WorldWideScience

Sample records for assessing cumulative health

  1. Urinary antibiotics of pregnant women in Eastern China and cumulative health risk assessment.

    Science.gov (United States)

    Wang, Hexing; Wang, Na; Qian, Junhua; Hu, Lingyun; Huang, Peixin; Su, Meifang; Yu, Xin; Fu, Chaowei; Jiang, Feng; Zhao, Qi; Zhou, Ying; Lin, Haijiang; He, Gengsheng; Chen, Yue; Jiang, Qingwu

    2017-02-23

    Exposure to antibiotics during pregnancy can pose a systematic effect on human health. A few bio-monitoring studies have demonstrated an extensive exposure of children to antibiotics, but there is still lack of data for pregnant women. To assess the exposure of pregnant women to antibiotics and potential health risk, we investigated 536 pregnant women aged 16-42 years from two geographically different study sites in Eastern China in 2015. We measured 21 antibiotics of five categories (seven fluoroquinolones, three phenicols, four tetracyclines, three macrolides, and four sulfonamides) in urines by using the isotope dilution ultra-performance liquid chromatography coupled to quadrupole time of-flight mass spectrometry. Hazard index (HI) was calculated based on estimated daily exposure dose and acceptable daily intakes. Sixteen antibiotics were found in urines with detection frequencies between 0.2% and 16.0%. Antibiotics were overall detected in 41.6% of urines, and two or more antibiotics were detected in 13.1% of urines. Ciprofloxacin, ofloxacin, and trimethoprim were most frequently detected in urine with detection frequencies between 10% and 20%. The majority of the antibiotics tested had an estimated daily exposure dose less than 1μg/kg/day and 4.3% of pregnant women had a HI value more than one. These findings indicated that pregnant women were frequently exposed to antibiotics and some individuals were in the potential risk of adverse microbiological effects induced by antibiotics.

  2. Cumulative health risk assessment of co-occurring mycotoxins of deoxynivalenol and its acetyl derivatives in wheat and maize: case study, Shanghai, China.

    Science.gov (United States)

    Han, Zheng; Nie, Dongxia; Ediage, Emmanuel Njumbe; Yang, Xianli; Wang, Jianhua; Chen, Bo; Li, Shuguang; On, Stephen L W; De Saeger, Sarah; Wu, Aibo

    2014-12-01

    Humans are naturally and frequently exposed to a multitude of mycotoxins, but health risk assessments are usually performed on individual mycotoxins, which may underestimate the total risks. In this study, we assessed for the first time the cumulative health risks of concomitant exposure via dietary intake (DI) to multiple mycotoxins, namely deoxynivalenol (DON) and its acetyl derivatives of 3-acetyldeoxynivalenol (3-ADON) and 15-acetyldeoxynivalenol (15-ADON), based on the concentration addition (CA) concept. A cross-sectional study was conducted in seven districts in Shanghai, China with 1269 participants and 330 wheat and maize samples analyzed. After probabilistic analysis using Monte Carlo simulation, the results showed no health risks to the population in Shanghai considering individual mycotoxins. However, if the cumulative health risks were calculated based on the combined consideration of DON with either 3-ADON or 15-ADON or both, the DI values in 95th percentile were up to 1087 ng/kg body weight/day, exceeding the Provisional Maximum Tolerable Daily Intake (PMTDI) of 1000 ng/kg body weight/day and hence representing potential health risks to the population in Shanghai. The integrated study proposed here could be a model strategy for cumulative health risk assessment on the co-occurring hazards in the fields of food safety combined with environmental contaminants.

  3. Cumulative health risk assessment of halogenated and parent polycyclic aromatic hydrocarbons associated with particulate matters in urban air.

    Science.gov (United States)

    Sun, Jian-Lin; Jing, Xin; Chang, Wen-Jing; Chen, Zheng-Xia; Zeng, Hui

    2015-03-01

    Halogenated polycyclic aromatic hydrocarbons (HPAHs) have been reported to occur widely in urban air. Nevertheless, knowledge about the human health risk associated with inhalation exposure to HPAHs is scarce so far. In the present study, nine HPAHs and 16 PAHs were determined in atmospheric particulate matter (PM) collected from Shenzhen, China to address this issue. Concentrations of Σ9HPAHs varied from 0.1 to 1.5 ng/m(3) and from 0.09 to 0.4 ng/m(3) in PM10 and PM2.5 samples, respectively. As for individuals, 9-bromoanthracene, 7-bromobenz(a)anthracene, and 9,10-dibromoanthracene were the dominant congeners. Levels of Σ16PAHs in PM10 and PM2.5 samples ranged from 3.2 to 81 ng/m(3) and from 2.8 to 85 ng/m(3), respectively. Among individual PAHs, chrysene, benzo[b]fluoranthene, and indeno[1,2,3-c,d]pyrene were the main congeners. According to the season, concentrations of HPAHs and PAHs in atmospheric PM10/PM2.5 samples show a similar decreasing trend with an order: winter>autumn>spring>summer. The daily intake (DI) of PM10/PM2.5-bound HPAHs and PAHs were estimated. Our results indicated that children have the highest DI levels via inhalation exposure. The incremental lifetime cancer risk (ILCR) induced by PM10/PM2.5-bound HPAHs and PAHs were calculated. The ILCR values showed a similar decreasing trend with an order: adults>children>seniors>adolescent. Overall, the ILCR values induced by HPAHs and PAHs were far below the priority risk level (10(-4)), indicating no obvious cancer risk. To our knowledge, this is the first study to investigate the human health risk associated with inhalation exposure to PM10/PM2.5-bound HPAHs.

  4. Cumulative Risk Assessment Toolbox: Methods and Approaches for the Practitioner

    Directory of Open Access Journals (Sweden)

    Margaret M. MacDonell

    2013-01-01

    Full Text Available The historical approach to assessing health risks of environmental chemicals has been to evaluate them one at a time. In fact, we are exposed every day to a wide variety of chemicals and are increasingly aware of potential health implications. Although considerable progress has been made in the science underlying risk assessments for real-world exposures, implementation has lagged because many practitioners are unaware of methods and tools available to support these analyses. To address this issue, the US Environmental Protection Agency developed a toolbox of cumulative risk resources for contaminated sites, as part of a resource document that was published in 2007. This paper highlights information for nearly 80 resources from the toolbox and provides selected updates, with practical notes for cumulative risk applications. Resources are organized according to the main elements of the assessment process: (1 planning, scoping, and problem formulation; (2 environmental fate and transport; (3 exposure analysis extending to human factors; (4 toxicity analysis; and (5 risk and uncertainty characterization, including presentation of results. In addition to providing online access, plans for the toolbox include addressing nonchemical stressors and applications beyond contaminated sites and further strengthening resource accessibility to support evolving analyses for cumulative risk and sustainable communities.

  5. Childhood poverty and health: cumulative risk exposure and stress dysregulation.

    Science.gov (United States)

    Evans, Gary W; Kim, Pilyoung

    2007-11-01

    A massive literature documents the inverse association between poverty or low socioeconomic status and health, but little is known about the mechanisms underlying this robust relation. We examined longitudinal relations between duration of poverty exposure since birth, cumulative risk exposure, and physiological stress in two hundred seven 13-year-olds. Chronic stress was assessed by basal blood pressure and overnight cortisol levels; stress regulation was assessed by cardiovascular reactivity to a standard acute stressor and recovery after exposure to this stressor. Cumulative risk exposure was measured by multiple physical (e.g., substandard housing) and social (e.g., family turmoil) risk factors. The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response (i.e., muted reactivity). Cardiovascular recovery was not affected by duration of poverty exposure. Unlike the duration of poverty exposure, concurrent poverty (i.e., during adolescence) did not affect these physiological stress outcomes. The effects of childhood poverty on stress dysregulation are largely explained by cumulative risk exposure accompanying childhood poverty.

  6. Mapping cumulative environmental effects, social vulnerability, and health in the San Joaquin Valley, California.

    Science.gov (United States)

    Huang, Ganlin; London, Jonathan

    2012-05-01

    To understand the social distribution of environmental hazards, methods to assess cumulative effects and their health implications are needed. We developed a cumulative environmental hazard index integrating environmental data on pollution sites, air quality, and pesticide use; a social vulnerability index to measure residents' resources to prevent or mitigate health effects; and a health index. We found that communities in California's San Joaquin Valley with high social vulnerability face more environmental burdens and have worse health conditions.

  7. Cumulative assessment : Strategic choices to influence students' study effort

    NARCIS (Netherlands)

    Kerdijk, Wouter; Tio, Rene A.; Mulder, B. Florentine; Cohen-Schotanus, Janke

    2013-01-01

    Background: It has been asserted that assessment can and should be used to drive students' learning. In the current study, we present a cumulative assessment program in which test planning, repeated testing and compensation are combined in order to influence study effort. The program is aimed at hel

  8. Experience of cumulative effects assessment in the UK

    Directory of Open Access Journals (Sweden)

    Piper Jake

    2004-01-01

    Full Text Available Cumulative effects assessment (CEA is a development of environmental impact assessment which attempts to take into account the wider picture of what impacts may affect the environment as a result of either multiple or linear projects, or development plans. CEA is seen as a further valuable tool in promoting sustainable development. The broader canvas upon which the assessment is made leads to a suite of issues such as complexity in methods and assessment of significance, the desirability of co-operation between developers and other parties, new ways of addressing mitigation and monitoring. After outlining the legislative position and the process of CEA, this paper looks at three cases studies in the UK where cumulative assessment has been carried out - the cases concern wind farms, major infrastructure and off-shore developments.

  9. Study on the cumulative impact of reclamation activities on ecosystem health in coastal waters.

    Science.gov (United States)

    Shen, Chengcheng; Shi, Honghua; Zheng, Wei; Li, Fen; Peng, Shitao; Ding, Dewen

    2016-02-15

    The purpose of this study is to develop feasible tools to investigate the cumulative impact of reclamations on coastal ecosystem health, so that the strategies of ecosystem-based management can be applied in the coastal zone. An indicator system and model were proposed to assess the cumulative impact synthetically. Two coastal water bodies, namely Laizhou Bay (LZB) and Tianjin coastal waters (TCW), in the Bohai Sea of China were studied and compared, each in a different phase of reclamations. Case studies showed that the indicator scores of coastal ecosystem health in LZB and TCW were 0.75 and 0.68 out of 1.0, respectively. It can be concluded that coastal reclamations have a historically cumulative effect on benthic environment, whose degree is larger than that on aquatic environment. The ecosystem-based management of coastal reclamations should emphasize the spatially and industrially intensive layout.

  10. Cumulative effects of noise and odour annoyances on environmental and health related quality of life.

    Science.gov (United States)

    Oiamo, Tor H; Luginaah, Isaac N; Baxter, Jamie

    2015-12-01

    Noise and odour annoyances are important considerations in research on health effects of air pollution and traffic noise. Cumulative exposures can occur via several chemical hazards or a combination of chemical and stressor-based hazards, and related health outcomes can be generalized as manifestations of physiological and/or psychological stress responses. A major research challenge in this field is to understand the combined health effects of physiological and psychological responses to exposure. The SF-12 Health Survey is a health related quality of life (HRQoL) instrument designed for the assessment of functional mental and physical health in clinical practice and therefore well suited to research on physiological health outcomes of exposure. However, previous research has not assessed its sensitivity to psychological stress as measured by noise annoyance and odour annoyance. The current study validated and tested this application of the SF-12 Health Survey in a cross-sectional study (n = 603) that included exposure assessment for traffic noise and air pollution in Windsor, Ontario, Canada. The results indicated that SF-12 scores in Windsor were lower than Canadian normative data. A structural equation model demonstrated that this was partially due to noise and odour annoyances, which were associated with covarying exposures to ambient nitrogen dioxide and traffic noise. More specifically, noise annoyance had a significant and negative effect on both mental and physical health factors of the SF-12 and there was a significant covariance between noise annoyance and odour annoyance. The study confirmed a significant effect of psychological responses to cumulative exposures on HRQoL. The SF-12 Health Survey shows promise with respect to assessing the cumulative health effects of outdoor air pollution and traffic noise.

