTI; 9%), and both areas of the respiratory tract (34%), at a median of 62 days after transplantation. In more recent years, HPIV has occurred later after HCT, whereas the proportion with nosocomial infection and mortality decreased. Over the last decade, HPIV was more common in older patients and in those receiving reduced intensity conditioning (RIC). RIC was a significant risk factor for later (beyond day +30). HPIV infections, and this association was strongest in patients with URTI. HCT using a matched unrelated donor (MURD), mismatched related donor (MMRD), age 10 to 19 years, and graft-versus-host disease (GVHD) were all risk factors for HPIV infections. LRTI, early (<30 days), age 10 to 19 years, MMRD, steroid use, and coinfection with other pathogens were risk factors for mortality. The survival of patients with LRTI, especially very early infections, was poor regardless of ribavirin treatment. HPIV incidence remains low, but may have delayed onset associated with RIC regimens and improving survival. Effective prophylaxis and treatment for HPIV are needed.

  14. A single-center experience and review of the literature: 64 cases of phyllodes tumors to better understand risk factors and disease management.

    PubMed

    Lightner, Amy L; Shurell, Elizabeth; Dawson, Nicole; Omidvar, Yasaman; Foster, Nova

    2015-03-01

    Phyllodes tumors of the breast are rare fibroepithelial tumors that are characterized as benign, borderline, or malignant based on cellular characteristics such as stromal overgrowth and number of mitoses. Currently, there is a lack of consensus on risk factors and management of patients with phyllodes tumors, which has led to variation in treatment patterns as well as patient outcomes across many institutions. This study seeks to understand the clinicopathologic features, risk factors for local and metastatic recurrence, and clinical outcomes of patients with phyllodes tumors to better define optimal treatment patterns.

  15. Risk Factors for Eating Disorders

    ERIC Educational Resources Information Center

    Striegel-Moore, Ruth H.; Bulik, Cynthia M.

    2007-01-01

    The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances…

  16. Risk Factors for Cholelithiasis.

    PubMed

    Pak, Mila; Lindseth, Glenda

    2016-01-01

    Gallstone disease is one of the most common public health problems in the United States. Approximately 10%-20% of the national adult populations currently carry gallstones, and gallstone prevalence is rising. In addition, nearly 750,000 cholecystectomies are performed annually in the United States; direct and indirect costs of gallbladder surgery are estimated to be $6.5 billion. Cholelithiasis is also strongly associated with gallbladder, pancreatic, and colorectal cancer occurrence. Moreover, the National Institutes of Health estimates that almost 3,000 deaths (0.12% of all deaths) per year are attributed to complications of cholelithiasis and gallbladder disease. Although extensive research has tried to identify risk factors for cholelithiasis, several studies indicate that definitive findings still remain elusive. In this review, predisposing factors for cholelithiasis are identified, the pathophysiology of gallstone disease is described, and nonsurgical preventive options are discussed. Understanding the risk factors for cholelithiasis may not only be useful in assisting nurses to provide resources and education for patients who are diagnosed with gallstones, but also in developing novel preventive measures for the disease.

  17. Managing Risks and Beyond

    DTIC Science & Technology

    2010-04-01

    situation occurring and its undesirable consequences          • Risk (Project Management Body of Knowledge  PMBOK ) – An uncertain even or condition that, if it...favorable or advantageous combination of circumstances – A chance for progress or advancement  • Opportunity ( PMBOK ) – A condition or situation favorable to...opportunities and reduce threats to project objectives      PMBOK – Includes Mitigation and Contingencies – Includes acceptance of the risk or issue

  18. Eastern European risk management

    SciTech Connect

    Honey, J.A. )

    1992-01-01

    Here the authors assess Eastern European risk management practices through the evaluation of the nuclear power plants in the region. This evaluation is limited to the Soviet-designed and -built VVER-440 pressurized water reactors (PWRs) that are currently operating in Bulgaria, Czechoslovakia, Hungary, Russia, and the Ukraine and until recently operated at Greifswald in the former East Germany. This evaluation is based on the basic design of the plants, a safety evaluation of the Greifswald facility by representatives from the Federal Republic of Germany and personal visits by the author to Greifswald and Loviisa.

  19. [Assessment of dynamic violent behavior risk factors].

    PubMed

    Folino, Jorge Oscar; Cáceres, María Soledad; Campos, María Laura; Silveri, Marina; Ucín, Silvana; Ascazibar, Mariel

    2005-01-01

    Dynamic violent behavior risk factors have special significance since they constitute the main target for preventive intervention. Different dynamic factors as well as violent recidivism were assessed with, among other instruments, the environmental risk (Risk Management) section of the Argentinean version of the HCR-20 in 25 parolees from the Province of Buenos Aires Penitentiary System. Among other findings, the prevalence of the risk factors linked to substance abuse and socioeconomic deprivation, and the heterogeneous perception of the official institutions are very significant. Exposure to destabilizers was the factor most associated with violent recidivism.

  20. Communicating Risk to Program Managers

    NASA Technical Reports Server (NTRS)

    Shivers, C. Herbert

    2005-01-01

    Program Managers (PM) can protect program resources and improve chances of success by anticipating, understanding and managing risks. Understanding the range of potential risks helps one to avoid or manage the risks. A PM must choose which risks to accept to reduce fire fighting, must meet the expectations of stakeholders consistently, and avoid falling into costly "black holes" that may open. A good risk management process provides the PM more confidence to seize opportunities save money, meet schedule, even improve relationships with people important to the program. Evidence of managing risk and sound internal controls can mean better support from superiors for the program by building a trust and reputation from being on top of issues. Risk managers have an obligation to provide the PM with the best information possible to allow the benefits to be realized (Small Business Consortium, 2004). The Institute for Chartered Accountants in England and Wales sees very important benefits for companies in providing better information about what they do to assess and manage key business risks. Such information will: a) provide practical forward-looking information; b) reduce the cost of capital; c) encourage better risk management; and d) improve accountability for stewardship, investor protection and the usefulness of financial reporting. We are particularly convinced that enhanced risk reporting will help listed companies obtain capital at the lowest possible cost (The Institute of Chartered Accountants in England &Wales, June 2002). Risk managers can take a significant role in quantifying the success of their department and communicating those figures to executive (program) management levels while pushing for a broader risk management role. Overall, risk managers must show that risk management work matters in the most crucial place-the bottom line- as they prove risk management can be a profit center (Sullivan, 2004).

  1. Long-term risk factor management after inpatient cardiac rehabilitation by means of a structured post-care programme.

    PubMed

    Harb, Birgit M; Wonisch, Manfred; Brandt, Dieter; Müller, Rudolf

    2011-12-01

    Initiation of a long-term improvement of cardiac risk factors is one of the major aims of a cardiac rehabilitation/secondary prevention programme. The Health Guide collected data in terms of cardiac risk factors: blood pressure, resting pulse, total cholesterol, LDL cholesterol, body weight, physical activity and number of cigarettes at admission and discharge after a stationary rehabilitation programme and every 3 months. After 12 months the Health Guides were returned. In the prospective study 2664 patients (71.8% men, age: MV = 62.94 years, SD = 9.96; 28% women, MV = 67.59 years, SD = 9.53) with coronary heart disease (CHD) were included. All cardiac risk factors documented by the Health Guide improved during the cardiac rehabilitation programme. After one year, risk factors were significantly lower than at admission, apart from total cholesterol. The individual goal in terms of body weight and LDL cholesterol was partially achieved after the rehabilitation programme and maintained after one year. In the investigation years, 2004-2007, the cholesterol and blood pressure were significantly lower than in the years 2000-2003. The use of a Health Guide resulted in an improved long-term effect of a cardiac rehabilitation/secondary prevention programme. It is a simple and cheap intervention and can help in the guidance of the patients.

  2. Managing information technology security risk

    NASA Technical Reports Server (NTRS)

    Gilliam, David

    2003-01-01

    Information Technology (IT) Security Risk Management is a critical task for the organization to protect against the loss of confidentiality, integrity and availability of IT resources. As systems bgecome more complex and diverse and and attacks from intrusions and malicious content increase, it is becoming increasingly difficult to manage IT security risk. This paper describes a two-pronged approach in addressing IT security risk and risk management in the organization: 1) an institutional enterprise appraoch, and 2) a project life cycle approach.

  3. Managing information technology security risk

    NASA Technical Reports Server (NTRS)

    Gilliam, David

    2003-01-01

    Information Technology (IT) Security Risk Management is a critical task for the organization to protect against the loss of confidentiality, integrity and availability of IT resources. As systems bgecome more complex and diverse and and attacks from intrusions and malicious content increase, it is becoming increasingly difficult to manage IT security risk. This paper describes a two-pronged approach in addressing IT security risk and risk management in the organization: 1) an institutional enterprise appraoch, and 2) a project life cycle approach.

  4. An analysis of the management of cardiovascular risk factors in routine clinical practice in Italy: an overview of the main findings of the EFFECTUS study.

    PubMed

    Tocci, Giuliano; Ferrucci, Andrea; Guida, Pietro; Avogaro, Angelo; Comaschi, Marco; Corsini, Alberto; Cortese, Claudio; Giorda, Carlo B; Manzato, Enzo; Medea, Gerardo; Mureddu, Gian F; Riccardi, Gabriele; Titta, Giulio; Ventriglia, Giuseppe; Zito, Giovanni B; Volpe, Massimo

    2011-03-01

    Cardiovascular diseases represent the leading cause of morbidity and mortality, worldwide. Early detection and appropriate management of cardiovascular risk factors and disease markers in daily clinical practice may improve preventive strategies and reduce the burden of cardiovascular disease. The EFFECTUS (Evaluation of Final Feasible Effect of Control Training and Ultra Sensitisation) programme was an educational programme aimed at evaluating prevalence of major cardiovascular risk factors among outpatients, and preferences and attitudes for cardiovascular disease management among Italian physicians in their routine clinical practice. This article provides an overview of the main findings of different analyses from the EFFECTUS database, which have demonstrated a high prevalence of cardiovascular risk factors, irrespective of the clinical settings and outpatient clinics in which patients were followed. Also, findings from this database suggest that more intensive clinical data recording was paralleled by better adherence to guidelines, and that use of electronic rather than conventional support for clinical data collection and registration improved accuracy in data recording, which translated into better management of patients at risk in daily clinical practice.

  5. Albuminuria, cardiovascular risk factors and disease management in subjects with type 2 diabetes: a cross sectional study

    PubMed Central

    Meisinger, Christa; Heier, Margit; Landgraf, Rüdiger; Happich, Michael; Wichmann, H-Erich; Piehlmeier, Wolfgang

    2008-01-01

    Background Epidemiological studies have shown that microalbuminuria is an important risk factor for arteriosclerosis, coronary heart disease and other vascular diseases in persons with type 2 diabetes. In the present study we examined the prevalence and risk factors for micro- and macroalbuminuria and examined glycemic control as well as treatment of modifiable cardiovascular risk factors in persons with known type 2 diabetes in Germany. Methods The presented data were derived from the 'KORA Augsburg Diabetes Family Study', conducted between October 2001 and September 2002. Participants were adults aged 29 years and older with previously diagnosed type 2 diabetes (n = 581). Microalbuminuria was defined as an albumin-creatinine ratio of 30 to 300 mg/g, and macroalbuminuria as an albumin-creatinine ratio of more than 300 mg/g. Results Microalbuminuria was revealed in 27.2% and macroalbuminuria in 9.0% of the 581 included diabetic persons. Multivariable regression analysis identified HBA1c, duration of diabetes, systolic blood pressure, serum creatinine, smoking and waist circumference as independent risk factors associated with albuminuria (micro- or macroalbuminuria). Relatively few persons with type 2 diabetes achieved treatment targets of HbA1c < 7% (46.6%), total cholesterol < 200 mg/dl (44.1%), and LDL cholesterol < 100 mg/dl (16.0%). Optimal HDL cholesterol values (> 45 mg/dl in men, > 55 mg/dl in women) were found in 55.8%, and blood pressure values < 130 and < 85 mmHg in 31.3% of the persons Conclusion Albuminuria is common among German persons with known type 2 diabetes. Despite evidence-based guidelines, only a small proportion of type 2 diabetic persons achieved the recommended levels of glycemic control and control of cardiovascular risk factors. PMID:18986536

  6. [Risk and risk management in aviation].

    PubMed

    Müller, Manfred

    2004-10-01

    RISK MANAGEMENT: The large proportion of human errors in aviation accidents suggested the solution--at first sight brilliant--to replace the fallible human being by an "infallible" digitally-operating computer. However, even after the introduction of the so-called HITEC-airplanes, the factor human error still accounts for 75% of all accidents. Thus, if the computer is ruled out as the ultimate safety system, how else can complex operations involving quick and difficult decisions be controlled? OPTIMIZED TEAM INTERACTION/PARALLEL CONNECTION OF THOUGHT MACHINES: Since a single person is always "highly error-prone", support and control have to be guaranteed by a second person. The independent work of mind results in a safety network that more efficiently cushions human errors. NON-PUNITIVE ERROR MANAGEMENT: To be able to tackle the actual problems, the open discussion of intervened errors must not be endangered by the threat of punishment. It has been shown in the past that progress is primarily achieved by investigating and following up mistakes, failures and catastrophes shortly after they happened. HUMAN FACTOR RESEARCH PROJECT: A comprehensive survey showed the following result: By far the most frequent safety-critical situation (37.8% of all events) consists of the following combination of risk factors: 1. A complication develops. 2. In this situation of increased stress a human error occurs. 3. The negative effects of the error cannot be corrected or eased because there are deficiencies in team interaction on the flight deck. This means, for example, that a negative social climate has the effect of a "turbocharger" when a human error occurs. It needs to be pointed out that a negative social climate is not identical with a dispute. In many cases the working climate is burdened without the responsible person even noticing it: A first negative impression, too much or too little respect, contempt, misunderstandings, not expressing unclear concern, etc. can

  7. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II.

    PubMed

    Vanhees, L; Geladas, N; Hansen, D; Kouidi, E; Niebauer, J; Reiner, Z; Cornelissen, V; Adamopoulos, S; Prescott, E; Börjesson, M; Bjarnason-Wehrens, B; Björnstad, H H; Cohen-Solal, A; Conraads, V; Corrado, D; De Sutter, J; Doherty, P; Doyle, F; Dugmore, D; Ellingsen, Ø; Fagard, R; Giada, F; Gielen, S; Hager, A; Halle, M; Heidbüchel, H; Jegier, A; Mazic, S; McGee, H; Mellwig, K P; Mendes, M; Mezzani, A; Pattyn, N; Pelliccia, A; Piepoli, M; Rauch, B; Schmidt-Trucksäss, A; Takken, T; van Buuren, F; Vanuzzo, D

    2012-10-01

    In a previous paper, as the first of a series of three on the importance of characteristics and modalities of physical activity (PA) and exercise in the management of cardiovascular health within the general population, we concluded that, in the population at large, PA and aerobic exercise capacity clearly are inversely associated with increased cardiovascular disease risk and all-cause and cardiovascular mortality and that a dose–response curve on cardiovascular outcome has been demonstrated in most studies. More and more evidence is accumulated that engaging in regular PA and exercise interventions are essential components for reducing the severity of cardiovascular risk factors, such as obesity and abdominal fat, high BP, metabolic risk factors, and systemic inflammation. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit for each separate risk factor. The present paper, therefore, will review and make recommendations for PA and exercise training in the management of cardiovascular health in individuals with cardiovascular risk factors. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and individual members of the public. Based on previous and the current literature overviews, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and regarding appropriate risk evaluation during exercise in individuals with cardiovascular risk factors.

  8. Salivary Gland Cancer: Risk Factors

    MedlinePlus

    ... Cancer > Salivary Gland Cancer: Risk Factors Request Permissions Salivary Gland Cancer: Risk Factors Approved by the Cancer.Net ... f t k e P Types of Cancer Salivary Gland Cancer Guide Cancer.Net Guide Salivary Gland Cancer ...

  9. [Cardiovascular risk factors in women].

    PubMed

    Cengel, Atiye

    2010-03-01

    It is estimated that at least 80% of patients with cardiovascular disease (CVD) have conventional risk factors and optimization of these risk factors can reduce morbidity and mortality due to this disease considerably. Contemporary women have increased burden of some of these risk factors such as obesity, metabolic syndrome and smoking. Turkish women have a worse CV risk profile than Turkish men in some aspects. Risk stratification systems such as Framingham have a tendency of underestimating the risk in women. Coronary artery disease remains in vessel wall for a longer period of time in women; therefore obstructive disease appear later in their lifespan necessitating risk stratification systems for estimating their lifetime risk.

  10. Risk management frameworks for human health and environmental risks.

    PubMed

    Jardine, Cindy; Hrudey, Steve; Shortreed, John; Craig, Lorraine; Krewski, Daniel; Furgal, Chris; McColl, Stephen

    2003-01-01

    (formative, process, and outcome evaluation), and be prepared to change the decision if new information becomes available. Comprehensive and sound principles are critical to providing structure and integrity to risk management frameworks. Guiding principles are intended to provide an ethical grounding for considering the many factors involved in risk management decision making. Ten principles are proposed to guide risk management decision making. The first four principles were adapted and modified from Hattis (1996) along with the addition of two more principles by Hrudey (2000). These have been supplemented by another four principles to make the 10 presented. The principles are based in fundamental ethical principles and values. These principles are intended to be aspirational rather than prescriptive--their application requires flexibility and practical judgement. Risk management is inherently a process in search of balance among competing interests and concerns. Each risk management decision will be "balancing act" of competing priorities, and trade-offs may sometimes have to be made between seemingly conflicting principles. The 10 decision-making principles, with the corresponding ethical principle in italics are: 1. Do more good than harm (beneficence, nonmalificence).- The ultimate goal of good risk management is to prevent or minimize risk, or to "do good" as much as possible. 2. Fair process of decision making (fairness, natural justice). - Risk management must be just, equitable, impartial, unbiased, dispassionate, and objective as far as possible given the circumstances of each situation. 3. Ensure an equitable distribution of risk (equity). - An equitable process of risk management would ensure fair outcomes and equal treatment of all concerned through an equal distribution of benefits and burdens (includes the concept of distributive justice, i.e., equal opportunities for all individuals). 4. Seek optimal use of limited risk management resources (utility

  11. Treat-to-target approach in managing modifiable risk factors of patients with coronary heart disease in primary care in Singapore: what are the issues?

    PubMed Central

    2011-01-01

    Background The key management strategy for established coronary heart disease (CHD) patients is to control the underlying risk factors. Further complications will be reduced when these risk factors are treated-to-target (TTT) as recommended by clinical practice guidelines. These targets include blood pressure (BP) lower than 130/80 mm Hg and LDL-cholesterol of less than 2.6 mmol/L and for those with type 2 diabetes mellitus (DM), HBA1c less than 7%. This article aimed to explore the issues affecting this approach from both the patients' and primary care physicians' (PCP) perspectives. Methods The study involved triangulation of research methods to determine the findings. Part A: focus group discussions to collect qualitative data from patients with CHD and from PCPs who were managing them in primary care. Part B: A subsequent questionnaire survey to determine the extent of their awareness of treatment targets for modifiable risk factors. Results CHD patients had variable awareness of the modifiable risk factors for CHD due to poor concordance between the PCPs' approach in managing the CHD patients and the latter's reception of information. 46% of participants knew their targets of BP control correctly; 11% of them were correct in stating their target for LDL-cholesterol control. Amongst these participants with DM (n = 146), 27% of them were correct in indicating their target of diabetic control. Conclusions Communication and practice barriers exist which hinder the treat-to-target approach in mitigating the risk factors for CHD patients. Incorporating this approach in routine clinical practice by PCPs has greater potential to achieve treatment targets for patients. PMID:21936960

  12. Risk Factor Assessment Branch (RFAB)

    Cancer.gov

    The Risk Factor Assessment Branch (RFAB) focuses on the development, evaluation, and dissemination of high-quality risk factor metrics, methods, tools, technologies, and resources for use across the cancer research continuum, and the assessment of cancer-related risk factors in the population.

  13. Risk Management: A Leader's Responsibility.

    ERIC Educational Resources Information Center

    Rowe, Roger E.

    1997-01-01

    Discusses what facilities management leaders can do to ensure the safety of students and employees. Focuses on six specific tasks, such as detecting hazards and assessing the risks, and offers three rules underlying the application of risk management, including do not accept unnecessary risk. Provides an outline of prevention responsibilities.…

  14. [Does clinical risk management require a structured conflict management?].

    PubMed

    Neumann, Stefan

    2015-01-01

    A key element of clinical risk management is the analysis of errors causing near misses or patient damage. After analyzing the causes and circumstances, measures for process improvement have to be taken. Process management, human resource development and other established methods are used. If an interpersonal conflict is a contributory factor to the error, there is usually no structured conflict management available which includes selection criteria for various methods of conflict processing. The European University Viadrina in Frankfurt (Oder) has created a process model for introducing a structured conflict management system which is suitable for hospitals and could fill the gap in the methodological spectrum of clinical risk management. There is initial evidence that a structured conflict management reduces staff fluctuation and hidden conflict costs. This article should be understood as an impulse for discussion on to what extent the range of methods of clinical risk management should be complemented by conflict management.

  15. Pediatric rhinitis risk factors

    PubMed Central

    Ji, Yaofeng; Liu, Yin; Yang, Na

    2016-01-01

    Rhinitis is a common global disorder that impacts on the quality of life of the sufferer and caregivers. Treatment for pediatric rhinitis is empirical and does not include a detailed history of the allergy triggers or allergy testing. Thus, allergen avoidance advice is not tailored to the child's sensitivities, which may result in adenoid hypertrophy. However, infant onset rhinitis, especially its relationship with respiratory viruses, remains to be further clarified. Rhinitis basically involves inflammation of the upper nasal lining, presenting typically with symptoms of runny nose (rhinorrhea), nasal blockage, and/or sneezing. While not typically fatal, it does impose significant health, psychological, and monetary burden to its sufferers, and is thus considered a global health problem. Previous findings showed that immunotherapy had significant clinical efficacy in children with allergic rhinitis. The present review article aims to highlight recent perspectives pertaining to the rhinitis risk factors especially in pediatric patients. PMID:27698737

  16. NGNP Risk Management Database: A Model for Managing Risk

    SciTech Connect

    John Collins; John M. Beck

    2011-11-01

    The Next Generation Nuclear Plant (NGNP) Risk Management System (RMS) is a database used to maintain the project risk register. The RMS also maps risk reduction activities to specific identified risks. Further functionality of the RMS includes mapping reactor suppliers Design Data Needs (DDNs) to risk reduction tasks and mapping Phenomena Identification Ranking Table (PIRTs) to associated risks. This document outlines the basic instructions on how to use the RMS. This document constitutes Revision 1 of the NGNP Risk Management Database: A Model for Managing Risk. It incorporates the latest enhancements to the RMS. The enhancements include six new custom views of risk data - Impact/Consequence, Tasks by Project Phase, Tasks by Status, Tasks by Project Phase/Status, Tasks by Impact/WBS, and Tasks by Phase/Impact/WBS.

  17. Prevention of thyroid associated-ophthalmopathy in children and adults: current views and management of preventable risk factors.

    PubMed

    Krassas, Gerasimos E; Perros, Petros

    2007-03-01

    Primary, secondary and tertiary prevention are defined according to the timing of the preventive intervention in the natural history of a disease. Secondary prevention in Graves' ophthalmopathy (GO) is challenging in the absence of reliable specific serum markers for subclinical GO that would allow an early diagnosis. Some risk factors for occurrence or progression of GO have been identified. Cigarette smoking, thyroid dysfunction and radioactive iodine (RAI) are known preventable risk factors. The list is probably much longer, and future research should be aimed at identifying more. Smoking cessation, restoration of euthyroidism by antithyroid drugs or L-thyroxine, glucocorticoid coverage after RAI or deferring RAI until the eye disease is inactive, may prevent progression of GO. Passive smoking seems to exacerbate autoimmune thyroid disease (AITD) in general, and may have a deleterious effect on childhood GO in particular, therefore avoidance of passive smoking is likely to be beneficial.

  18. Dyslipidemia and Cardiovascular Disease Risk Factor Management in HIV-1-Infected Subjects Treated with HAART in the Spanish VACH Cohort

    PubMed Central

    Domingo, Pere; Suarez-Lozano, Ignacio; Teira, Ramón; Lozano, Fernando; Terrón, Alberto; Viciana, Pompeyo; González, Juan; Galindo, Mª José; Geijo, Paloma; Vergara, Antonio; Cosín, Jaime; Ribera, Esteban; Roca, Bernardino; Garcia-Alcalde, Mª Luisa; Sánchez, Trinitario; Torres, Ferran; Lacalle, Juan Ramón; Garrido, Myriam

    2008-01-01

    Background: There is increasing evidence that metabolic adverse effects associated with antiretroviral therapy may translate into an increased cardiovascular risk in HIV-1-infected patients. Objectives: To determine the prevalence of risk factors for cardiovascular disease (CVD) among HIV-1-infected persons, and to investigate any association between them, stage of HIV-1 disease, and use of antiretroviral therapies. Methods: Multicentric, cross-sectional analysis of CVD risk factors of treated patients in the VACH cohort. The data collected includes: demographic variables, cigarette smoking, diabetes mellitus, hypertension, dyslipidemia, body mass index, stage of HIV-1 infection, and antiretroviral therapy. Results: The analysis included 2358 patients. More than 18% of the study population was at an age of appreciable risk of CVD. 1.7% had previous CVD and 59.2% were smokers. Increased prevalence of elevated total cholesterol was observed among subjects receiving an NNRTI but no PI [odds ratio (OR), 3.34; 95% confidence interval (CI), 1.77–6.31], PI but no NNRTI (OR, 4.04; 95% CI, 2.12–7.71), or NNRTI + PI (OR, 17.77; 95% CI, 7.24–43.59) compared to patients treated only with nucleoside reverse transcriptase inhibitors (NRTI). Higher CD4 cell count, lower plasma HIV-1 RNA levels, clinical signs of lipodystrophy, longer exposure times to NNRTI and PI, and older age were all also associated with elevated cholesterol levels. The use of lipid lowering agents was very low among our patients. Conclusion: Patients in the VACH cohort present multiple known risk factors for CVD, and a very low rate of lipid lowering therapy use. NNRTI and/or PI-based antiretroviral therapies are associated with the worst lipid profile. This is more frequent in older subjects with greater CD4 counts and controlled HIV-1 replication. PMID:18923695

  19. Risk Management Is Everyone's Responsibility: Reminders for Entertainment Providers.

    ERIC Educational Resources Information Center

    Talarico, Scott

    1999-01-01

    Offers guidelines for risk management to campus entertainers and their representatives, including options for insurance coverage, types of insurance policies, and risk management for non-insurable factors associated with concerts and novelty events. (MSE)

  20. Risk Management Is Everyone's Responsibility: Reminders for Entertainment Providers.

    ERIC Educational Resources Information Center

    Talarico, Scott

    1999-01-01

    Offers guidelines for risk management to campus entertainers and their representatives, including options for insurance coverage, types of insurance policies, and risk management for non-insurable factors associated with concerts and novelty events. (MSE)

  1. RISK MANAGEMENT USING PROJECT RECON

    DTIC Science & Technology

    2016-11-28

    Risk Management Using Project Recon UNCLASSIFIED: Distribution Statement A. Approved for public release; distribution is unlimited. Bonnie Leece...Project Recon Lead What is Project Recon? • A web-based GOTS tool designed to capture, manage , and link Risks, Issues, and Opportunities in a...centralized database. • Project Recon (formerly Risk Recon) is designed to be used by all Program Management Offices, Integrated Project Teams and any

  2. Risk factors in school shootings.

    PubMed

    Verlinden, S; Hersen, M; Thomas, J

    2000-01-01

    Nine incidents of multiple-victim homicide in American secondary schools are examined and common risk factors are identified. The literature dealing with individual, family, social, societal, and situational risk factors for youth violence and aggression is reviewed along with existing risk assessment methods. Checklists of risk factors for serious youth violence and school violence are used in reviewing each school shooting case. Commonalties among the cases and implications for psychologists practicing in clinical and school settings are discussed.

  3. Improving Information Security Risk Management

    ERIC Educational Resources Information Center

    Singh, Anand

    2009-01-01

    manaOptimizing risk to information to protect the enterprise as well as to satisfy government and industry mandates is a core function of most information security departments. Risk management is the discipline that is focused on assessing, mitigating, monitoring and optimizing risks to information. Risk assessments and analyses are critical…

  4. Improving Information Security Risk Management

    ERIC Educational Resources Information Center

    Singh, Anand

    2009-01-01

    manaOptimizing risk to information to protect the enterprise as well as to satisfy government and industry mandates is a core function of most information security departments. Risk management is the discipline that is focused on assessing, mitigating, monitoring and optimizing risks to information. Risk assessments and analyses are critical…

  5. Farm characteristics and calf management practices on dairy farms with and without diarrhea: a case-control study to investigate risk factors for calf diarrhea.