  11. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

    Science.gov (United States)

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

    2010-01-01

    Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

  12. Neutron source capability assessment for cumulative fission yields measurements

    Energy Technology Data Exchange (ETDEWEB)

    Descalle, M A; Dekin, W; Kenneally, J

    2011-04-06

    A recent analysis of high-quality cumulative fission yields data for Pu-239 published in the peer-reviewed literature showed that the quoted experimental uncertainties do not allow a clear statement on how the fission yields vary as a function of energy. [Prussin2009] To make such a statement requires a set of experiments with well 'controlled' and understood sources of experimental errors to reduce uncertainties as low as possible, ideally in the 1 to 2% range. The Inter Laboratory Working Group (ILWOG) determined that Directed Stockpile Work (DSW) would benefit from an experimental program with the stated goal to reduce the measurement uncertainties significantly in order to make a definitive statement of the relationship of energy dependence to the cumulative fission yields. Following recent discussions between Lawrence Livermore National Laboratory (LLNL) and Los Alamos National Laboratory (LANL), there is a renewed interest in developing a concerted experimental program to measure fission yields in a neutron energy range from thermal energy (0.025 eV) to 14 MeV with an emphasis on discrete energies from 0.5 to 4 MeV. Ideally, fission yields would be measured at single energies, however, in practice there are only 'quasi-monoenergetic' neutrons sources of finite width. This report outlines a capability assessment as of June 2011 of available neutron sources that could be used as part of a concerted experimental program to measure cumulative fission yields. In a framework of international collaborations, capabilities available in the United States, at the Atomic Weapons Establishment (AWE) in the United Kingdom and at the Commissariat Energie Atomique (CEA) in France are listed. There is a need to develop an experimental program that will reduce the measurement uncertainties significantly in order to make a definitive statement of the relationship of energy dependence to the cumulative fission yields. Fission and monoenergetic neutron sources

  13. Cumulative Effects Assessment: Linking Social, Ecological, and Governance Dimensions

    Directory of Open Access Journals (Sweden)

    Marian Weber

    2012-06-01

    Full Text Available Setting social, economic, and ecological objectives is ultimately a process of social choice informed by science. In this special feature we provide a multidisciplinary framework for the use of cumulative effects assessment in land use planning. Forest ecosystems are facing considerable challenges driven by population growth and increasing demands for resources. In a suite of case studies that span the boreal forest of Western Canada to the interior Atlantic forest of Paraguay we show how transparent and defensible methods for scenario analysis can be applied in data-limited regions and how social dimensions of land use change can be incorporated in these methods, particularly in aboriginal communities that have lived in these ecosystems for generations. The case studies explore how scenario analysis can be used to evaluate various land use options and highlight specific challenges with identifying social and ecological responses, determining thresholds and targets for land use, and integrating local and traditional knowledge in land use planning. Given that land use planning is ultimately a value-laden and often politically charged process we also provide some perspective on various collective and expert-based processes for identifying cumulative impacts and thresholds. The need for good science to inform and be informed by culturally appropriate democratic processes calls for well-planned and multifaceted approaches both to achieve an informed understanding of both residents and governments of the interactive and additive changes caused by development, and to design action agendas to influence such change at the ecological and social level.

  14. Epigenome: A Biomarker or Screening Tool to Evaluate Health Impact of Cumulative Exposure to Chemical and Non-Chemical Stressors.

    Science.gov (United States)

    Olden, Kenneth; Lin, Yu-Sheng; Bussard, David

    2016-06-01

    Current risk assessment practices and toxicity information are hard to utilize for assessing the health impact of combined or cumulative exposure to multiple chemical and non-chemical stressors encountered in the "real world" environment. Non-chemical stressors such as heat, radiation, noise, humidity, bacterial and viral agents, and social factors, like stress related to violence and socioeconomic position generally cannot be currently incorporated into the risk assessment paradigm. The Science and Decisions report released by the National Research Council (NRC) in 2009 emphasized the need to characterize the effects of multiple stressors, both chemical and non-chemical exposures. One impediment to developing information relating such non-chemical stressors to health effects and incorporating them into cumulative assessment has been the lack of analytical tools to easily and quantitatively monitor the cumulative exposure to combined effects of stressors over the life course.

  15. The Contribution of Project Environmental Assessment to Assessing and Managing Cumulative Effects: Individually and Collectively Insignificant?

    Science.gov (United States)

    Noble, Bram; Liu, Jialang; Hackett, Paul

    2017-04-01

    This paper explores the opportunities and constraints to project-based environmental assessment as a means to support the assessment and management of cumulative environmental effects. A case study of the hydroelectric sector is used to determine whether sufficient information is available over time through project-by-project assessments to support an adequate understanding of cumulative change. Results show inconsistency from one project to the next in terms of the components and indicators assessed, limited transfer of baseline information between project assessments over time, and the same issues and concerns being raised by review panels-even though the projects reviewed are operating in the same watershed and operated by the same proponent. Project environmental assessments must be managed, and coordinated, as part of a larger system of impact assessment, if project-by-project assessments are to provide a meaningful forum for learning and understanding cumulative change. The paper concludes with recommendations for improved project-based assessment practice in support of cumulative effects assessment and management.

  16. Deliberative Democracy, Institution Building, and the Pragmatics of Cumulative Effects Assessment

    Directory of Open Access Journals (Sweden)

    John R. Parkins

    2011-09-01

    Full Text Available Cumulative effects assessment is a process of scientific analysis, social choice, and public policy development, yet the linkages among these domains are often less than transparent. Limits to scientific and technical assessment, issues of power and control of information, and episodic forms of civic engagement represent serious challenges to meaningful understanding of cumulative effects assessment and land-use planning. In articulating these challenges, I draw on case studies from Ontario's Lands for Life and Alberta's Land-use Framework to illustrate current limitations to cumulative effects assessment on public lands in Canada. As a partial remedy for these limitations, insights into a pragmatic approach to impact assessment, in contrast to decisionistic and technocratic approaches, offer a way forward through a more robust integration of scientific information, civic engagement, and public policy development. I also identify a need for longer-standing institutions that are dedicated to regional planning and cumulative effects assessment in Canada.

  17. Elaboration of a concept for the cumulative environmental exposure assessment of biocides

    Energy Technology Data Exchange (ETDEWEB)

    Gross, Rita; Bunke, Dirk; Moch, Katja [Oeko-Institut e.V. - Institut fuer Angewandte Oekologie e.V., Freiburg im Breisgau (Germany); Gartiser, Stefan [Hydrotox GmbH, Freiburg im Breisgau (Germany)

    2011-12-15

    Article 10(1) of the EU Biocidal Products Directive 98/8/EC (BPD) requires that for the inclusion of an active substance in Annex I, Annex IA or IB, cumulation effects from the use of biocidal products containing the same active substance shall be taken into account, where relevant. The study proves the feasibility of a technical realisation of Article 10(1) of the BPD and elaborates a first concept for the cumulative environmental exposure assessment of biocides. Existing requirements concerning cumulative assessments in other regulatory frameworks have been evaluated and their applicability for biocides has been examined. Technical terms and definitions used in this context were documented with the aim to harmonise terminology with other frameworks and to set up a precise definition within the BPD. Furthermore, application conditions of biocidal products have been analysed to find out for which cumulative exposure assessments may be relevant. Different parameters were identified which might serve as indicators for the relevance of cumulative exposure assessments. These indicators were then integrated in a flow chart by means of which the relevance of cumulative exposure assessments can be checked. Finally, proposals for the technical performance of cumulative exposure assessments within the Review Programme have been elaborated with the aim to bring the results of the project into the upcoming development and harmonization processes on EU level. (orig.)

  18. Non-chemical stressors and cumulative risk assessment: an overview of current initiatives and potential air pollutant interactions.

    Science.gov (United States)

    Lewis, Ari S; Sax, Sonja N; Wason, Susan C; Campleman, Sharan L

    2011-06-01

    Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit

  19. The Challenge of Developing Social Indicators for Cumulative Effects Assessment and Land Use Planning

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    John R. Parkins

    2011-06-01

    Full Text Available This paper provides a synopsis on social indicators as relevant to cumulative effects assessment and land use planning. Although much has been done to better understand the social dimensions of environmental assessment, empirical work has been lacking on social indicators that could be used either as measurable inputs or outputs for cumulative effects assessment and land use planning in different kinds of communities and regions. Cumulative effects models currently in practice often fail to address deeper issues of community and regional well-being. Against this gap, social scientists are being asked to make reliable generalizations about functional, measurable relationships between certain social indicators and land use change or scenarios. To address this challenge, the Alberta Research Council held a two-day workshop in 2005 with social scientists. The workshop resulted in a list of prioritized social indicators that could be included in cumulative effects modeling/assessments and land use planning. The top five social indicators included population growth rate, education attainment, self-assessed quality of life, equity, i.e., distribution of benefits, and locus of control. Although consensus on social indicators and social thresholds for cumulative effects models was not reached, the insight gained from the workshop will help inform future cumulative effects assessment and land use planning.

  20. Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors

    Science.gov (United States)

    Bisgaier, Joanna; Rhodes, Karin V.

    2011-01-01

    This article examines associations between cumulative adverse financial circumstances and patient health in a sample of 1,506 urban emergency department (ED) patients. Study participants completed a previously validated Social Health Survey between May and October 2009. Five categories of economic deprivation were studied: food insecurity, housing…

  1. Assessing the cumulative environmental effects of marine renewable energy developments: Establishing common ground.

    Science.gov (United States)

    Willsteed, Edward; Gill, Andrew B; Birchenough, Silvana N R; Jude, Simon

    2017-01-15

    Assessing and managing the cumulative impacts of human activities on the environment remains a major challenge to sustainable development. This challenge is highlighted by the worldwide expansion of marine renewable energy developments (MREDs) in areas already subject to multiple activities and climate change. Cumulative effects assessments in theory provide decision makers with adequate information about how the environment will respond to the incremental effects of licensed activities and are a legal requirement in many nations. In practise, however, such assessments are beset by uncertainties resulting in substantial delays during the licensing process that reduce MRED investor confidence and limit progress towards meeting climate change targets. In light of these targets and ambitions to manage the marine environment sustainably, reducing the uncertainty surrounding MRED effects and cumulative effects assessment are timely and vital. This review investigates the origins and evolution of cumulative effects assessment to identify why the multitude of approaches and pertinent research have emerged, and discusses key considerations and challenges relevant to assessing the cumulative effects of MREDs and other activities on ecosystems. The review recommends a shift away from the current reliance on disparate environmental impact assessments and limited strategic environmental assessments, and a move towards establishing a common system of coordinated data and research relative to ecologically meaningful areas, focussed on the needs of decision makers tasked with protecting and conserving marine ecosystems and services.

  2. Cumulative Risk Assessment and Environmental Equity in Air Permitting: Interpretation, Methods, Community Participation and Implementation of a Unique Statute

    Directory of Open Access Journals (Sweden)

    Gregory C. Pratt

    2011-11-01

    Full Text Available In 2008, the statute authorizing the Minnesota Pollution Control Agency (MPCA to issue air permits was amended to include a unique requirement to analyze and consider “cumulative levels and effects of past and current environmental pollution from all sources on the environment and residents of the geographic area within which the facility's emissions are likely to be deposited.” Data describing the Statute Area suggest it is challenged by environmental and socioeconomic concerns, i.e., concerns which are often described by the phrase ‘environmental equity’. With input from diverse stakeholders, the MPCA developed a methodology for implementing a cumulative levels and effects analysis when issuing air permits in the designated geographic area. A Process Document was created defining explicit steps a project proposer must complete in the analysis. An accompanying Reference Document compiles all available environmental health data relevant to the Statute Area that could be identified. The final cumulative levels and effects methodology is organized by health endpoint and identifies hazard, exposure and health indices that require further evaluation. The resulting assessment is summarized and presented to decision makers for consideration in the regulatory permitting process. We present a description of the methodology followed by a case study summary of the first air permit processed through the “cumulative levels and effects analysis”.

  3. Cumulative risk assessment and environmental equity in air permitting: interpretation, methods, community participation and implementation of a unique statute.

    Science.gov (United States)

    Ellickson, Kristie M; Sevcik, Sarah M; Burman, Shelley; Pak, Steven; Kohlasch, Frank; Pratt, Gregory C

    2011-11-01

    In 2008, the statute authorizing the Minnesota Pollution Control Agency (MPCA) to issue air permits was amended to include a unique requirement to analyze and consider "cumulative levels and effects of past and current environmental pollution from all sources on the environment and residents of the geographic area within which the facility's emissions are likely to be deposited." Data describing the Statute Area suggest it is challenged by environmental and socioeconomic concerns, i.e., concerns which are often described by the phrase 'environmental equity'. With input from diverse stakeholders, the MPCA developed a methodology for implementing a cumulative levels and effects analysis when issuing air permits in the designated geographic area. A Process Document was created defining explicit steps a project proposer must complete in the analysis. An accompanying Reference Document compiles all available environmental health data relevant to the Statute Area that could be identified. The final cumulative levels and effects methodology is organized by health endpoint and identifies hazard, exposure and health indices that require further evaluation. The resulting assessment is summarized and presented to decision makers for consideration in the regulatory permitting process. We present a description of the methodology followed by a case study summary of the first air permit processed through the "cumulative levels and effects analysis".