    PubMed

    Klein-Jöbstl, D; Iwersen, M; Drillich, M

    2014-01-01

    Calf diarrhea is one of the most important problems in calf rearing on dairy farms worldwide. Besides pathogens, several noninfectious management factors, especially management around birth, colostrum management, calf housing, feeding, and hygiene are important in the pathogenesis of diarrhea. To date, few data are available concerning calf rearing management on small and medium-sized dairy farms that are typical for Austria and the alpine region. Consequently, the objectives of this case-control study were to evaluate routine calf management practices on Austrian dairy farms and to examine differences in management between farms with and without the presence of calf diarrhea to identify risk factors. Overall, 100 dairy farms were visited. Of these farms, 50 were chosen based on the history and presence of calf diarrhea (case farms). Another 50 farms with no presence of calf diarrhea were chosen to serve as a standard of comparison (control farms). On farms, management was evaluated by face-to-face interview, and health status and hygiene were surveyed. Several calf rearing management procedures were similar on all of the visited farms, especially in areas regulated by national and European law. These factors include colostrum management and feeding. Consequently, no influence of these factors on the appearance of calf diarrhea could be detected. In contrast, other areas such as hygiene measures differed between farms and showed a partial association with the presence of calf diarrhea on farm. Variables related to diarrhea on farm were farm size; that is, the number of cows on farm. Farms with diarrhea cases were larger (median 40 cows, interquartile range 24.5 to 64.0) compared with farms with no presence of diarrhea (median 28 cows, interquartile range 18.8 to 44.0). Other risk factors that influenced the presence of diarrhea were the presence of other farm animal species on the farm [odds ratio (OR) 26.89, 95% confidence interval (CI): 2.64 to 273.5], frequency

  6. Challenges to sustainable risk management

    SciTech Connect

    Pinto, Ariel C., Aurora, Ashish, Hall, Dennis E.,

    2004-08-09

    This paper summarizes the intermediate lessons learned from the analyses of the risk management problems in three technological endeavors. These problems are: the absence of a structure for rewarding successful project risk management; the need for an ever-more accurate economic measure of risk; and the difficulty of transferring risks to contract-bound independent outsourcing entity. This paper also describes recent advancement towards providing answers to these challenges and future research endeavors in this field.

  7. Knowledge management: an innovative risk management strategy.

    PubMed

    Zipperer, Lorri; Amori, Geri

    2011-01-01

    Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success.

  8. Continuous Risk Management at NASA

    NASA Technical Reports Server (NTRS)

    Hammer, Theodore F.; Rosenberg, Linda

    1999-01-01

    NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions. This risk management structure of functions has been taught to projects at all NASA Centers and is being successfully implemented on many projects. This presentation will give project managers the information they need to understand if risk management is to be effectively implemented on their projects at a cost they can afford.

  9. Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management.

    PubMed

    Vollherbst, Dominik; Bertheau, Robert; Kauczor, Hans-Ulrich; Radeleff, Boris Alexis; Pereira, Philippe L; Sommer, Christof-Matthias

    2017-03-01

    Background Radiofrequency ablation (RFA) is an established treatment for small renal tumors. The objective of this review is to systematically assess the type, frequency, risk factors and management of treatment failure after image-guided percutaneous RFA of renal tumors. Method 10 studies (967 patients, 1033 tumors) with a mean/median follow-up of ≥ 30 months were systematically identified and analyzed. Results and Conclusion Image-guided percutaneous RFA of localized renal tumors is very effective. The most common type of treatment failure is residual unablated tumor (5.9 %), followed by local tumor progression (4.7 %). De novo tumors in the kidneys occur in 1.3 % of cases and extra-renal metastases in 2.0 %. Local tumor progression, de novo tumors in the kidneys and extra-renal metastases occur predominantly later than 12 months after initial RFA. Tumor size > 3 cm and central tumor location are the major risk factors for treatment failure. In the case of treatment failure, repeated RFA shows high success rates (86.3 % for residual unablated tumors and 87.5 % for local tumor progression). Key Points: · Treatment failure can be subdivided into residual unablated tumor and local tumor progression.. · Residual unablated tumor occurs in 5.9 % of cases.. · Local tumor progression occurs in 4.7 % of cases.. · Tumor size and location are the major risk factors for treatment failure.. · Repeated RFA is effective and commonly used for management.. Citation Format · Vollherbst D, Bertheau R, Kauczor H et al. Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management. Fortschr Röntgenstr 2017; 189: 219 - 227.

  10. Assessment and Predicting Factors of Repeated Brain Computed Tomography in Traumatic Brain Injury Patients for Risk-Stratified Care Management: A 5-Year Retrospective Study

    PubMed Central

    Sumritpradit, Preeda; Setthalikhit, Thitipong

    2016-01-01

    Background and Objective. To determine the value of repeated brain CT in TBI cases for risk-stratified care management (RSCM) and to identify predicting factors which will change the neurosurgical management after repeated brain CTs. Methods. A 5-year retrospective study from January 2009 to August 2013 was conducted. The primary outcome was the value of repeated brain CT in TBI cases. The secondary outcome is to identify predicting factors which will change the neurosurgical management after repeated brain CTs. Results. There were 145 consecutive patients with TBI and repeated brain CT after initial abnormal brain CT. Forty-two percent of all cases (N = 61) revealed the progression of intracranial hemorrhage after repeated brain CT. In all 145 consecutive patients, 67.6% of cases (N = 98) were categorized as mild TBI. For mild head injury, 8.2% of cases (N = 8) had undergone neurosurgical management after repeated brain CT. Only 1 from 74 mild TBI patients with repeated brain CT had neurosurgical intervention. Clopidogrel and midline shift more than 2 mm on initial brain CT were significant predicting factors to indicate the neurosurgical management in mild TBI cases. Conclusion. Routine repeated brain CT for RSCM had no clinical benefit in mild TBI cases. PMID:27703812

  11. NGNP Risk Management Database: A Model for Managing Risk

    SciTech Connect

    John Collins

    2009-09-01

    To facilitate the implementation of the Risk Management Plan, the Next Generation Nuclear Plant (NGNP) Project has developed and employed an analytical software tool called the NGNP Risk Management System (RMS). A relational database developed in Microsoft® Access, the RMS provides conventional database utility including data maintenance, archiving, configuration control, and query ability. Additionally, the tool’s design provides a number of unique capabilities specifically designed to facilitate the development and execution of activities outlined in the Risk Management Plan. Specifically, the RMS provides the capability to establish the risk baseline, document and analyze the risk reduction plan, track the current risk reduction status, organize risks by reference configuration system, subsystem, and component (SSC) and Area, and increase the level of NGNP decision making.

  12. 12 CFR 917.3 - Risk management.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Risk management. 917.3 Section 917.3 Banks and... RESPONSIBILITIES OF BANK BOARDS OF DIRECTORS AND SENIOR MANAGEMENT § 917.3 Risk management. (a) Risk management... all times a risk management policy that addresses the Bank's exposure to credit risk, market risk...

  13. Management of cardiovascular risk factors with pioglitazone combination therapies in type 2 diabetes: an observational cohort study

    PubMed Central

    2011-01-01

    Background Type 2 diabetes (T2D) is strongly associated with cardiovascular risk and requires medications that improve glycemic control and other cardiovascular risk factors. The authors aimed to assess the relative effectiveness of pioglitazone (Pio), metformin (Met) and any sulfonylurea (SU) combinations in non-insulin-treated T2D patients who were failing previous hypoglycemic therapy. Methods Over a 1-year period, two multicenter, open-labeled, controlled, 1-year, prospective, observational studies evaluated patients with T2D (n = 4585) from routine clinical practice in Spain and Greece with the same protocol. Patients were eligible if they had been prescribed Pio + SU, Pio + Met or SU + Met serving as a control cohort, once they had failed with previous therapy. Anthropometric measurements, lipid and glycemic profiles, blood pressure, and the proportions of patients at microvascular and macrovascular risk were assessed. Results All study treatment combinations rendered progressive 6-month and 12-month lipid, glycemic, and blood pressure improvements. Pio combinations, especially Pio + Met, were associated with increases in HDL-cholesterol and decreases in triglycerides and in the atherogenic index of plasma. The proportion of patients at high risk decreased after 12 months in all study cohorts. Minor weight changes (gain or loss) and no treatment-related fractures occurred during the study. The safety profile was good and proved similar among treatments, except for more hypoglycemic episodes in patients receiving SU and for the occurrence of edema in patients using Pio combinations. Serious cardiovascular events were rarely reported. Conclusions In patients with T2D failing prior hypoglycemic therapies, Pio combinations with SU or Met (especially Pio + Met) improved blood lipid and glycemic profiles, decreasing the proportion of patients with a high microvascular or macrovascular risk. The combination of Pio with SU or Met may therefore be recommended for T2D

  14. Prevalence of self-reported diagnosis of diabetes mellitus and associated risk factors in a national survey in the US population: SHIELD (Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes)

    PubMed Central

    Bays, Harold E; Bazata, Debbra D; Clark, Nathaniel G; Gavin, James R; Green, Andrew J; Lewis, Sandra J; Reed, Michael L; Stewart, Walter; Chapman, Richard H; Fox, Kathleen M; Grandy, Susan

    2007-01-01

    Background Studies derived from continuous national surveys have shown that the prevalence of diagnosed diabetes mellitus in the US is increasing. This study estimated the prevalence in 2004 of self-reported diagnosis of diabetes and other conditions in a community-based population, using data from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Methods The initial screening questionnaire was mailed in 2004 to a stratified random sample of 200,000 households in the US, to identify individuals, age ≥ 18 years of age, with diabetes or risk factors associated with diabetes. Follow-up disease impact questionnaires were then mailed to a representative, stratified random sample of individuals (n = 22,001) in each subgroup of interest (those with diabetes or different numbers of risk factors for diabetes). Estimated national prevalence of diabetes and other conditions was calculated, and compared to prevalence estimates from the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Results Response rates were 63.7% for the screening, and 71.8% for the follow-up baseline survey. The SHIELD screening survey found overall prevalence of self-reported diagnosis of diabetes (either type 1 or type 2) was 8.2%, with increased prevalence with increasing age and decreasing income. In logistic regression modeling, individuals were more likely to be diagnosed with type 2 diabetes if they had abdominal obesity (odds ratio [OR] = 3.50; p < 0.0001), BMI ≥28 kg/m2 (OR = 4.04; p < 0.0001), or had been diagnosed with dyslipidemia (OR = 3.95; p < 0.0001), hypertension (OR = 4.82; p < 0.0001), or with cardiovascular disease (OR = 3.38; p < 0.0001). Conclusion The SHIELD design allowed for a very large, community-based sample with broad demographic representation of the population of interest. When comparing results from the SHIELD screening survey (self-report only) to those from NHANES 1999–2002 (self

  15. Alcohol Risk Management Survey Summary.

    ERIC Educational Resources Information Center

    Janosik, Steven M.; Anderson, David S.

    Results of the Alcohol Risk Management Survey, which was completed by 325 college chief student affairs officers at four-year institutions, are presented. Adapted from the "Collegiate Alcohol Risk Assessment Guide," the survey assesses the management of alcohol-related activities on the college campus, with a focus on policy, procedure,…

  16. Continuous Risk Management

    NASA Technical Reports Server (NTRS)

    Sabelhaus, Phil

    2002-01-01

    Risk identification is an ongoing activity that takes place during the routine project work flow. Project activities such as programmatic and technical meetings, telecons, reviews, and other forms of communication often bring to light project risks. When this occurs, we record and analyze the risk on a Risk Information Sheet. This process helps the project team identify and cope with project risks throughout the life of the project.

  17. [Risk factors for birth injuries].

    PubMed

    García, Heladia; Rubio-Espíritu, Jorge; Islas-Rodríguez, Maria Teresa

    2006-01-01

    To identify risk factors associated with birth trauma. Servicio de Neonatología, Hospital General "Dr. Manuel Gea González", Secretaría de Salud. Case-control, prolective study. There were 129 cases and 134 controls. We recorded the following variables: a) maternal and delivery: age, weight, height, prenatal care, pre-existing disease or gestational disease, mode of delivery, anesthetic management during labor, use of external maneuvers or forceps; b) newborn: birth weight, gestational age, academic degree of attendant physician at delivery, and type of birth injury. The independent risk factors associated to birth injury were: for ecchymoses; general anesthesia (OR 13.7, 95% CI = 3 - 62.6), breech presentation (OR 6.4, 95% IC 95% = 1.4 - 27.9) and gestational age < or = 32 weeks (OR 6.4, 95% CI = 1.3 - 31.1); for lacerations, vaginal dystocic delivery or cesarean section (OR 19, 95% CI = 4.4 - 81.1) and use of external maneuvers (OR 5.6, 95% CI = 1.5 - 21.6); for cephalhematoma maternal height < or = 1.54 m (OR 7.4, 95% CI = 2.3 - 23.7) and external maneuvers (OR 7.2, 95% CI = 2.3 - 23.7); for caput succedaneum, external maneuvers (OR 3.4, 95% CI = 1.5-7.7) and maternal age < or = 19 or > or = 36 years (OR 3.0, 95% CI = 1.4 - 6.4). Risk factors associated with birth injuries identified in this study involved maternal conditions, neonatal conditions and mechanism of delivery.

  18. Manageable risk factors associated with bacterial and coliform counts in unpasteurized bulk milk in Flemish dairy herds.

    PubMed

    Piepers, S; Zrimšek, P; Passchyn, P; De Vliegher, S

    2014-01-01

    Associations between herd management practices and both bacterial counts (BC) and coliform counts (CC) from 254 and 242 dairy herds in Flanders (Belgium), respectively, were studied. Data were analyzed using multivariable, multilevel linear regression analysis, allowing variance components analyses. Both BC and CC fluctuated throughout the year, although the milk quality parameters followed an opposite pattern. Bacterial count values decreased with each increase of the cleaning frequency of the cubicles (once per week, once per day, twice per day, or more than twice per day) between January and March. Herds with a conventional milking parlor had substantially lower BC than herds where the cows were milked using an automatic milking system. Lower BC were observed when the milking parlor was equipped with an automatic cluster removal system, when premilking teat disinfection was applied, when the dry cows were supplemented with a mix of minerals and vitamins, and when the teats were prepared either first wet and dried or via an automatic milking system. Milking cows with a high-pipeline milking parlor setup or with an automatic milking system was associated with substantially higher CC values. Herds where prepartum heifers were often treated with antimicrobials before calving had a lower CC than farms where heifers were either not or only rarely treated. Most variation in BC and CC resided at the herd level rather than at the observation level, indicating that management is important in the control of both BC and CC. Still, only a small proportion of the total variance was explained by factors capturing information related to the milking, herd health, and dry cow management, which suggests that the bacteriological milk quality and, in particular, CC is primarily driven by other factors than the ones included in this study.

  19. Opportunity, risk, and success recognizing, addressing, and balancing multiple factors crucial to the success of a project management system deployed to support multi-lateral decommissioning programs

    SciTech Connect

    Funk, Greg; Longsworth, Paul

    2007-07-01

    This paper addresses the factors involved in effectively implementing a world-class program/project management information system funded by multiple nations. Along with many other benefits, investing in and utilizing such systems improves delivery and drive accountability for major expenditures. However, there are an equally large number of impediments to developing and using such systems. To be successful, the process requires a dynamic combining of elements and strategic sequencing of initiatives. While program/project-management systems involve information technologies, software and hardware, they represent only one element of the overall system.. Technology, process, people and knowledge must all be integrated and working in concert with one another to assure a fully capable system. Major system implementations occur infrequently, and frequently miss established targets in relatively small organizations (with the risk increasing with greater complexity). The European Bank of Reconstruction (EBRD) is midway through just such an implementation. The EBRD is using funds from numerous donor countries to sponsor development of an overarching program management system. The system will provide the Russian Federation with the tools to effectively manage prioritizing, planning, and physically decommissioning assets{sub i}n northwest Russia to mitigate risks associated the Soviet era nuclear submarine program. Project-management delivery using world-class techniques supported by aligned systems has been proven to increase the probability of delivering on-time and on-budget, assuring those funding such programs optimum value for money. However, systems deployed to manage multi-laterally funded projects must be developed with appropriate levels of consideration given to unique aspects such as: accommodation of existing project management methods, consideration for differences is management structures and organizational behaviors, incorporation of unique strengths, and

  20. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys

    PubMed Central

    Mallinger, Leslie; Abbott-Klafter, Jesse; Guerrero, Ramiro; Villalpando, Salvador; Ridaura, Ruy Lopez; Aekplakorn, Wichai; Naghavi, Mohsen; Lim, Stephen; Lozano, Rafael; Murray, Christopher JL

    2011-01-01

    Abstract Objective To examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socioeconomic factors. Methods We used nationally representative health examination surveys from Colombia, England, the Islamic Republic of Iran, Mexico, Scotland, Thailand and the United States of America to obtain data on diagnosis, treatment and control of hyperglycaemia, arterial hypertension and hypercholesterolaemia among individuals with diabetes. Using logistic regression, we explored the socioeconomic determinants of diagnosis and effective case management. Findings A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries. The figures range from 24% of the women in Scotland and the USA to 62% of the men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure and serum cholesterol was very low, ranging from 1% of male patients in Mexico to about 12% in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States. Conclusion There are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia. While no large socioeconomic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management. PMID:21379413

  1. Managing Risk in Systems Development.

    ERIC Educational Resources Information Center

    DePaoli, Marilyn M.; And Others

    Stanford University's use of a risk assessment methodology to improve the management of systems development projects is discussed. After examining the concepts of hazard, peril, and risk as they relate to the system development process, three ways to assess risk are covered: size, structure, and technology. The overall objective for Stanford…

  2. Managing Risk in Systems Development.

    ERIC Educational Resources Information Center

    DePaoli, Marilyn M.; And Others

    Stanford University's use of a risk assessment methodology to improve the management of systems development projects is discussed. After examining the concepts of hazard, peril, and risk as they relate to the system development process, three ways to assess risk are covered: size, structure, and technology. The overall objective for Stanford…

  3. Smart Grid Risk Management

    NASA Astrophysics Data System (ADS)

    Abad Lopez, Carlos Adrian

    Current electricity infrastructure is being stressed from several directions -- high demand, unreliable supply, extreme weather conditions, accidents, among others. Infrastructure planners have, traditionally, focused on only the cost of the system; today, resilience and sustainability are increasingly becoming more important. In this dissertation, we develop computational tools for efficiently managing electricity resources to help create a more reliable and sustainable electrical grid. The tools we present in this work will help electric utilities coordinate demand to allow the smooth and large scale integration of renewable sources of energy into traditional grids, as well as provide infrastructure planners and operators in developing countries a framework for making informed planning and control decisions in the presence of uncertainty. Demand-side management is considered as the most viable solution for maintaining grid stability as generation from intermittent renewable sources increases. Demand-side management, particularly demand response (DR) programs that attempt to alter the energy consumption of customers either by using price-based incentives or up-front power interruption contracts, is more cost-effective and sustainable in addressing short-term supply-demand imbalances when compared with the alternative that involves increasing fossil fuel-based fast spinning reserves. An essential step in compensating participating customers and benchmarking the effectiveness of DR programs is to be able to independently detect the load reduction from observed meter data. Electric utilities implementing automated DR programs through direct load control switches are also interested in detecting the reduction in demand to efficiently pinpoint non-functioning devices to reduce maintenance costs. We develop sparse optimization methods for detecting a small change in the demand for electricity of a customer in response to a price change or signal from the utility

  4. Risk Management Issues - An Aerospace Perspective

    NASA Technical Reports Server (NTRS)

    Perera, Jeevan S.

    2011-01-01

    Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks--risk office personnel. Each group is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk reporting and communication is an essential element of risk management and will combine both qualitative and quantitative elements.. Risk informed decision making should be introduced to all levels of management. Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner, Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

  5. Risk factors for surgical infections.

    PubMed

    Dominioni, Lorenzo; Imperatori, Andrea; Rotolo, Nicola; Rovera, Francesca

    2006-01-01

    Many risk factors for postoperative infections have been identified that can be used individually or in combination as scoring indices. Infection risk scores can be applied in clinical practice to identify high-risk surgical patients, to indicate the need to implement risk-reduction strategies, and to stratify risk for comparison of outcome among different patient series. In the hierarchy of patient-related risk factors, serum albumin concentration and advanced age rank at the top of the list. Among the treatment-related factors, the quality of the surgical technique is a most important determinant, although most surgical site infections are attributable to patient-related risk factors rather than to flawed surgical care. Scoring systems can identify the patients at highest risk, thus prompting the implementation of therapy to improve modifiable conditions, but most clinicians outside the academic and research setting do not use them. Risk assessment also can be performed by expert clinical judgment. Discussion with the patient and informed consent are essential. Carefully collected scores of patient risk factors may be valuable to document the relations between the risk and the outcome of surgery. Ideally, each institution should select a validated scoring system to audit postoperative infectious morbidity and surgical performance in the various specialties.

  6. Stroke - risk factors

    MedlinePlus

    ... a higher risk. Diseases such as cancer, chronic kidney disease, and some types of arthritis. Weak areas in an artery wall or abnormal arteries and veins . Pregnancy. Both during and in the weeks right after ...

  7. A narrative review on role of Yoga as an adjuvant in the management of risk factor, disease progression and the complications of type 2 diabetes mellitus.

    PubMed

    Mooventhan, A

    2017-03-06

    Type 2 diabetes mellitus (T2DM) is one of the major health problems in the world as well as in India that greatly affects the health care sector and economy. Use of drugs has its own drawbacks and in recent days the use of non-medical measures were reported not only to manage T2DM, but also to prevent its complications. Through there are various review articles that are dealing with the effect of Yoga on risk profiles, management along with the mechanisms of action of yoga in T2DM separately, there is a lack of comprehensive review on the effect of Yoga in combination with all the above mentioned including the effect of Yoga in the management of T2DM complications. Hence, we performed a narrative review in Medline/PubMed using keyword "Yoga and diabetes". All the relevant articles published till 08th November 2016 were included. Based on the available literature, it could be concluded that Yoga plays a vital role as an adjuvant in the management of risk factors, disease progression and the complications of the T2DM. Further studies are warranted using standard research designs and variables to find out the various mechanisms of effects of Yoga in detail. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  8. A Targeted Self-Management Approach for Reducing Stroke Risk Factors in African American Men Who Have Had a Stroke or Transient Ischemic Attack.

    PubMed

    Sajatovic, Martha; Tatsuoka, Curtis; Welter, Elisabeth; Colon-Zimmermann, Kari; Blixen, Carol; Perzynski, Adam T; Amato, Shelly; Cage, Jamie; Sams, Johnny; Moore, Shirley M; Pundik, Svetlana; Sundararajan, Sophia; Modlin, Charles; Sila, Cathy

    2017-01-01

    This study compared a novel self-management (TargetEd MAnageMent Intervention [TEAM]) versus treatment as usual (TAU) to reduce stroke risk in African American (AA) men. Six-month prospective randomized controlled trial with outcomes evaluated at baseline, 3 months, and 6 months. Academic health center. Thirty-eight (age < 65) AA men who had a stroke or transient ischemic attack and a Barthel index score of >60 were randomly assigned to TEAM (n = 19) or TAU (n = 19). Self-management training, delivered in 1 individual and 4 group sessions (over 3 months). Blood pressure, glycosylated hemoglobin (HbA1c), lipids, medication adherence, weight, and standardized measures of health behaviors (diet, exercise, smoking, substances), depression, and quality of life. Qualitative assessments evaluated the perspectives of TEAM participants. T tests for paired differences and nonparametric tests. Thematic content qualitative analysis. Mean age was 52.1 (standard deviation [SD] = 7.4) and mean body mass index was 31.4 (SD = 7.4). Compared to TAU, TEAM participants had significantly lower mean systolic blood pressure by 24 weeks, and there was also improvement in HbA1c and high-density lipoprotein cholesterol ( P = .03). Other biomarker and health behaviors were similar between groups. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support.

  9. Evaluation of equine breeding farm management and preventative health practices as risk factors for development of Rhodococcus equi pneumonia in foals.

    PubMed

    Chaffin, M Keith; Cohen, Noah D; Martens, Ronald J

    2003-02-15

    To determine whether foal management practices, environmental management, and preventative health practices are risk factors for development of Rhodococcus equi pneumonia in foals. Prospective matched case-control study. 2,764 foals on 64 equine breeding farms with 9,991 horses. During 1997, participating veterinarians completed paired data collection forms for comparison; 1 for an affected farm (containing > or = 1 foal with pneumonia caused by R equi) and 1 for a control farm. Information collected pertained to stabling facilities, environmental management, foal husbandry, and preventative equine health practices. Matched farm data compared by use of conditional logistic regression indicated that personnel on affected farms were more likely to attend foal births, test foals for adequacy of passive immunity, administer plasma or other treatments to foals to supplement serum immunoglobulin concentrations, administer hyperimmune plasma prophylactically to foals, vaccinate mares and foals against Streptococcus equi infection, and use multiple anthelmintics in deworming programs. Affected farms were also more likely to have foals that developed other respiratory tract disorders and were approximately 4 times as likely to have dirt floors in stalls used for housing foals as were control farms. Rhodococcus equi pneumonia does not appear to be associated with poor farm management or a lack of attention to preventative health practices. Housing foals in stalls with dirt floors may increase the risk for development of R equi pneumonia.

  10. F200Y polymorphism in the β-tubulin gene in field isolates of Haemonchus contortus and risk factors of sheep flock management practices related to anthelmintic resistance.

    PubMed

    Niciura, Simone Cristina Méo; Veríssimo, Cecília José; Gromboni, Juliana Gracielle Gonzaga; Rocha, Marina Ibelli Pereira; de Mello, Suelen Scarpa; Barbosa, Cristina Maria Pacheco; Chiebao, Daniela Pontes; Cardoso, Daniel; Silva, Giane Serafim; Otsuk, Ivani Pozar; Pereira, José Roberto; Ambrosio, Luis Alberto; Nardon, Romeu Fernandes; Ueno, Tatiana Evelyn Hayama; Molento, Marcelo Beltrão

    2012-12-21

    Haemonchus contortus is the most prevalent and pathogenic nematode of sheep in tropical areas. The objectives of this study were to assess the frequency of the F200Y polymorphism on the β-tubulin gene in third-stage larvae of H. contortus from 33 sheep flocks in São Paulo state, Brazil, and to associate this frequency to risk factors based on farm management practices. The resistance allele frequency varied from 9 to 74%, and the resistance genotype frequency varied from 0 to 66.7%. Resistance genotype frequencies higher than 40% were associated with multiple risk factors - new sheep farming enterprises, the absence of farm records, the use of Dorper and Suffolk breeds, rotational grazing, the lack of wetlands on farms, pasture sharing with cattle or horses, frequent incorporation of animals into the flock, semi-intensive farming systems, whole-flock treatment, failure to use the FAMACHA method, lack of the dose-and-move practice, anthelmintic rotation after each application, visual estimation of animal weight for treatment, and lack of drug combination use. It can be concluded that genotyping the F200Y polymorphism can be used to monitor the resistance in sheep flocks and the knowledge of management strategies at the farm level is important to identify drug resistance related factors. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Risk Management Plan

    SciTech Connect

    HODGES, ANN LOUISE; FROEHLICH, GARY K.; PILCH, MARTIN; PEERCY, DAVID E.

    2002-04-01

    This document describes a proactive plan for assessing and controlling sources of risk for the ASCI (Accelerated Strategic Computing Initiative) V&V program at Sandia National Laboratories. It offers a graded approach for identifying, analyzing, prioritizing, responding to, and monitoring risks.

  12. Consumer evaluations of food risk management quality in Europe.

    PubMed

    Van Kleef, E; Houghton, J R; Krystallis, A; Pfenning, U; Rowe, G; Van Dijk, H; Van der Lans, I A; Frewer, L J

    2007-12-01

    In developing and implementing appropriate food risk management strategies, it is important to understand how consumers evaluate the quality of food risk management practices. The aim of this study is to model the underlying psychological factors influencing consumer evaluations of food risk management quality using structural equation modeling techniques (SEM), and to examine the extent to which the influence of these factors is country-specific (comparing respondents from Denmark, Germany, Greece, Slovenia, and the United Kingdom). A survey was developed to model the factors that drive consumer evaluations of food risk management practices and their relative importance (n= 2,533 total respondents). The measurement scales included in the structural model were configurally and metrically invariant across countries. Results show that some factors appear to drive perceptions of effective food risk management in all the countries studied, such as proactive consumer protection, which was positively related to consumers' evaluation of food risk management quality, while opaque and reactive risk management was negatively related to perceived food risk management quality. Other factors appeared to apply only in certain countries. For example, skepticism in risk assessment and communication practices was negatively related to food risk management quality, particularly so in the UK. Expertise of food risk managers appeared to be a key factor in consumers' evaluation of food risk management quality in some countries. However, trust in the honesty of food risk managers did not have a significant effect on food risk management quality. From the results, policy implications for food risk management are discussed and important directions for future research are identified.

  13. Brugada Syndrome:Risk Stratification And Management.

    PubMed

    Letsas Md Fesc, Konstantinos P; Georgopoulos Md, Stamatis; Vlachos Md, Konstantinos; Karamichalakis Md, Nikolaos; Liatakis Md, Ioannis; Korantzopoulos Md PhD, Panagiotis; Liu Md PhD, Tong; Efremidis Md, Michael; Sideris Md, Antonios

    2016-01-01

    The Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation and sudden cardiac death. The risk stratification and management of BrS patients, particularly of asymptomatic ones, still remains challenging. A previous history of aborted sudden cardiac death or arrhythmic syncope in the presence of spontaneous type 1 ECG pattern of BrS phenotype appear to be the most reliable predictors of future arrhythmic events. Several other ECG parameters have been proposed for risk stratification. Among these ECG markers, QRS-fragmentation appears very promising. Although the value of electrophysiological study still remains controversial, it appears to add important information on risk stratification, particularly when incorporated in multiparametric scores in combination with other known risk factors. The present review article provides an update on the pathophysiology, risk stratification and management of patients with BrS.

  14. Management of drought risk under global warming

    NASA Astrophysics Data System (ADS)

    Zhang, Qiang; Han, Lanying; Jia, Jianying; Song, Lingling; Wang, Jinsong

    2016-07-01

    Drought is a serious ecological problem around the world, and its impact on crops and water availability for humans can jeopardize human life. Although drought has always been common, the drought risk has become increasingly prominent because of the climatic warming that has occurred during the past century. However, it still does not comprehensively understand the mechanisms that determine the occurrence of the drought risk it poses to humans, particularly in the context of global climate change. In this paper, we summarize the progress of research on drought and the associated risk, introduce the principle of a drought "transition" from one stage to another, synthesize the characteristics of key factors and their interactions, discuss the potential effect of climatic warming on drought risk, and use this discussion to define the basic requirements for a drought risk management system. We also discuss the main measures that can be used to prevent or mitigate droughts in the context of a risk management strategy.

  15. Human Research Risk Management

    NASA Image and Video Library

    Crew health and performance is critical to successful human exploration beyond low Earth orbit. The Human Research Program (HRP) investigates and mitigates the highest risks to human health and per...

  16. Risk analysis and management

    NASA Technical Reports Server (NTRS)

    Smith, H. E.

    1990-01-01

    Present software development accomplishments are indicative of the emerging interest in and increasing efforts to provide risk assessment backbone tools in the manned spacecraft engineering community. There are indications that similar efforts are underway in the chemical processes industry and are probably being planned for other high risk ground base environments. It appears that complex flight systems intended for extended manned planetary exploration will drive this technology.

  17. Comparing ELISA test-positive prevalence, risk factors and management recommendations for Johne's disease prevention between organic and conventional dairy farms in Ontario, Canada.

    PubMed

    Pieper, Laura; Sorge, Ulrike S; DeVries, Trevor; Godkin, Ann; Lissemore, Kerry; Kelton, David

    2015-11-01

    Johne's disease (JD) is a chronic, infectious disease in cattle. Between 2010 and 2013, a voluntary JD control program was successfully launched in Ontario, Canada, including a Risk Assessment and Management Plan (RAMP) and JD ELISA testing of the entire milking herd. Over the last decade, the organic dairy sector has been growing. However, organic farming regulations and philosophies may influence the risk for JD transmission on Ontario organic dairy farms. The aim of this cross-sectional study was to investigate differences in JD ELISA test positive prevalence, risk factors for JD and recommendations for JD prevention between organic and conventional dairy herds in Ontario. RAMP results (i.e. RAMP scores and recommendations) and ELISA results were available for 2103 dairy herds, including 42 organic herds. If available, additional data on milk production, milk quality, and herd characteristics were gathered. Organic and conventional herds had a similar herd-level JD ELISA test-positive prevalence (26.2% and 27.2%, respectively). Organic herds (4.2%) had a higher within-herd JD ELISA test-positive prevalence compared to conventional herds (2.3%) if they had at least one JD test-positive animal on the farm. Organic farms had lower risk scores for biosecurity (9 points lower), and higher scores in the calving (7 points higher) and the calf-rearing management areas (4 points higher). After accounting for RAMP score, organic farms received fewer recommendations for the calving management area (Odds Ratio=0.41) and more recommendations in the adult cow management area (Odds Ratio=2.70). A zero-inflated negative binomial model was built with purchase of animals and the herd size included in the logistic portion of the model. Herd type (organic or conventional), colostrum and milk feeding practices, average bulk tank somatic cell count, and presence of non-Holstein breeds were included in the negative binomial portion of the model. Organic farms had a higher number of

  18. Environmental risk factors for autism

    PubMed Central

    Dietert, Rodney R.; Dietert, Janice M.; Dewitt, Jamie C.

    2010-01-01

    Autism is a devastating childhood condition that has emerged as an increasing social concern just as it has increased in prevalence in recent decades. Autism and the broader category of autism spectrum disorders are among the increasingly seen examples in which there is a fetal basis for later disease or disorder. Environmental, genetic, and epigenetic factors all play a role in determining the risk of autism and some of these effects appear to be transgenerational. Identification of the most critical windows of developmental vulnerability is paramount to understanding when and under what circumstances a child is at elevated risk for autism. No single environmental factor explains the increased prevalence of autism. While a handful of environmental risk factors have been suggested based on data from human studies and animal research, it is clear that many more, and perhaps the most significant risk factors, remain to be identified. The most promising risk factors identified to date fall within the categories of drugs, environmental chemicals, infectious agents, dietary factors, and other physical/psychological stressors. However, the rate at which environmental risk factors for autism have been identified via research and safety testing has not kept pace with the emerging health threat posed by this condition. For the way forward, it seems clear that additional focused research is needed. But more importantly, successful risk reduction strategies for autism will require more extensive and relevant developmental safety testing of drugs and chemicals. PMID:24149029

  19. Sexual dimorphism in socioeconomic differences regarding the risk factors, symptomatology and management of patients with stable coronary artery disease in Poland.

    PubMed

    Tubek, Stanislaw; Stepkowski, Michal; Szczurowska, Agata; Storek, Monika; Rzasa, Anna; Matyjaszczyk, Monika; Pociupany, Robert; Wilkins, Arleta; Banasiak, Waldemar; Ponikowski, Piotr; Jankowska, Ewa A

    2015-01-01

    Relationships between socioeconomic status (SES) and the risk factors, applied treatment and outcomes of patients with coronary artery disease (CAD) have been demonstrated in Western European countries, however analogous evidence is missing from Eastern and Central European countries. The aim of the study was to investigate SES gradients regarding the risk factors, symptoms and management of patients with stable CAD in Poland, separately in men and women. We analyzed the data of 2,593 participants of the RECENT study. SES was assessed based on the level of education attainment: university, secondary school or primary school. Socioeconomic differences in risk profile were most markedly seen in women: lower the education, higher body mass index (p < 0.01), systolic and diastolic blood pressure (p < 0.05), resting heart rate (p < 0.01), and greater prevalence of heart failure (p < 0.05) and dyslipidemia (p < 0.05). Importantly, smoking habit was the most frequent in women who graduated from univer-sity (p < 0.01). In men, socioeconomic gradients were only seen within resting heart rate (p < 0.01), LDL cholesterol level (p < 0.05) and smoking habit (p < 0.05). In both genders, better education was associated with less severe symptoms of angina and more frequent use of statins (p < 0.05). SES stratified based on education level differentiates patients with stable CAD in Poland regarding their risk profile, symptom control and the use of statins. Sexual dimorphism is found mainly within SES gradients regarding the prevalence of risk factors.

  20. Risk assessment and risk management of mycotoxins.

    PubMed

    2012-01-01

    Risk assessment is the process of quantifying the magnitude and exposure, or probability, of a harmful effect to individuals or populations from certain agents or activities. Here, we summarize the four steps of risk assessment: hazard identification, dose-response assessment, exposure assessment, and risk characterization. Risk assessments using these principles have been conducted on the major mycotoxins (aflatoxins, fumonisins, ochratoxin A, deoxynivalenol, and zearalenone) by various regulatory agencies for the purpose of setting food safety guidelines. We critically evaluate the impact of these risk assessment parameters on the estimated global burden of the associated diseases as well as the impact of regulatory measures on food supply and international trade. Apart from the well-established risk posed by aflatoxins, many uncertainties still exist about risk assessments for the other major mycotoxins, often reflecting a lack of epidemiological data. Differences exist in the risk management strategies and in the ways different governments impose regulations and technologies to reduce levels of mycotoxins in the food-chain. Regulatory measures have very little impact on remote rural and subsistence farming communities in developing countries, in contrast to developed countries, where regulations are strictly enforced to reduce and/or remove mycotoxin contamination. However, in the absence of the relevant technologies or the necessary infrastructure, we highlight simple intervention practices to reduce mycotoxin contamination in the field and/or prevent mycotoxin formation during storage.

  1. Wildfire Risk Management: Challenges and Opportunities

    NASA Astrophysics Data System (ADS)

    Thompson, M.; Calkin, D. E.; Hand, M. S.; Kreitler, J.

    2014-12-01

    In this presentation we address federal wildfire risk management largely through the lens of economics, targeting questions related to costs, effectiveness, efficiency, and tradeoffs. Beyond risks to resources and assets such as wildlife habitat, watersheds, and homes, wildfires present financial risk and budgetary instability for federal wildfire management agencies due to highly variable annual suppression costs. Despite its variability, the costs of wildfire management have continued to escalate and account for an ever-growing share of overall agency budgets, compromising abilities to attain other objectives related to forest health, recreation, timber management, etc. Trends associated with a changing climate and human expansion into fire-prone areas could lead to additional suppression costs in the future, only further highlighting the need for an ability to evaluate economic tradeoffs in investments across the wildfire management spectrum. Critically, these economic analyses need to accurately capture the complex spatial and stochastic aspects of wildfire, the inherent uncertainty associated with monetizing environmental impacts of wildfire, the costs and effectiveness of alternative management policies, and linkages between pre-fire investments and active incident management. Investing in hazardous fuels reduction and forest restoration in particular is a major policy lever for pre-fire risk mitigation, and will be a primary focus of our presentation. Evaluating alternative fuel management and suppression policies could provide opportunities for significant efficiency improvements in the development of risk-informed management fire management strategies. Better understanding tradeoffs of fire impacts and costs can help inform policy questions such as how much of the landscape to treat and how to balance investments in treating new areas versus maintaining previous investments. We will summarize current data needs, knowledge gaps, and other factors

  2. Flood Risk and Asset Management

    DTIC Science & Technology

    2011-06-15

    WN911NF-10-2-0104 FLOOD RISK AND ASSET MANGEMENT PN 01 1 R. 1.0 WN911NF-10-2-0104 FLOOD RISK AND ASSET MANAGEMENT Progress Note 2... MANGEMENT PN 01 2 R. 1.0 Contents 1. Progress statement...0104 FLOOD RISK AND ASSET MANGEMENT PN 01 3 R. 1.0 The next stages in the project, until the end of July, are described below: • HR

  3. Managing Risk in Hodgkin Lymphoma.

    PubMed

    Armitage, James O; Chen, Robert W; Moskowitz, Craig H; Sweetenham, John

    2015-02-01

    Approximately 90% of patients with limited-stage Hodgkin lymphoma are cured. The cure rate in advanced-stage Hodgkin lymphoma is dramatically better than it once was, but it is still lower than the rate in patients with limited disease. The choice of treatment is based on several factors, including symptoms, disease stage, extent of tumor burden, and prognosis. Positron emission tomography scanning can be used to assess the patient's stage of disease, which can allow further individualization of therapy. Traditional frontline treatment options include doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and, for high-risk patients, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP). Autologous stem cell transplantation cures approximately 50% of patients. The antibody-drug conjugate brentuximab vedotin is very active in relapsed/refractory Hodgkin lymphoma. Data presented at the 2014 meeting of the American Society of Hematology (ASH) showed that brentuximab vedotin was beneficial in several settings, including as consolidation therapy posttransplant in patients at high risk for relapse, as first-line salvage therapy in relapsed/refractory Hodgkin lymphoma prior to autologous hematopoietic cell transplantation, and in combination with bendamustine in relapsed/refractory disease. The ASH meeting also offered promising data on novel agents, such as the programmed cell death 1 (PD-1) inhibitors. In this monograph, 4 experts in the management of Hodgkin lymphoma discuss various aspects of the disease and provide their perspectives on the new data presented at the ASH meeting.

  4. LNG risk management

    NASA Astrophysics Data System (ADS)

    Martino, P.

    1980-12-01

    A general methodology is presented for conducting an analysis of the various aspects of the hazards associated with the storage and transportation of liquefied natural gas (LNG) which should be considered during the planning stages of a typical LNG ship terminal. The procedure includes the performance of a hazards and system analysis of the proposed site, a probability analysis of accident scenarios and safety impacts, an analysis of the consequences of credible accidents such as tanker accidents, spills and fires, the assessment of risks and the design and evaluation of risk mitigation measures.

  5. Managing Corporate Risk through Better Knowledge Management

    ERIC Educational Resources Information Center

    Neef, Dale

    2005-01-01

    Purpose: To explain how progressive companies are using a combination of knowledge and risk management (KRM) systems and techniques in order to help them to prevent, or respond most effectively to, ethical or reputation-damaging incidents. Design/methodology/approach: The paper explains KRM, develops a corporate integrity framework, and then…

  6. Managing Corporate Risk through Better Knowledge Management

    ERIC Educational Resources Information Center

    Neef, Dale

    2005-01-01

    Purpose: To explain how progressive companies are using a combination of knowledge and risk management (KRM) systems and techniques in order to help them to prevent, or respond most effectively to, ethical or reputation-damaging incidents. Design/methodology/approach: The paper explains KRM, develops a corporate integrity framework, and then…

  7. Risk perception as a driver for risk management policies

    NASA Astrophysics Data System (ADS)

    Carmona, María; Mañez, María

    2016-04-01

    Risk is generally defined as the "combination of the probability of the occurrence of an event and its negative consequences" ( UNISDR, 2009). However, the perception of a risk differs among cultures regarding different features such as the context,causes, benefits or damage. Risk perception is the subjective valuation of the probability of an event happening and how concerned individuals or groups are with the consequences (Sjöberg, 2004). Our study is based on an existing framework for risk perception (Rehn and Rohrmann, 2000). We analyse the characteristics of the risk perception regarding extreme events (e.g.droughts) and how the perception of the group drives the action to manage the risk. We do this to achieve an overview of the conditions that let stakeholders join each other to improve risk management especially when governments are not reacting properly. For our research, attention is paid on risk perception of Multi-Sector Partnerships not taking into account the individual level of risk perception. We focus on those factors that make risk management effective and increase resilience. Multi-Sector Partnerships, considered as significant governance structures for risk management, might contribute to reduce vulnerability in prone areas to natural hazards and disasters. The Multi-Sector Partnerships used for our research are existing partnerships identified in the cases studies of the European project ENHANCE. We implement a survey to analyse the perception of risk in the case studies. That survey is based on the Cultural Theory (Douglas and Wildavsky, 1982)and the Protection Motivation Theory (Rogers, 1975). We analyse the results using the Qualitative-Comparative Analysis proposed by Ragin in 1987. The results show the main characteristics of a risk culture that are beneficial to manage a risk. Those characteristics are shaped by the perception of risk of the people involved in the partnership, which in turn shapes their risk management. Nevertheless, we

  8. Issue Management Risk Ranking Systems

    SciTech Connect

    Novack, Steven David; Marshall, Frances Mc Clellan; Stromberg, Howard Merion; Grant, Gary Michael

    1999-06-01

    Thousands of safety issues have been collected on-line at the Idaho National Engineering and Environmental Laboratory (INEEL) as part of the Issue Management Plan. However, there has been no established approach to prioritize collected and future issues. The authors developed a methodology, based on hazards assessment, to identify and risk rank over 5000 safety issues collected at INEEL. This approach required that it was easily applied and understandable for site adaptation and commensurate with the Integrated Safety Plan. High-risk issues were investigated and mitigative/preventive measures were suggested and ranked based on a cost-benefit scheme to provide risk-informed safety measures. This methodology was consistent with other integrated safety management goals and tasks providing a site-wide risk informed decision tool to reduce hazardous conditions and focus resources on high-risk safety issues. As part of the issue management plan, this methodology was incorporated at the issue collection level and training was provided to management to better familiarize decision-makers with concepts of safety and risk. This prioritization methodology and issue dissemination procedure will be discussed. Results of issue prioritization and training efforts will be summarized. Difficulties and advantages of the process will be reported. Development and incorporation of this process into INEELs lessons learned reporting and the site-wide integrated safety management program will be shown with an emphasis on establishing self reliance and ownership of safety issues.

  9. Issue Management Risk Ranking Systems

    SciTech Connect

    F. M. Marshall; G. M. Grant; H. M. Stromberg; S. D. Novack

    1999-06-01

    Thousands of safety issues have been collected on-line at the Idaho National Engineering and Environmental Laboratory (INEEL) as part of the Issue Management Plan. However, there has been no established approach to prioritize collected and future issues. The authors developed a methodology, based on hazards assessment, to identify and risk rank over 5000 safety issues collected at INEEL. This approach required that it was easily applied and understandable for site adaptation and commensurate with the Integrated Safety Plan. High-risk issues were investigated and mitigative/preventive measures were suggested and ranked based on a cost-benefit scheme to provide risk-informed safety measures. This methodology was consistent with other integrated safety management goals and tasks providing a site-wide risk-informed decision tool to reduce hazardous conditions and focus resources on high-risk safety issues. As part of the issue management plan, this methodology was incorporated at the issue collection level and training was provided to management to better familiarize decision-makers with concepts of safety and risk. This prioritization methodology and issue dissemination procedure will be discussed. Results of issue prioritization and training efforts will be summarized. Difficulties and advantages of the process will be reported. Development and incorporation of this process into INEEL's lessons learned reporting and the site-wide integrated safety management program will be shown with an emphasis on establishing self reliance and ownership of safety issues.

  10. Hidden Risk Factors for Women

    MedlinePlus

    ... previous history of clots in the legs (deep vein thrombosis) and livedo reticularis, a mottled purplish discoloration of the skin. “Risk factors are cumulative,” Dr. Kittner adds. “Reducing even one ...

  11. What Are the Risk Factors?

    MedlinePlus

    ... Cancer Home What Are the Risk Factors for Lung Cancer? Language: English (US) Español (Spanish) Recommend on ... those who smoke. Personal or Family History of Lung Cancer If you are a lung cancer survivor, there ...

  12. Risk management in radiology departments

    PubMed Central

    Craciun, Horea; Mankad, Kshitij; Lynch, Jeremy

    2015-01-01

    Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as a result of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients. PMID:26120383

  13. Risk management in radiology departments.

    PubMed

    Craciun, Horea; Mankad, Kshitij; Lynch, Jeremy

    2015-06-28

    Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as a result of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients.

  14. Cardiac risk factors: environmental, sociodemographic, and behavioral cardiovascular risk factors.

    PubMed

    Anthony, David; George, Paul; Eaton, Charles B

    2014-06-01

    Several environmental exposures are associated with increased risk of coronary heart disease (CHD). Exposure to secondhand smoke may increase the risk by as much as 25% to 30%. Exposure to third hand smoke, residual components of tobacco smoke that remain in the environment after a cigarette is extinguished, also appears to increase risk. These residual components can remain in rooms and automobiles for up to 30 years and enter the body through the skin or via inhalation or ingestion. Exposure to particulate matter air pollution from automobile emissions, power plants, and other sources is yet another environmental risk factor for CHD, resulting in tens of thousands of deaths annually in the United States. Exposure to other environmental toxins, particularly bisphenol A and phthalates, also has been linked to CHD. There are sociodemographic risks for CHD, with numerous studies showing that lower socioeconomic status is associated with higher risk. Behavioral risk factors include poor diet, such as frequent consumption of fast food and processed meals; sleep disturbance; and psychological stress, particularly related to marital or work issues. Finally, although high alcohol consumption is associated with increased CHD risk, moderate alcohol consumption (ie, less than 1 to 2 drinks/day), particularly of wine and possibly beer, appears to reduce the risk.

  15. Effects of a weight management program delivered by social media on weight and metabolic syndrome risk factors in overweight and obese adults: A randomised controlled trial.

    PubMed

    Jane, Monica; Hagger, Martin; Foster, Jonathan; Ho, Suleen; Kane, Robert; Pal, Sebely

    2017-01-01

    The aim of this project was to evaluate the effectiveness of using social media to augment the delivery of, and provide support for, a weight management program delivered to overweight and obese individuals during a twenty four week intervention. Participants randomly divided into either one of two intervention groups or a control group. The two intervention groups were instructed to follow identical weight-management program. One group received the program within a Facebook group, along with a support network with the group, and the other intervention group received the same program in a booklet. The control group was given standard care. Participants' weight and other metabolic syndrome risk factors were measured at baseline and at weeks 6, 12, 18 and 24. The Facebook Group reported a 4.8% reduction in initial weight, significant compared to the CG only (p = 0.01), as well as numerically greater improvements in body mass index, waist circumference, fat mass, lean mass, and energy intake compared to the Pamphlet Group and the Control Group. These results demonstrate the potential of social media to assist overweight and obese individuals with respect to dietary and physical activity modifications for weight management, and justify further research into the inclusion of social media in clinical weight management programs. It is anticipated that social media will provide an invaluable resource for health professionals, as a low maintenance vehicle for communicating with patients, as well as a source of social support and information sharing for individuals undergoing lifestyle modifications.

  16. [Perception of reproductive risk factors].

    PubMed

    Salinas-Martinez, A M; Martínez-Sanchez, C; Pérez-Segura, J

    1993-01-01

    The objective of this study was to identify risk perception on several factors related to reproductive health, with the goal of implementing an educational intervention based on detected needs. 405 women between 12 and 44 years were interviewed at home. 62.2% perceived the risk of pregnancy at 17 years and younger; 78.8% the risk of pregnancy at 35 years and older; 76.6% the risk of parity of 5 and higher; and 55.1% the risk of birth interval of 2 years and less. 60.5% recognized family history of birth defects, 80.2% age 35 years and older, and 84.4% rubella during pregnancy, as risk factors for newborns with congenital malformations. 27.7% identified history of a low birth weight and 61.0% birth interval of 1 year and less, as risk factors for low birth weight. The majority perceived the risk of tobacco, alcohol and drugs consumption during pregnancy, diseases with no treatment and deficient nutrition. There was an inconsistent influence of social and obstetric variables on risk perception. No linear correlation was detected. Health educators should recognize differences on knowledge and behavior of future receptors before an educational intervention starts.

  17. [Risk factors for Alzheimer's disease].

    PubMed

    Ikeda, Tokuhei; Yamada, Masahito

    2010-07-01

    Alzheimer disease (AD) is the most common cause of dementia in elderly patients. Identification of risk factors for AD would contribute to the understanding of AD pathogenesis and thus, help in the development of preventive methods. Early-onset familial AD is associated with mutations of the genes encoding amyloid precursor protein (APP), presenilin 1 (PS-1), or PS-2, resulting in the overproduction of amyloid beta-protein. Epidemiological and case-control studies have led to the identification of several risk factors for sporadic AD. The most concrete genetic risk factor for AD is the epsilon4 allele of apolipoprotein E gene (APOE). In addition, several genes such as CTNNA3, GAB2, PVRL2, TOMM40, and APOC1 are known to be the risk factors that contribute to AD pathogenesis. On the other hand, nongenetic risk factors, such as age, sex, alcohol consumption, smoking, depression, head injury, and nutrition have also been reported. Although aging is the strongest risk factor for AD, the mechanisms underlying the development of AD as a result of ageing remain to be elucidated.

  18. Prevention through health risk management.

    PubMed

    Friedman, G M

    1992-08-01

    Risk can lead to catastrophe. Risk-management systems are highly effective in preventing the catastrophes of fire, earthquakes, and work-site injuries. No such effective systems are present to prevent health and social problems. A practical, cost-effective system to manage risk in children is being developed by the nonprofit Arizona Health Evaluation and Longevity Planning (HELP) Foundation. Information regarding such risk is collected in the school setting. This voluntary information comes from the administration, the school nurse, physical fitness testing, blood testing by the local hospital, self-esteem instruments, and parent, teacher, and child questionnaires. The HELP Foundation then develops an individual child and class risk profile that is presented to the teacher, school nurse, principal, and parent. Those involved with each child then prioritize, plan, and implement programs and activities to manage the identified risk(s). Risks is tracked throughout the child's school career by periodic reassessment. Evaluation of change in problem outcome will be a natural extension of the process.

  19. ASPIRE-2-PREVENT: a survey of lifestyle, risk factor management and cardioprotective medication in patients with coronary heart disease and people at high risk of developing cardiovascular disease in the UK.

    PubMed

    Kotseva, Kornelia; Jennings, Catriona S; Turner, Elizabeth L; Mead, Alison; Connolly, Susan; Jones, Jennifer; Bowker, Timothy J; Wood, David A

    2012-06-01

    To determine in patients with coronary heart disease (CHD) and people at high risk of developing cardiovascular disease (CVD) whether the Joint British Societies' guidelines on CVD prevention (JBS2) are followed in everyday clinical practice. A cross-sectional survey was undertaken of medical records and patient interviews and examinations at least 6 months after the recruiting event or diagnosis using standardised instruments and a central laboratory for measurement of lipids and glucose. The ASPIRE-2-PREVENT survey was undertaken in 19 randomly selected hospitals and 19 randomly selected general practices in 12 geographical regions in England, Northern Ireland, Wales and Scotland. In hospitals, 1474 consecutive patients with CHD were identified and 676 (25.6% women) were interviewed. In general practice, 943 people at high CVD risk were identified and 446 (46.5% women) were interviewed. The prevalence of risk factors in patients with CHD and high-risk individuals was, respectively: smoking 14.1%, 13.3%; obesity 38%, 50.2%; not reaching physical activity target 83.3%, 85.4%; blood pressure ≥130/80 mm Hg (patients with CHD and self-reported diabetes) or ≥140/85 mm Hg (high-risk individuals) 46.9%, 51.3%; total cholesterol ≥4 mmol/l 52.6%, 78.7%; and diabetes 17.8%, 43.8%. The potential among patients with CHD and individuals at high risk of developing CVD in the UK to achieve the JBS2 lifestyle and risk factor targets is considerable. CVD prevention needs a comprehensive multidisciplinary approach, addressing all aspects of lifestyle and risk factor management. The challenge is to engage and motivate cardiologists, physicians and other health professionals to routinely practice high quality preventive cardiology in a healthcare system which must invest in prevention.

  20. Successful Acquisition Risk Management: A Concept,

    DTIC Science & Technology

    analysis, has recently been advocating a shift from a focus on risk assessment and risk acceptance analysis towards risk management . The purpose of this...risk managers fail to realize their true and productive role in the risk management process. Finally, it is possible that the Deming management...philosophy underlying his quality control concepts can be adapted to aid more effective DoD systems acquisition risk management . (Author)

  1. Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

    PubMed Central

    Kones, Richard

    2010-01-01

    The objectives in treating angina are relief of pain and prevention of disease progression through risk reduction. Mechanisms, indications, clinical forms, doses, and side effects of the traditional antianginal agents – nitrates, β-blockers, and calcium channel blockers – are reviewed. A number of patients have contraindications or remain unrelieved from anginal discomfort with these drugs. Among newer alternatives, ranolazine, recently approved in the United States, indirectly prevents the intracellular calcium overload involved in cardiac ischemia and is a welcome addition to available treatments. None, however, are disease-modifying agents. Two options for refractory angina, enhanced external counterpulsation and spinal cord stimulation (SCS), are presented in detail. They are both well-studied and are effective means of treating at least some patients with this perplexing form of angina. Traditional modifiable risk factors for coronary artery disease (CAD) – smoking, hypertension, dyslipidemia, diabetes, and obesity – account for most of the population-attributable risk. Individual therapy of high-risk patients differs from population-wide efforts to prevent risk factors from appearing or reducing their severity, in order to lower the national burden of disease. Current American College of Cardiology/American Heart Association guidelines to lower risk in patients with chronic angina are reviewed. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial showed that in patients with stable angina, optimal medical therapy alone and percutaneous coronary intervention (PCI) with medical therapy were equal in preventing myocardial infarction and death. The integration of COURAGE results into current practice is discussed. For patients who are unstable, with very high risk, with left main coronary artery lesions, in whom medical therapy fails, and in those with acute coronary syndromes, PCI is indicated. Asymptomatic

  2. Risk factors associated with the surgical management of craniopharyngiomas in pediatric patients: analysis of 1961 patients from a national registry database.

    PubMed

    Bakhsheshian, Joshua; Jin, Diana L; Chang, Ki-Eun; Strickland, Ben A; Donoho, Dan A; Cen, Steven; Mack, William J; Attenello, Frank; Christian, Eisha A; Zada, Gabriel

    2016-12-01

    OBJECTIVE Patient demographic characteristics, hospital volume, and admission status have been shown to impact surgical outcomes of sellar region tumors in adults; however, the data available following the resection of craniopharyngiomas in the pediatric population remain limited. The authors sought to identify potential risk factors associated with outcomes following surgical management of pediatric craniopharyngiomas. METHODS The Nationwide Inpatient Sample database and Kids' Inpatient Database were analyzed to include admissions for pediatric patients (≤ 18 years) who underwent a transcranial or transsphenoidal craniotomy for resection of a craniopharyngioma. Patient-level factors, including age, race, comorbidities, and insurance type, as well as hospital factors were collected. Outcomes analyzed included mortality rate, endocrine and nonendocrine complications, hospital charges, and length of stay. A multivariate model controlling for variables analyzed was constructed to examine significant independent risk factors. RESULTS Between 2000 and 2011, 1961 pediatric patients were identified who underwent a transcranial (71.2%) or a transsphenoidal (28.8%) craniotomy for resection of a craniopharyngioma. A major predilection for age was observed with the selection of a transcranial (23.4% in < 7-year-olds, 28.1% in 7- to 12-year-olds, and 19.7% in 13- to 18-year-olds) versus transphenoidal (2.9% in < 7-year-olds, 7.4% in 7- to 12-year-olds, and 18.4% in 13- to 18-year-olds) approach. No significant outcomes were associated with a particular surgical approach, except that 7- to 12-year-old patients had a higher risk of nonendocrine complications (relative risk [RR] 2.42, 95% CI 1.04-5.65, p = 0.04) with the transsphenoidal approach when compared with 13- to 18-year-old patients. The overall inpatient mortality rate was 0.5% and the most common postoperative complication was diabetes insipidus (64.2%). There were no independent factors associated with inpatient

  3. Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis.