  4. Framework for Multi-Pathway Cumulative Exposure for Comparative Assessments

    DEFF Research Database (Denmark)

    McKone, Tom; Fantke, Peter

    2016-01-01

    as a framework for comparative assessment of chemicals, products, and services. We first review the development and evolution of the multimedia mass-balance approach to pollutant fate and exposure evaluation and illustrate some of the calculations used in multimedia, multi-pathway exposure assessments....... The multimedia approach requires comprehensive assessments that locate all points of chemical release to the environment, characterize mass-balance relationships, and track contaminants through the entire environmental system to exposure of individuals or populations or specific ecosystems. For use...... in comparative risk assessment, life-cycle assessment (LCA), and chemical alternatives assessment (CAA), multimedia fate and exposure models synthesize information about partitioning, reaction, and intermedia-transport properties of chemicals in a representative (local to regional) or generic (continental...

  5. A Conceptual Framework for the Assessment of Cumulative Exposure to Air Pollution at a Fine Spatial Scale.

    Science.gov (United States)

    Wahida, Kihal-Talantikite; Padilla, Cindy M; Denis, Zmirou-Navier; Olivier, Blanchard; Géraldine, Le Nir; Philippe, Quenel; Séverine, Deguen

    2016-03-15

    Many epidemiological studies examining long-term health effects of exposure to air pollutants have characterized exposure by the outdoor air concentrations at sites that may be distant to subjects' residences at different points in time. The temporal and spatial mobility of subjects and the spatial scale of exposure assessment could thus lead to misclassification in the cumulative exposure estimation. This paper attempts to fill the gap regarding cumulative exposure assessment to air pollution at a fine spatial scale in epidemiological studies investigating long-term health effects. We propose a conceptual framework showing how major difficulties in cumulative long-term exposure assessment could be surmounted. We then illustrate this conceptual model on the case of exposure to NO₂ following two steps: (i) retrospective reconstitution of NO₂ concentrations at a fine spatial scale; and (ii) a novel approach to assigning the time-relevant exposure estimates at the census block level, using all available data on residential mobility throughout a 10- to 20-year period prior to that for which the health events are to be detected. Our conceptual framework is both flexible and convenient for the needs of different epidemiological study designs.

  6. Methodological Considerations in Screening for Cumulative Environmental Health Impacts: Lessons Learned from a Pilot Study in California

    Directory of Open Access Journals (Sweden)

    Lauren Zeise

    2012-08-01

    Full Text Available Polluting facilities and hazardous sites are often concentrated in low-income communities of color already facing additional stressors to their health. The influence of socioeconomic status is not considered in traditional models of risk assessment. We describe a pilot study of a screening method that considers both pollution burden and population characteristics in assessing the potential for cumulative impacts. The goal is to identify communities that warrant further attention and to thereby provide actionable guidance to decision- and policy-makers in achieving environmental justice. The method uses indicators related to five components to develop a relative cumulative impact score for use in comparing communities: exposures, public health effects, environmental effects, sensitive populations and socioeconomic factors. Here, we describe several methodological considerations in combining disparate data sources and report on the results of sensitivity analyses meant to guide future improvements in cumulative impact assessments. We discuss criteria for the selection of appropriate indicators, correlations between them, and consider data quality and the influence of choices regarding model structure. We conclude that the results of this model are largely robust to changes in model structure.

  7. Socioeconomic status and cumulative disadvantage processes across the life course: implications for health outcomes.

    Science.gov (United States)

    Seabrook, Jamie A; Avison, William R

    2012-02-01

    Given the complexity surrounding various interactions among health determinants and the challenge of being able to adequately describe the dynamic processes through which health determinants have their effects, the purpose of this paper is to provide a conceptual overview demonstrating the effects of socioeconomic status and cumulative disadvantage on producing health disparities across the life course. The idea underlying cumulative disadvantage is that socioeconomic-based health inequalities will increase across the life course, mostly because of differential exposure to risk factors and access to protective resources. The advantage of life course sociology is its consideration of early life experiences, and the social and historical context of their occurrences, as important contingencies in producing these systematic socioeconomic differences in health gradients.

  8. Probabilistic cumulative risk assessment of anti-androgenic pesticides in food.

    NARCIS (Netherlands)

    Müller, A.K.; Bosgra, S.; Boon, P.E.; van der Voet, H.; Nielsen, E.; Ladefoged, O.

    2009-01-01

    In this paper, we present a cumulative risk assessment of three anti-androgenic pesticides (vinclozolin, procymidone and prochloraz) using the relative potency factor (RPF) approach and an integrated probabilistic risk assessment (IPRA) model. RPFs for each substance were estimated for three reprodu

  9. Probabilistic cumulative risk assessment of anti-androgenic pesticides in food

    NARCIS (Netherlands)

    Muller, A.K.; Bosgra, S.; Boon, P.E.; Voet, van der H.; Nielsen, E.; Ladefoged, O.

    2009-01-01

    In this paper, we present a cumulative risk assessment of three anti-androgenic pesticides (vinclozolin, procymidone and prochloraz) using the relative potency factor (RPF) approach and an integrated probabilistic risk assessment (IPRA) model. RPFs for each substance were estimated for three reprodu

  10. Probabilistic cumulative risk assessment of anti-androgenic pesticides in food

    DEFF Research Database (Denmark)

    Müller, Anne Kirstine; Nielsen, Elsa

    2008-01-01

    A cumulative risk assessment of three anti-androgenic pesticides vinclozolin, procymidone and prochloraz in combination has been carried out using an Integrated Probabilistic Risk Assessment (IPRA) model. In the model, variability in both exposure and sensitivity between individuals were combined...

  11. A method proposal for cumulative environmental impact assessment based on the landscape vulnerability evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Pavlickova, Katarina; Vyskupova, Monika, E-mail: vyskupova@fns.uniba.sk

    2015-01-15

    Cumulative environmental impact assessment deals with the occasional use in practical application of environmental impact assessment process. The main reasons are the difficulty of cumulative impact identification caused by lack of data, inability to measure the intensity and spatial effect of all types of impacts and the uncertainty of their future evolution. This work presents a method proposal to predict cumulative impacts on the basis of landscape vulnerability evaluation. For this purpose, qualitative assessment of landscape ecological stability is conducted and major vulnerability indicators of environmental and socio-economic receptors are specified and valuated. Potential cumulative impacts and the overall impact significance are predicted quantitatively in modified Argonne multiple matrixes while considering the vulnerability of affected landscape receptors and the significance of impacts identified individually. The method was employed in the concrete environmental impact assessment process conducted in Slovakia. The results obtained in this case study reflect that this methodology is simple to apply, valid for all types of impacts and projects, inexpensive and not time-consuming. The objectivity of the partial methods used in this procedure is improved by quantitative landscape ecological stability evaluation, assignment of weights to vulnerability indicators based on the detailed characteristics of affected factors, and grading impact significance. - Highlights: • This paper suggests a method proposal for cumulative impact prediction. • The method includes landscape vulnerability evaluation. • The vulnerability of affected receptors is determined by their sensitivity. • This method can increase the objectivity of impact prediction in the EIA process.

  12. Cumulative risk assessment of the intake of organophosphorus and carbamate pesticides in the Danish diet

    DEFF Research Database (Denmark)

    Jensen, A. F.; Petersen, Annette; Granby, Kit

    2003-01-01

    The aim of the study is to evaluate the potential cumulative effects of organophosphorus and carbamate pesticides that act through a common mechanism of toxicity, and to assess the long- and short-term risks for the Danish population. The intake estimates are based on dietary intake data collected...... in the Danish nation-wide food consumption survey in 1995. The pesticide data are based on the Danish pesticide residue-monitoring programme from 1996-2001. The amount of 35 organophosphorus pesticides and carbamates were included in the cumulative risk assessment. Processing factors, such as reduction...... of pesticide levels by rinsing and peeling, were applied in the exposure assessment. The "Toxicity Equivalence Factor" (TEF) approach was used to normalise the toxicity of the different organophosphorus and carbamate pesticides. Cumulative chronic exposure of organophosphorus and carbamates pesticides via...

  13. [Recommendations for the analysis of cumulated data in antimicrobial susceptibility in health institutions].

    Science.gov (United States)

    2010-04-01

    Due to the great variability in antimicrobial resistance patterns, local reports of cumulative antimicrobial susceptibility data are necessary in every health center. The purpose is to guide clinical decisions and the early detection of patterns that allow preventive measures to avoid dissemination of resistant strains. The main objective of this guide is to provide recommendations for the analysis of antimicrobial susceptibility data and elaboration of a local report. Recommendations provided in this guide are based on the Clinical and Laboratory Standards Institute (CLSI) document "Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data" (3). Key aspects related to information gathering and data processing, analysis and presentation are described.

  14. Cumulative violence exposure, emotional nonacceptance, and mental health symptoms in a community sample of women.

    Science.gov (United States)

    Sundermann, Jane M; Chu, Ann T; DePrince, Anne P

    2013-01-01

    Women exposed to more types of violence (e.g., emotional, physical, or sexual violence)--referred to here as cumulative violence exposure--are at risk for more severe mental health symptoms compared to women who are exposed to a single type of violence or no violence. Women exposed to violence may also experience greater emotional nonacceptance compared to women with no exposure to violence. Emotional nonacceptance refers to an unwillingness to experience emotional states, including cognitive and behavioral attempts to avoid experiences of emotion. Given the links between cumulative violence exposure, emotional nonacceptance, and mental health symptoms among female victims of violence, the current study tested victims' emotional nonacceptance as a partial mediator between cumulative violence exposure and the severity of 3 types of symptoms central to complex trauma responses: depression, dissociation, and posttraumatic stress disorder (PTSD) symptoms. A non-treatment-seeking community sample of women (N = 89; M age = 30.70 years) completed self-report questionnaires and interviews. Bootstrap procedures were then used to test 3 mediation models for the separate predictions of depression, dissociation, and PTSD symptoms. Results supported our hypotheses that emotional nonacceptance would mediate the relationship between women's cumulative violence exposure and severity for all symptom types. The current findings highlight the role that emotional nonacceptance may play in the development of mental health symptoms for chronically victimized women and point to the need for longitudinal research in such populations.

  15. Assessing the cumulative impact of disturbance on canopy structure and chemistry in Appalachian forests

    Science.gov (United States)

    Deel, Lindsay N.

    Eastern forests experience a range of disturbance events over time, from stand-replacing disturbances, such as clear cuts, to ephemeral disturbances, such as insect outbreaks. By understanding the cumulative impact of disturbances on canopy structure and chemistry, we can gain insight into management strategies, assess a variety of ecosystem services, and even contribute to a larger body of knowledge on global climate change. I transformed a series of Landsat images spanning approximately 25 years into cumulative disturbance maps covering Green Ridge State Forest and Savage River State Forest in western Maryland. Intensive field surveys collected during the summer of 2009 provided measurements of canopy N and estimates of canopy cover, understory cover, and leaf cover. I used AVIRIS imagery flown concurrently with field data collection to map canopy nitrogen across both forests. Through this project, I tested the impact of cumulative disturbance on forest canopy cover and canopy nitrogen. I found that increased values of cumulative disturbance had a measurable negative impact on forest canopy structure and canopy nitrogen. Moreover, by testing varying methods of summing cumulative disturbance, I found that past disturbances diminish over time in importance, yet still influence the current canopy structure and canopy N of a forest. Thus, my study suggests that Landsat time series data can be synthesized into cumulative metrics incorporating multiple disturbance types, which help explain important disturbance-mediated changes in ecosystem functions.

  16. A prospective study of cumulative job stress in relation to mental health

    Science.gov (United States)

    Godin, Isabelle; Kittel, France; Coppieters, Yves; Siegrist, Johannes

    2005-01-01

    Background This study tests associations between psychosocial stress at work measured by the effort-reward imbalance model in a dynamic perspective, and multiple indicators of poor mental health, in a prospective design. Methods 1986 male and female employees from four Belgian enterprises were followed-up over one year within the framework of the Somstress study. Based on two consecutive measurements, an index of cumulative job stress was constructed and its associations with five indicators of mental health were studied, excluding caseness at entry (for depression, anxiety, somatisation, chronic fatigue and psychotropic drug consumption respectively). Taking into account the longitudinal design, four categories of job stress are defined: 1) employees free from stress at both measures, 2) job stress present at first measure but not at the second one, 3) recent onset of job stress as evidenced by second measure 4) workers exposed to stress at both measures. Multivariate logistic regression with appropriate adjustments was applied. Results In bivariate analysis, a clear graded association of cumulative job stress with all five mental health indicators is observed, both in men and women. In multivariate logistic regression analysis, recent onset of stress is strongly associated with poor mental health among men (odds ratios ranging from 1.8 to 4.6), while cumulative stress shows strongest effects on mental health in women (odds ratios ranging from 1.4 to 7.1). Conclusion Cumulative experience and recent onset of job stress in terms of high effort spent and low reward received is associated with elevated risk of all five indicators of poor mental health at follow-up in a large cohort of employees. PMID:15958170

  17. A prospective study of cumulative job stress in relation to mental health

    Directory of Open Access Journals (Sweden)

    Coppieters Yves

    2005-06-01

    Full Text Available Abstract Background This study tests associations between psychosocial stress at work measured by the effort-reward imbalance model in a dynamic perspective, and multiple indicators of poor mental health, in a prospective design. Methods 1986 male and female employees from four Belgian enterprises were followed-up over one year within the framework of the Somstress study. Based on two consecutive measurements, an index of cumulative job stress was constructed and its associations with five indicators of mental health were studied, excluding caseness at entry (for depression, anxiety, somatisation, chronic fatigue and psychotropic drug consumption respectively. Taking into account the longitudinal design, four categories of job stress are defined: 1 employees free from stress at both measures, 2 job stress present at first measure but not at the second one, 3 recent onset of job stress as evidenced by second measure 4 workers exposed to stress at both measures. Multivariate logistic regression with appropriate adjustments was applied. Results In bivariate analysis, a clear graded association of cumulative job stress with all five mental health indicators is observed, both in men and women. In multivariate logistic regression analysis, recent onset of stress is strongly associated with poor mental health among men (odds ratios ranging from 1.8 to 4.6, while cumulative stress shows strongest effects on mental health in women (odds ratios ranging from 1.4 to 7.1. Conclusion Cumulative experience and recent onset of job stress in terms of high effort spent and low reward received is associated with elevated risk of all five indicators of poor mental health at follow-up in a large cohort of employees.

  18. Cumulative versus end-of-course assessment : effects on self-study time and test performance

    NARCIS (Netherlands)

    Kerdijk, Wouter; Cohen-Schotanus, Janke; Mulder, B. Florentine; Muntinghe, Friso L. H.; Tio, Rene A.

    2015-01-01

    ContextStudents tend to postpone preparation for a test until the test is imminent, which raises various risks associated with cramming' behaviours, including that for suboptimal learning. Cumulative assessment utilises spaced testing to stimulate students to study more frequently and to prevent pro

  19. Weak self-directed learning skills hamper performance in cumulative assessment

    NARCIS (Netherlands)

    Tio, Rene A.; Stegmann, Mariken E.; Koerts, Janke; van Os, Titus W. D. P.; Cohen-Schotanus, Janke

    2016-01-01

    Background: Self-regulated learning is an important determinant of academic performance. Previous research has shown that cumulative assessment encourages students to work harder and improve their results. However, not all students seem to respond as intended. We investigated the influence of studen

  20. 78 FR 25440 - Request for Information and Citations on Methods for Cumulative Risk Assessment

    Science.gov (United States)

    2013-05-01

    ... Environmental Protection Agency (EPA) is requesting information and citations on approaches and methods for the... agents or stressors'' using scientifically defensible approaches and methods. The Guidelines will assist... approaches and methods that can be used to plan and conduct cumulative risk assessments (CRA)....

  1. New approaches to uncertainty analysis for use in aggregate and cumulative risk assessment of pesticides

    NARCIS (Netherlands)

    Kennedy, M.C.; Voet, van der H.; Roelofs, V.J.; Roelofs, W.; Glass, C.R.; Boer, de W.J.; Kruisselbrink, J.W.; Hart, A.D.M.

    2015-01-01

    Risk assessments for human exposures to plant protection products (PPPs) have traditionally focussed on single routes of exposure and single compounds. Extensions to estimate aggregate (multi-source) and cumulative (multi-compound) exposure from PPPs present many new challenges and additional uncert

  2. Why cumulative impacts assessments of hydrocarbon activities in the Arctic fail to meet their purpose

    DEFF Research Database (Denmark)

    Kirkfeldt, Trine Skovgaard; Hansen, Anne Merrild; Olsen, Pernille;

    2016-01-01

    The Arctic Region is characterised by vulnerable ecosystems and residing indigenous people, dependent on nature for fishing and hunting. The Arctic also contains a wealth of non-living natural resources such as minerals and hydrocarbons. Synergies between increased access and growing global demand...... of methodology for assessment of cumulative impacts, knowledge gap of Arctic ecosystems and other....

  3. Cumulative risk assessment of phthalate exposure of Danish children and adolescents using the hazard index approach

    DEFF Research Database (Denmark)

    Søeborg, T; Frederiksen, H; Andersson, Anna-Maria

    2012-01-01

    and adolescents and resulting estimated daily intakes of four different phthalates. These daily intake estimates are used for a cumulative risk assessment with anti-androgenic effects as the endpoint using Tolerable Daily Intake (TDI) values determined by the European Food Safety Authorities (EFSA) or Reference...... endpoint for the phthalates included in this article. Using the EFSA TDI values, 12 children exceeded the hazard quotient for the sum of di-n-butyl phthalate and di-iso-butyl phthalate (∑DBP((i+n)) ) and one child exceeded the hazard quotient for di-(2-ethylhexyl)phthalate (DEHP). Nineteen children...... exceeded the cumulated hazard index for three phthalates. Using the RfD AA values, one child exceeded the hazard quotient for DEHP and the same child exceeded the cumulated hazard index for four phthalates. The EFSA TDI approach thus is more restrictive and identifies ∑DBP((i+n)) as the compound...

  4. Cumulative advantages and social capabilities in scientific mobility in the Health Sciences: The Spanish case

    Science.gov (United States)

    Melchor, Lorenzo; Danvila-del-Valle, Joaquín; Bousoño-Calzón, Carlos

    2017-01-01

    Background The big problem in global public health, arising from the international migration of physicians from less-developed to more-developed countries, increases if this migration also affects scientists dedicated to health areas. This article analyzes critical variables in the processes of Spanish scientific mobility in Health Sciences to articulate effective management policies for the benefit of national public health services and the balance between local and global science. Methods This study develops a survey to measure and analyze the following crucial variables: research career, training, funding, working with a world-class team, institutional prestige, wages, facilities/infrastructure, working conditions in the organization of the destination country, fringe benefits in the organization of the destination country and social responsibility in the organization of the departure country. A total of 811 researchers have participated in the survey, of which 293 were from the health sector: Spanish scientists abroad (114), scientists that have returned to Spain (32) and young researchers in Spain (147). Results The most crucial variables for Spanish scientists and young researchers in Spain in Health Sciences moving abroad are the cumulative advantages (research career, training, funding and institutional prestige) plus wages. On the other hand, the return of Spanish scientists in the Health Sciences is influenced by cumulative variables (working with a world-class team, research career and institutional prestige) and also by other variables related to social factors, such as working conditions and fringe benefits in the destination country. Permanent positions are rare for these groups and their decisions regarding mobility depend to a large extent on job opportunities. Conclusions Spanish health organizations can influence researchers to return, since these decisions mainly depend on job opportunities. These organizations can complement the cumulative

  5. Cumulative risk assessment for plasticizer-contaminated food using the hazard index approach.

    Science.gov (United States)

    Chang, J W; Chen, C Y; Yan, B R; Chang, M H; Tseng, S H; Kao, Y M; Chen, J C; Lee, C C

    2014-06-01

    Phthalates strongly and adversely affect reproduction, development and liver function. We did a cumulative risk assessment for simultaneous exposure to nine phthalates using the hazard index (HI) and the levels of nine phthalates in 1200 foodstuff samples. DEHP (di-2-ethylhexyl phthalate) present the highest level (mean: 0.443 mg/kg) in 1200 samples, and the highest average daily dose (ADD) was found in DEHP, ΣDBP(i + n) (the sum of dibutyl phthalate [DBP] isomers [DnBP + DiBP]) posed the highest risk potential of all the phthalates. In seven phthalates, the 95th percentiles of the ADDs for ΣDBP(i + n) in 0-6-yr-old children accounted for 91% (79-107%) of the tolerable daily intake, and the 95th percentiles of the HIs for the anti-androgenic effects of five phthalates in 0-3-yr-old children and 4-6-yr-old girls were >1. We conclude that the health of younger Taiwanese may be adversely affected by overexposure of phthalate-contaminated foods.

  6. ENVIRONMENTAL AUDITING: A Synoptic Approach for Assessing CumulativeImpacts to Wetlands

    Science.gov (United States)

    Abbruzzese; Leibowitz

    1997-05-01

    / The US Environmental Protection Agency's Wetlands ResearchProgram has developed the synoptic approach as a proposed method forassessing cumulative impacts to wetlands by providing both a general and acomprehensive view of the environment. It can also be applied more broadly toregional prioritization of environmental issues. The synoptic approach is aframework for making comparisons between landscape subunits, such aswatersheds, ecoregions, or counties, thereby allowing cumulative impacts tobe considered in management decisions. Because there is a lack of tools thatcan be used to address cumulative impacts within regulatory constraints, thesynoptic approach was designed as a method that could make use of availableinformation and best professional judgement. Thus, the approach is acompromise between the need for rigorous results and the need for timelyinformation. It is appropriate for decision making when quantitative,accurate information is not available; the cost of improving existinginformation or obtaining better information is high; the cost of a wronganswer is low; there is a high demand for the information; and the situationcalls for setting priorities between multiple decisions versus optimizing fora single decision. The synoptic approach should be useful for resourcemanagers because an assessment is timely; it can be completed within one totwo years at relatively low cost, tested, and improved over time. Anassessment can also be customized to specific needs, and the results arepresented in mapped format. However, the utility of a synoptic assessmentdepends on how well knowledge of the environment is incorporated into theassessment, relevant to particular management questions.KEY WORDS: Cumulative impact assessment; Landscape ecology; Regionalprioritization

  7. Probabilistic assessment of the cumulative dietary exposure of the population of Denmark to endocrine disrupting pesticides

    DEFF Research Database (Denmark)

    Jensen, Bodil Hamborg; Petersen, Annette; Christiansen, Sofie

    2013-01-01

    The four pesticides epoxiconazole, prochloraz, procymidone and tebuconazole, are commonly used pesticides, all suspected of acting as endocrine disrupters. In the present study, we assessed the acute cumulative dietary exposure to the women of child bearing age and the general population of Denmark...... to these pesticides from the intake of fruit and vegetables. The assessment was carried out using the probabilistic approach combined with the relative potency factor (RPF) approach. Residue data for prochloraz, procymidone, and tebuconazole were obtained from the Danish monitoring programme 2006–2009, while residue....... Prochloraz was used as the index compound. All four pesticides increased nipple retention in male offspring, and epoxiconazole, prochloraz, and tebuconazole also increased the gestation period in pregnant rat dams. For women of childbearing age, the high-end cumulative exposure (99.9th percentile...

  8. Cumulative risk and developmental health: an argument for the importance of a family-wide science.

    Science.gov (United States)

    Browne, Dillon T; Plamondon, Andre; Prime, Heather; Puente-Duran, Sofia; Wade, Mark

    2015-01-01

    A substantial body of research links social disadvantage and developmental health via a cascade running from poverty, to cumulative psychosocial risk, to disrupted family dynamics, to child biological regulatory systems and neurocognitive processing, and finally to morbidity across the lifespan. Most research in this area employs single-dyad or between-family methodology. While informative, there are limitations to this approach. Specifically, it is impossible to determine how risk alters psychosocial environments that are similar for all persons within a household, versus processes that are unique to particular children. This is important in light of literature citing the primacy of child-specific environments in driving developmental health. Methodologically speaking, there are both benefits and challenges to family-wide approaches that differentiate between- and within-family environments. This review describes literature linking cumulative risk and developmental health via family process, while articulating the importance of family-wide approaches. Areas of shortcoming and recommendations for a family-wide science are provided.

  9. Single-compound and cumulative risk assessment of mycotoxins present in breakfast cereals consumed by children from Lisbon region, Portugal.

    Science.gov (United States)

    Assunção, Ricardo; Vasco, Elsa; Nunes, Baltazar; Loureiro, Susana; Martins, Carla; Alvito, Paula

    2015-12-01

    Humans can be exposed to multiple chemicals, but current risk assessment is usually carried out on one chemical at a time. Mycotoxins are commonly found in a variety of foods including those intended to consumption by children namely breakfast cereals. The present study aims to perform, the risk assessment of single and multiple mycotoxins present in breakfast cereals consumed by children (1-3 years old) from Lisbon region, Portugal. Daily exposure of children to ochratoxin A, fumonisins and trichothecenes showed no health risks to the children population considering individual mycotoxins, while exposure to aflatoxin B1 (AFB1) suggested a potential health concern for the high percentiles of intake (P90, P95 and P99). The combined exposure to fumonisins and trichothecenes are not expected to be of health concern. The combined margin of exposure (MoET) for the aflatoxins group could constitute a potential health concern and AFB1 was the main contributor for MoET. Legal limits and control strategies regarding the presence of multiple mycotoxins in foodstuffs is an urgent need. To the best of our knowledge, this is the first time a cumulative risk assessment was performed on multiple mycotoxins present in breakfast cereals consumed by children.