    PubMed

    Huang, Shih-Ming; Huang, Shu-Chien; Wang, Chih-Hsien; Wu, I-Hui; Chi, Nai-Hsin; Yu, Hsi-Yu; Hsu, Ron-Bin; Chang, Chung-I; Wang, Shoei-Shen; Chen, Yih-Sharng

    2015-05-04

    Ventricular septal rupture (VSR) is an uncommon but well-recognized mechanical complication of acute myocardial infarction (AMI). The outcome of VSR remains poor even in the era of reperfusion therapy. We reviewed our experience with surgical repair of post-infarction VSR and analyzed outcomes in an attempt to identify prognostic factors. From October 1995 to December 2013, data from 47 consecutive patients (mean age, 68 ± 9.5 years) with post-infarction VSR who underwent surgical repair at our institute were retrospectively reviewed. The preoperative conditions, morbidity and surgical mortality were analyzed. Multivariate analysis was subsequently carried out by constructing a logistic regression model in order to identify independent predictors of postoperative mortality. Long term survival function were estimated using the Kaplan-Meier method and compared using the log-rank test. Percutaneous coronary intervention was performed in 17 (36.2%) patients, intra-aortic balloon pump (IABP) was used in 34 (72.3%), and six (12.8%) were supported with extracorporeal membrane oxygenation (ECMO) preoperatively. Forty-one (87.2%) patients received emergent surgical treatment. Concomitant coronary artery bypass grafting was performed in 27 (57.4%) patients. Operative mortality was 36.2% (17 of 47). The survival rate was 59.3% with concomitant CABG and 70% without concomitant CABG (p = 14). Multivariate analysis revealed that the survivors had higher preoperative left ventricular ejection fractions (LVEFs) compared with those who died (51 ± 13.7% vs. 36.6 ± 6.4% , respectively; p < 0.001) and lower European system for cardiac operative risk evaluation II (EuroSCORE II) (22.9 ± 14.9 vs. 38.3 ± 13.9, respectively; p < 0.001). The patients receiving total revascularization has long term survival benefit (p = 0.028). Post-infarction VSR remains a serious and challenging complication of AMI in the modern surgical era. The EuroSCORE II can

  4. Engaging Physicians in Risk Factor Reduction

    PubMed Central

    Friedman, Felix; Gumnit, Stephen A.; Schmidt, Eric J.

    2010-01-01

    Abstract OptumHealth tested the feasibility of physician-directed population management in 3 primary care practices and with 546 continuously insured patients who exhibited claims markers for coronary artery disease, diabetes, and/or hypertension. During the intervention portion of the study, we asked physicians to improve the following health measurements: blood pressure, body mass index, cholesterol, hemoglobin A1c, and smoking status. We offered a modest pay-for-outcomes incentive for each risk factor improvement achieved. Additionally, on an eligible subset of these patients, we asked physicians to actively refer to population management programs those patients they determined could benefit from nurse or health coach interventions, advising us as to which components of their treatment plan they wished us to address. The 6-month intervention period exhibited a 10-fold improvement in the trend rate of risk factor management success when compared to the prior 6-month period for the same patients. A net of 96 distinct risk factor improvements were achieved by the 546 patients during the intervention period, whereas 9 net risk factor improvements occurred in the comparison period. This difference in improvement trends was statistically significant at P < 0.01. Of the 546 study participants, a subset of 187 members was eligible for participation in OptumHealth care management programs. Physicians identified 80 of these 187 eligible members as appropriate targets for program intervention. Representing ourselves as “calling on behalf” of the physician practices, we established contact with 50 referred members; 43 members (86%) actively enrolled in our programs. This enrollment rate is 2 to 3 times the rate of enrollment through our standard program outreach methods. We conclude that physician-directed population management with aligned incentives offers promise as a method of achieving important health and wellness goals. (Population Health Management 2010

  5. Training Manual for Human Service Risk Managers. Final Report.

    ERIC Educational Resources Information Center

    Davis, Frank W.; And Others

    This manual is designed to educate human service agency management personnel involved in transportation about basic risk management principles and insurance issues. Chapter I illustrates the liability factors that create the insurance and risk management needs. Both legal and humanitarian obligations of human service agencies involved in…

  6. 48 CFR 1815.203-72 - Risk management.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Risk management. 1815.203... Proposals and Information 1815.203-72 Risk management. In all RFPs and RFOs for supplies or services for... discuss risk factors and issues throughout the proposal where they are relevant, and describe their...

  7. Management practices as risk factors for the presence of bulk milk antibodies to Salmonella, Neospora caninum and Leptospira interrogans serovar hardjo in Irish dairy herds.

    PubMed

    O' Doherty, E; Berry, D P; O' Grady, L; Sayers, R

    2014-06-01

    A survey of management practices in 309 Irish dairy herds was used to identify risk factors for the presence of antibodies to Salmonella, Neospora caninum and Leptospira interrogans serovar hardjo in extensively managed unvaccinated dairy herds. A previous study documented a herd-level seroprevalence in bulk milk of 49%, 19% and 86% for Salmonella, Neospora caninum and leptospira interrogans serovar hardjo, respectively in the unvaccinated proportion of these 309 herds in 2009. Association analyses in the present study were carried out using multiple logistic regression models. Herds where cattle were purchased or introduced had a greater likelihood of being positive to leptospira interrogans serovar hardjo (P<0.01) and Salmonella (P<0.01). Larger herds had a greater likelihood of recording a positive bulk milk antibody result to leptospira interrogans serovar hardjo (P<0.05). Herds that practiced year round calving were more likely to be positive to Neospora caninum (P<0.05) compared to herds with a spring-calving season, with no difference in risk between herds that practiced split calving compared to herds that practiced spring calving. No association was found between presence of dogs on farms and prevalence of Neospora caninum possibly due to limited access of dogs to infected materials including afterbirths. The information from this study will assist in the design of suitable control programmes for the diseases under investigation in pasture-based livestock systems.

  8. Risk Management Programs for Defense Acquisition Systems

    DTIC Science & Technology

    2007-11-02

    The audit objective was to evaluate the effectiveness of risk management programs for Defense acquisition systems. Specifically, we determined whether DoD risk management policies and procedures for Defense acquisition systems were effectively implemented and what impact risk management programs bad on reducing program risks and costs. We also reviewed management controls as they applied to the audit objectives.

  9. Managing cardiovascular risk inpatients with metabolic syndrome.

    PubMed

    Nesto, Richard W

    2005-01-01

    The metabolic syndrome is a constellation of risk factors that contribute to the onset of type 2 diabetes mellitus and cardiovascular disease (CVD). CVD has been identified by the National Cholesterol Education Program (NCEP) as the primary clinical outcome of the metabolic syndrome. Although no algorithm is currently available for estimating the absolute risk of CVD for patients with the metabolic syndrome, screening for cardiovascular (CV) risk in these patients involves testing for lipoprotein abnormalities (namely, an analysis of specific low-density lipoprotein particle numbers) and an assessment of various surrogate markers for subclinical coronary artery disease. Such screening can be used to help predict the development of CVD and thereby allow for effective interventions to help prevent coronary events. Strategies for reducing CV risk in patients with the metabolic syndrome are multifactorial. In addition to placing an emphasis on therapeutic lifestyle changes that increase levels of physical activity, dietary modification, and weight reduction, several pharmacologic therapies are available. One novel approach for managing CV risk in patients with the metabolic syndrome involves the inhibition of the endocannabinoid system, including the use of rimonabant. A review of CV risk factors in patients with the metabolic syndrome is beneficial for clinicians to apply in the care of their patients, along with a discussion about strategies for identifying at-risk patients and managing CVD risk for these patients.

  10. Risk Management: Realistic Training to Standard

    DTIC Science & Technology

    2000-01-01

    analysis and execution and allows commands to manaqe risk. Risk management is, in reality, smart decision making. It focuses on mission accomplishment...make decisions that entail hazardous operations, risk management techniques are applicable to soldiers at all levels. Leaders must be trained to use... risk management skills and techniques to establish "situational" standards that effectively balance risk with operational objectives.

  11. Obstetrics Hospitalists: Risk Management Implications.

    PubMed

    Veltman, Larry

    2015-09-01

    The concept of having an in-house obstetrician (serving as an obstetrics [OB] hospitalist) available 24 hours a day, 7 days a week provides a safety net for OB events that many need immediate intervention for a successful outcome. A key precept of risk management, that of loss prevention, fits perfectly with the addition of an OB hospitalist role in the perinatal department. Inherent in the role of OB hospitalists are the patient safety and risk management principles of improved communication, enhanced readiness, and immediate availability. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Risk Management Concepts and Guidance

    DTIC Science & Technology

    1989-03-01

    Baillie, Allan S., "Management of Risk and Uncertainty," Research Management, Vol. 23, No. 2, March 1980, pp. 20-24. 34. Banash, Robert C., and...Monterey), 1974. 106. Edgar , J.D., LTC USAF, "Controlling Murphy: How to Budget for Program Risk, Concepts," - The Journal of Defense Systems...Secretary of Defense (OSD), 5-57 Point Cost Estimate ( POE ), 5-39 thru 5-43 OPERA, 5-33 Polaris Submarine Program, 5-29 Operating Cost, 5-35, 5-59, 6

  13. Cyber Insurance - Managing Cyber Risk

    DTIC Science & Technology

    2015-04-01

    regulations with respect to data breaches. The Health Insur - ance Portability and Accountability Act (HIPPA) Breach Notification Rule 45 CFR §§ 164.400...I N S T I T U T E F O R D E F E N S E A N A L Y S E S Cyber Insurance – Managing Cyber Risk Laura A. Odell, Project Leader...license under the clause at DFARS 252.227-7013 (a)(16) [Jun 2013]. Cyber Insurance – Managing Cyber Risk Data breaches involving

  14. Incidence, risk factors, management and outcomes of amniotic-fluid embolism: a population-based cohort and nested case-control study.

    PubMed

    Fitzpatrick, K E; Tuffnell, D; Kurinczuk, J J; Knight, M

    2016-01-01

    To describe the incidence, risk factors, management and outcomes of amniotic-fluid embolism (AFE) over time. A population-based cohort and nested case-control study using the UK Obstetric Surveillance System (UKOSS). All UK hospitals with obstetrician-led maternity units. All women diagnosed with AFE in the UK between February 2005 and January 2014 (n = 120) and 3839 control women. Prospective case and control identification through UKOSS monthly mailing. Amniotic-fluid embolism, maternal death or permanent neurological injury. The total and fatal incidence of AFE, estimated as 1.7 and 0.3 per 100 000, respectively, showed no significant temporal trend over the study period and there was no notable temporal change in risk factors for AFE. Twenty-three women died (case fatality 19%) and seven (7%) of the surviving women had permanent neurological injury. Women who died or had permanent neurological injury were more likely to present with cardiac arrest (83% versus 33%, P < 0.001), be from ethnic-minority groups (adjusted odds ratio [OR] 2.85, 95% confidence interval [95% CI] 1.02-8.00), have had a hysterectomy (unadjusted OR 2.49, 95% CI 1.02-6.06), had a shorter time interval between the AFE event and when the hysterectomy was performed (median interval 77 minutes versus 248 minutes, P = 0.0315), and were less likely to receive cryoprecipitate (unadjusted OR 0.30, 95% CI 0.11-0.80). There is no evidence of a temporal change in the incidence of or risk factors for AFE. Further investigation is needed to establish whether earlier treatments can reverse the cascade of deterioration leading to severe outcomes. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  15. Risk Management Structured for Today's Environment

    NASA Technical Reports Server (NTRS)

    Greenfield, Michael A.

    1998-01-01

    In NPG (NASA Procedures and Guidelines) 7120.5A, we define risk management as "an organized, systematic decision-making process that efficiently identifies, analyzes, plans, tracks, controls, and communicates and documents risk in order to increase the likelihood of achieving program/project goals." Effective risk management depends upon a thorough understanding of the concept of risk, the principles of risk management and the formation of a disciplined risk management process. In human spaceflight programs, NASA has always maintained a rigorous and highly structured risk management effort. When lives are at stake, NASA's missions must be 100% safe; the risk management approach used in human spaceflight has always been comprehensive.

  16. Control of glycemia and other cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: data from the Adult Diabetes Control and Management.

    PubMed

    Sazlina, Shariff-Ghazali; Mastura, Ismail; Ahmad, Zaiton; Cheong, Ai-Theng; Adam, Bujang-Mohamad; Jamaiyah, Haniff; Lee, Ping-Yein; Syed-Alwi, Syed-Abdul-Rahman; Chew, Boon-How; Sriwahyu, Taher

    2014-01-01

    The aims of the present study were to assess the control of glycemia and other cardiovascular disease risk factors, and the association between age and these controls among older adults with type 2 diabetes in Malaysia. A cross-sectional study was carried out using cases notified to the Adult Diabetes Control and Management database between 1 January and 31 December 2009. A total of 10 363 people aged over 60 years with type 2 diabetes mellitus were included in the analyses. A standard online case report form was used to record demographic data, clinical factors (diabetes duration, comorbid condition and treatment modalities), cardiovascular disease risk factors, diabetes complications and laboratory assessments. The cardiovascular disease risk factors controls assessed included glycosylated hemoglobin (HbA(1c)) <7.0%, blood pressure, body mass index, waist circumference and lipid profiles. The proportion of older adults who achieved target HbA(1c) (<7.0%) was 41.7%. A greater proportion of older adults aged ≥80 years significantly achieved the targets of HbA(1c) <7% (P < 0.001), waist circumference (P < 0.001), low-density lipoprotein cholesterol <2.6 mmol/L (P = 0.007) and triglycerides <1.7 mmol/L (P = 0.001) when compared with the younger elderly groups. They were also associated with achieving target HbA(1c) <7.0% (OR = 1.90, 95% CI 1.68-2.26) and triglycerides <1.7 mmol/L (OR = 1.20, 95%CI 1.04-1.46) than those aged 60-69 years. The control of cardiovascular disease risk factors was suboptimal in older adults with type 2 diabetes. The oldest elderly were more likely to achieve target HbA(1c) (<7.0%) and triglycerides (<1.7 mmol/L) than older adults aged 60-69 years. © 2013 Japan Geriatrics Society.

  17. [Risk factors for arterial disease].

    PubMed

    Madoery, Roberto; Rubin, Graciela; Luquez, Hugo; Luquez, Cecilia; Cravero, Cecilia

    2004-01-01

    The risk factors of arterial disease (FREA) predict a future damage over the vascular system of the human body. Its detection are considered a key for the diagnostic as well as for the preventive and even curative strategies. For a long time, scientist considered those factors originated as a consecuence of large studies during the middle of the last century, with current validity up to our days. A simple classification spoke of them as traditionals. Further investigations described the so called new or emergents.factors that where joint together accordingly to their actions: coagulation factors, psicosocial, inflamatories and infectious. A recent classification, taking into account the type of impact, divided them into; causatives, predisposals and conditionals. Also, it was described a mechanism, the oxidative power, with consecuences over the endothelium, in the last part of the process. Before, another mechanism was described: the insulin resistance and the hiperinsulinism, bases for the Metabolic Syndrome, that includes a number of traditional risk factors.

  18. Injury risk management plan for volleyball athletes.

    PubMed

    James, Lachlan P; Kelly, Vincent G; Beckman, Emma M

    2014-09-01

    Volleyball is an increasingly popular team sport. As with any competitive sport, there is an inherent risk of injury that must be recognized and collaboratively managed. This article provides a practical approach to the management of volleyball injuries within a team or organization. A brief review of the epidemiological data is presented which establishes (i) ankle sprain, (ii) shoulder overuse injury, (iii) patella tendinopathy, and (iv) anterior cruciate ligament injury as the primary injuries to address amongst these athletes. The interaction of modifiable and non-modifiable risk factors for these injuries are used to classify athletes into high-, medium- and low-risk groups. Targeted training interventions are suggested, based upon the risk level of the athlete, to minimize the occurrence of these injuries. Practical methods for integrating these activities into a training plan are also discussed.

  19. Structured prototyping as risk management

    NASA Technical Reports Server (NTRS)

    Hornstein, Rhoda SH.; Gardner, J. A.; Willoughby, J. K.

    1991-01-01

    A methodology is presented for integrating the systems-engineering management recommendation of prototyping into the traditional project-management process for developing large-scale systems. The suggested methodology begins with the identification of life-cycle risk areas, outlines the structure and conduct of the prototyping process, and defines the composition of the prototyping team. The methodology includes a step-by-step procedure for creating, executing, and documenting a prototyping test plan to evaluate design alternatives. It is argued that managers who adopt this methodology and apply it rigorously will increase the likelihood that the systems they build will be operationally effective and will be accepted by the intended users.

  20. Environmental risk factors for osteoporosis

    SciTech Connect

    Goyer, R.A.; Korach, K.S. ); Epstein, S. ); Bhattacharyya, M. ); Pounds, J. )

    1994-04-01

    Environmental risk factors for osteoporosis were reviewed at a conference held at the National Institute for Environmental Health Sciences 8-9 November 1993. The conference was co-sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Disease and the NIH Office of Research in Women's Health. The objective of the conference was to review what is known about risk factors for osteoporosis and to identify gaps in the present state of knowledge that might be addressed by future research. The conference was divided into two broad themes. The first session focused on current knowledge regarding etiology, risk factors, and approaches to clinical and laboratory diagnosis. This was followed by three sessions in which various environmental pollutants were discussed. Topics selected for review included environmental agents that interfere with bone and calcium metabolism, such as the toxic metals lead, cadmium, aluminum, and fluoride, natural and antiestrogens, calcium, and vitamin D.

  1. Ideology and Environmental Risk Management.

    ERIC Educational Resources Information Center

    Miller, Alan

    1985-01-01

    Discusses the influence of ideology (including both psychological and political dimensions) on an individual's approach to environmental risk management. Compares and contrasts technocratic and humanist forms of environmental ideologies. Also reviews the implications of socio-political and psychological constraints on environmental decision…

  2. Risk Management for Wilderness Programs.

    ERIC Educational Resources Information Center

    Schimelpfenig, Tod

    This paper discusses subjective hazards in wilderness activities and suggests means of assessing and managing related risks. Wilderness educators conveniently group hazards into objective and subjective ones. Objective hazards such as rockfall, moving water, and weather, while not necessarily predictable, are visible and understandable. Subjective…

  3. Risk factors for eosinophilic esophagitis.

    PubMed

    Philpott, H; Nandurkar, S; Royce, S G; Thien, F; Gibson, P R

    2014-08-01

    Eosinophilic esophagitis (EoE) is a chronic antigen driven disease, whereby food and/or aeroallergens result in inflammation and luminal narrowing, and the clinical symptoms of dysphagia and food bolus obstruction events (FBOE). Established risk factors are male gender, Caucasian race and atopy. Increased risk amongst family members, and a single nucleotide polymorphism (SNP) in a gene coding thymic stromal lymphopoietin (TSLP) on the pseudoautosomal region of the X and Y chromosomes supports a genetic predisposition. Environmental factors including the timing and nature of food and aeroallergen exposure to the developing immune system may be important, whilst esophageal barrier function integrity and the influence of microbiota are worthy of future research.

  4. Acrylamide: considerations for risk management.

    PubMed

    Slayne, Martin A; Lineback, David R

    2005-01-01

    The presence of acrylamide in many carbohydrate-rich foods is due to its formation during conventional heating and preparation methods. Although acrylamide is established to be a toxic substance, the implications to public health from the amounts found in food are not clear. A better scientific understanding is required to help determine whether, and to what extent, formal risk management action might be necessary. Since acrylamide in food was highlighted in 2002, numerous investigations and initiatives have been developed, including international collaborations across governments, industry, research organizations, and consumer representations. The newly generated information is being used to help the overall understanding of this issue. In particular, new information on health aspects will be important to update the scientific risk assessment. The basis for decisions on possible risk management measures would then be clearer. If future risk assessment concludes that the amounts of acrylamide in food can pose a health threat, then options for risk management will need to be considered, such as limits, guide levels, codes of practice, guidance information, and advice to the food and catering industries and to consumers. In the meantime, it is possible to benefit from progress already made on how acrylamide is formed in food and on ways to lower the amounts present. Raising awareness to the approaches that can reduce the presence of acrylamide in food should be encouraged. Where feasible, such approaches can be assessed for practical use in production, processing, and preparation of the relevant food products.

  5. Overview of the Hanford risk management plan

    SciTech Connect

    Halverson, T.G.

    1998-03-26

    The Project Hanford Management Contract called for the enhancement of site-wide decision processes, and development of a Hanford Risk Management Plan to adopt or develop a risk management system for the Hanford Site. This Plan provides a consistent foundation for Site issues and addresses site-wide management of risks of all types. It supports the Department of Energy planning and sitewide decision making policy. Added to this requirement is a risk performance report to characterize the risk management accomplishments. This paper presents the development of risk management within the context of work planning and performance. Also discussed are four risk elements which add value to the context.

  6. Self-promotion as a risk factor for women: the costs and benefits of counterstereotypical impression management.

    PubMed

    Rudman, L A

    1998-03-01

    Three experiments tested and extended recent theory regarding motivational influences on impression formation (S. T. Fiske & S. L. Neuberg, 1990; J. L. Hilton & J. M. Darley, 1991) in the context of an impression management dilemma that women face: Self-promotion may be instrumental for managing a competent impression, yet women who self-promote may suffer social reprisals for violating gender prescriptions to be modest. Experiment 1 investigated the influence of perceivers' goals on processes that inhibit stereotypical thinking, and reactions to counterstereotypical behavior. Experiments 2-3 extended these findings by including male targets. For female targets, self-promotion led to higher competence ratings but incurred social attraction and hireability costs unless perceivers were outcome-dependent males. For male targets, self-effacement decreased competence and hireability ratings, though its effects on social attraction were inconsistent.

  7. Risk management and climate change

    NASA Astrophysics Data System (ADS)

    Kunreuther, Howard; Heal, Geoffrey; Allen, Myles; Edenhofer, Ottmar; Field, Christopher B.; Yohe, Gary

    2013-05-01

    The selection of climate policies should be an exercise in risk management reflecting the many relevant sources of uncertainty. Studies of climate change and its impacts rarely yield consensus on the distribution of exposure, vulnerability or possible outcomes. Hence policy analysis cannot effectively evaluate alternatives using standard approaches, such as expected utility theory and benefit-cost analysis. This Perspective highlights the value of robust decision-making tools designed for situations such as evaluating climate policies, where consensus on probability distributions is not available and stakeholders differ in their degree of risk tolerance. A broader risk-management approach enables a range of possible outcomes to be examined, as well as the uncertainty surrounding their likelihoods.

  8. Enhanced Capabilities for Subcritical Experiments (ECSE) Risk Management Plan

    SciTech Connect

    Urban, Mary Elizabeth

    2016-05-02

    Risk is a factor, element, constraint, or course of action that introduces an uncertainty of outcome that could impact project objectives. Risk is an inherent part of all activities, whether the activity is simple and small, or large and complex. Risk management is a process that identifies, evaluates, handles, and monitors risks that have the potential to affect project success. The risk management process spans the entire project, from its initiation to its successful completion and closeout, including both technical and programmatic (non-technical) risks. This Risk Management Plan (RMP) defines the process to be used for identifying, evaluating, handling, and monitoring risks as part of the overall management of the Enhanced Capabilities for Subcritical Experiments (ECSE) ‘Project’. Given the changing nature of the project environment, risk management is essentially an ongoing and iterative process, which applies the best efforts of a knowledgeable project staff to a suite of focused and prioritized concerns. The risk management process itself must be continually applied throughout the project life cycle. This document was prepared in accordance with DOE O 413.3B, Program and Project Management for the Acquisition of Capital Assets, its associated guide for risk management DOE G 413.3-7, Risk Management Guide, and LANL ADPM AP-350-204, Risk and Opportunity Management.

  9. Risk Management of NASA Projects

    NASA Technical Reports Server (NTRS)

    Sarper, Hueseyin

    1997-01-01

    Various NASA Langley Research Center and other center projects were attempted for analysis to obtain historical data comparing pre-phase A study and the final outcome for each project. This attempt, however, was abandoned once it became clear that very little documentation was available. Next, extensive literature search was conducted on the role of risk and reliability concepts in project management. Probabilistic risk assessment (PRA) techniques are being used with increasing regularity both in and outside of NASA. The value and the usage of PRA techniques were reviewed for large projects. It was found that both civilian and military branches of the space industry have traditionally refrained from using PRA, which was developed and expanded by nuclear industry. Although much has changed with the end of the cold war and the Challenger disaster, it was found that ingrained anti-PRA culture is hard to stop. Examples of skepticism against the use of risk management and assessment techniques were found both in the literature and in conversations with some technical staff. Program and project managers need to be convinced that the applicability and use of risk management and risk assessment techniques is much broader than just in the traditional safety-related areas of application. The time has come to begin to uniformly apply these techniques. The whole idea of risk-based system can maximize the 'return on investment' that the public demands. Also, it would be very useful if all project documents of NASA Langley Research Center, pre-phase A through final report, are carefully stored in a central repository preferably in electronic format.

  10. Application of data mining to medical risk management

    NASA Astrophysics Data System (ADS)

    Tsumoto, Shusaku; Matsuoka, Kimiko; Yokoyama, Shigeki

    2008-03-01

    This paper proposes an application of data mining to medical risk management, where data mining techniques were applied to detection, analysis and evaluation of risks potentially existing in clinical environments. We applied this technique to the following two medical domains: risk aversion of nurse incidents and infection control. The results show that data mining methods were effective to detection and aversion of risk factors.

  11. Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes: a randomized controlled trial.

    PubMed

    Ishani, Areef; Greer, Nancy; Taylor, Brent C; Kubes, Laurie; Cole, Paula; Atwood, Melissa; Clothier, Barbara; Ercan-Fang, Nacide

    2011-08-01

    To determine whether nurse case management with a therapeutic algorithm could effectively improve rates of control for hypertension, hyperglycemia, and hyperlipidemia compared with usual care among veterans with diabetes. A randomized controlled trial of diabetic patients that had blood pressure (BP) >140/90 mmHg, hemoglobin A(1c) (HbA(1c)) >9.0%, or LDL >100 mg/dL. Intervention patients received case management (n = 278) versus usual care (n = 278) over a 1-year period. The primary outcome was the percentage of patients achieving simultaneous control of all three parameters (defined by BP <130/80 mmHg, HbA(1c) <8.0%, and LDL <100 mg/dL) at 1 year. Secondary outcomes included improvements within each individual component of the composite primary outcome. Differences between groups were analyzed using t tests, Pearson χ(2) tests, and linear and logistic regression. A greater number of individuals assigned to case management achieved the primary study outcome of having all three outcome measures under control (61 [21.9%] compared with 28 [10.1%] in the usual care group [P < 0.01]). In addition, a greater number of individuals assigned to the intervention group achieved the individual treatment goals of HbA(1c) <8.0% (73.7 vs. 65.8%, P = 0.04) and BP <130/80 mmHg (45.0 vs. 25.4%, P < 0.01), but not for LDL <100 mg/dL (57.6 vs. 55.4%, P = 0.61), compared with those in the usual care group. In patients with diabetes, nurse case managers using a treatment algorithm can effectively improve the number of individuals with control of multiple cardiovascular risk factors at 1 year.

  12. Sexual harassment: identifying risk factors.

    PubMed

    O'Hare, E A; O'Donohue, W

    1998-12-01

    A new model of the etiology of sexual harassment, the four-factor model, is presented and compared with several models of sexual harassment including the biological model, the organizational model, the sociocultural model, and the sex role spillover model. A number of risk factors associated with sexually harassing behavior are examined within the framework of the four-factor model of sexual harassment. These include characteristics of the work environment (e.g., sexist attitudes among co-workers, unprofessional work environment, skewed sex ratios in the workplace, knowledge of grievance procedures for sexual harassment incidents) as well as personal characteristics of the subject (e.g., physical attractiveness, job status, sex-role). Subjects were 266 university female faculty, staff, and students who completed the Sexual Experience Questionnaire to assess the experience of sexual harassment and a questionnaire designed to assess the risk factors stated above. Results indicated that the four-factor model is a better predictor of sexual harassment than the alternative models. The risk factors most strongly associated with sexual harassment were an unprofessional environment in the workplace, sexist atmosphere, and lack of knowledge about the organization's formal grievance procedures.

  13. Risk factors for Down syndrome.

    PubMed

    Coppedè, Fabio

    2016-12-01

    Down syndrome (DS) originates, in most of the cases (95 %), from a full trisomy of chromosome 21. The remaining cases are due to either mosaicism for chromosome 21 or the inheritance of a structural rearrangement leading to partial trisomy of the majority of its content. Full trisomy 21 and mosaicism are not inherited, but originate from errors in cell divisions during the development of the egg, sperm or embryo. In addition, full trisomy for chromosome 21 should be further divided into cases of maternal origin, the majority, and cases of paternal origin, less than 10 %. Among cases of maternal origin, a further stratification should be performed into errors that have occurred or originated during the first meiotic division in the maternal grandmother's body and errors that occurred later in life during the second maternal meiotic division. This complex scenario suggests that our understanding of the risk factors for trisomy 21 should take into account the above stratification as it reflects different individuals and generations in which the first error has occurred. Unfortunately, most of the available literature is focused on maternal risk factors, and the only certain risk factors for the birth of a child with DS are advanced maternal age at conception and recombination errors, even though the molecular mechanisms leading to chromosome 21 nondisjunction are still a matter of debate. This article critically reviews the hypotheses and the risk factors which have been suggested to contribute to the birth of a child with DS, including folate metabolism, dietary, lifestyle, environmental, occupational, genetic and epigenetic factors, with focus on maternal and paternal risk factors, and taking into account the possible contribution of the maternal grandmother and that of the developing trisomic embryo, in a complex scenario depicting the birth of a child with DS as the result of complex gene-environment interactions and selection processes involving different

  14. 12 CFR 917.3 - Risk management.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Risk management. 917.3 Section 917.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD GOVERNANCE AND MANAGEMENT OF THE FEDERAL HOME LOAN BANKS POWERS AND RESPONSIBILITIES OF BANK BOARDS OF DIRECTORS AND SENIOR MANAGEMENT § 917.3 Risk management. (a) Risk...

  15. 42 CFR 441.476 - Risk management.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Risk management. 441.476 Section 441.476 Public... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must... plan for how identified risks will be mitigated. (d) The State must ensure that the risk management...

  16. Health Risk Management for Bioenvironmental Engineering

    DTIC Science & Technology

    2013-06-01

    Health Risk Management ( HRM ). HRM is a decision-making process to evaluate and...4.1 Health Risk Management Interface HRM and RM decisions are based on operations and scenarios; therefore, an HRA may provide a COA that interferes... health risk estimate HRM health risk management OEH occupational and environmental health PH Public Health PPE personal protective

  17. 42 CFR 441.476 - Risk management.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Risk management. 441.476 Section 441.476 Public... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must... plan for how identified risks will be mitigated. (d) The State must ensure that the risk management...

  18. Risk Management and the Joint Military Commander.

    DTIC Science & Technology

    1997-02-01

    risk assessment, is the process called risk management . Practiced repeatedly, personal and professional risk management can become ’common sense...war and military operations other than war (MOOTW). This report discusses the USA Five Step Process, from which users develop tools, techniques, and procedures for applying risk management in their areas of responsibility.

  19. Effect of consuming salad and yogurt as preload on body weight management and cardiovascular risk factors: a randomized clinical trial.

    PubMed

    Azadbakht, Leila; Haghighatdoost, Fahimeh; Karimi, Golgis; Esmaillzadeh, Ahmad

    2013-06-01

    Few investigations reported the reductive effect of preload consuming on energy intake. The objective of the study was to compare the effects of consuming a mix of low glycaemic index foods such as vegetable salad, yogurt and water before or with meal on anthropometric measures and cardio vascular diseases (CVD) risks. In this randomized controlled clinical trial, 25 men and 35 women were recruited to consume similar amounts of macronutrients within a hypocaloric diet for 3 months. Although subjects in the preload group consumed preload 15 min before the main meal, subjects in the control group consumed them with meal. The results showed that body weight, waist circumference, triglyceride, total cholesterol and systolic blood pressure decreased in more amount in the preload group ( - 7.8 ± 0.5%, - 2.7 ± 0.2%, - 5.7 ± 1.1%, - 3.1 ± 0.53% and - 4.4 ± 0.4%, respectively; p < 0.05 for all). Fasting blood sugar and low density lipoprotein (LDL)-cholesterol decreased significantly only in the preload group. Consuming vegetable salad, yogurt and water as preload leads to greater changes in anthropometric measures and CVD risks.

  20. Breast cancer and spaceflight: risk and management.

    PubMed

    Barr, Yael R; Bacal, Kira; Jones, Jeffrey A; Hamilton, Douglas R

    2007-04-01

    Spaceflight exposes astronauts to a host of environmental factors which could increase their risk for cancer. Epidemiological studies have shown an increased incidence of breast cancer in female commercial flight attendants, with occupational risk factors as one of the proposed mechanisms for the higher incidence in this cohort. Since female astronauts are exposed to similar occupational conditions as flight attendants, they too may be at an increased risk for breast cancer. With the planning of exploration class missions to the Moon and to Mars it is important to assess and minimize the risk for breast malignancy, and to have a well-defined protocol for the diagnosis and treatment of a breast mass discovered during a mission. Risk factors for development of breast cancer in the female astronaut include ionizing radiation, disrupted melatonin homeostasis secondary to circadian shifting, chemical exposure, and changes in immune function. Preflight, in-flight, and postflight screening and management modalities include imaging and fine needle aspiration (FNA). Employing such a strategy may provide a viable management approach in the case of a newly diagnosed breast mass inflight.

  1. Clinical risk management in obstetrics.

    PubMed

    Holden, Deborah A; Quin, Maureen; Holden, Des P

    2004-04-01

    Over recent years there has been a growing appreciation that a small but significant proportion of patients experience (sometimes serious) adverse events in the hands of health care workers. Although research in this area is very much in its infancy there has been an increasing move towards applying principles of risk management from industry to health care organizations. With the particularly disastrous and costly nature of adverse outcomes in obstetrics it is appropriate to review clinical risk management issues in maternity. This review explores the appropriateness of applying lessons learned in industry to maternity. The classification of errors into individual and latent, or organizational, is examined. Furthermore, the way in which these errors can be identified and subsequently analysed, with examples from maternity units in the UK and USA, is discussed. The importance of an educational and supportive environment, rather than a blame culture, for both reporting of incidents and learning from adverse outcomes is emphasized. Improvement in patient experience of health care rests not just with improved treatments, but also with a reduction in the adverse events which occur in health care institutions. The principles by which risk can be identified prospectively and retrospectively, and the mechanisms for both local risk management and regional/national reporting and learning are considered.

  2. Safety optimization through risk management

    NASA Astrophysics Data System (ADS)

    Wright, K.; Peltonen, P.

    The paper discusses the overall process of system safety optimization in the space program environment and addresses in particular methods that enhance the efficiency of this activity. Effective system safety optimization is achieved by concentrating the available engineering and safety assurance resouces on the main risk contributors. The qualitative risk contributor identification by means of the hazard analyses and the FMECA constitute the basis for the system safety process. The risk contributors are ranked firstly on a qualitative basis according to the consequence severities. This ranking is then refined by mishap propagation/recovery time considerations and by probabilistic means (PRA). Finally, in order to broaden and extend the use of risk contributor ranking as a managerial tool in project resource assignment, quality, manufacturing and operations related critical characteristics, i.e. risk influencing factors, are identified for managerial visibility.

  3. Fatigue Risk Management: A Maritime Framework

    PubMed Central

    Grech, Michelle Rita

    2016-01-01

    It is evident that despite efforts directed at mitigating the risk of fatigue through the adoption of hours of work and rest regulations and development of codes and guidelines, fatigue still remains a concern in shipping. Lack of fatigue management has been identified as a contributory factor in a number of recent accidents. This is further substantiated through research reports with shortfalls highlighted in current fatigue management approaches. These approaches mainly focus on prescriptive hours of work and rest and include an individualistic approach to managing fatigue. The expectation is that seafarers are responsible to manage and tolerate fatigue as part of their working life at sea. This attitude is an accepted part of a seafarer’s role. Poor compliance is one manifest of this problem with shipboard demands making it hard for seafarers to follow hours of work and rest regulations, forcing them into this “poor compliance” trap. This makes current fatigue management approaches ineffective. This paper proposes a risk based approach and way forward for the implementation of a fatigue risk management framework for shipping, aiming to support the hours of work and rest requirements. This forms part of the work currently underway to review and update the International Maritime Organization, Guidelines on Fatigue. PMID:26840326

  4. Human factors in waste management

    SciTech Connect

    Moray, N.

    1994-10-01

    This article examines the role of human factors in radioactive waste management. Although few problems and ergonomics are special to radioactive waste management, some problems are unique especially with long term storage. The entire sociotechnical system must be looked at in order to see where improvement can take place because operator errors, as seen in Chernobyl and Bhopal, are ultimately the result of management errors.

  5. Recurrent Shoulder Dystocia: Risk Factors and Counseling.

    PubMed

    Gurewitsch Allen, Edith D

    2016-12-01

    A prior history of delivery complicated by shoulder dystocia confers a 6-fold to nearly 30-fold increased risk of shoulder dystocia recurrence in a subsequent vaginal delivery, with most reported rates between 12% and 17%. Whereas prevention of shoulder dystocia in the general population is neither feasible nor cost-effective, directing intervention efforts at the particular subgroup of women with a prior history of shoulder dystocia has merit. Potentially modifiable risk factors and individualized management strategies that may reduce shoulder dystocia recurrence and its associated significant morbidities are reviewed.

  6. Managing risks and hazardous in industrial operations

    SciTech Connect

    Almaula, S.C.

    1996-12-31

    The main objective of this paper is to demonstrate that it makes good business sense to identify risks and hazards of an operation and take appropriate steps to manage them effectively. Developing and implementing an effective risk and hazard management plan also contibutes to other industry requirements and standards. Development of a risk management system, key elements of a risk management plan, and hazards and risk analysis methods are outlined. Comparing potential risk to the cost of prevention is also discussed. It is estimated that the cost of developing and preparing the first risk management plan varies between $50,000 to $200,000. 3 refs., 2 figs., 1 tab.

  7. Hanford Tanks Initiative risk management guide

    SciTech Connect

    Schaus, P.S.

    1997-10-29

    This project-specific Risk Management Guide describes the general approach and process being used by the HTI Project to manage risk associated with execution of the HTI mission. It includes the initial identification of risk and the quantification of its likelihood and severity of its consequences. It further addresses the formulation of risk mitigation plans, periodic statusing of the Risk Management List, and risk closure.

  8. First myocardial infarction in patients of Indian subcontinent and European origin: comparison of risk factors, management, and long term outcome.

    PubMed Central

    Shaukat, N.; Lear, J.; Lowy, A.; Fletcher, S.; de Bono, D. P.; Woods, K. L.

    1997-01-01

    OBJECTIVE: To compare long term outcome after first myocardial infarction among British patients originating from the Indian subcontinent and from Europe. DESIGN: Matched pairs study. SETTING: Coronary care unit in central Leicester. SUBJECTS: 238 pairs of patients admitted during 1987-93 matched for age (within 2 years), sex, date of admission (within 3 months), type of infarction (Q/non-Q), and site of infarction. MAIN OUTCOME MEASURES: Incidence of angina, reinfarction, or death during follow up of 1-7 years. RESULTS: Patients of Indian subcontinent origin had a higher prevalence of diabetes (35% v 9% in patients of European origin, P < 0.001), lower prevalence of smoking (39% v 63%, P < 0.001), longer median delay from symptom onset to admission (5 hours v 3 hours, P < 0.01), and lower use of thrombolysis (50% v 66%, P < 0.001). During long term follow up (median 39 months), mortality was higher in patients of Indian subcontinent origin (unadjusted hazard ratio = 2.1, 95% confidence interval 1.3 to 3.4, P = 0.002). After adjustment for smoking, history of diabetes, and thrombolysis the estimated hazard ratio fell slightly to 2.0 (1.1 to 3.6, P = 0.02). Patients of Indian subcontinent origin had almost twice the incidence of angina (54% v 29%; P < 0.001) and almost three times the risk of reinfarction during follow up (34% v 12.5% at 3 years, P < 0.001). The unadjusted hazard ratio for reinfarction in patients of Indian subcontinent origin was 2.8 (1.8 to 4.4, P < 0.001). Adjustment for smoking, history of diabetes, and thrombolysis made little difference to the hazard ratio. Coronary angiography was performed with similar frequency in the two groups; triple vessel disease was the commonest finding in patients of Indian subcontinent origin and single vessel disease the commonest in Europeans (P < 0.001). CONCLUSIONS: Patients of Indian subcontinent origin are at substantially higher risk of mortality and of further coronary events than Europeans after first

  9. Risk factors associated with lambing traits.

    PubMed

    McHugh, N; Berry, D P; Pabiou, T

    2016-01-01

    The objective of this study was to establish the risk factors associated with both lambing difficulty and lamb mortality in the Irish sheep multibreed population. A total of 135 470 lambing events from 42 675 ewes in 839 Irish crossbred and purebred flocks were available. Risk factors associated with producer-scored ewe lambing difficulty score (scale of one (no difficulty) to four (severe difficulty)) were determined using linear mixed models. Risk factors associated with the logit of the probability of lamb mortality at birth (i.e. binary trait) were determined using generalised estimating equations. For each dependent variable, a series of simple regression models were developed as well as a multiple regression model. In the simple regression models, greater lambing difficulty was associated with quadruplet bearing, younger ewes, of terminal breed origin, lambing in February; for example, first parity ewes experienced greater (P7.0 kg) birth weights, quadruplet born lambs and lambs that experienced a more difficult lambing (predicted probability of death for lambs that required severe and veterinary assistance of 0.15 and 0.32, respectively); lambs from dual-purpose breeds and born to younger ewes were also at greater risk of mortality. In the multiple regression model, the association between ewe parity, age at first lambing, year of lambing and lamb mortality no longer persisted. The trend in solutions of the levels of each fixed effect that remained associated with lamb mortality in the multiple regression model, did not differ from the trends observed in the simple regression models although the differential in relative risk between the different lambing difficulty scores was greater in the multiple regression model. Results from this study show that many common flock- and animal-level factors are associated with both lambing difficulty and lamb mortality and management of different risk category groups (e.g. scanned litter sizes, ewe age groups) can be used

  10. Great Lakes management: Ecological factors

    NASA Astrophysics Data System (ADS)

    Sonzogni, W. C.; Robertson, A.; Beeton, A. M.

    1983-11-01

    Although attempts to improve the quality of the Great Lakes generally focus on chemical pollution, other factors are important and should be considered Ecological factors, such as invasion of the lakes by foreign species, habitat changes, overfishing, and random variations in organism populations, are especially influential. Lack of appreciation of the significance of ecological factors stems partly from the inappropriate application of the concept of eutrophication to the Great Lakes. Emphasis on ecological factors is not intended to diminish the seriousness of pollution, but rather to point out that more cost-effective management, as well as more realistic expectations of management efforts by the public, should result from an ecosystem management approach in which ecological factors are carefully considered.

  11. Prediction of fracture risk. II: Other risk factors.

    PubMed

    Ross, P D

    1996-12-01

    Many osteoporotic fractures are probably preventable-by definition, prevention requires identification of those at risk prior to fracture. There is a continuum in fracture risk and a very wide range in risk among individuals. Bone density, previous fractures, and the frequency and types of falls are important risk factors for fractures. There are also many other risk factors for bone loss, falls, and fractures. People with multiple risk factors are at greater risk than those with either a single risk factor or none. Identification of risk factors can help when planning interventions. For example, dietary deficiencies are amenable to dietary modification or supplementation; however, the effects of many risk factors have not been quantified separately, making it difficult to determine the importance. In addition, it is not possible to accurately predict current bone density and fracture risk from risk factors for bone loss; bone density should always be measured directly.

  12. Community-Based Management of Child Malnutrition in Zambia: HIV/AIDS Infection and Other Risk Factors on Child Survival

    PubMed Central

    Moramarco, Stefania; Amerio, Giulia; Ciarlantini, Clarice; Chipoma, Jean Kasengele; Simpungwe, Matilda Kakungu; Nielsen-Saines, Karin; Palombi, Leonardo; Buonomo, Ersilia

    2016-01-01

    (1) Background: Supplementary feeding programs (SFPs) are effective in the community-based treatment of moderate acute malnutrition (MAM) and prevention of severe acute malnutrition (SAM); (2) Methods: A retrospective study was conducted on a sample of 1266 Zambian malnourished children assisted from 2012 to 2014 in the Rainbow Project SFPs. Nutritional status was evaluated according to WHO/Unicef methodology. We performed univariate and multivariate Cox proportional risk regression to identify the main predictors of mortality. In addition, a time-to event analysis was performed to identify predictors of failure and time to cure events; (3) Results: The analysis included 858 malnourished children (19 months ± 9.4; 49.9% males). Program outcomes met international standards with a better performance for MAM compared to SAM. Cox regression identified SAM (3.8; 2.1–6.8), HIV infection (3.1; 1.7–5.5), and WAZ <−3 (3.1; 1.6–5.7) as predictors of death. Time to event showed 80% of children recovered by SAM/MAM at 24 weeks. (4) Conclusions: Preventing deterioration of malnutrition, coupled to early detection of HIV/AIDS with adequate antiretroviral treatment, and extending the duration of feeding supplementation, could be crucial elements for ensuring full recovery and improve child survival in malnourished Zambian children. PMID:27376317

  13. Community-Based Management of Child Malnutrition in Zambia: HIV/AIDS Infection and Other Risk Factors on Child Survival.

    PubMed

    Moramarco, Stefania; Amerio, Giulia; Ciarlantini, Clarice; Chipoma, Jean Kasengele; Simpungwe, Matilda Kakungu; Nielsen-Saines, Karin; Palombi, Leonardo; Buonomo, Ersilia

    2016-07-01

    (1) BACKGROUND: Supplementary feeding programs (SFPs) are effective in the community-based treatment of moderate acute malnutrition (MAM) and prevention of severe acute malnutrition (SAM); (2) METHODS: A retrospective study was conducted on a sample of 1266 Zambian malnourished children assisted from 2012 to 2014 in the Rainbow Project SFPs. Nutritional status was evaluated according to WHO/Unicef methodology. We performed univariate and multivariate Cox proportional risk regression to identify the main predictors of mortality. In addition, a time-to event analysis was performed to identify predictors of failure and time to cure events; (3) RESULTS: The analysis included 858 malnourished children (19 months ± 9.4; 49.9% males). Program outcomes met international standards with a better performance for MAM compared to SAM. Cox regression identified SAM (3.8; 2.1-6.8), HIV infection (3.1; 1.7-5.5), and WAZ <-3 (3.1; 1.6-5.7) as predictors of death. Time to event showed 80% of children recovered by SAM/MAM at 24 weeks. (4) CONCLUSIONS: Preventing deterioration of malnutrition, coupled to early detection of HIV/AIDS with adequate antiretroviral treatment, and extending the duration of feeding supplementation, could be crucial elements for ensuring full recovery and improve child survival in malnourished Zambian children.

  14. Cultural resource management: The risk of compliance

    SciTech Connect

    Curtis, S.A.

    1994-02-01

    The statutory mandate for federal agencies to involve American Indians in the management of cultural resources may create a cultural risk for the people those statutes are intended to protect. A conceptual framework is given to help understand this dilemma. Factors that can exacerbate the severity of the adverse cultural impacts for tribal people are also examined. Policy recommendations are offered for reducing tensions among an the participants in the statutory process.

  15. Evaluation of pet-related management factors and the risk of Salmonella spp. carriage in pet dogs from volunteer households in Ontario (2005-2006).

    PubMed

    Leonard, E K; Pearl, D L; Finley, R L; Janecko, N; Peregrine, A S; Reid-Smith, R J; Weese, J S

    2011-03-01

    The purpose of this study was to determine pet-related management factors that may be associated with the presence of Salmonella spp. in feces of pet dogs from volunteer households. From October 2005 until May 2006, 138 dogs from 84 households in Ontario were recruited to participate in a cross-sectional study. Five consecutive daily fecal samples were collected from each dog and enrichment culture for Salmonella spp. was performed. A higher than expected number of the dogs (23.2%; 32/138) had at least one fecal sample positive for Salmonella, and 25% (21/84) of the households had at least one dog shedding Salmonella. Twelve serotypes of Salmonella enterica subsp. enterica were identified, with the predominant serotypes being Typhimurium (33.3%; 13/39), Kentucky (15.4%; 6/39), Brandenburg (15.4%; 6/39) and Heidelberg (12.8%; 5/39). Univariable logistic regression models were created with a random effect for household to account for clustering. Statistically significant risk factors for a dog testing positive included having contact with livestock, receiving a probiotic in the previous 30 days, feeding a commercial or homemade raw food diet, feeding raw meat and eggs, feeding a homemade cooked diet, and having more than one dog in the household. In two-variable models that controlled for feeding raw food, the non-dietary variables were no longer statistically significant. These results highlight the potential public health risk of including raw animal products in canine diets. © 2010 Blackwell Verlag GmbH.

  16. Risk factors for abruptio placentae and eclampsia: analysis of 445 consecutively managed women with severe preeclampsia and eclampsia.

    PubMed

    Witlin, A G; Saade, G R; Mattar, F; Sibai, B M

    1999-06-01

    Our purpose was to characterize the clinical presentation or laboratory variables predictive of either abruptio placentae or eclampsia in women with severe preeclampsia. Prospective collection of perinatal data from 445 consecutively managed women with severe preeclampsia and eclampsia. Univariate analysis was used to determine which of the independent variables were significantly different between the groups (abruptio placentae vs no abruptio placentae; eclampsia vs no eclampsia). Those with significant differences were then entered into multiple logistic regression analysis to determine those characteristics that were independently related to the outcome variable (abruptio placentae or eclampsia). Before multivariate analysis, the independent variables with an interval scale of measurement were converted to a dichotomous scale, with the receiver-operator characteristic curve used to determine a cutoff level. Univariate analysis revealed statistical significance for the following variables associated with eclampsia: uric acid concentration, > 8.1 mg/dL; proteinuria (>3+); headache; visual symptoms; deep tendon reflexes >3+; serum albumin concentration, <3 mg/dL; and serum creatinine concentration, >1.3 mg/dL. However, with subsequent multivariate analysis, only headache and deep tendon reflexes >3+ remained significant. Univariate analysis for variables associated with abruptio placentae revealed an association between bleeding and platelet count <60,000/mm3. There was no association between abruptio placentae and eclampsia and systolic, diastolic, or mean arterial pressure, quantitative proteinuria, epigastric pain, bleeding, gestational age at delivery, history of preeclampsia, or chronic hypertension. Quantitative proteinuria and degree of blood pressure elevation were not predictive of either abruptio placentae or eclampsia, as has previously been suggested. The greatest morbidity associated with eclampsia occurred in women with preterm gestations not

  17. [Risk factors associated to preclampsia].

    PubMed

    López-Carbajal, Mario Joaquín; Manríquez-Moreno, María Esther; Gálvez-Camargo, Daniela; Ramírez-Jiménez, Evelia

    2012-01-01

    preeclampsia constitutes one of the main causes of maternal and perinatal morbidity and mortality. The aim was to identify the risk factors associated to the developmental of preeclampsia mild-moderate and severe, as well as the force of association of these factors in a hospital of second-level medical care. study of cases and controls, a relation 1:1, in women withdrawn of the Service of Gynecology and Obstetrics during 2004 to 2007. Pregnant women with more than 20 weeks gestation were included. In the cases group we included patients with diagnosis of preeclampsia mild-moderate or severe (corroborated clinical and laboratory). In the controls group that had a normal childbirth without pathology during the pregnancy. 42 cases and 42 controls. The average age was of 27 years. The associated risk factors were overweight, obesity, irregular prenatal control, short or long intergenesic period, history of caesarean or preeclampsia in previous pregnancies. the knowledge of the risk factors will allow the accomplishment of preventive measures and decrease the fetal and maternal morbidity and mortality due to preeclampsia.

  18. [Risk management and patient safety].

    PubMed

    Lessing, C

    2009-06-01

    Risk management and patient safety are of indisputable importance for the quality of health care. At the same time they confront all professional groups in the health system with high demands. The Action Alliance for Patient Safety inc. wants to demonstrate ways in which measures for avoiding errors and improving safety can reach the healthcare practice. Interdisciplinary cooperation and the availability of mutually developed materials are the maxims of the work of the society.

  19. [Success factors in hospital management].

    PubMed

    Heberer, M

    1998-12-01

    The hospital environment of most Western countries is currently undergoing dramatic changes. Competition among hospitals is increasing, and economic issues have become decisive factors for the allocation of medical care. Hospitals therefore require management tools to respond to these changes adequately. The balanced scorecard is a method of enabling development and implementation of a business strategy that equally respects the financial requirements, the needs of the customers, process development, and organizational learning. This method was used to derive generally valid success factors for hospital management based on an analysis of an academic hospital in Switzerland. Strategic management, the focus of medical services, customer orientation, and integration of professional groups across the hospital value chain were identified as success factors for hospital management.

  20. Racial and ethnic disparities in the prevalence and management of cardiovascular risk factors in the United States workforce.

    PubMed

    Hertz, Robin P; McDonald, Margaret; Unger, Alan N; Lustik, Michael B

    2007-10-01

    To assess racial or ethnic differences in workers with respect to awareness, treatment, and control of hypertension, diabetes, and dyslipidemia, and to identify factors associated with these disparities. Analysis of nationally representative data collected from employed persons participating in the National Health and Nutrition Examination Survey 1999 to 2002, with sub-analyses by race and ethnicity. Mexican-American workers are less likely than non-Hispanic whites to be aware of their hypertension (odds ratio [OR] = 0.60; 95% confidence interval [CI] = 0.39-0.94) and less likely to be treated (OR = 0.45; 95% CI = 0.23-0.85); less likely to be aware (OR = 0.56; 95% CI = 0.33-0.93) and treated (OR = 0.33; 95% CI = 0.14-0.78) for dyslipidemia; and more likely to be aware of diabetes (OR = 3.01; 95% CI = 1.14-7.95). Non-Hispanic blacks treated for hypertension are less likely than whites to reach blood pressure goal (OR = 0.47; 95% CI = 0.33-0.66). Having a usual place of care is independently associated with awareness and treatment for hypertension, and treatment for dyslipidemia. Understanding cardiovascular health disparities in the workforce can help employers structure appropriate workplace screening and prevention programs.

  1. Risk Management On-the-Run.

    ERIC Educational Resources Information Center

    Pope, Daniel C.

    1985-01-01

    Presents the options available in risk management insurance and group health insurance programs, while outlining recent changes in the industry and their effects on school risk management programs. (MD)

  2. Risk Management Practices and Accounting Requirements.

    ERIC Educational Resources Information Center

    Cheng, Rita Hartung; Yahr, Robert B.

    1989-01-01

    Reviews current school district risk management practices and the related accounting requirements. Summarizes the Governmental Accounting Standards Board's proposed accounting standards and the impact of these on school districts' risk management practices and on their financial statements. (11 references) (MLF)

  3. Risk Management On-the-Run.

    ERIC Educational Resources Information Center

    Pope, Daniel C.

    1985-01-01

    Presents the options available in risk management insurance and group health insurance programs, while outlining recent changes in the industry and their effects on school risk management programs. (MD)

  4. You can manage construction risks.

    PubMed

    Macomber, J D

    1989-01-01

    A construction project is about the riskiest thing any company does in the normal course of business. Hundreds of things can go wrong, dozens will. But officers who analyze and manage every other sort of risk often ignore construction risk as if it were uncontrollable. The truth is, it can't be eliminated, but it can be controlled. Construction is not a product but a confusing and often exasperating service. A group of experts--architects, bankers, consultants, contractors, engineers, users, city officials--coordinate the activities of an army of suppliers, laborers, designers, subcontractors, and inspectors. The job of the company officers is to coordinate the coordinators; to make prompt, informed decisions as the work progresses; to take and retain project responsibility at the highest level; and to analyze and manage the entire process in the following seven stages: 1. Study the types and phases of construction risk. 2. Assess the risks of the company's particular project. 3. Match these risks with the in-house capabilities. 4. Define a building strategy. 5. Pick the right kind of contract. 6. Choose a contractor. 7. Monitor construction. Analyzing risk is largely a matter of assessing the complexity of the building, the site, the financing, the schedule, and the special uses and problems of the project. This analysis then drives the choice of contract and contractor. The range runs from low-cost providers, lump sum contracts and very little teamwork at one end of the spectrum to highly differentiated construction companies, guaranteed-maximum-prince contracts, and consultative coordination at the other.

  5. An Extensible Information Grid for Risk Management

    NASA Technical Reports Server (NTRS)

    Maluf, David A.; Bell, David G.

    2003-01-01

    This paper describes recent work on developing an extensible information grid for risk management at NASA - a RISK INFORMATION GRID. This grid is being developed by integrating information grid technology with risk management processes for a variety of risk related applications. To date, RISK GRID applications are being developed for three main NASA processes: risk management - a closed-loop iterative process for explicit risk management, program/project management - a proactive process that includes risk management, and mishap management - a feedback loop for learning from historical risks that escaped other processes. This is enabled through an architecture involving an extensible database, structuring information with XML, schemaless mapping of XML, and secure server-mediated communication using standard protocols.

  6. An Extensible Information Grid for Risk Management

    NASA Technical Reports Server (NTRS)

    Maluf, David A.; Bell, David G.