  10. Framework tool for a rapid cumulative effects assessment: case of a prominent wetland in Myanmar.

    Science.gov (United States)

    Pradhan, N; Habib, H; Venkatappa, M; Ebbers, T; Duboz, R; Shipin, O

    2015-06-01

    The wetland of focus, Inle Lake, located in central Myanmar, is well known for its unique biodiversity and culture, as well as for ingenious floating garden agriculture. During the last decades, the lake area has seen extensive degradation in terms of water quality, erosion, deforestation, and biodiversity concomitant with a major shift to unsustainable land use. The study was conducted, with an emphasis on water quality, to analyze environmental impacts (effects) changing the ecosystem and to comprehensively evaluate the environmental state of the ecosystem through an innovative Rapid Cumulative Effects Assessment framework tool. The assessment started with a framework-forming Participatory Rural Appraisal (PRA), which quantified and prioritized impacts over space and time. Critically important impacts were assessed for "intra-inter interactions" using the loop analysis simulation. Water samples were analyzed while geographic information system (GIS) and remote sensing were used to identify water pollution hotspots. It was concluded that out of a plethora of impacts, pollution from municipal sources, sedimentation, and effects exerted by floating gardens had the most detrimental impacts, which cumulatively affected the entire ecosystem. The framework tool was designed in a broad sense with a reference to highly needed assessments of poorly studied wetlands where degradation is evident, but scarcely quantified, and where long-term field studies are fraught with security issues and resource unavailability (post-conflict, poor and remote regions, e.g., Afghanistan, Laos, Sudan, etc.).

  11. Assessing cumulative pressures and impacts in a regional scale: HELCOM Baltic Sea Impact Index

    DEFF Research Database (Denmark)

    Korpinen, S.; Meski, L.; Andersen, Jesper;

    of identifying hot spots needs to be replaced by spatial high-resolution maps associated with estimated impacts on key ecosystem components. The Baltic Sea Marine Environment Protection Commission (HELCOM) took a first step towards an initial regional assessment of anthropogenic pressures in the Initial Holistic...... of macrozoobenthic communities in some Baltic sub-basins and the results have suggested that more specific selection of pressures is needed in order to assess anthropogenic impacts on benthic habitats. Such an adaptation of the tool has already been tested to assess the sea-floor integrity under the MSFD qualitative...... Assessment of the Baltic Sea by producing the Baltic Sea Pressure Index (BSPI) and the Baltic Sea Impact Index (BSII). The BSPI visualizes cumulative anthropogenic pressures in the Baltic Sea scale, whereas the BSII consists of potential impacts of anthropogenic pressures on key ecosystem components...

  12. Probabilistic cumulative risk assessment of anti-androgenic pesticides in food

    DEFF Research Database (Denmark)

    Müller, Anne Kirstine; Bosgra, Sieto; Boon, Polly E.;

    2009-01-01

    reproductive endpoints (ano-genital distance, and weights of the seminal vesicles and the musculus levator ani/bulbocavernosus) in male rat foetuses exposed in utero. The cumulative dietary intake was estimated based on consumption data and residue data from the Netherlands. The IPRA model combines variability...... in both exposure and sensitivity between individuals into a distribution of individual margins of exposures (IMoEs) and IMoEs of 1 or less indicate a possible concern. The assessment did not result in IMoEs ≤ 1. The endpoint ‘weight of seminal vesicles’ resulted in the lowest IMoEs (0.1th percentile: 198...

  13. Crane Safety Assessment Method Based on Entropy and Cumulative Prospect Theory

    Directory of Open Access Journals (Sweden)

    Aihua Li

    2017-01-01

    Full Text Available Assessing the safety status of cranes is an important problem. To overcome the inaccuracies and misjudgments in such assessments, this work describes a safety assessment method for cranes that combines entropy and cumulative prospect theory. Firstly, the proposed method transforms the set of evaluation indices into an evaluation vector. Secondly, a decision matrix is then constructed from the evaluation vectors and evaluation standards, and an entropy-based technique is applied to calculate the index weights. Thirdly, positive and negative prospect value matrices are established from reference points based on the positive and negative ideal solutions. Thus, this enables the crane safety grade to be determined according to the ranked comprehensive prospect values. Finally, the safety status of four general overhead traveling crane samples is evaluated to verify the rationality and feasibility of the proposed method. The results demonstrate that the method described in this paper can precisely and reasonably reflect the safety status of a crane.

  14. Phthalates in Commercial Chinese Rice Wines: Concentrations and the Cumulative Risk Assessment to Adult Males in Shanghai.

    Science.gov (United States)

    Huang, Yue; Lu, Wen Wei; Chen, Bo; You, Jie; Wu, Min; Li, Shu Guang

    2014-10-01

    The concentrations of 16 phthalates in 164 commercial Chinese rice wines (CRW) were detected by GC-MS, and consumption data on CRW in different packaging types was investigated from 634 adult males in Shanghai using a food frequency questionnaire. Based on the principles of probabilistic modelling and cumulative risk assessment, the exposure and health risk of phthalates from CRW to adult males in Shanghai was evaluated. DMP, DEP, DIBP, DnBP, BBP, and DEHP were detected in the samples, the range of detection frequency of individual phthalates varied from 6.10% for BBP to 15.24% for DIBP, and the detected concentrations were 51.06-200.34 ng/mL. All the respondents consumed CRW, 90.69% of them consumed CRW 0.01-49.9 mL/d, the minimum value of the average daily intake of CRW was 6.25 mL/d, the median was 13.72 mL/d and the maximum was 300 mL/d. The median exposure level of the 6 detected Phthalates to adult males in Shanghai were 6.58-7.10 ng/(d•kg), and the maximum exposure level were 137.38-540.47 ng/(d•kg). The cumulative exposure health risk index (HI) based on the median and maximum exposure level of the 6 Phthalates (DMP, DEP, DIBP, DnBP, BBP, and DEHP) were 0.001147 and 0.063396, both were far less than 1. In conclusion, CRW were generally consumed by the adult males in Shanghai, although multiple phthalates were detected in commercial CRW, health risk of such exposure levels from commercial CRW to the target adult males in Shanghai was very low.

  15. Collaboration, Participation and Technology: The San Joaquin Valley Cumulative Health Impacts Project

    Directory of Open Access Journals (Sweden)

    Jonathan K. London

    2011-11-01

    Full Text Available Community-university partnerships have been shown to produce significant value for both sets of partners by providing reciprocal learning opportunities, (rebuilding bonds of trust, and creating unique venues to formulate and apply research that responds to community interests and informs collaborative solutions to community problems. For such partnerships to be mutually empowering, certain design characteristics are necessary. These include mutual respect for different modes and expressions of knowledge, capacity-building for all parties, and an environment that promotes honest and constructive dialogue about the inevitable tensions associated with the interplay of power/knowledge. This article explores an innovative case of community-university partnerships through participatory action research involving a coalition of environmental justice and health advocates, the San Joaquin Valley Cumulative Health Impacts Project, and researchers affiliated with the University of California, Davis. In particular, we examine how participatory GIS and community mapping can promote co-learning and interdependent science. Keywords Community-based participatory research, environmental justice, Public Participation Geographic Information System

  16. Health Behavior Theory and cumulative knowledge regarding health behaviors: are we moving in the right direction?

    Science.gov (United States)

    Noar, Seth M; Zimmerman, Rick S

    2005-06-01

    Although research on Health Behavior Theory (HBT) is being conducted at a rapid pace, the extent to which the field is truly moving forward in understanding health behavior has been questioned. This issue is examined in the current article. First, we discuss the problems within the HBT literature. Second, we discuss the proliferation of HBT and why theory comparison is essential to this area of research. Finally, we reflect on ways that the field might move forward by suggesting a new agenda for HBT research. It is argued that increased recognition of the similarity of health behavior constructs as well as increased empirical comparisons of theories are essential for true scientific progress in this line of inquiry.

  17. The Interacting Axes of Environmental, Health, and Social Justice Cumulative Impacts: A Case Study of the Blueberry River First Nations.

    Science.gov (United States)

    Gislason, Maya K; Andersen, Holly K

    2016-10-18

    We consider the case of intensive resource extractive projects in the Blueberry River First Nations in Northern British Columbia, Canada, as a case study. Drawing on the parallels between concepts of cumulative environmental and cumulative health impacts, we highlight three axes along which to gauge the effects of intensive extraction projects. These are environmental, health, and social justice axes. Using an intersectional analysis highlights the way in which using individual indicators to measure impact, rather than considering cumulative effects, hides the full extent by which the affected First Nations communities are impacted by intensive extraction projects. We use the case study to contemplate several mechanisms at the intersection of these axes whereby the negative effects of each not only add but also amplify through their interactions. For example, direct impact along the environmental axis indirectly amplifies other health and social justice impacts separately from the direct impacts on those axes. We conclude there is significant work still to be done to use cumulative indicators to study the impacts of extractive industry projects-like liquefied natural gas-on peoples, environments, and health.

  18. The Interacting Axes of Environmental, Health, and Social Justice Cumulative Impacts: A Case Study of the Blueberry River First Nations

    Directory of Open Access Journals (Sweden)

    Maya K Gislason

    2016-10-01

    Full Text Available We consider the case of intensive resource extractive projects in the Blueberry River First Nations in Northern British Columbia, Canada, as a case study. Drawing on the parallels between concepts of cumulative environmental and cumulative health impacts, we highlight three axes along which to gauge the effects of intensive extraction projects. These are environmental, health, and social justice axes. Using an intersectional analysis highlights the way in which using individual indicators to measure impact, rather than considering cumulative effects, hides the full extent by which the affected First Nations communities are impacted by intensive extraction projects. We use the case study to contemplate several mechanisms at the intersection of these axes whereby the negative effects of each not only add but also amplify through their interactions. For example, direct impact along the environmental axis indirectly amplifies other health and social justice impacts separately from the direct impacts on those axes. We conclude there is significant work still to be done to use cumulative indicators to study the impacts of extractive industry projects—like liquefied natural gas—on peoples, environments, and health.

  19. Using Physiologically-Based Pharmacokinetic Models to Incorporate Chemical and Non-Chemical Stressors into Cumulative Risk Assessment: A Case Study of Pesticide Exposures

    Directory of Open Access Journals (Sweden)

    Jonathan I. Levy

    2012-05-01

    Full Text Available Cumulative risk assessment has been proposed as an approach to evaluate the health risks associated with simultaneous exposure to multiple chemical and non-chemical stressors. Physiologically based pharmacokinetic/pharmacodynamic (PBPK/PD models can allow for the inclusion and evaluation of multiple stressors, including non-chemical stressors, but studies have not leveraged PBPK/PD models to jointly consider these disparate exposures in a cumulative risk context. In this study, we focused on exposures to organophosphate (OP pesticides for children in urban low-income environments, where these children would be simultaneously exposed to other pesticides (including pyrethroids and non-chemical stressors that may modify the effects of these exposures (including diet. We developed a methodological framework to evaluate chemical and non-chemical stressor impacts on OPs, utilizing an existing PBPK/PD model for chlorpyrifos. We evaluated population-specific stressors that would influence OP doses or acetylcholinesterase (AChE inhibition, the relevant PD outcome. We incorporated the impact of simultaneous exposure to pyrethroids and dietary factors on OP dose through the compartments of metabolism and PD outcome within the PBPK model, and simulated combinations of stressors across multiple exposure ranges and potential body weights. Our analyses demonstrated that both chemical and non-chemical stressors can influence the health implications of OP exposures, with up to 5-fold variability in AChE inhibition across combinations of stressor values for a given OP dose. We demonstrate an approach for modeling OP risks in the presence of other population-specific environmental stressors, providing insight about co-exposures and variability factors that most impact OP health risks and contribute to children’s cumulative health risk from pesticides. More generally, this framework can be used to inform cumulative risk assessment for any compound impacted by

  20. Methodologies for Assessing the Cumulative Environmental Effects of Hydroelectric Development of Fish and Wildlife in the Columbia River Basin, Volume 1, Recommendations, 1987 Final Report.

    Energy Technology Data Exchange (ETDEWEB)

    Stull, Elizabeth Ann

    1987-07-01

    This volume is the first of a two-part set addressing methods for assessing the cumulative effects of hydropower development on fish and wildlife in the Columbia River Basin. Species and habitats potentially affected by cumulative impacts are identified for the basin, and the most significant effects of hydropower development are presented. Then, current methods for measuring and assessing single-project effects are reviewed, followed by a review of methodologies with potential for use in assessing the cumulative effects associated with multiple projects. Finally, two new approaches for cumulative effects assessment are discussed in detail. Overall, this report identifies and reviews the concepts, factors, and methods necessary for understanding and conducting a cumulative effects assessment in the Columbia River Basin. Volume 2 will present a detailed procedural handbook for performing a cumulative assessment using the integrated tabular methodology introduced in this volume. 308 refs., 18 figs., 10 tabs.

  1. The effect of camera viewing angle on posture assessment repeatability and cumulative spinal loading.

    Science.gov (United States)

    Sutherland, C A; Albert, W J; Wrigley, A T; Callaghan, J P

    2007-06-01

    Video-based task analysis in the workplace is often limited by equipment location and production line arrangement, therefore making it difficult to capture the motion in a single plane. The purpose of this study was to investigate the effects of camera placement on an observer's ability to accurately assess working postures in three dimensions and the resultant influence on the reliability and repeatability of calculated cumulative loading variables. Four video cameras were placed at viewing angles of 0 degrees, 45 degrees, 60 degrees and 90 degrees to the frontal plane, enabling the simultaneous collection of views of four lifting tasks (two symmetric and two asymmetric). A total of 11 participants were trained in the use of the 3DMatch 3-D posture matching software package (developed at the University of Waterloo) and were required to analyse 16 lifting trials. Four of the participants were randomly selected to return within 72 h and repeat the analysis protocol to test intra-observer repeatability. Posture matching agreement between camera views was higher when the body segments had a minimal range of motion during the task. There was no significant participant main effect; however, there was a significant (p 0.75). Joint anterior shear and joint posterior shear both provided fair to good reliability (0.4 > ICC camera viewing angle on an observer's ability to match working postural exposure was found to be small.

  2. An Assessment of Cumulative Axial and Torsional Fatigue in a Cobalt-Base Superalloy

    Science.gov (United States)

    Kalluri, Sreeramesh; Bonacuse, Peter J.

    2010-01-01

    Cumulative fatigue under axial and torsional loading conditions can include both load-order (higMow and low/high) as well as load-type sequence (axial/torsional and torsional/axial) effects. Previously reported experimental studies on a cobalt-base superalloy, Haynes 188 at 538 C, addressed these effects. These studies characterized the cumulative axial and torsional fatigue behavior under high amplitude followed by low amplitude (Kalluri, S. and Bonacuse, P. J., "Cumulative Axial and Torsional Fatigue: An Investigation of Load-Type Sequance Effects," in Multiaxial Fatigue and Deformation: Testing and Prediction, ASTM STP 1387, S. Kalluri, and P. J. Bonacuse, Eds., American Society for Testing and Materials, West Conshohocken, PA, 2000, pp. 281-301) and low amplitude followed by high amplitude (Bonacuse, P. and Kalluri, S. "Sequenced Axial and Torsional Cumulative Fatigue: Low Amplitude Followed by High Amplitude Loading," Biaxial/Multiaxial Fatigue and Fracture, ESIS Publication 31, A. Carpinteri, M. De Freitas, and A. Spagnoli, Eds., Elsevier, New York, 2003, pp. 165-182) conditions. In both studies, experiments with the following four load-type sequences were performed: (a) axial/axial, (b) torsional/torsional, (c) axial/torsional, and (d) torsional/axial. In this paper, the cumulative axial and torsional fatigue data generated in the two previous studies are combined to generate a comprehensive cumulative fatigue database on both the load-order and load-type sequence effects. This comprehensive database is used to examine applicability of the Palmgren-langer-Miner linear damage rule and a nonlinear damage curve approach for Haynes 188 subjected to the load-order and load-type sequencing described above. Summations of life fractions from the experiments are compared to the predictions from both the linear and nonlinear cumulative fatigue damage approaches. The significance of load-order versus load-type sequence effects for axial and torsional loading conditions

  3. Playing It Safe: Assessing Cumulative Impact and Social Vulnerability through an Environmental Justice Screening Method in the South Coast Air Basin, California

    Directory of Open Access Journals (Sweden)

    Justin Scoggins

    2011-05-01

    Full Text Available Regulatory agencies, including the U.S. Environmental Protection Agency (US EPA and state authorities like the California Air Resources Board (CARB, have sought to address the concerns of environmental justice (EJ advocates who argue that chemical-by-chemical and source-specific assessments of potential health risks of environmental hazards do not reflect the multiple environmental and social stressors faced by vulnerable communities. We propose an Environmental Justice Screening Method (EJSM as a relatively simple, flexible and transparent way to examine the relative rank of cumulative impacts and social vulnerability within metropolitan regions and determine environmental justice areas based on more than simply the demographics of income and race. We specifically organize 23 indicator metrics into three categories: (1 hazard proximity and land use; (2 air pollution exposure and estimated health risk; and (3 social and health vulnerability. For hazard proximity, the EJSM uses GIS analysis to create a base map by intersecting land use data with census block polygons, and calculates hazard proximity measures based on locations within various buffer distances. These proximity metrics are then summarized to the census tract level where they are combined with tract centroid-based estimates of pollution exposure and health risk and socio-economic status (SES measures. The result is a cumulative impacts (CI score for ranking neighborhoods within regions that can inform diverse stakeholders seeking to identify local areas that might need targeted regulatory strategies to address environmental justice concerns.

  4. Linking turbine collision risks with population models to assess cumulative impacts of multiple wind farms on threatened birds

    Energy Technology Data Exchange (ETDEWEB)

    Smales, Ian; Muir, Stuart; Meredith, Charles; Baird, Robert

    2011-07-01

    Full text: Assessment of the effects on birds of wind turbine collisions has generally been focussed on the number of individuals that might be killed at a particular facility. However, this measure, of itself, may have little relevance to evaluating the potential or real effects on conservation status of threatened species. Determination of the overall effect any such mortality may have on the functioning of these populations will provide a better basis for decisions that have a strong foundation in ecology. For species with sufficient demographic information, we have developed and applied an approach combining collision risk modelling for all wind farms within the range of a threatened species with population modelling. This permits population-level evaluation of potential cumulative impacts of multiple wind farms. In Australia, regulatory authorities are increasingly interested in the cumulative risk to threatened species that may be posed by multiple wind energy facilities within a species. range. The approach outlined here has been applied in the pre-construction approval stage using collision risk modelling, and can be applied to operational facilities using data on actual mortalities. Cumulative modelling of risk posed by multiple wind farms requires different approaches for sedentary and migratory species. For sedentary species the cumulative effect will be the sum of the impact experienced by those parts of the population whose range intersects with wind farms. Cumulative impact is derived for migratory species by assessing the probability of birds surviving encounters with one wind farm after another on the migratory route and is thus the product of their survivorship rates for the relevant wind farms. The collision risk modelling used will be outlined along with the method in which it is integrated with a population model. Case studies for a crane (Brolga Grus rubicundus) and a parrot (orange- bellied parrot Neophema chrysogaster) species will be

  5. Learning curve of vitrification assessed by cumulative summation test for learning curve (LC-CUSUM).

    Science.gov (United States)

    Dessolle, Lionel; Biau, David J; de Larouzière, Vanina; Ravel, Célia; Antoine, Jean-Marie; Daraï, Emile; Mandelbaum, Jacqueline

    2009-09-01

    We used the cumulative summation test for learning curve (LC-CUSUM), a specifically designed statistical tool, to evaluate the first 50 procedures performed by a trainee in vitrification and to provide a usable model for monitoring the learning process of this technique. Given the lack of models to evaluate IVF technologies, the CUSUM methodology could prove useful for quality control in laboratories.

  6. Cumulative Impact Assessment and Management : Guidance for the Private Sector in Emerging Markets

    OpenAIRE

    2013-01-01

    The major environmental and social management challenges that we face today, climate change, loss of biodiversity, the decline of ocean fisheries, limitations on food security, the scarcity of usable freshwater resources, displacement of communities with consequent increases in urban poverty, and inviability of traditional local livelihoods, are all the result of cumulative impacts from a ...

  7. Developing the scientific basis for assessing cumulative effects of wetland loss and degradation on landscape functions: Status, perspectives, and prospects

    Science.gov (United States)

    Bedford, Barbara L.; Preston, Eric M.

    1988-09-01

    The incongruity between the regional and national scales at which wetland losses are occurring, and the project-specific scale at which wetlands are regulated and studied, has become obvious. This article presents a synthesis of recent efforts by the US Environmental Protection Agency and the Ecosystems Research Center at Cornell University to bring wetland science and regulation into alignment with the reality of the cumulative effects of wetland loss and degradation on entire landscapes and regions. The synthesis is drawn from the other articles in this volume, the workshop that initiated them, and the scientific literature. It summarizes the status of our present scientific understanding, discusses means by which to actualize the existing potential for matching the scales of research and regulation with the scales at which effects are observed, and provides guidelines for building a stronger scientific base for landscape-level assessments of cumulative effects. It also provides the outlines for a synoptic and qualitative approach to cumulative effects assessment based on a reexamination of the generic assessment framework we proposed elsewhere in this volume. The primary conclusion to be drawn from the articles and the workshop is that a sound scientific basis for regulation will not come merely from acquiring more information on more variables. It will come from recognizing that a perceptual shift to larger temporal, spatial, and organizational scales is overdue. The shift in scale will dictate different—not necessarily more—variables to be measured in future wetland research and considered in wetland regulation.

  8. CUMULATIVE TRAUMAS AND RISK THRESHOLDS: 12-MONTH PTSD IN THE WORLD MENTAL HEALTH (WMH) SURVEYS

    Science.gov (United States)

    Karam, Elie G.; Friedman, Matthew J.; Hill, Eric D.; Kessler, Ronald C.; McLaughlin, Katie A.; Petukhova, Maria; Sampson, Laura; Shahly, Victoria; Angermeyer, Matthias C.; Bromet, Evelyn J.; de Girolamo, Giovanni; de Graaf, Ron; Demyttenaere, Koen; Ferry, Finola; Florescu, Silvia E.; Haro, Josep Maria; He, Yanling; Karam, Aimee N.; Kawakami, Norito; Kovess-Masfety, Viviane; Medina-Mora, María Elena; Browne, Mark A. Oakley; Posada-Villa, José A.; Shalev, Arieh Y.; Stein, Dan J.; Viana, Maria Carmen; Zarkov, Zahari; Koenen, Karestan C.

    2014-01-01

    Background Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. Methods Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. Results 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyper-arousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. Conclusions A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more “complex” clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies. Depression and Anxiety 31:130–142, 2014. PMID:23983056

  9. Assessing environmental impacts on stream water quality: the use of cumulative flux and cumulative flux difference approaches to deforestation of the Hafren Forest, mid-Wales

    Directory of Open Access Journals (Sweden)

    C. Neal

    2002-01-01

    Full Text Available A method for examining the impacts of disturbance on stream water quality based on paired catchment “controlâ€? and “responseâ€? water quality time series is described in relation to diagrams of cumulative flux and cumulative flux difference. The paper describes the equations used and illustrates the patterns expected for idealised flux changes followed by an application to stream water quality data for a spruce forested catchment, the Hore, subjected to clear fell. The water quality determinands examined are sodium, chloride, nitrate, calcium and acid neutralisation capacity. The anticipated effects of felling are shown in relation to reduction in mist capture and nitrate release with felling as well as to the influence of weathering and cation exchange mechanisms, but in a much clearer way than observed previously using other approaches. Keywords: Plynlimon, stream, Hore, acid neutralisation capacity, calcium, chloride, nitrate, sodium, cumulative flux, flux

  10. Assessing the implications of human land-use change for the transient climate response to cumulative carbon emissions

    Science.gov (United States)

    Simmons, C. T.; Matthews, H. D.

    2016-03-01

    Recent research has shown evidence of a linear climate response to cumulative CO2 emissions, which implies that the source, timing, and amount of emissions does not significantly influence the climate response per unit emission. Furthermore, these analyses have generally assumed that the climate response to land-use CO2 emissions is equivalent to that of fossil fuels under the assumption that, once in the atmosphere, the radiative forcing induced by CO2 is not sensitive to the emissions source. However, land-cover change also affects surface albedo and the strength of terrestrial carbon sinks, both of which have an additional climate effect. In this study, we use a coupled climate-carbon cycle model to assess the climate response to historical and future cumulative land-use CO2 emissions, in order to compare it to the response to fossil fuel CO2. We find that when we isolate the CO2-induced (biogeochemical) temperature changes associated with land-use change, then the climate response to cumulative land-use emissions is equivalent to that of fossil fuel CO2. We show further that the globally-averaged albedo-induced biophysical cooling from land-use change is non-negligible and may be of comparable magnitude to the biogeochemical warming, with the result that the net climate response to land-use change is substantially different from a linear response to cumulative emissions. However, our new simulations suggest that the biophysical cooling from land-use change follows its own independent (negative) linear response to cumulative net land-use CO2 emissions, which may provide a useful scaling factor for certain applications when evaluating the full transient climate response to emissions.

  11. Cumulative human impacts on Mediterranean and Black Sea marine ecosystems: assessing current pressures and opportunities.