    2003-01-01

    This paper describes recent work on developing an extensible information grid for risk management at NASA - a RISK INFORMATION GRID. This grid is being developed by integrating information grid technology with risk management processes for a variety of risk related applications. To date, RISK GRID applications are being developed for three main NASA processes: risk management - a closed-loop iterative process for explicit risk management, program/project management - a proactive process that includes risk management, and mishap management - a feedback loop for learning from historical risks that escaped other processes. This is enabled through an architecture involving an extensible database, structuring information with XML, schemaless mapping of XML, and secure server-mediated communication using standard protocols.

  7. Neighborhood risk factors for obesity.

    PubMed

    Lopez, Russ P

    2007-08-01

    The goal of this study was to explore neighborhood environmental factors associated with obesity in a sample of adults living in a major U.S. metropolitan area. This was a multi-level study combining data from the U.S. Behavioral Risk Factor Surveillance System with data from the U.S. Census. A total of 15,358 subjects living in 327 zip code tabulation areas were surveyed between 1998 and 2002. The outcome was obesity (BMI >30), and independent variables assessed included individual level variables (age, education, income, smoking status, sex, black race, and Hispanic ethnicity), and zip code level variables (percentage black, percentage Hispanic, percentage with more than a high school education, retail density, establishment density, employment density, population density, the presence of a supermarket, intersection density, median household income, and density of fast food outlets). After controlling for individual level factors, median household income [relative risk (RR) = 0.992; 95% confidence interval (CI) = 0.990, 0.994], population density (RR = 0.98; 95% CI = 0.972, 0.990), employment density (RR = 1.004; 95% CI = 1.001, 1.009), establishment density (RR = 0.981 95% CI = 0.964, 0.999), and the presence of a supermarket (RR = 0.893; 95% CI = 0.815, 0.978) were associated with obesity risk. Fast food establishment density was poorly associated with obesity risk. Where one lives may affect obesity status. Given the influence of the presence of a supermarket on obesity risk, efforts to address food access might be a priority for reducing obesity.

  8. Risk factors of striae gravidarum.

    PubMed

    Kasielska-Trojan, A; Sobczak, M; Antoszewski, B

    2015-04-01

    Stretch marks are a common skin disorder. Pregnancy-related lesions are defined as striae gravidarum. The root cause of striae formation remains unknown. The aim of this paper was to identify the risk factors associated with striae gravidarum (SG) development. The study was conducted at Plastic, Reconstructive and Aesthetic Surgery Clinic and Obstetrics Outpatient Department among 299 Caucasian women maximum 6 months after the delivery, regardless of whether they were primiparas or multiparas. Among the women participating in the study, 71.2% (213 of 299) developed striae gravidarum at least in one site. Logistic regression analysis showed that four of the analysed factors were independent predictors of striae gravidarum occurrence: family history of SG, BMI before pregnancy, the lack of chronic diseases and birthweight (P < 0.0001). It has been found that the presence of striae distensae on the breasts increases the risk of SG development (71.4% vs. 28.6%, P = 0.0008), whereas the presence of these lesions on the thighs decreases the risk (23% vs. 77%, P = 0.0076). In this study, we presented a model that can help to predict the risk of SG formation, including family history of SG, BMI before pregnancy, birthweight and chronic diseases. Moreover, women with stretch marks on their breasts should know that the risk of SG development is significantly higher, whereas lesions on the thighs do not increase such a risk. © 2014 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

  9. Efficacy of optimal long-term management of multiple cardiovascular risk factors (CVD) on walking and quality of life in patients with peripheral artery disease (PAD): protocol for randomized controlled trial.

    PubMed

    Oka, Roberta K; Conte, Michael S; Owens, Christopher D; Rapp, Joseph; Fung, Gordon; Alley, Hugh F; Giacomini, John C; Myers, Jonathan; Mohler, Emile R

    2012-02-01

    Peripheral artery disease (PAD) is an understudied chronic illness most prevalent in elderly individuals. PAD patients experience substantial walking impairment due to symptoms of limb ischemia that significantly diminishes quality of life (QOL). Cardiovascular disease (CVD) morbidity and mortality is increased in this population because of aggressive atherosclerosis resulting from untreated CVD risk factors. Despite current national guidelines recommending intensive CVD risk factor management for PAD patients, untreated CVD risk factors are common. Interventions that bridge this gap are imperative. The Vascular Insufficiency - Goals for Optimal Risk Reduction (VIGOR(2)) study is a randomized controlled trial (RCT) that examines the effectiveness of a long-term multifactor CVD risk reduction program on walking and quality of life in patients with PAD. The purpose of this article is to provide a detailed description of the design and methods of VIGOR(2). Clinical Trial Registration - URL: http://clinicaltrials.gov/ct2/show/NCT00537225.

  10. Risk factors for mortality in Down syndrome.

    PubMed

    Uppal, H; Chandran, S; Potluri, R

    2015-09-01

    Down syndrome is a genetic condition that contributes to a significantly shorter life expectancy compared with the general population. We investigated the most common comorbidities in a population of acute hospital patients with Down syndrome and further explored what the most common risk factors for mortality are within this population. From our database of one million patients admitted to National Health Service (NHS) Trusts in northern England, we identified 558 people who had Down syndrome. We compared this group with an age- and gender-matched control group of 5580 people. The most prevalent comorbid diseases within the Down's population were hypothyroidism (22.9%) and epilepsy (20.3%). However, the conditions that had the highest relative risks (RRs) in the Down's population were septal defects and dementia. Respiratory failure, dementia and pneumonia were the most significantly related comorbidities to mortality in the Down syndrome population. In the control population, respiratory failure, dementia and renal failure were the most significant disease contributors. When these contributors were analysed using multivariate analysis, heart failure, respiratory failure, pneumonia and epilepsy were the identified risk factors for in-hospital mortality in the Down syndrome population. Respiratory failure was the sole risk factor for mortality in the Down syndrome population [RR = 9.791 (1.6-59.9) P ≤ 0.05], when compared with the risk factors for mortality in the control population. There is significant medical morbidity in Down syndrome. This morbidity contributes to the lower life expectancy. Respiratory failure is a risk factor for mortality in Down syndrome. We need to thoroughly investigate people with Down syndrome to ensure any treatable illnesses are well managed. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  11. Risk Management for Human Support Technology Development

    NASA Technical Reports Server (NTRS)

    jones, Harry

    2005-01-01

    NASA requires continuous risk management for all programs and projects. The risk management process identifies risks, analyzes their impact, prioritizes them, develops and carries out plans to mitigate or accept them, tracks risks and mitigation plans, and communicates and documents risk information. Project risk management is driven by the project goal and is performed by the entire team. Risk management begins early in the formulation phase with initial risk identification and development of a risk management plan and continues throughout the project life cycle. This paper describes the risk management approach that is suggested for use in NASA's Human Support Technology Development. The first step in risk management is to identify the detailed technical and programmatic risks specific to a project. Each individual risk should be described in detail. The identified risks are summarized in a complete risk list. Risk analysis provides estimates of the likelihood and the qualitative impact of a risk. The likelihood and impact of the risk are used to define its priority location in the risk matrix. The approaches for responding to risk are either to mitigate it by eliminating or reducing the effect or likelihood of a risk, to accept it with a documented rationale and contingency plan, or to research or monitor the risk, The Human Support Technology Development program includes many projects with independently achievable goals. Each project must do independent risk management, considering all its risks together and trading them against performance, budget, and schedule. Since the program can succeed even if some projects fail, the program risk has a complex dependence on the individual project risks.

  12. Risk Management for Human Support Technology Development

    NASA Technical Reports Server (NTRS)

    jones, Harry

    2005-01-01

    NASA requires continuous risk management for all programs and projects. The risk management process identifies risks, analyzes their impact, prioritizes them, develops and carries out plans to mitigate or accept them, tracks risks and mitigation plans, and communicates and documents risk information. Project risk management is driven by the project goal and is performed by the entire team. Risk management begins early in the formulation phase with initial risk identification and development of a risk management plan and continues throughout the project life cycle. This paper describes the risk management approach that is suggested for use in NASA's Human Support Technology Development. The first step in risk management is to identify the detailed technical and programmatic risks specific to a project. Each individual risk should be described in detail. The identified risks are summarized in a complete risk list. Risk analysis provides estimates of the likelihood and the qualitative impact of a risk. The likelihood and impact of the risk are used to define its priority location in the risk matrix. The approaches for responding to risk are either to mitigate it by eliminating or reducing the effect or likelihood of a risk, to accept it with a documented rationale and contingency plan, or to research or monitor the risk, The Human Support Technology Development program includes many projects with independently achievable goals. Each project must do independent risk management, considering all its risks together and trading them against performance, budget, and schedule. Since the program can succeed even if some projects fail, the program risk has a complex dependence on the individual project risks.

  13. Managing Risk Assessment in Science Departments.

    ERIC Educational Resources Information Center

    Forlin, Peter; Forlin, Chris

    1997-01-01

    Describes a health-and-safety risk-management audit in four Queensland, Australia high schools. One major outcome of this research project is the development of a comprehensive risk-management policy in compliance with the law. Other outcomes include the preparation of a professional-development package in risk-management policy for use as a…

  14. 12 CFR 932.1 - Risk management.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

  15. 12 CFR 932.1 - Risk management.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

  16. Determining hospital risk management staffing through analytics.

    PubMed

    Howard, Chrystina M; Felton, Kenneth W

    2013-01-01

    This article presents the development of an independent research project to gather time data from hospital risk managers in order to establish an objective, justifiable means of determining staffing levels recommended to support risk management activities and department functions. © 2013 American Society for Healthcare Risk Management of the American Hospital Association.

  17. Risk Management in Student Personnel Administration.

    ERIC Educational Resources Information Center

    Hammond, Edward H.; Hagan, Charles F.

    1979-01-01

    A risk management plan is an effective tool for postsecondary institutions to utilize in organizing management of both personal and institutional liability. Important considerations involve criminal and civil liabilities, causes of risk, and integral elements of a good risk management plan. (NRB)

  18. Risk factors for persistent diarrhoea.

    PubMed

    Shahid, N S; Sack, D A; Rahman, M; Alam, A N; Rahman, N

    1988-10-22

    With a systematically sampled population of children aged under 5 attending this centre for diarrhoeal disease research during 1983-5 a retrospective analysis of persistent diarrhoea (defined as greater than 14 days' duration) was performed to identify the possible risk factors for this syndrome. Of the 4155 children included in the analysis, 410 (10%) gave a history of persistent diarrhoea. A comparison with children with acute diarrhoea matched for age showed that 11 factors were correlated with persistent diarrhoea, and strongly associated factors were stools with blood or mucus, or both, lower respiratory tract infection, malnutrition, vitamin A deficiency, and antibiotic use before presentation. The peak age was 2 years, and there was no sex difference. Deaths occurred more often in the group with persistent diarrhoea. Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea. No seasonal variation was observed in the rates of persistent diarrhoea. Although the introduction of family food to the diet was associated with higher rates, this factor was difficult to separate from the age dependent risks.

  19. Obesity and related risk factors.

    PubMed

    Mozaffari, H; Nabaei, B

    2007-03-01

    To study the prevalence of overweight and obesity among Iranian schoolgirls and to identify risk factors which lead to obesity. This cross-sectional study was conducted in 2002 and a sample of 1800 female students between 7-12 years old was obtained using a multistage cluster sampling method from Tehran. Height and weight were measured and related socio-economic information was collected. The overall percent of overweight and obesity was 13.3% and 7.7% respectively. BMI (Body Mass Index) was directly and significantly(r=+0.28, P< 0.001) correlated with increasing age. Physical activity was significantly different between obese and non-obese children. (P=0.03) Also, economical factors such as the type of school (private&public) were different in these children. (P=0.03) The statistical analysis of the data revealed a significant and inverse correlation(r=-0.03, P=0.04) between maternal education and occurrence of overweight and obesity in children. The prevalence of overweight and obesity in young Iranian girls was high. Advanced age, lack of physical inactivity, low economical factors and maternal educational status could be risk factors for obesity in children.

  20. Risk factors for persistent diarrhoea.

    PubMed Central

    Shahid, N. S.; Sack, D. A.; Rahman, M.; Alam, A. N.; Rahman, N.

    1988-01-01

    With a systematically sampled population of children aged under 5 attending this centre for diarrhoeal disease research during 1983-5 a retrospective analysis of persistent diarrhoea (defined as greater than 14 days' duration) was performed to identify the possible risk factors for this syndrome. Of the 4155 children included in the analysis, 410 (10%) gave a history of persistent diarrhoea. A comparison with children with acute diarrhoea matched for age showed that 11 factors were correlated with persistent diarrhoea, and strongly associated factors were stools with blood or mucus, or both, lower respiratory tract infection, malnutrition, vitamin A deficiency, and antibiotic use before presentation. The peak age was 2 years, and there was no sex difference. Deaths occurred more often in the group with persistent diarrhoea. Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea. No seasonal variation was observed in the rates of persistent diarrhoea. Although the introduction of family food to the diet was associated with higher rates, this factor was difficult to separate from the age dependent risks. PMID:3142603

  1. Risk Management in High Adventure Outdoor Pursuits.

    ERIC Educational Resources Information Center

    Cinnamon, Jerry

    This paper outlines management guidelines for outdoor adventure pursuits based on analysis of accident case studies in the literature. Managing risk, to a large degree, involves managing human errors related to natural environmental hazards. The knowledge needed to manage risk may be gained through personal experience (the most dangerous way),…

  2. What Are the Risk Factors for Eye Cancer?

    MedlinePlus

    ... Causes, Risk Factors, and Prevention What Are the Risk Factors for Eye Cancer? A risk factor is ... may have few or no known risk factors. Risk factors for eye melanoma Race/ethnicity The risk ...

  3. 42 CFR 441.476 - Risk management.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must specify the risk assessment methods it uses to identify potential risks to the participant. (b) The State... 42 Public Health 4 2014-10-01 2014-10-01 false Risk management. 441.476 Section 441.476...

  4. 12 CFR 932.1 - Risk management.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... requirement, and for the risk assessment procedures and controls (whether established as part of its risk... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS...

  5. 12 CFR 932.1 - Risk management.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... requirement, and for the risk assessment procedures and controls (whether established as part of its risk... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS...

  6. 12 CFR 932.1 - Risk management.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... requirement, and for the risk assessment procedures and controls (whether established as part of its risk... 12 Banks and Banking 8 2014-01-01 2014-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS...

  7. 42 CFR 441.476 - Risk management.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must specify the risk assessment methods it uses to identify potential risks to the participant. (b) The State... 42 Public Health 4 2013-10-01 2013-10-01 false Risk management. 441.476 Section 441.476...

  8. 12 CFR 917.3 - Risk management.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... risk, including contingency plans where appropriate. (c) Risk assessment. The senior management of each Bank shall perform, at least annually, a risk assessment that is reasonably designed to identify and... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Risk management. 917.3 Section 917.3 Banks...

  9. 12 CFR 917.3 - Risk management.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... risk, including contingency plans where appropriate. (c) Risk assessment. The senior management of each Bank shall perform, at least annually, a risk assessment that is reasonably designed to identify and... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Risk management. 917.3 Section 917.3 Banks...

  10. 42 CFR 441.476 - Risk management.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must specify the risk assessment methods it uses to identify potential risks to the participant. (b) The State... 42 Public Health 4 2012-10-01 2012-10-01 false Risk management. 441.476 Section 441.476...

  11. Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behaviour change for improved plaque control in periodontal management.

    PubMed

    Newton, J Timothy; Asimakopoulou, Koula

    2015-04-01

    Plaque control in patients with periodontal disease is critically dependent upon self-care through specific oral hygiene-related behaviours. To determine the relationship between adherence to oral hygiene instructions in adult periodontal patients and psychological constructs. To determine the effect of interventions based on psychological constructs on oral health-related behaviour in adult periodontal patients. The Cochrane Oral Health Group's Trials Register, MEDLINE, EMBASE and PsycINFO. Studies were grouped according to the study design, and appraised using an appropriate methodology, either the Newcastle-Ottawa assessment for observational studies, or the Cochrane criteria for trials. Fifteen reports of studies were identified. There was a low risk of bias identified for the observational studies. Older trials suffered from high risk of bias, but more recent trials had low risk of bias. However, the specification of the psychological intervention was generally poor. The use of goal setting, self-monitoring and planning are effective interventions for improving oral hygiene-related behaviour in patients with periodontal disease. Understanding the benefits of behaviour change and the seriousness of periodontal disease are important predictors of the likelihood of behaviour change. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Health management program: factors influencing completion of therapy with high-dose interferon alfa-2b for high-risk melanoma

    PubMed Central

    Levesque, N.; Mitchinson, K.; Lawrie, D.; Fedorak, L.; MacDonald, D.; Normand, C.; Pouliot, J.F.

    2008-01-01

    The goal of the 1-year observational, multicentre, open-label study reported here was to identify factors influencing adherence to high-dose interferon alfa-2b adjuvant therapy in patients at high risk of recurrence following surgical excision of malignant melanoma. The study was carried out in 23 tertiary-care centres across Canada. The 225 patients enrolled in the study all had malignant melanoma that was surgically excised and that required adjuvant treatment with interferon alfa-2b. Of these patients, 64% were men. Mean age was 51.7 years. All patients received interferon alfa-2b treatment during a 4-week induction phase (20 MU/m2 intravenously 5 days per week) followed by a 48-week maintenance phase (10 MU/m2 subcutaneously 3 days per week). Oncology nurses reviewed side-effect management with the patients before the induction and maintenance phases. Patients were provided with daily diaries, comprehensive educational materials, and ongoing nursing support. Data on side effects and discontinuations were obtained from patient interviews and diaries. The main outcome measurements were related to treatment discontinuation: rate, timing, reason, and prevention. Of the 225 patients, 75 (33.3%) discontinued interferon during the induction phase, and 58 (25.8%) discontinued during the maintenance phase. The main reasons for discontinuation were adverse events (58%) and disease progression (26%). Patients with a daily fluid intake greater than 1.5 L were more likely to complete therapy than were those with an intake less than 1.5 L (64% vs. 36%, p < 0.0001). Of 225 patients enrolled in the interferon alfa-2b health management program, 41% completed the 1-year treatment course. Higher fluid intake (>1.5 L daily) was associated with increased adherence to therapy. PMID:18317583

  13. Gram-negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones.

    PubMed

    Grossi, O; Asseray, N; Bourigault, C; Corvec, S; Valette, M; Navas, D; Happi-Djeukou, L; Touchais, S; Bémer, P; Boutoille, D

    2016-09-01

    To describe the outcome and risk factors for treatment failure of 76 Gram-negative bacilli (GNB) prosthetic joint infections (PJIs) managed with a curative intent according to a standardized protocol derived from published guidelines. We analysed data from all the cases of GNB-PJI treated surgically over an 8 year period. Treatment failure was defined as persistence or recurrence of PJI signs during follow-up, resulting in additional surgery and/or antibiotic administration or death. Treatment failure within the follow-up period (median = 2.6 years) was observed in 16 of 76 (21.1%) patients. The failure rate was similar whether the patients were treated with fluoroquinolones in the whole cohort (22.4% versus 16.7%, P = 0.75) and after stratification according to the surgical procedure. The low failure rate observed in patients not receiving fluoroquinolones might be explained by the standardized attitude of maintaining intravenous β-lactams throughout treatment duration (median = 90 days). In multivariate analysis, C-reactive protein level ≥175 mg/L was significantly associated with treatment failure (adjusted HR = 7.75, 95% CI = 2.66-22.59, P < 0.0001). Management according to standardized procedures may improve the prognosis of GNB-PJI. Intravenous β-lactams, continued for 3 months, should be considered an effective alternative to fluoroquinolones. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  14. Factors that may increase the risk of aquatic organisms to the harmful effects of ultraviolet-B radiation: A management perspective

    SciTech Connect

    Little, E.E.; Fabacher, D.L.

    1995-12-31

    Elevated levels of solar ultraviolet-B (UVB) radiation resulting from stratospheric ozone depletion may cause harmful effects in aquatic organisms. Solar UVB radiation penetrates clear water and can have a direct biological impact on some organisms, causing lesions, infection, and mortality. Numerous evolutionary adaptations and repair mechanisms appear to have evolved in aquatic organisms for coping with solar radiation. The authors found that some species of fish are more susceptible to the harmful effects of solar simulated UVB than other species. Such differences were directly related to the amount of an unidentified dorsal skin component that may function as a natural sunscreen and protect some fish from the harmful effects of UVB. Ozone depletion arising from the destruction of ozone by chlorofluorocarbons is expected to average around 11% annually in mid-northern latitudes through the rest of the century. Since many aquatic organisms appear to exist at their limits of tolerance for solar UVB radiation, environmental changes that result in increased UVB radiation may be directly harmful to sensitive populations. Identification of risk factors and management of aquatic communities exposed to enhanced UVB require not only information about UVB climatology, but also knowledge of the sensitivity and behavioral habits of each species, and an assessment of environmental variables that may increase or mitigate UVB exposure.

  15. The Role of Risk and Risk Management in Experiential Education.

    ERIC Educational Resources Information Center

    Mobley, Michael

    A monograph examines the role of risk and risk management in experiential education, particularly stress/challenge programming. Definitions of risk are presented. The importance of risk and stress in experiential education is emphasized. Implications of subjective versus objective risk assessment in adventure education are discussed, with…

  16. Cardiovascular Risk Factors of Taxi Drivers.

    PubMed

    Elshatarat, Rami Azmi; Burgel, Barbara J

    2016-06-01

    In the United States (U.S.), cardiovascular disease (CVD) is a major leading cause of death. Despite the high mortality rate related to CVD, little is known about CVD risk factors among urban taxi drivers in the U.S. A cross-sectional design was used to identify the predictors of high cardiovascular risk factors among taxi drivers. Convenience sampling method was used to recruit 130 taxi drivers. A structured questionnaire was used to obtain the data. The sample was male (94 %), age mean (45 ± 10.75) years, married (54 %), born outside of the USA (55 %), had some college or below (61.5 %), night drivers (50.8 %), and driving on average 9.7 years and 41 h/week. About 79 % of them were eligible for CVD prevention, and 35.4 % had high CVD risk factors (4-9 risk factors). A CVD high-risk profile had a significant relationship with the subjects who were ≥55 years old; had hypertension, diabetes, or hyperlipidemia; were drinking alcohol ≥2 times/week; and had insufficient physical activity. Subjects who worked as a taxi driver for more than 10 years (OR 4.37; 95 % CI 1.82, 10.50) and had mental exertion from cab driving >5 out of 10 (OR 2.63; 95 % CI 1.05, 6.57) were more likely to have a CVD high-risk profile. As a conclusion, system-level or worksite interventions include offering healthy food at taxi dispatching locations, creating a work culture of frequent walking breaks, and interventions focusing on smoking, physical activity, and weight management. Improving health insurance coverage for this group of workers is recommended.

  17. Management of cardiovascular risk factors in advanced type 2 diabetic nephropathy: a comparative analysis in nephrology, diabetology and primary care settings.

    PubMed

    Minutolo, Roberto; Sasso, Ferdinando C; Chiodini, Paolo; Cianciaruso, Bruno; Carbonara, Ornella; Zamboli, Pasquale; Tirino, Giuseppina; Pota, Andrea; Torella, Roberto; Conte, Giuseppe; De Nicola, Luca

    2006-08-01

    Advanced diabetic nephropathy (DN) is characterized by a marked development of cardiovascular and renal disease. These patients are frequently managed by different health professionals with the consequence that the quality of care may differ substantially. To compare the management of cardiovascular risk factors in patients with type 2 DN and an estimated glomerular filtration rate (GFR) of 15-60 ml/min per 1.73 m2 followed in nephrology, diabetology and primary care. This multicentre cross-sectional study verified the control of blood pressure (BP), total cholesterol, triglycerides, glycosylated haemoglobin A1c (HbA1c) and haemoglobin in patients exclusively followed in either nephrology (n = 266), diabetology (n = 246) or primary care (n = 195) of the same metropolitan area for at least 1 year. Primary care patients were older and had a greater prevalence of previous cardiovascular events. The GFR was lower in nephrology than in diabetology and primary care (33 +/- 13 versus 47 +/- 9 and 40 +/- 12 ml/min per 1.73 m2, P < 0.0001). The prevalence of BP target (< 130/80 mmHg) was similarly low in nephrology, diabetology and primary care (14, 13 and 10%, P = 0.421) probably because of insufficient prescription of diuretics and low-salt diet. Whereas the prevalence of the triglycerides target was similar, that of total cholesterol (< 200 mg/dl) was larger in diabetology (63%) than in nephrology and primary care (59 and 46%, P = 0.003) because of greater statin prescription in hypercholesterolemic individuals (70, 50 and 41%, respectively, P = 0.002). The attainment of HbA1c less than 7% was less frequent in diabetology (32%) than in nephrology and primary care (61 and 46%, P = 0.0003) despite a more frequent prescription of insulin/oral agents in diabetology. The control of anaemia was better in diabetology. Multivariate analysis adjusted for the patient case-mix and physician-level clustering confirmed these differences except for anaemia. Patients with advanced DN

  18. Calysto: Risk Management for Commercial Manned Spaceflight

    NASA Technical Reports Server (NTRS)

    Dillaman, Gary

    2012-01-01

    The Calysto: Risk Management for Commercial Manned Spaceflight study analyzes risk management in large enterprises and how to effectively communicate risks across organizations. The Calysto Risk Management tool developed by NASA's Kennedy Space Center's SharePoint team is used and referenced throughout the study. Calysto is a web-base tool built on Microsoft's SharePoint platform. The risk management process at NASA is examined and incorporated in the study. Using risk management standards from industry and specific organizations at the Kennedy Space Center, three methods of communicating and elevating risk are examined. Each method describes details of the effectiveness and plausibility of using the method in the Calysto Risk Management Tool. At the end of the study suggestions are made for future renditions of Calysto.

  19. Environmental Risk Factors for ARDS

    PubMed Central

    Moazed, Farzad; Calfee, Carolyn S.

    2014-01-01

    The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in critically ill patients. Over the past several decades, alcohol abuse and cigarette smoke exposure have been identified as risk factors for the development of ARDS. The mechanisms underlying these relationships are complex and remain under investigation but are thought to involve pulmonary immune impairment as well as alveolar epithelial and endothelial dysfunction. This review summarizes the epidemiologic data supporting links between these exposures and ARDS susceptibility and outcomes and highlights key mechanistic investigations that provide insight into the pathways by which each exposure is linked to ARDS. PMID:25453414

  20. Knowledge of osteoporosis risk factors and prevalence of risk factors for osteoporosis, falls, and fracture in functionally independent older adults.

    PubMed

    Burke-Doe, Annie; Hudson, Angela; Werth, Heather; Riordan, Deborah G

    2008-01-01

    This study had three goals: (1) to assess knowledge of osteoporosis risk factors, (2) to determine the prevalence of risk factors for osteoporosis, falls, and fractures, and (3) to ascertain the relationship between knowledge and prevalence of osteoporosis risk factors in affluent independent community-dwelling aging adults. Forty-nine individuals over the age of 50 years completed a series of questionnaires and clinical testing procedures to identify osteoporosis knowledge, fall and fracture risk factors. Positive correlations were found between greater knowledge of osteoporosis risk factors and confidence in performing activities of daily living (r=0.32, p=0.05), better static and dynamic balance (r=0.42, p=0.01) and greater lower extremity strength (r=0.33, p=0.05). Despite these correlations 64% of participants had less than 50% correct responses related to osteoporosis knowledge. The average number of risk factors was 5.5 with many participants having modifiable risk factors including inadequate calcium and vitamin D intake and limitations in agility, balance, strength and flexibility. Participants with increased knowledge of risk factors presented with increased confidence performing activities of daily living, greater lower extremity strength and lower fall risk. Knowledge of disease processes, risk factors and strategies for prevention and management may improve patient compliance for behavioral changes necessary in successful participatory management.

  1. Neospora caninum in pastured cattle: determination of climatic, environmental, farm management and individual animal risk factors using remote sensing and geographical information systems.

    PubMed

    Rinaldi, L; Fusco, G; Musella, V; Veneziano, V; Guarino, A; Taddei, R; Cringoli, G

    2005-03-31

    A cross-sectional serological survey was conducted on cattle pasturing in an area of the southern Italian Apennines to evaluate the seroprevalence to Neospora caninum, and to investigate the climatic, environmental, farm management, and individual animal factors that influence the distribution of this protozoan. Blood samples were collected from 864 pastured cattle raised on 81 farms. Serum samples were tested for antibodies to N. caninum using an ELISA assay (HerdCheck), IDEXX). A geographical information system (GIS) for the study area was constructed using the following remote sensing (RS) and landscape feature data: autumn-winter, spring and summer normalized difference vegetation index (NDVI), land cover, elevation, slope, aspect, mean rainfall and minimum, mean, and maximum temperature in spring, summer, autumn and winter. Data on each of these features were then extracted for "buffer zones" consisting of the area included in a circle of 3 km diameter centered on the 81 geo-referenced centroids of the main cattle pastures. Climatic and environmental data obtained from RS and GIS and individual animal characteristics and farm management data obtained from a questionnaire were analyzed in relation to N. caninum seropositivity and antibody titres both by linear and logistic regression models. Out of the 81 farms sampled, 63 (77.8%) had at least one tested animal positive for N. caninum. Out of the 864 bovine sera samples, 266 (30.8%) were found to have antibodies to N. caninum. The results of the logistic regression model show that significantly high seroprevalence to N. caninum was found in heifers/steers and adults, in cattle raised on farms having a large number of dogs, and in cattle raised in buffer zones having high minimum temperatures in the spring, and a narrow extension of summer NDVI. In addition, positive linear correlations were found between N. caninum antibody titres and the number of dogs on farm, and the minimum temperature in spring. All the

  2. Feedback on flood risk management

    NASA Astrophysics Data System (ADS)

    Moreau, K.; Roumagnac, A.

    2009-09-01

    For several years, as floods were increasing in South of France, local communities felt deprive to assume their mission of protection and information of citizens, and were looking for assistance in flood management. In term of flood disaster, the fact is that physical protection is necessary but inevitably limited. Tools and structures of assistance to anticipation remain slightly developed. To manage repeated crisis, local authorities need to be able to base their policy against flood on prevention, warnings, post-crisis analysis and feedback from former experience. In this objective, after 3 years of test and improvement since 2003, the initiative Predict-Services was developed in South of France: it aims at helping communities and companies to face repeated flood crisis. The principle is to prepare emergency plans, to organize crisis management and reduce risks; to help and assist communities and companies during crisis to activate and adapt their emergency plans with enough of anticipation; and to analyse floods effects and improve emergency plans afterwards. With the help of Meteo France datas and experts, Predict services helps local communities and companies in decision making for flood management. In order to reduce risks, and to keep the benefits of such an initiative, local communities and companies have to maintain the awareness of risk of the citizens and employees. They also have to maintain their safety plans to keep them constantly operational. This is a part of the message relayed. Companies, Local communities, local government authorities and basin stakeholders are the decision makers. Companies and local communities have to involve themselves in the elaboration of safety plans. They are also completely involved in their activation that is their own responsability. This applies to other local government authorities, like districts one's and basin stakeholders, which participle in the financing community safety plans and adminitrative district which

  3. Women's Heart Disease: Heart Disease Risk Factors

    MedlinePlus

    ... this page please turn JavaScript on. Feature: Women's Heart Disease Heart Disease Risk Factors Past Issues / Winter 2014 Table ... or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk ...

  4. [Subjective perception of maladjustment risk factors].

    PubMed

    Salomone, M; Romano, L; Esposito, A; Nigro, E; Boggia, B; Napolano, E; Carbone, U

    2007-01-01

    Maladjustment at work results from organizational and relational features of the work, the so-called fourth type factors; they include working hours, ways and contents of working activities, and horizontal and vertical business relations. The study reports the percentage of sensed disturbing factors in workers with maladjustment and disaffection at work. Data have been taken from 1382 white collars, 1117 males and 265 females, observed from January 2006 to June 2007 for Health Surveillance. Maladjustment prevalence was higher in females than in males. As individual variables, ageing and family care increased the prevalence of maladjustment among females, whilst a higher prevalence of maladjustment were found in youngest and unmarried males. A very different perception of work harmfulness were found between sexes. As risk factors, female have denounced more wear and tear and authoritarian management; male denounced physical strain.

  5. Risk factors identified for certain lymphoma subtypes

    Cancer.gov

    In a large international collaborative analysis of risk factors for non-Hodgkin lymphoma (NHL), scientists were able to quantify risk associated with medical history, lifestyle factors, family history of blood or lymph-borne cancers, and occupation for 11

  6. Heart Disease Risk Factors You Can Control

    MedlinePlus

    ... and Stroke Heart disease risk factors you can control Did you know? In women, high triglycerides combined ... information on Heart disease risk factors you can control Read more from womenshealth.gov Heart Disease Fact ...

  7. Risk Factors and Causes of Syncope

    MedlinePlus

    ... Causes of Sy... Back to Fainting Risk Factors & Causes of Syncope Risk Factors for Cardiovascular Syncope The ... heart. LQTS is believed to be a common cause of sudden and unexplained death in children and ...

  8. Commercializing fuel cells: managing risks

    NASA Astrophysics Data System (ADS)

    Bos, Peter B.

    Commercialization of fuel cells, like any other product, entails both financial and technical risks. Most of the fuel cell literature has focussed upon technical risks, however, the most significant risks during commercialization may well be associated with the financial funding requirements of this process. Successful commercialization requires an integrated management of these risks. Like any developing technology, fuel cells face the typical 'Catch-22' of commercialization: "to enter the market, the production costs must come down, however, to lower these costs, the cumulative production must be greatly increased, i.e. significant market penetration must occur". Unless explicit steps are taken to address this dilemma, fuel cell commercialization will remain slow and require large subsidies for market entry. To successfully address this commercialization dilemma, it is necessary to follow a market-driven commercialization strategy that identifies high-value entry markets while minimizing the financial and technical risks of market entry. The financial and technical risks of fuel cell commercialization are minimized, both for vendors and end-users, with the initial market entry of small-scale systems into high-value stationary applications. Small-scale systems, in the order of 1-40 kW, benefit from economies of production — as opposed to economies to scale — to attain rapid cost reductions from production learning and continuous technological innovation. These capital costs reductions will accelerate their commercialization through market pull as the fuel cell systems become progressively more viable, starting with various high-value stationary and, eventually, for high-volume mobile applications. To facilitate market penetration via market pull, fuel cell systems must meet market-derived economic and technical specifications and be compatible with existing market and fuels infrastructures. Compatibility with the fuels infrastructure is facilitated by a

  9. Acquisition Program Risk Management: Does the Department of Defense Risk Management Practices Guide Provide an Effective Risk Tool for Program Managers in Today’s Acquisition Environment?

    DTIC Science & Technology

    2012-05-01

    Management Definition ........................................................................................... 32 Table 16. Risk Management Tracking...Other (please specify) 5 Table 15. Risk Management Definition Question 7: Does your Program Office or Risk Management IPT track risks for cost...aligned to collect information on program risk definition. Question 6 was designed to collect information on risk management definition . Participants

  10. [The relevance of clinical risk management].

    PubMed

    Gulino, Matteo; Vergallo, Gianluca Montanari; Frati, Paola

    2011-01-01

    Medical activity includes a risk of possible injury or complications for the patients, that should drive the Health Care Institutions to introduce and/ or improve clinical Risk management instruments. Although Italy is still lacking a National project of Clinical Risk Management, a number of efforts have been made by different Italian Regions to introduce instruments of risk management. In addition, most of National Health Care Institutions include actually a Department specifically in charge to manage the clinical risk. Despite the practical difficulties, the results obtained until now suggest that the risk management may represent a useful instrument to contribute to the reduction of errors in clinical conduct. Indeed, the introduction of adequate instruments of prevention and management of clinical risk may help to ameliorate the quality of health care Institution services.

  11. Sexual violence as a limiting factor on the perception and management of the risk of HIV in women married to migrants 1

    PubMed Central

    Flores, Yesica Yolanda Rangel

    2016-01-01

    ABSTRACT Objective: to analyze the influence of sexual violence on the perception and management of the risk of HIV in women married to migrants. Methods: study with an ethnographic approach carried out in urban and rural communities. Data were obtained by methodological triangulation, with participant and non-participant observation, as well as interviews. The informants were 21 women married to international migrants. The interviews were transcribed and discourse analysis was applied to them. Results: three categories emerged from the speeches to problematize the influence of sexual violence in the perception and management of the risk of HIV: "Characterization of sexual practices in the context of migration", "Experiences of sexual violence" and "Construction of the risk of HIV-AIDS". Conclusion: women have difficulty to recognize the acts of sexual violence in their daily lives, and their perceptions of risk are not decisive in the management of the threat to which they are exposed. Therefore, it is becoming increasingly urgent that nursing problematizes the sexual violence within "steady couples", as a challenge to the promotion of healthy lifestyles. PMID:27598375

  12. Human System Risk Management for Space Flight

    NASA Technical Reports Server (NTRS)

    Davis, Jeffrey

    2015-01-01

    2004 of evaluating the tolerance limits and safe operating bands called for in the Bioastronautics Strategy. Over the next several years, the concept of the "operating bands" were turned into Space Flight Human System Standards (SFHSS), developed by the technical resources of the SLSD at the NASA Johnson Space Center (JSC). These standards were developed and reviewed at the SLSD and then presented to the OCHMO for acceptance. The first set of standards was published in 2007 as the NASA-STD-3001, Volume 1, Crew Health that elaborated standards for several physiological areas such as cardiovascular, musculoskeletal, radiation exposure and nutrition. Volume 2, Human Factors, Habitability and Human Health was published in 2011, along with development guidance in the Human Integration Design Handbook (HIDH). Taken together, the SFHSS Volumes 1 and 2, and the HIDH replaced the NASA-STD-3000 with new standards and revisions of the older document. Three other changes were also taking place that facilitated the development of the human system risk management approach. In 2005, the life sciences research and development portfolio underwent a comprehensive review through the Exploration Systems Architecture Study (ESAS) that resulted in the reformulation of the Bioastronautics Program into Human Research Program (HRP) that was focused on appropriate mitigation results for high priority human health risks. The baseline HRP budget was established in August 2005. In addition, the OCHMO formulated the Health and Medical Technical Authority (HMTA) in 2006 that established the position of the Chief Medical Officer (CMO) at the NASA JSC along with other key technical disciplines, and the OCHMO became the responsible office for the SFHSS as noted above. The final change was the establishment in 2008 of the Human System Risk Board (HSRB), chaired by the CMO with representation from the HRP, SLSD management and technical experts. The HSRB then began to review all human system risks

  13. Incidence of Cardiovascular Risk Factors in Oskoo (Northwest Iran): An Approach through WHO CVD-risk Management Package for Low–and Medium-Resource Settings on 37,329 Adults ≥30 Years Old

    PubMed Central

    Khalili, Ahmadali; Yaghoubi, Alireza; Safaie, Naser; Eyvazi, Karim; Azarfarin, Rasoul; Ebrahimzadeh, Adel; Alizadehasl, Azin; Safarzadeh, Ghader; Farzandan, Abbas; Zamanzadeh, Amir

    2011-01-01

    Introduction The aim of this study was to determine incidence of cardiovascular disease (CVD) risk factors [hypertension (HTN), obesity, Dyslipidemia (DLP), diabetes mellitus (DM) and smoking] in Oskoo. Methods This study was planned according to WHO protocol “WHO CVD-risk management package for low and medium-resource settings” and named “East Azerbaijan healthy heart program”. The pilot study of this program was done in Oskoo in 2007-2009. In this study, demographic data and CVD risk factors of 37,329 adults aged ≥30 years old living in Oskoo were collected. In addition, blood samples of 17,388 adults ≥40 years old were taken (free of charge) for assessment of serum glucose and lipid profile. Results The study covered 93.52% of Oskoo town population aged≥30 years old. We studied 18637 male (91.50% coverage) and 18692 female (95.52% coverage) participants. The incidence of HTN [SBP≥140 & DBP≥90 mmHg] was 16.25% (M:15.08%, F:17.29%), pre-hypertension [SBP=120-139 & DBP=80-89 mmHg] =37.78% (M:41.38%, F:34.18%), DM [fast blood glucose (FBS)≥126mg/dl] was 7.45% (M:6.35%, F:8.54%), smoking was 9.40% (M:17.00%, F:1.57%), hypercholesterolemia (>200mg/dl) was 47.64% (M:42.46%, F:52.81%) and obesity [body mass index (BMI) ≥27] was 50.47% (M:38.79%, F:62.09%). Conclusion Considering high incidence of CVD risk factors (except smoking) in Oskoo adults ≥30 years, it is recommended that this pilot study expanded to all of East Azerbaijan. Free of charge taking blood samples from people ≥ 40 years to evaluate lipid profile and glucose levels is worthy to early detecting the prevalent DM or DLP in this target population. PMID:24250965

  14. The Influence Factors and Mechanism of Societal Risk Perception

    NASA Astrophysics Data System (ADS)

    Zheng, Rui; Shi, Kan; Li, Shu

    Risk perception is one of important subjects in management psychology and cognitive psychology. It is of great value in the theory and practice to investigate the societal hazards that the public cares a lot especially in Socio-economic transition period. A survey including 30 hazards and 6 risk attributes was designed and distributed to about 2, 485 residents of 8 districts, Beijing. The major findings are listed as following: Firstly, a scale of societal risk perception was designed and 2 factors were identified (Dread Risk & Unknown Risk). Secondly, structural equation model was used to analyze the influence factors and mechanism of societal risk perception. Risk preference, government support and social justice could influence societal risk perception directly. Government support fully moderated the relationship between government trust and societal risk perception. Societal risk perception influenced life satisfaction, public policy preferences and social development belief.

  15. Configurations of Common Childhood Psychosocial Risk Factors

    ERIC Educational Resources Information Center

    Copeland, William; Shanahan, Lilly; Costello, E. Jane; Angold, Adrian

    2009-01-01

    Background: Co-occurrence of psychosocial risk factors is commonplace, but little is known about psychiatrically-predictive configurations of psychosocial risk factors. Methods: Latent class analysis (LCA) was applied to 17 putative psychosocial risk factors in a representative population sample of 920 children ages 9 to 17. The resultant class…

  16. Configurations of Common Childhood Psychosocial Risk Factors

    ERIC Educational Resources Information Center

    Copeland, William; Shanahan, Lilly; Costello, E. Jane; Angold, Adrian

    2009-01-01

    Background: Co-occurrence of psychosocial risk factors is commonplace, but little is known about psychiatrically-predictive configurations of psychosocial risk factors. Methods: Latent class analysis (LCA) was applied to 17 putative psychosocial risk factors in a representative population sample of 920 children ages 9 to 17. The resultant class…

  17. Understanding managed care risk sharing arrangements.

    PubMed

    Leigh, J R

    1995-01-01

    A risk sharing agreement between a managed care organization and an employer can be used by employers to either guarantee a managed care plan's short-term success or mitigate its failure. Under such arrangements, the managed care organization financially shares the employer's risk of unfavorable claims experience.

  18. Manejo de riesgo (Risk Management). ERIC Digest.

    ERIC Educational Resources Information Center

    Gaustad, Joan

    The ordinary conduct of school business is accompanied today by risks that were rare or unknown a few decades ago. This ERIC Digest in Spanish discusses how risk management, a concept long used by corporate decision makers, can help school boards and administrators conserve their districts' assets. Risk management is a coordinated effort to…

  19. Risk Management. ERIC Digest, Number 86.

    ERIC Educational Resources Information Center

    Gaustad, Joan

    The ordinary conduct of school business is accompanied today by risks that were rare or unknown a few decades ago. This ERIC Digest discusses how risk management, a concept long used by corporate decision makers, can help school boards and administrators conserve their districts' assets. Risk management is a coordinated effort to protect an…

  20. Risk Management (Is Not) for Dummies

    DTIC Science & Technology

    2005-02-01

    FEB 2005 2. REPORT TYPE 3. DATES COVERED 00-00-2005 to 00-00-2005 4. TITLE AND SUBTITLE Risk Management (Is Not) for Dummies 5a. CONTRACT NUMBER...recorded for each Open Forum Risk Management (Is Not) For Dummies February 2005 www.stsc.hill.af.mil 29 risk? Who will use the data and how? Now

  1. Pharmacokinetic drug–drug interactions between 1,4-dihydropyridine calcium channel blockers and statins: factors determining interaction strength and relevant clinical risk management

    PubMed Central

    Zhou, Yi-Ting; Yu, Lu-Shan; Zeng, Su; Huang, Yu-Wen; Xu, Hui-Min; Zhou, Quan

    2014-01-01

    with simvastatin seems mainly driven by CYP3A4 inhibition at the intestinal level, whereas the interaction with atorvastatin is more due to hepatic CYP3A4 inhibition. The interaction of CYP3A4 inhibitor with simvastatin has been more pronounced compared with atorvastatin. From the current data, atorvastatin seems to be a safer CYP3A4-statin for comedication with DHP-CCB. There is no convincing evidence that amlodipine is an unusual DHP-CCB, either as a precipitant drug or as an object drug, from the perspective of CYP3A4-mediated drug metabolism. Amlodipine may have interactions with CYP3A5 in addition to CYP3A4, which may explain its particular characteristics in comparison with other DHP-CCBs. The degree of DDIs between the DHP-CCB and statin and the clinical outcome depends on many factors, such as the kind of statin, physicochemical proprieties of the DHP-CCB, the dose of either the precipitant drug or the object drug, the sex of the patient (eg, isradipine–lovastatin), route of drug administration (eg, oral versus intravenous nicardipine–lovastatin), the administration schedule (eg, nonconcurrent dosing method versus concurrent dosing method), and the pharmacogenetic status (eg, CYP3A5-nonexpressers versus CYP3A5-expressers). Conclusion Clinical professionals should enhance risk management regarding the combination use of two classes of drugs by increasing their awareness of the potential changes in therapeutic efficacy and adverse drug reactions, by rationally prescribing alternatives, by paying attention to dose adjustment and the administration schedule, and by review of the appropriateness of physician orders. Further study is needed – the DDIs between DHP-CCBs and statins have not all been studied in humans, from either a pharmacokinetic or a clinical perspective; also, the strength of the different pharmacokinetic interactions of DHP-CCBs with statins should be addressed by systematic investigations. PMID:24379677

  2. Medical Device Risk Management For Performance Assurance Optimization and Prioritization.

    PubMed

    Gaamangwe, Tidimogo; Babbar, Vishvek; Krivoy, Agustina; Moore, Michael; Kresta, Petr

    2015-01-01

    Performance assurance (PA) is an integral component of clinical engineering medical device risk management. For that reason, the clinical engineering (CE) community has made concerted efforts to define appropriate risk factors and develop quantitative risk models for efficient data processing and improved PA program operational decision making. However, a common framework that relates the various processes of a quantitative risk system does not exist. This article provides a perspective that focuses on medical device quality and risk-based elements of the PA program, which include device inclusion/exclusion, schedule optimization, and inspection prioritization. A PA risk management framework is provided, and previous quantitative models that have contributed to the advancement of PA risk management are examined. A general model for quantitative risk systems is proposed, and further perspective on possible future directions in the area of PA technology is also provided.

  3. Controlling Legal Risk for Effective Hospital Management.

    PubMed

    Park, Hyun Jun; Cho, Duk Young; Park, Yong Sug; Kim, Sun Wook; Park, Jae-Hong; Park, Nam Cheol

    2016-04-01

    To analyze the types of medical malpractice, medical errors, and medical disputes in a university hospital for the proposal of countermeasures that maximize the efficiency of hospital management, medical departments, and healthcare providers. This study retrospectively reviewed and analyzed 55 closed civil lawsuits among 64 medical lawsuit cases carried out in Pusan National University Hospital from January 2000 to April 2013 using medical records, petitions, briefs, and data from the Medical Dispute Mediation Committee. Of 55 civil lawsuits, men were the main plaintiffs in 31 cases (56.4%). The average period from medical malpractice to malpractice proceeding was 16.5 months (range, 1 month to 6.4 years), and the average period from malpractice proceeding to the disposition of a lawsuit was 21.7 months (range, 1 month to 4 years and 11 months). Hospitals can effectively manage their legal risks by implementing a systematic medical system, eliminating risk factors in administrative service, educating all hospital employees on preventative strategies, and improving customer service. Furthermore, efforts should be made to establish standard coping strategies to manage medical disputes and malpractice lawsuits, operate alternative dispute resolution methods including the Medical Dispute Mediation Committee, create a compliance support center, deploy a specialized workforce including improved legal services for employees, and specialize the management-level tasks of the hospital.

  4. Risk management-an industry approach.

    PubMed

    Huggett, A C

    2001-06-01

    An effective risk management system covering the whole process of food production from "farm to fork" is required by the food industry in order to assure that the food provided to consumers is safe. Food safety and quality assurance begins with the design and development of food products starting with product conceptualisation and continuing with the selection, purchasing, and evaluation of raw materials and with the specifications for processing, packaging and distribution. Within a larger quality management framework a number of tools have been developed by the food industry, which when used in an integrated fashion facilitate the management of food safety. These include good manufacturing practice (GMP), good hygiene practice (GHP) and HACCP (hazard analysis critical control point) as well as quality systems which allow the verification that all factors affecting the safety of a product are under control. Finally, regulations and systems can only function if they are applied. Everyone, from the farmer, the line operator in the manufacturing plant, to the person handling the food in distribution and sales, needs to be aware of his influence with regards safety. The effectiveness of safety awareness programs specific to each area is key to an industry approach to risk management.

  5. Changes in pre-hospital management of vascular risk factors among patients admitted due to recurrent stroke in Poland from 1995 to 2013

    PubMed Central

    Bembenek, Jan P.; Karlinski, Michał; Kurkowska-Jastrzebska, Iwona

    2016-01-01

    Introduction The aim of this study was to investigate long-term trends in secondary stroke prevention through management of vascular risk factors directly before hospital admission for recurrent stroke. Material and methods This is a retrospective registry-based analysis of consecutive recurrent acute stroke patients from a highly urbanized area (Warsaw, Poland) admitted to a single stroke center between 1995 and 2013 with previous ischemic stroke. We compared between four consecutive time periods: 1995–1999, 2000–2004, 2005–2009 and 2010–2013. Results During the study period, 894 patients with recurrent strokes were admitted (18% of all strokes), including 867 with previous ischemic stroke (our study group). Among those patients, the proportion of recurrent ischemic strokes (88.1% to 93.9%) (p = 0.319) and males (44% to 49.7%) (p = 0.5) remained stable. However, there was a rising trend in patients’ age (median age of 73, 74, 76 and 77 years, respectively). There was also an increase in the use of antihypertensives (from 70.2% to 83.8%) (p = 0.013), vitamin K antagonists (from 4.8% to 15.6%) (p = 0.012) and statins (from 32.5% to 59.4%) (p < 0.001). Nonetheless, 21% of patients did not receive any antithrombotic prophylaxis. Tobacco smoking pattern remained unchanged. Conclusions Our data indicate a clear overall improvement of secondary stroke prevention. However, persistent use of antithrombotic drugs and tobacco smoking after the first ischemic stroke is constantly suboptimal. PMID:27482236

  6. Identifying risks in the realm of enterprise risk management.

    PubMed

    Carroll, Roberta

    2016-01-01

    An enterprise risk management (ERM) discipline is comprehensive and organization-wide. The effectiveness of ERM is governed in part by the strength and breadth of its practices and processes. An essential element in decision making is a thorough process by which organizational risks and value opportunities can be identified. This article will offer identification techniques that go beyond those used in traditional risk management programs and demonstrate how these techniques can be used to identify risks and opportunity in the ERM environment.

  7. Stroke Risk Factors, Genetics, and Prevention.

    PubMed

    Boehme, Amelia K; Esenwa, Charles; Elkind, Mitchell S V

    2017-02-03

    Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention. © 2017 American Heart Association, Inc.

  8. A Modified Behavior Risk Factor Surveillance System to Assess Diabetes Self-management Behaviors and Diabetes Care in Monterrey Mexico: A Cross-sectional Study

    PubMed Central

    McEwen, Marylyn Morris; Elizondo-Pereo, Rogelio Andrès; Pasvogel, Alice E.; Meester, Irene; Vargas-Villarreal, Javier; González-Salazar, Francisco

    2017-01-01

    Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)–United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged. PMID:28512629

  9. Quick Fix for Managing Risks

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Under a Phase II SBIR contract, Kennedy and Lumina Decision Systems, Inc., jointly developed the Schedule and Cost Risk Analysis Modeling (SCRAM) system, based on a version of Lumina's flagship software product, Analytica(R). Acclaimed as "the best single decision-analysis program yet produced" by MacWorld magazine, Analytica is a "visual" tool used in decision-making environments worldwide to build, revise, and present business models, minus the time-consuming difficulty commonly associated with spreadsheets. With Analytica as their platform, Kennedy and Lumina created the SCRAM system in response to NASA's need to identify the importance of major delays in Shuttle ground processing, a critical function in project management and process improvement. As part of the SCRAM development project, Lumina designed a version of Analytica called the Analytica Design Engine (ADE) that can be easily incorporated into larger software systems. ADE was commercialized and utilized in many other developments, including web-based decision support.

  10. Continuous Risk Management: A NASA Program Initiative

    NASA Technical Reports Server (NTRS)

    Hammer, Theodore F.; Rosenberg, Linda

    1999-01-01

    NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

  11. High Risk Pregnancy: Detection and Management

    PubMed Central

    Fellows, G. Fraser; Chance, Graham W.

    1982-01-01

    Risk in pregnancy relates to events which lead to perinatal morbidity and mortality. Numerous risk scoring systems have been devised to bring attention to risk factors so that problems can be prevented, identified and treated. However, by carrying out very few fundamental assessments at regular antenatal office visits: checking blood pressure, testing urine for protein, measuring the symphysis to fundus height and carefully establishing the expected date of confinement during the first trimester, the principal causes of perinatal morbidity and mortality—intrauterine growth retardation, prematurity, congenital anomalies, infection, abruptio placentae and meconium aspiration—can be identified and treated. Appropriate perinatal management of the very premature fetus/neonate (less than 34 weeks gestation) is a critical factor which will influence outcome. Whenever possible the mother should be transferred to a centre equipped and staffed for all necessary intrapartum and neonatal care, to minimize the risk of adverse outcome: postnatal transfer of the deteriorating, sick, small neonate is at best hazardous. PMID:21286514

  12. Business resilience: Reframing healthcare risk management.

    PubMed

    Simeone, Cynthia L

    2015-09-01

    The responsibility of risk management in healthcare is fractured, with multiple stakeholders. Most hospitals and healthcare systems do not have a fully integrated risk management system that spans the entire organizational and operational structure for the delivery of key services. This article provides insight toward utilizing a comprehensive Business Resilience program and associated methodology to understand and manage organizational risk leading to organizational effectiveness and operational efficiencies, with the fringe benefit of realizing sustainable operational capability during adverse conditions.

  13. Risk Management for Brigades and Battalions

    DTIC Science & Technology

    1995-05-01

    This report describes a concept, with procedures and responsibilities, for risk management in brigades and battlalions during Mission Essential Task...FM 100-5, Operations. The risk management procedures and responsibilities are consistent with those presented in FM 101-5, Command and Control for... risk management tactics, techniques and procedures published in the Center for Army Lessons Learned Newsletter, "Force Protection (Safety)", No. 9, December 1993.

  14. Managing financial risk with options on futures.

    PubMed

    Bond, M T; Marshall, B S

    1995-05-01

    With the rise of managed care and capitation, more providers will be sharing in the financial risk of providing care. To help protect their organizations from the risk of unexpectedly high utilization under such a fixed-payment system, healthcare financial managers soon will be able to use options on futures contracts. These contracts provide wide profit potential but limited loss potential. Before investing in options on futures, however, healthcare financial managers should consider issues such as basis risk and trading costs.

  15. Geographical variations in the prevalence and management of cardiovascular risk factors in outpatients with CAD: Data from the contemporary CLARIFY registry.

    PubMed

    Ferrari, Roberto; Ford, Ian; Greenlaw, Nicola; Tardif, Jean-Claude; Tendera, Michal; Abergel, Hélène; Fox, Kim; Hu, Dayi; Shalnova, Svetlana; Steg, Ph Gabriel

    2015-08-01

    To determine the current prevalence and control of major cardiovascular risk factors in stable CAD outpatients worldwide. We analysed variations in cardiovascular risk factors in stable CAD outpatients from CLARIFY, a 5-year observational longitudinal cohort study, in seven geographical zones (Western/Central Europe; Canada/South Africa/Australia/UK; Eastern Europe; Central/South America; Middle East; East Asia; and India). Patient presentation (N=32,954, mean age 64.2 years, 78% male) varied between zones, as did prevalence of risk factors (all p < 0.0001). Obesity ranged from 20% (East Asia) to 42% (Middle East), raised blood pressure from 28% (Central/South America and East Asia) to 48% (Eastern Europe), raised LDL cholesterol from 24% (Canada/South Africa/Australia/UK) to 65% (Eastern Europe), elevated heart rate (≥70 bpm) from 38% (Western/Central Europe) to 78% (India), diabetes from 17% (Eastern Europe) to 60% (Middle East), and smoking from 6% (Central/South America) to 19% (Eastern Europe). Aspirin and lipid-lowering drugs were widely used everywhere (≥84% and ≥88%, respectively). Rates of risk factor control varied geographically (all p < 0.0001). Rate of controlled blood pressure in hypertension varied from 47% (Eastern Europe) to 66% (Central/South America), glucose control in diabetes from 23% (India) to 51% (Western/Central Europe and East Asia), controlled LDL cholesterol and dyslipidaemia from 32% (Eastern Europe) to 75% (Canada/South Africa/Australia/UK), heart rate <70 bpm from 22% (India) to 62% (Western/Central Europe), and heart rate ≤60 bpm in angina patients from 2% (India) to 29% (Canada/South Africa/Australia/UK and Central/South America). Prevalence and control of major cardiovascular risk factors in stable CAD vary markedly worldwide. Many stable CAD outpatients are being treated suboptimally. © The European Society of Cardiology 2014.

  16. Patient race/ethnicity and patient-physician race/ethnicity concordance in the management of cardiovascular disease risk factors for patients with diabetes.