    Directory of Open Access Journals (Sweden)

    Fiorenza Micheli

    Full Text Available Management of marine ecosystems requires spatial information on current impacts. In several marine regions, including the Mediterranean and Black Sea, legal mandates and agreements to implement ecosystem-based management and spatial plans provide new opportunities to balance uses and protection of marine ecosystems. Analyses of the intensity and distribution of cumulative impacts of human activities directly connected to the ecological goals of these policy efforts are critically needed. Quantification and mapping of the cumulative impact of 22 drivers to 17 marine ecosystems reveals that 20% of the entire basin and 60-99% of the territorial waters of EU member states are heavily impacted, with high human impact occurring in all ecoregions and territorial waters. Less than 1% of these regions are relatively unaffected. This high impact results from multiple drivers, rather than one individual use or stressor, with climatic drivers (increasing temperature and UV, and acidification, demersal fishing, ship traffic, and, in coastal areas, pollution from land accounting for a majority of cumulative impacts. These results show that coordinated management of key areas and activities could significantly improve the condition of these marine ecosystems.

  12. Making the case for cumulative impacts assessment : modelling the potential impacts of climate change, harvesting, oil and gas, and fire

    Energy Technology Data Exchange (ETDEWEB)

    Yamasaki, S.H.; Duchesneau, R.; Doyon, F. [Inst. quebecois d' Amenagement de la Foret feuillue, Ripon, PQ (Canada); Russell, J.S. [Millar Western Forest Products Ltd., Whitecourt, AB (Canada); Gooding, T. [Forestry Corp., Edmonton, AB (Canada)

    2008-05-15

    Oil and gas activities and wildfires are altering the composition, age-class structure, and spatial configuration of Alberta's forests. Climate change may also be modifying forest dynamics which will lead to important changes in the future. This paper presented a landscape model designed to simulate the long-term cumulative effects of forestry, oil and gas activities, climate change, wildlife, and demographic change for the Whitecourt forest management area. Various landscape scenarios were presented for the forest, and key indicators for biodiversity and forest productivity were evaluated. Multiple disturbance agents were simulated in order to detect potential interactions among disturbance agents. Results of the study showed that climate and demographic changes will intensify the impacts of fires on timber supplies. It was concluded that cumulative impacts assessments and spatial and temporal stochastic modelling should be included in forest management practices. 34 refs., 2 tabs., 22 figs.

  13. [Assessment on the ecological suitability in Zhuhai City, Guangdong, China, based on minimum cumulative resistance model].

    Science.gov (United States)

    Li, Jian-fei; Li, Lin; Guo, Luo; Du, Shi-hong

    2016-01-01

    Urban landscape has the characteristics of spatial heterogeneity. Because the expansion process of urban constructive or ecological land has different resistance values, the land unit stimulates and promotes the expansion of ecological land with different intensity. To compare the effect of promoting and hindering functions in the same land unit, we firstly compared the minimum cumulative resistance value of promoting and hindering functions, and then looked for the balance of two landscape processes under the same standard. According to the ecology principle of minimum limit factor, taking the minimum cumulative resistance analysis method under two expansion processes as the evaluation method of urban land ecological suitability, this research took Zhuhai City as the study area to estimate urban ecological suitability by relative evaluation method with remote sensing image, field survey, and statistics data. With the support of ArcGIS, five types of indicators on landscape types, ecological value, soil erosion sensitivity, sensitivity of geological disasters, and ecological function were selected as input parameters in the minimum cumulative resistance model to compute urban ecological suitability. The results showed that the ecological suitability of the whole Zhuhai City was divided into five levels: constructive expansion prohibited zone (10.1%), constructive expansion restricted zone (32.9%), key construction zone (36.3%), priority development zone (2.3%), and basic cropland (18.4%). Ecological suitability of the central area of Zhuhai City was divided into four levels: constructive expansion prohibited zone (11.6%), constructive expansion restricted zone (25.6%), key construction zone (52.4%), priority development zone (10.4%). Finally, we put forward the sustainable development framework of Zhuhai City according to the research conclusion. On one hand, the government should strictly control the development of the urban center area. On the other hand, the

  14. Probabilistic assessment of the cumulative dietary acute exposure of the population of Denmark to organophosphorus and carbamate pesticides

    DEFF Research Database (Denmark)

    Jensen, Bodil Hamborg; Petersen, Annette; Christensen, Tue

    2009-01-01

    Organophosphorus and carbamate pesticides are acetylcholinesterase-inhibiting pesticides and as such have a common mode of action. We assessed the cumulative acute exposure of the population of Denmark to 25 organophosphorus and carbamate pesticide residues from the consumption of fruit, vegetables...... the nationwide dietary survey conducted in 2000-2002. Contributions from 43 commodities were included in the calculations. We used the relative potency factor (RPF) approach to normalize the toxicity of the various organophosphorus and carbamate pesticides to the two index compounds chlorpyriphos...

  15. Modeling cumulative effects in life cycle assessment: the case of fertilizer in wheat production contributing to the global warming potential.

    Science.gov (United States)

    Laratte, Bertrand; Guillaume, Bertrand; Kim, Junbeum; Birregah, Babiga

    2014-05-15

    This paper aims at presenting a dynamic indicator for life cycle assessment (LCA) measuring cumulative impacts over time of greenhouse gas (GHG) emissions from fertilizers used for wheat cultivation and production. Our approach offers a dynamic indicator of global warming potential (GWP), one of the most used indicator of environmental impacts (e.g. in the Kyoto Protocol). For a case study, the wheat production in France was selected and considered by using data from official sources about fertilizer consumption and production of wheat. We propose to assess GWP environmental impact based on LCA method. The system boundary is limited to the fertilizer production for 1 ton of wheat produced (functional unit) from 1910 to 2010. As applied to wheat production in France, traditional LCA shows a maximum GWP impact of 500 kg CO2-eq for 1 ton of wheat production, whereas the GWP impact of wheat production over time with our approach to dynamic LCA and its cumulative effects increases to 18,000 kg CO2-eq for 1 ton of wheat production. In this paper, only one substance and one impact assessment indicator are presented. However, the methodology can be generalized and improved by using different substances and indicators.

  16. In vivo measurements of lead-210 for assessing cumulative radon exposure in uranium miners

    Energy Technology Data Exchange (ETDEWEB)

    Guilmette, R.A.; Laurer, G.R. [New York Univ. Inst. of Environmental Medicine, Tuxedo, NY (United States); Lambert, W.E.; Gilliland, F.D. [Univ. of New Mexico, Albuquerque, NM (United States)] [and others

    1995-12-01

    It has long been recognized that a major contributor to the uncertainty in risk analysis of lung cancer in uranium and other hard rock miners is the estimation of total radon progeny exposure of individual miners under study. These uncertainties arise from the fact that only a limited number of measurements of airborne {sup 222}Rn progeny concentrations were made in the mines during the times that the miners were being exposed, and that dosimeters capable of integrating the Rn progeny exposures of the miners did not exist. Historically, the cumulative exposures for individual uranium and other hard rock miners have been calculated by combining the employee`s work history, which may or may not have included time spent at different jobs within the mines and at different locations within the mines, with whatever periodic measurements of Rn and Rn progeny were available. The amount and quality of the measurement data varied enormously from mine to mine and from population to population. Because the quality of the exposure data collected during the period of active mining in the United STates cannot now be altered substantially, significant improvement in individual miner exposure estimates is only likely to be achieved if a new cumulative exposure metric is developed and implemented. The decay chain of Rn includes the production of {sup 210}Pb, which can accumulate in the skeleton in amounts proportional to the intake of Rn progeny. We hypothesize that the in vivo measurement of {sup 210}Pb in the skulls of miners will provide such a metric. In summary, the primary purpose of this pilot study to demonstrate the feasibility of measuring {sup 210}Pb in the heads of former uranium miners has been accomplished.

  17. A geographic model to assess and limit cumulative ecological degradation from Marcellus Shale exploitation in New York, USA

    Science.gov (United States)

    Davis, John B.; Robinson, George R.

    2012-01-01

    When natural resources are exploited, environmental costs and economic benefits are often asymmetric. An example is apparent in the environmental impacts from fossil fuel extraction by hydraulic fracturing. So far, most scrutiny has been focused on water quality in affected aquifers, with less attention paid to broader ecological impacts beyond individual drilling operations. Marcellus Shale methane exploitation in New York State, USA, has been delayed because of a regulatory moratorium, pending evaluation that has been directed primarily at localized impacts. We developed a GIS-based model, built on a hexagonal grid underlay nested within the U.S. Environmental Protection Agency’s EMAP system, to examine potential cumulative ecological impacts. In a two-step process, we characterized > 19,000 hexagons, each sized to approximate the footprint of one drilling site (2.57 km²), using ecological attributes; we then developed a method for apportioning resource access that includes assessments of cumulative ecological costs. Over one-quarter of the hexagons were excluded as off-limits on the basis of six criteria: slope suitability, regulated wetland cover, protected-land cover, length of high-quality streams, mapped road density, and open water cover. Three additional criteria were applied to assess the estimated conservation vulnerability of the remaining sites: density of grassland birds (North American Breeding Bird Survey), percent core forest (Coastal Change Analysis Program), and total density of all state-mapped streams; these were determined and used in combination to rank the 14,000 potentially accessible sites. In a second step, an iterative process was used to distribute potential site access among all towns (sub-county governments) within the Marcellus Shale Formation. At each iteration, one site was selected per town, either randomly or in rank order of increasing vulnerability. Results were computed as percent cumulative impact versus the number of

  18. A Geographic Model to Assess and Limit Cumulative Ecological Degradation from Marcellus Shale Exploitation in New York, USA

    Directory of Open Access Journals (Sweden)

    George R. Robinson

    2012-06-01

    Full Text Available When natural resources are exploited, environmental costs and economic benefits are often asymmetric. An example is apparent in the environmental impacts from fossil fuel extraction by hydraulic fracturing. So far, most scrutiny has been focused on water quality in affected aquifers, with less attention paid to broader ecological impacts beyond individual drilling operations. Marcellus Shale methane exploitation in New York State, USA, has been delayed because of a regulatory moratorium, pending evaluation that has been directed primarily at localized impacts. We developed a GIS-based model, built on a hexagonal grid underlay nested within the U.S. Environmental Protection Agency’s EMAP system, to examine potential cumulative ecological impacts. In a two-step process, we characterized > 19,000 hexagons, each sized to approximate the footprint of one drilling site (2.57 km², using ecological attributes; we then developed a method for apportioning resource access that includes assessments of cumulative ecological costs. Over one-quarter of the hexagons were excluded as off-limits on the basis of six criteria: slope suitability, regulated wetland cover, protected-land cover, length of high-quality streams, mapped road density, and open water cover. Three additional criteria were applied to assess the estimated conservation vulnerability of the remaining sites: density of grassland birds (North American Breeding Bird Survey, percent core forest (Coastal Change Analysis Program, and total density of all state-mapped streams; these were determined and used in combination to rank the 14,000 potentially accessible sites. In a second step, an iterative process was used to distribute potential site access among all towns (sub-county governments within the Marcellus Shale Formation. At each iteration, one site was selected per town, either randomly or in rank order of increasing vulnerability. Results were computed as percent cumulative impact versus

  19. Health technology assessment in Finland

    DEFF Research Database (Denmark)

    Mäkelä, Marjukka; Roine, Risto P

    2010-01-01

    Since the 1990s, health policy makers in Finland have been supportive of evidence-based medicine and approaches to implement its results. The Finnish Office for Health Technology Assessment (Finohta) has grown from a small start in 1995 to a medium-sized health technology assessment (HTA) agency...

  20. Using Marginal Structural Modeling to Estimate the Cumulative Impact of an Unconditional Tax Credit on Self-Rated Health.

    Science.gov (United States)

    Pega, Frank; Blakely, Tony; Glymour, M Maria; Carter, Kristie N; Kawachi, Ichiro

    2016-02-15

    In previous studies, researchers estimated short-term relationships between financial credits and health outcomes using conventional regression analyses, but they did not account for time-varying confounders affected by prior treatment (CAPTs) or the credits' cumulative impacts over time. In this study, we examined the association between total number of years of receiving New Zealand's Family Tax Credit (FTC) and self-rated health (SRH) in 6,900 working-age parents using 7 waves of New Zealand longitudinal data (2002-2009). We conducted conventional linear regression analyses, both unadjusted and adjusted for time-invariant and time-varying confounders measured at baseline, and fitted marginal structural models (MSMs) that more fully adjusted for confounders, including CAPTs. Of all participants, 5.1%-6.8% received the FTC for 1-3 years and 1.8%-3.6% for 4-7 years. In unadjusted and adjusted conventional regression analyses, each additional year of receiving the FTC was associated with 0.033 (95% confidence interval (CI): -0.047, -0.019) and 0.026 (95% CI: -0.041, -0.010) units worse SRH (on a 5-unit scale). In the MSMs, the average causal treatment effect also reflected a small decrease in SRH (unstabilized weights: β = -0.039 unit, 95% CI: -0.058, -0.020; stabilized weights: β = -0.031 unit, 95% CI: -0.050, -0.007). Cumulatively receiving the FTC marginally reduced SRH. Conventional regression analyses and MSMs produced similar estimates, suggesting little bias from CAPTs.