    PubMed

    Traylor, Ana H; Subramanian, Usha; Uratsu, Connie S; Mangione, Carol M; Selby, Joe V; Schmittdiel, Julie A

    2010-03-01

    OBJECTIVE Patient-physician race/ethnicity concordance can improve care for minority patients. However, its effect on cardiovascular disease (CVD) care and prevention is unknown. We examined associations of patient race/ethnicity and patient-physician race/ethnicity concordance on CVD risk factor levels and appropriate modification of treatment in response to high risk factor values (treatment intensification) in a large cohort of diabetic patients. RESEARCH DESIGN AND METHODS The study population included 108,555 adult diabetic patients in Kaiser Permanente Northern California in 2005. Probit models assessed the effect of patient race/ethnicity on risk factor control and treatment intensification after adjusting for patient and physician-level characteristics. RESULTS African American patients were less likely than whites to have A1C <8.0% (64 vs. 69%, P < 0.0001), LDL cholesterol <100 mg/dl (40 vs. 47%, P < 0.0001), and systolic blood pressure (SBP) <140 mmHg (70 vs. 78%, P < 0.0001). Hispanic patients were less likely than whites to have A1C <8% (62 vs. 69%, P < 0.0001). African American patients were less likely than whites to have A1C treatment intensification (73 vs. 77%, P < 0.0001; odds ratio [OR] 0.8 [95% CI 0.7-0.9]) but more likely to receive treatment intensification for SBP (78 vs. 71%, P < 0.0001; 1.5 [1.3-1.7]). Hispanic patients were more likely to have LDL cholesterol treatment intensification (47 vs. 45%, P < 0.05; 1.1 [1.0-1.2]). Patient-physician race/ethnicity concordance was not significantly associated with risk factor control or treatment intensification. CONCLUSIONS Patient race/ethnicity is associated with risk factor control and treatment intensification, but patient-physician race/ethnicity concordance was not. Further research should investigate other potential drivers of disparities in CVD care.

  17. Managing Research in a Risk World

    NASA Technical Reports Server (NTRS)

    Anton, W.; Havenhill, M.

    2014-01-01

    The Office of Chief Medical Officer (OCHMO) owns all human health and performance risks managed by the Human System Risk Board (HSRB). While the HSRB manages the risks, the Human Research Program (HRP) manages the research portion of the overall risk mitigation strategy for these risks. The HSRB manages risks according to a process that identifies and analyzes risks, plans risk mitigation and tracks and reviews the implementation of these strategies according to its decisions pertaining to the OCHMO risk posture. HRP manages risk research work using an architecture that describes evidence-based risks, gaps in our knowledge about characterizing or mitigating the risk, and the tasks needed to produce deliverables to fill the gaps and reduce the risk. A planning schedule reflecting expected research milestones is developed, and as deliverables and new evidence are generated, research progress is tracked via the Path to Risk Reduction (PRR) that reflects a risk's research plan for a design reference mission. HRP's risk research process closely interfaces with the HSRB risk management process. As research progresses, new deliverables and evidence are used by the HSRB in conjunction with other operational and non-research evidence to inform decisions pertaining to the likelihood and consequence of the risk and risk posture. Those decisions in turn guide forward work for research as it contributes to overall risk mitigation strategies. As HRP tracks its research work, it aligns its priorities by assessing the effectiveness of its contributions and maintaining specific core competencies that would be invaluable for future work for exploration missions.

  18. Risk Factors of Periodontal Disease: Review of the Literature

    PubMed Central

    AlJehani, Yousef A.

    2014-01-01

    Objectives. This paper aims to review the evidence on the potential roles of modifiable and nonmodifiable risk factors associated with periodontal disease. Data. Original articles that reported on the risk factors for periodontal disease were included. Sources. MEDLINE (1980 to Jan 2014), PubMed (using medical subject headings), and Google Scholar were searched using the following terms in different combinations: “periodontal disease,” “periodontitis,” “risk factors,” and “causal.” This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Conclusions. It is important to understand the etiological factors and the pathogenesis of periodontal disease to recognize and appreciate the associated risk factors. As periodontal disease is multifactorial, effective disease management requires a clear understanding of all the associated risk factors. PMID:24963294

  19. Best practice of nurse managers in risk management.

    PubMed

    Costa, Veridiana Tavares; Meirelles, Betina Hörner Schlindwein; Erdmann, Alacoque Lorenzini

    2013-01-01

    To identify the actions, undertaken by nurse managers in a risk management program, considered as best practice. A case study undertaken in a private hospital in the south of Brazil. A risk manager and nurse managers working in a risk management program participated in this study. The data was collected between May and September 2011 through analysis of documents, semi-structured interviews and non-participant observation. Based on the triangulation, the data was analyzed through practical measures. Educational actions, the critical analysis of the context, and the multiple dimensions of the management were evidenced as best practice. The broadening of understanding regarding risk management best practice offers further support for nurse managers to achieve excellence in their actions and thus provide safe and quality care.

  20. [The colorectal carcinoma risk factors].

    PubMed

    Sobczak, Andrzej; Wawrzyn-Sobczak, Katarzyna; Sobaniec-Lotowska, Maria

    2005-12-01

    Colorectal carcinoma constitutes the second, as for the rate, death cause due to a malignant disease both in the western countries and in Poland. Despite deep knowledge concerning morphogenesis and spread of colorectal carcinoma as well as vast achievements in surgery, chemo- and radiotherapy, the percentage of 5-year-survivals still reaches 40%. According to most authors there are 4 risk factor categories: epidemiological, intestinal, dietetic, and mixed. It is well-known that colorectal carcinoma, like neoplasms localized in other organs and systems, is a disease, in which genetic mutations of somatic cells are the molecular base/source of the disease. The inner innervation of the colon seems to play an important role in carcinoma pathogenesis and spread. At present, 80% of colorectal carcinomas are diagnosed in the advanced stage, with infiltration exceeding the intestinal wall or spreading to neighboring organs, which gives full clinical symptoms. The prognosis as to survival and disease progression is usually poor. Therefore, the ways of early diagnosis, monitoring, and the knowledge of etiological factors are so important in medical practice.

  1. Risk Management Questions for News Reporting Classes.

    ERIC Educational Resources Information Center

    Stiff, Cindy

    1995-01-01

    Reviews court rulings which demonstrate that the potential for liability is significant when students are injured on journalism assignments. Offers guidelines on risk management for journalism professors. (SR)

  2. Educational Risk Management: Eliminate, Assume, or Transfer.

    ERIC Educational Resources Information Center

    Shoop, Robert J.; Dunklee, Dennis R.

    1989-01-01

    An Educational Risk Management Plan (ERMP) should be incorporated throughout every school district. Discusses property and liability insurance classifications and features of a good ERMP. (12 references) (MLF)

  3. Assessing and Managing Risk with Suicidal Individuals

    ERIC Educational Resources Information Center

    Linehan, Marsh M.; Comtois, Katherine A.; Ward-Ciesielski, Erin F.

    2012-01-01

    The University of Washington Risk Assessment Protocol (UWRAP) and Risk Assessment and Management Protocol (UWRAMP) have been used in numerous clinical trials treating high-risk suicidal individuals over several years. These protocols structure assessors and treatment providers to provide a thorough suicide risk assessment, review standards of care…

  4. Assessing and Managing Risk with Suicidal Individuals

    ERIC Educational Resources Information Center

    Linehan, Marsh M.; Comtois, Katherine A.; Ward-Ciesielski, Erin F.

    2012-01-01

    The University of Washington Risk Assessment Protocol (UWRAP) and Risk Assessment and Management Protocol (UWRAMP) have been used in numerous clinical trials treating high-risk suicidal individuals over several years. These protocols structure assessors and treatment providers to provide a thorough suicide risk assessment, review standards of care…

  5. COMMUNICATING PROBABILISTIC RISK OUTCOMES TO RISK MANAGERS

    EPA Science Inventory

    Increasingly, risk assessors are moving away from simple deterministic assessments to probabilistic approaches that explicitly incorporate ecological variability, measurement imprecision, and lack of knowledge (collectively termed "uncertainty"). While the new methods provide an...

  6. Safety risk management for ESA space systems

    NASA Astrophysics Data System (ADS)

    Wright, K. M.

    1991-08-01

    ESA's safety program as defined in ESA PSS-01-40, system safety requirements for ESA space systems, comprise the systematic identification and evaluation of space system hazardous characteristics and their associated risks, together with a process of safety optimization through hazard and risk reduction, and implementation verification. This safety optimization and verification process is termed safety risk management. The fundamental principles of safety risk management are discussed.

  7. Coronary Heart Disease Risk Factors in College Students12

    PubMed Central

    Arts, Jennifer; Fernandez, Maria Luz; Lofgren, Ingrid E.

    2014-01-01

    More than one-half of young adults aged 18–24 y have at least 1 coronary heart disease (CHD) risk factor and nearly one-quarter have advanced atherosclerotic lesions. The extent of atherosclerosis is directly correlated with the number of risk factors. Unhealthy dietary choices made by this age group contribute to weight gain and dyslipidemia. Risk factor profiles in young adulthood strongly predict long-term CHD risk. Early detection is critical to identify individuals at risk and to promote lifestyle changes before disease progression occurs. Despite the presence of risk factors and pathological changes, risk assessment and disease prevention efforts are lacking in this age group. Most young adults are not screened and are unaware of their risk. This review provides pathological evidence along with current risk factor prevalence data to demonstrate the need for early detection. Eighty percent of heart disease is preventable through diet and lifestyle, and young adults are ideal targets for prevention efforts because they are in the process of establishing lifestyle habits, which track forward into adulthood. This review aims to establish the need for increased screening, risk assessment, education, and management in young adults. These essential screening efforts should include the assessment of all CHD risk factors and lifestyle habits (diet, exercise, and smoking), blood pressure, glucose, and body mass index in addition to the traditional lipid panel for effective long-term risk reduction. PMID:24618758

  8. Coronary heart disease risk factors in college students.

    PubMed

    Arts, Jennifer; Fernandez, Maria Luz; Lofgren, Ingrid E

    2014-03-01

    More than one-half of young adults aged 18-24 y have at least 1 coronary heart disease (CHD) risk factor and nearly one-quarter have advanced atherosclerotic lesions. The extent of atherosclerosis is directly correlated with the number of risk factors. Unhealthy dietary choices made by this age group contribute to weight gain and dyslipidemia. Risk factor profiles in young adulthood strongly predict long-term CHD risk. Early detection is critical to identify individuals at risk and to promote lifestyle changes before disease progression occurs. Despite the presence of risk factors and pathological changes, risk assessment and disease prevention efforts are lacking in this age group. Most young adults are not screened and are unaware of their risk. This review provides pathological evidence along with current risk factor prevalence data to demonstrate the need for early detection. Eighty percent of heart disease is preventable through diet and lifestyle, and young adults are ideal targets for prevention efforts because they are in the process of establishing lifestyle habits, which track forward into adulthood. This review aims to establish the need for increased screening, risk assessment, education, and management in young adults. These essential screening efforts should include the assessment of all CHD risk factors and lifestyle habits (diet, exercise, and smoking), blood pressure, glucose, and body mass index in addition to the traditional lipid panel for effective long-term risk reduction.

  9. Risk Management for the International Space Station

    NASA Technical Reports Server (NTRS)

    Sebastian, J.; Brezovic, Philip

    2002-01-01

    The International Space Station (ISS) is an extremely complex system, both technically and programmatically. The Space Station must support a wide range of payloads and missions. It must be launched in numerous launch packages and be safely assembled and operated in the harsh environment of space. It is being designed and manufactured by many organizations, including the prime contractor, Boeing, the NASA institutions, and international partners and their contractors. Finally, the ISS has multiple customers, (e.g., the Administration, Congress, users, public, international partners, etc.) with contrasting needs and constraints. It is the ISS Risk Management Office strategy to proactively and systematically manages risks to help ensure ISS Program success. ISS program follows integrated risk management process (both quantitative and qualitative) and is integrated into ISS project management. The process and tools are simple and seamless and permeate to the lowest levels (at a level where effective management can be realized) and follows the continuous risk management methodology. The risk process assesses continually what could go wrong (risks), determine which risks need to be managed, implement strategies to deal with those risks, and measure effectiveness of the implemented strategies. The process integrates all facets of risk including cost, schedule and technical aspects. Support analysis risk tools like PRA are used to support programatic decisions and assist in analyzing risks.

  10. Diabetic Nephropathy: New Risk Factors and Improvements in Diagnosis.

    PubMed

    Tziomalos, Konstantinos; Athyros, Vasilios G

    2015-01-01

    Diabetic nephropathy is the leading cause of end-stage renal disease. Patients with diabetic nephropathy have a high cardiovascular risk, comparable to patients with coronary heart disease. Accordingly, identification and management of risk factors for diabetic nephropathy as well as timely diagnosis and prompt management of the condition are of paramount importance for effective treatment. A variety of risk factors promotes the development and progression of diabetic nephropathy, including elevated glucose levels, long duration of diabetes, high blood pressure, obesity, and dyslipidemia. Most of these risk factors are modifiable by antidiabetic, antihypertensive, or lipid-lowering treatment and lifestyle changes. Others such as genetic factors or advanced age cannot be modified. Therefore, the rigorous management of the modifiable risk factors is essential for preventing and delaying the decline in renal function. Early diagnosis of diabetic nephropathy is another essential component in the management of diabetes and its complications such as nephropathy. New markers may allow earlier diagnosis of this common and serious complication, but further studies are needed to clarify their additive predictive value, and to define their cost-benefit ratio. This article reviews the most important risk factors in the development and progression of diabetic nephropathy and summarizes recent developments in the diagnosis of this disease.

  11. Risk Management Model in Surface Exploitation of Mineral Deposits

    NASA Astrophysics Data System (ADS)

    Stojanović, Cvjetko

    2016-06-01

    Risk management is an integrative part of all types of project management. One of the main tasks of pre-investment studies and other project documentation is the tendency to protect investment projects as much as possible against investment risks. Therefore, the provision and regulation of risk information ensure the identification of the probability of the emergence of adverse events, their forms, causes and consequences, and provides a timely measures of protection against risks. This means that risk management involves a set of management methods and techniques used to reduce the possibility of realizing the adverse events and consequences and thus increase the possibilities of achieving the planned results with minimal losses. Investment in mining projects are of capital importance because they are very complex projects, therefore being very risky, because of the influence of internal and external factors and limitations arising from the socio-economic environment. Due to the lack of a risk management system, numerous organizations worldwide have suffered significant financial losses. Therefore, it is necessary for any organization to establish a risk management system as a structural element of system management system as a whole. This paper presents an approach to a Risk management model in the project of opening a surface coal mine, developed based on studies of extensive scientific literature and personal experiences of the author, and which, with certain modifications, may find use for any investment project, both in the mining industry as well as in investment projects in other areas.

  12. 7 CFR 2.44 - Administrator, Risk Management Agency and Manager, Federal Crop Insurance Corporation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Agency. (2) Conduct pilot programs involving revenue insurance, risk management savings accounts, or the... a study and issue a report on the efficacy and accuracy of the application of pack factors regarding...

  13. 7 CFR 2.44 - Administrator, Risk Management Agency and Manager, Federal Crop Insurance Corporation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Agency. (2) Conduct pilot programs involving revenue insurance, risk management savings accounts, or the... a study and issue a report on the efficacy and accuracy of the application of pack factors regarding...

  14. Feedback on flood risk management

    NASA Astrophysics Data System (ADS)

    Moreau, K.; Roumagnac, A.

    2009-09-01

    For several years, as floods were increasing in South of France, local communities felt deprive to assume their mission of protection and information of citizens, and were looking for assistance in flood management. In term of flood disaster, the fact is that physical protection is necessary but inevitably limited. Tools and structures of assistance to anticipation remain slightly developed. To manage repeated crisis, local authorities need to be able to base their policy against flood on prevention, warnings, post-crisis analysis and feedback from former experience. In this objective, after 3 years of test and improvement since 2003, the initiative Predict-Services was developped in South of France: it aims at helping communities and companies to face repeated flood crisis. The principle is to prepare emergency plans, to organize crisis management and reduce risks; to help and assist communities and companies during crisis to activate and adapt their emergency plans with enough of anticipation; and to analyse floods effects and improve emergency plans afterwards. In order to reduce risks, and to keep the benefits of such an initiative, local communities and companies have to maintain the awareness of risk of the citizens and employees. They also have to maintain their safety plans to keep them constantly operational. This is a part of the message relayed. Companies, Local communities, local government authorities and basin stakeholders are the decision makers. Companies and local communities have to involve themselves in the elaboration of safety plans. They are also completely involved in their activation that is their own responsability. This applies to other local government authorities, like districts one's and basin stakeholders, which participle in the financing community safety plans and adminitrative district which are responsible of the transmission of meteorological alert and of rescue actions. In the crossing of the géo-information stemming from the

  15. Family Factors Predicting Categories of Suicide Risk

    ERIC Educational Resources Information Center

    Randell, Brooke P.; Wang, Wen-Ling; Herting, Jerald R.; Eggert, Leona L.

    2006-01-01

    We compared family risk and protective factors among potential high school dropouts with and without suicide-risk behaviors (SRB) and examined the extent to which these factors predict categories of SRB. Subjects were randomly selected from among potential dropouts in 14 high schools. Based upon suicide-risk status, 1,083 potential high school…

  16. Suicide Risk Factors in Alcohol Abuse.

    ERIC Educational Resources Information Center

    Motto, Jerome A.

    1980-01-01

    A current focus in evaluating suicide risk is the "clinical model" approach, which determines those factors associated with high risk for suicide. The sociological factors identified as estimators of suicide risk included impaired health, job instability, multiple unit residence, no change in living setting, and modest financial resources. (JAC)

  17. [Suicide risk factors among the elderly].

    PubMed

    Pérez Barrero, Sergio Andrés

    2012-08-01

    The author offers a brief overview of suicide risk factors among the elderly such as depression, all manner of abuse of the elderly, as well as medical, psychological and social risk factors, etc. By way of conclusion, a practical guide to evaluate suicide risk among the elderly is provided.

  18. Overview of Risk Management for Engineered Nanomaterials

    NASA Astrophysics Data System (ADS)

    Schulte, P. A.; Geraci, C. L.; Hodson, L. L.; Zumwalde, R. D.; Kuempel, E. D.; Murashov, V.; Martinez, K. F.; Heidel, D. S.

    2013-04-01

    Occupational exposure to engineered nanomaterials (ENMs) is considered a new and challenging occurrence. Preliminary information from laboratory studies indicates that workers exposed to some kinds of ENMs could be at risk of adverse health effects. To protect the nanomaterial workforce, a precautionary risk management approach is warranted and given the newness of ENMs and emergence of nanotechnology, a naturalistic view of risk management is useful. Employers have the primary responsibility for providing a safe and healthy workplace. This is achieved by identifying and managing risks which include recognition of hazards, assessing exposures, characterizing actual risk, and implementing measures to control those risks. Following traditional risk management models for nanomaterials is challenging because of uncertainties about the nature of hazards, issues in exposure assessment, questions about appropriate control methods, and lack of occupational exposure limits (OELs) or nano-specific regulations. In the absence of OELs specific for nanomaterials, a precautionary approach has been recommended in many countries. The precautionary approach entails minimizing exposures by using engineering controls and personal protective equipment (PPE). Generally, risk management utilizes the hierarchy of controls. Ideally, risk management for nanomaterials should be part of an enterprise-wide risk management program or system and this should include both risk control and a medical surveillance program that assesses the frequency of adverse effects among groups of workers exposed to nanomaterials. In some cases, the medical surveillance could include medical screening of individual workers to detect early signs of work-related illnesses. All medical surveillance should be used to assess the effectiveness of risk management; however, medical surveillance should be considered as a second line of defense to ensure that implemented risk management practices are effective.

  19. Overview of Risk Management for Engineered Nanomaterials.

    PubMed

    Schulte, P A; Geraci, C L; Hodson, L L; Zumwalde, R D; Kuempel, E D; Murashov, V; Martinez, K F; Heidel, D S

    Occupational exposure to engineered nanomaterials (ENMs) is considered a new and challenging occurrence. Preliminary information from laboratory studies indicates that workers exposed to some kinds of ENMs could be at risk of adverse health effects. To protect the nanomaterial workforce, a precautionary risk management approach is warranted and given the newness of ENMs and emergence of nanotechnology, a naturalistic view of risk management is useful. Employers have the primary responsibility for providing a safe and healthy workplace. This is achieved by identifying and managing risks which include recognition of hazards, assessing exposures, characterizing actual risk, and implementing measures to control those risks. Following traditional risk management models for nanomaterials is challenging because of uncertainties about the nature of hazards, issues in exposure assessment, questions about appropriate control methods, and lack of occupational exposure limits (OELs) or nano-specific regulations. In the absence of OELs specific for nanomaterials, a precautionary approach has been recommended in many countries. The precautionary approach entails minimizing exposures by using engineering controls and personal protective equipment (PPE). Generally, risk management utilizes the hierarchy of controls. Ideally, risk management for nanomaterials should be part of an enterprise-wide risk management program or system and this should include both risk control and a medical surveillance program that assesses the frequency of adverse effects among groups of workers exposed to nanomaterials. In some cases, the medical surveillance could include medical screening of individual workers to detect early signs of work-related illnesses. All medical surveillance should be used to assess the effectiveness of risk management; however, medical surveillance should be considered as a second line of defense to ensure that implemented risk management practices are effective.

  20. ESMD Risk Management Workshop: Systems Engineering and Integration Risks

    NASA Technical Reports Server (NTRS)

    Thomas, L. Dale

    2005-01-01

    This report has been developed by the National Aeronautics and Space Administration (NASA) Exploration Systems Mission Directorate (ESMD) Risk Management team in close coordination with the Systems Engineering Team. This document provides a point-in-time, cumulative, summary of key lessons learned derived from the SE RFP Development process. Lessons learned invariably address challenges and risks and the way in which these areas have been addressed. Accordingly the risk management thread is woven throughout the document.

  1. Violence Risk Assessment and Management in Outpatient Clinical Practice.

    PubMed

    Kivisto, Aaron J

    2016-04-01

    The aims of this review were to highlight fundamental distinctions between risk assessment in forensic versus therapeutic settings, review the best available evidence regarding key risk and protective factors for violence of particular relevance to clinicians in outpatient therapeutic settings, and describe an approach to evaluating and managing violence risk in outpatient treatment. An integrative literature review was undertaken to examine violence risk and protective factors most relevant to outpatient clinicians in therapeutic settings. Based on the available research, the Integrative Outpatient Violence Risk Assessment and Management (IVRAM) model, a 5-step strategy for evaluating and managing violence risk in therapeutic contexts, is introduced. The IVRAM emphasizes the integration of nomothetic and idiographic data through a focus on empirically derived dynamic risk and protective factors in the context of an individualized anamnestic analysis. Clinicians working in forensic and therapeutic settings will increasingly benefit from the contributions of the other as the distinctions between risk assessment and risk management continue to decrease. © 2015 Wiley Periodicals, Inc.

  2. Failed subacromial decompression. Risk factors.

    PubMed

    Bouchard, A; Garret, J; Favard, L; Charles, H; Ollat, D

    2014-12-01

    Arthroscopic subacromial decompression (acromioplasty) is widely held to be effective, although pain may persist after the procedure. The objective of this study was to evaluate the proportion of patients with residual pain (i.e., the failure rate) after isolated subacromial decompression and to look for predictors of failure. We conducted a retrospective multicentre study of 108 patients managed with isolated arthroscopic subacromial decompression between 2007 and 2011, for any reason. We excluded patients in whom surgical procedures on the rotator cuff tendons were performed concomitantly. Data were collected from the medical records, a telephone questionnaire, and radiographs obtained before surgery and at last follow-up. Failure was defined as persistent pain (visual analogue scale score>3) more than 6 months after surgery and at last follow-up. The failure rate was 29% (31/108). Two factors significantly predicted failure, namely, receiving workers' compensation benefits for the shoulder condition and co-planing. Heterogeneous calcific tendinopathy and deep partial-thickness rotator cuff tears were also associated with poorer outcomes, but the effect was not statistically significant. Co-planing may predict failure of subacromial decompression, although whether this effect is due to an insufficient degree of co-planing or to the technique itself is unclear. Nevertheless, in patients with symptoms from the acromio-clavicular joint, acromio-clavicular resection is probably the best option. Receiving workers' compensation benefits was also associated with treatment failure, as a result of well-known parameters related to the social welfare system. Isolated arthroscopic subacromial decompression is effective in 70% of cases. We recommend the utmost caution if co-planing is considered and/or the patient receives workers' compensation benefits for the shoulder condition, as these two factors are associated with a significant increase in the failure rate. IV

  3. [Genetic risk factors in schizophrenia].

    PubMed

    Fabisch, H; Kroisel, P M; Fabisch, Karin

    2005-11-01

    The high pathogenetic relevance of genetic factors in schizophrenia is beyond doubt based on the findings of epidemiological studies. By means of a complex mode of transmission, it is likely that several genes with weak to moderate effect jointly constitute a genetic basis for a vulnerability to schizophrenia that may well vary for different individuals. Other organic and psychosocial factors also play an individually different -- in some cases significant -- role in terms of pathogenesis, as a result of which an oligogenic/polygenic multifactor model is assumed from the standpoint of aetiopathogenetics. Molecular genetic methods consist in linkage analyses and association analyses. Positive linkage findings accumulate particularly for the chromosomes 1q, 6p, 8p, 13q and 22q. By themselves, individual mutations contribute little to the range of schizophrenic feature characteristics, it was not possible -- irrespective of some subtypes -- to replicate genes of major effect. From the large number of possible candidate genes, although studies on DRD3, DRD2 and HTR2A produced positive results, the magnitudes of effect were low. The findings for alleles of dysbindin, neuregulin 1, DAO, COMT, PRODH, ZDHHC and DISC are less clear. The search for schizophrenia-relevant mutations is hampered by the possibility of a heterogeneous phenotype of schizophrenia in case of a homogeneous genotype as much as by the possibility of inter-individually homogeneous phenotypical characteristics in case of schizophrenia-relevant heterotype in the genome. With the aid of the concept of endo-phenotypes, based on neurobiological phenomena, it might be possible to take a more direct approach that leads from relevant mutations to the risk of schizophrenias. However, replacing schizophrenic alienation with neurobiological aspects leads to difficulties in explaining these complex disorder profiles. Schizophrenic diseases require an explanatory approach that also incorporates personality and

  4. [Vascular risk factors and Alzheimer disease risk: epidemiological studies review].

    PubMed

    Cowppli-Bony, Pascale; Dartigues, Jean-François; Orgogozo, Jean-Marc

    2006-03-01

    Etiology of Alzheimer's disease (AD) is still undefined in its most frequent sporadic type, but a role of vascular risk factor is more and more evocated in its pathophysiology. This role enables to hope that preventive or curative care of vascular risk factors could decrease AD incidence. Among these factors, high blood pressure, diabetes, hypercholesterolemia and tobacco consumption were the most studied. We review the risk for AD, which had been associated with each of these factors in epidemiological studies. High blood pressure is associated with an increased risk of AD in most studies while the results are more controversial for the others factors. All these four vascular risk factors have variable interaction with the presence of cerebrovascular diseases and of the epsilon 4 allele of the apolipoprotein E gene which is a predisposition factor for sporadic AD.

  5. Blood pressure variability on antihypertensive therapy in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-intracerebral hemorrhage study.

    PubMed

    Tanaka, Eijirou; Koga, Masatoshi; Kobayashi, Junpei; Kario, Kazuomi; Kamiyama, Kenji; Furui, Eisuke; Shiokawa, Yoshiaki; Hasegawa, Yasuhiro; Okuda, Satoshi; Todo, Kenichi; Kimura, Kazumi; Okada, Yasushi; Okata, Takuya; Arihiro, Shoji; Sato, Shoichiro; Yamagami, Hiroshi; Nagatsuka, Kazuyuki; Minematsu, Kazuo; Toyoda, Kazunori

    2014-08-01

    The associations between early blood pressure (BP) variability and clinical outcomes in patients with intracerebral hemorrhage after antihypertensive therapy, recently clarified by a post hoc analysis of Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2), were confirmed using the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-intracerebral hemorrhage study cohort. Patients with hyperacute (<3 hours from onset) intracerebral hemorrhage with initial systolic BP (SBP) >180 mm Hg were registered in a prospective, multicenter, observational study. All patients received antihypertensive therapy based on a predefined standardized protocol to lower and maintain SBP between 120 and 160 mm Hg using intravenous nicardipine. BPs were measured hourly during the initial 24 hours. BP variability was determined as SD and successive variation. The associations between BP variability and hematoma expansion (>33%), neurological deterioration within 72 hours, and unfavorable outcome (modified Rankin Scale, 4-6) at 3 months were assessed. Of the 205 patients, 33 (16%) showed hematoma expansion, 14 (7%) showed neurological deterioration, and 81 (39%) had unfavorable outcomes. The SD and successive variation of SBP were 13.8 (interquartile range, 11.5-16.8) and 14.9 (11.7-17.7) mm Hg, respectively, and those of diastolic BP were 9.4 (7.5-11.2) and 13.1 (11.2-15.9) mm Hg, respectively. On multivariate regression analyses, neurological deterioration was associated with the SD of SBP (odds ratio, 2.75; 95% confidence interval, 1.45-6.12 per quartile) and the successive variation of SBP (2.37; 1.32-4.83), and unfavorable outcome was associated with successive variation of SBP (1.42; 1.04-1.97). Hematoma expansion was not associated with any BP variability. SBP variability during the initial 24 hours of acute intracerebral hemorrhage was independently associated with neurological deterioration and unfavorable outcomes