  1. Experimental assessment of cumulative temperature and UV-B radiation effects on Mediterranean plankton metabolism

    KAUST Repository

    Garcia-Corral, Lara S.

    2015-07-07

    The Mediterranean Sea is a vulnerable region for climate change, warming at higher rates compare to the global ocean. Warming leads to increased stratification of the water column and enhanced the oligotrophic nature of the Mediterranean Sea. The oligotrophic waters are already highly transparent, however, exposure of Mediterranean plankton to ultraviolet radiation (UV-B and UV-A) may increase further if the waters become more oligotrophic, thereby, allowing a deeper UV radiation penetration and likely enhancing impacts to biota. Here we experimentally elucidate the cumulative effects of warming and natural UV-B radiation on the net community production (NCP) of plankton communities. We conducted five experiments at monthly intervals, from June to October 2013, and evaluated the responses of NCP to ambient UV-B radiation and warming (+3°C), alone and in combination, in a coastal area of the northwest Mediterranean Sea. UV-B radiation and warming lead to reduced NCP and resulted in a heterotrophic (NCP < 0) metabolic balance. Both UV-B radiation and temperature, showed a significant individual effect in NCP across treatments and time. However, their joint effect showed to be synergistic as the interaction between them (UV × Temp) was statistically significant in most of the experiments performed. Our results showed that both drivers, would affect the gas exchange of CO2−O2 from and to the atmosphere and the role of plankton communities in the Mediterranean carbon cycle.

  2. Experimental assessment of cumulative temperature and UV-B radiation effects on Mediterranean plankton metabolism

    Directory of Open Access Journals (Sweden)

    Lara S. eGarcia-Corral

    2015-07-01

    Full Text Available The Mediterranean Sea is a vulnerable region for climate change, warming at higher rates compare to the global ocean. Warming leads to increased stratification of the water column and enhanced the oligotrophic nature of the Mediterranean Sea. The oligotrophic waters are already highly transparent, however, exposure of Mediterranean plankton to ultraviolet radiation (UV-B and UV-A may increase further if the waters become more oligotrophic, thereby, allowing a deeper UV radiation penetration and likely enhancing impacts to biota.Here we experimentally elucidate the cumulative effects of warming and natural UV-B radiation on the net community production (NCP of plankton communities. We conducted five experiments at monthly intervals, from June to October 2013, and evaluated the responses of NCP to ambient UV-B radiation and warming (+3ºC, alone and in combination, in a coastal area of the northwest Mediterranean Sea. UV-B radiation and warming lead to reduced net community production and resulted in a heterotrophic (NCP<0 metabolic balance. Both UV-B radiation and temperature, showed a significant individual effect in NCP across treatments and time. However, their joint effect showed to be synergistic as the interaction between them (UV x Temp was statistically significant in most of the experiments performed. Our results showed that both drivers, would affect the gas exchange of CO2-O2 from and to the atmosphere and the role of plankton communities in the Mediterranean carbon cycle

  3. Cumulative and residual effects of potato cropping system management strategies on crop and soil health parameters

    Science.gov (United States)

    Soil and crop management practices can greatly affect parameters related to soil health, as well as crop productivity and disease development, and may provide options for more sustainable production. Different 3-yr potato cropping systems focused on specific management goals of soil conservation (SC...

  4. Cumulative risk and AIDS-orphanhood: interactions of stigma, bullying and poverty on child mental health in South Africa.

    Science.gov (United States)

    Cluver, Lucie; Orkin, Mark

    2009-10-01

    Research shows that AIDS-orphaned children are more likely to experience clinical-range psychological problems. Little is known about possible interactions between factors mediating these high distress levels. We assessed how food insecurity, bullying, and AIDS-related stigma interacted with each other and with likelihood of experiencing clinical-range disorder. In South Africa, 1025 adolescents completed standardised measures of depression, anxiety and post-traumatic stress. 52 potential mediators were measured, including AIDS-orphanhood status. Logistic regressions and hierarchical log-linear modelling were used to identify interactions among significant risk factors. Food insecurity, stigma and bullying all independently increased likelihood of disorder. Poverty and stigma were found to interact strongly, and with both present, likelihood of disorder rose from 19% to 83%. Similarly, bullying interacted with AIDS-orphanhood status, and with both present, likelihood of disorder rose from 12% to 76%. Approaches to alleviating psychological distress amongst AIDS-affected children must address cumulative risk effects.

  5. Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores among Urban Youth in the United States

    Science.gov (United States)

    Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

    2014-01-01

    Background: The Institute of Medicine (2012) concluded that we must "strengthen schools as the heart of health." To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement,…

  6. CUMEX: a cumulative hazard index for assessing limiting exposures to environmental pollutants

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, P.J.; Killough, G.G.; Parzyck, D.C.; Rohwer, P.S.; Rupp, e.M.; Whitfield, B.L.; Booth, R.S.; Raridon, R.J.

    1977-04-01

    A hazard index methodology called CUMEX has been developed for limiting human exposure to environmental pollutants. Hazard index is defined as Q/Q/sub L/ where Q is exposure or dose to total-body, organ or tissue from all environmental pathways and Q/sub L/ is a limit which should not be exceeded because of health risk to humans. Mathematical formulations for hazard indices are developed for each sampling medium corresponding to each effluent type. These hazard indices are accumulated into composite indices such that total human intake or dose would not exceed the health risk limit. Mathematical formulation for composite hazard indices or CUMEX indices for multiple pollutants are presented. An example CUMEX application to cadmium release from a smelter complex in East Helena, Montana demonstrates details of the methodology for a single pollutant where human intake occurs through inhalation and ingestion.

  7. Estimated Daily Intake and Cumulative Risk Assessment of Phthalates in the General Taiwanese after the 2011 DEHP Food Scandal

    Science.gov (United States)

    Chang, Jung-Wei; Lee, Ching-Chang; Pan, Wen-Harn; Chou, Wei-Chun; Huang, Han-Bin; Chiang, Hung-Che; Huang, Po-Chin

    2017-03-01

    A food scandal occurred in Taiwan in 2011 because the DEHP (di-2-ethylhexyl phthalate) had been intentionally used in food products. We assessed the daily intakes (DIs) and cumulative risk of phthalates in Taiwan’s general population after the scandal. The DIs of 6 phthalates, including di-n-butyl phthalate (DnBP), di-iso-butyl phthalate (DiBP), and DEHP, were evaluated using urinary phthalate metabolites. Hazard quotients of phthalates classified as affecting the reproductive (HQrep) and hepatic (HQhep) systems were assessed using cumulative approach. The creatinine-based model showed that the highest DI values in children 7-to 12- years-old were for DEHP (males: median: 4.79 μg/kg bw/d; females: median: 2.62 μg/kg bw/d). The 95th percentile (P95) of HQrep values were all >1 in the 7- to 12-year-old and 18- to 40-year-old male groups. The P95 of HQhep values were all >1 in the 7- to 18- year-old male groups. Most of the HQrep was attributable to the HQs of DnBP and DiBP (53.9–84.7%), and DEHP contributed most to HQhep (83.1–98.6%), which reveals that DnBP, DiBP and DEHP were the main risk of phthalate exposure for Taiwanese. Taiwan’s general population is widely exposed to DnBP, DiBP and DEHP, especially for young children.

  8. Longitudinal patterns of poverty and health in early childhood: exploring the influence of concurrent, previous, and cumulative poverty on child health outcomes

    Directory of Open Access Journals (Sweden)

    Béatrice Nikiéma

    2012-09-01

    longitudinal research is warranted to disentangle time-specific from cumulative effects of poverty on child health.

  9. Ground-Truthing Validation to Assess the Effect of Facility Locational Error on Cumulative Impacts Screening Tools

    OpenAIRE

    Sadd, J. L.; Hall, E. S.; Pastor, M.; Morello-Frosch, R. A.; D. Lowe-Liang; Hayes, J.; Swanson, C

    2015-01-01

    Researchers and government regulators have developed numerous tools to screen areas and populations for cumulative impacts and vulnerability to environmental hazards and risk. These tools all rely on secondary data maintained by government agencies as part of the regulatory and permitting process. Stakeholders interested in cumulative impacts screening results have consistently questioned the accuracy and completeness of some of these datasets. In this study, three cumulative impacts screenin...

  10. Health technology assessment in Singapore.

    Science.gov (United States)

    Pwee, Keng Ho

    2009-07-01

    The Republic of Singapore is an island city-state in Southeast Asia. Its population enjoys good health and the Singapore Ministry of Health's mission is to promote good health and reduce illness, ensure access to good and affordable health care, and pursue medical excellence. This is achieved through a healthcare system that includes both private and public sector elements. The financing philosophy of Singapore's healthcare delivery system is based on individual responsibility and community support. Health care in Singapore is financed by a combination of taxes, employee medical benefits, compulsory health savings, insurance, and out-of-pocket payment. The capability for health technology assessment in Singapore was developed concurrently with its medical device regulation system in the 1990s. The first formal unit with health technology assessment (HTA) functions was established in September 1995. Today, HTA features in decision making for the Standard Drug List, licensing of medical clinics, the Health Service Development Programme, healthcare subsidies, and policy development. The public sector healthcare delivery clusters have also recently started health services research units with HTA functions. Singapore is organizing the 6th Health Technology Assessment International (HTAi) Annual Meeting in June 2009. Bringing this prestigious international conference to Asia for the first time will help raise awareness of HTA in the region.

  11. Procedure and assessment of cumulative environmental effects Sameiginlegt mat á umhverfisáhrifum

    Directory of Open Access Journals (Sweden)

    Margrét Vala Kristjánsdóttir

    2011-12-01

    Full Text Available This paper deals with a provision in Article 5.2 of the Icelandic Act on Environmental Impact Assessment (EIA, No. 106/2000 that allows for a special procedure of joint EIA of two or more associated projects. Its main aim is to ensure that the overall assessment of environmental effects is taken into account before decisions are made. This provision has raised questions in relation to its scope and applicability. The provision´s origin, substance and application are analysed as well as its conformity to Directive 85/337/EEC as it has been introduced into the EEA Agreement. The paper concludes that administrative implementation has clarified certain aspects, including the legal conditions for its application. However, the application of the provision raises questions as to whether its aim may be achieved by a less onerous procedure; in line with Directive 85/337/EEC as interpreted by the European Commission.Í greininni er fjallað um ákvæði um sameiginlegt mat á umhverfisáhrifum í 2. mgr. 5. gr. laga nr. 106/2000 um mat á umhverfisáhrifum. Meginmarkmið ákvæðisins er að upplýsa um heildaráhrif framkvæmda á umhverfið áður en ákvarðanir um þær eru teknar. Vegna álitaefna sem upp hafa komið í tengslum við framkvæmd ákvæðisins er í greininni leitast við að skýra tilurð þess og efni með hliðsjón af lögskýringargögnum, framkvæmd þess og reglum tilskipunar 85/337/EBE eins og hún hefur verið tekin upp í EES-samninginn. Í greininni er komist að þeirri niðurstöðu að skilyrði fyrir beitingu ákvæðisins hafi skýrst í framkvæmd. Framkvæmdin veki jafnframt spurningar um hvort ná megi markmiðum ákvæðisins jafn vel, með einfaldari leiðum sem samræmast tilskipun 85/337/EBE eins og hún hefur verið skýrð af framkvæmdastjórn Evrópusambandsins.

  12. VA telemental health: suicide assessment.

    Science.gov (United States)

    Godleski, Linda; Nieves, J Edwin; Darkins, Adam; Lehmann, Laurent

    2008-01-01

    The Department of Veterans Affairs (VA) encompasses one of the largest telemental health networks in the world, with over 45,000 videoconferencing and over 5,000 home telemental health encounters annually. Recently, the VA designated suicide prevention as a major priority, with telehealth modalities providing opportunities for remote interventions. Suicide risk assessments, using videoconferencing, are now documented in the literature, as are current studies that find telemental health to be equivalent to face-to-face treatment. Remote assessment of suicidality, however, involves complex legal issues: licensing requirements for remote delivery of care, legal procedures for involuntary detainment and commitment of potentially harmful patients, and liability questions related to the remote nature of the mental health service. VA best practices for remote suicide risk assessment include paradigms for establishing procedures in the context of legal challenges (licensing and involuntary detainment/commitment), for utilizing clinical assessment and triage decision protocols, and for contingency planning to optimize patient care and reduce liability.

  13. Introducing Health Impact Assessment

    DEFF Research Database (Denmark)

    Mannheimer, L N; Gulis, G; Lehto, J;

    2007-01-01

    health status of the population. There was a lack of multi-intersectoral knowledge, co-operation and function between sectors and actors. Enablers on the other hand were the membership of international organizations which called for new solutions, and the strong political commitment and belief...

  14. Cumulative exergy extraction from the natural environment (CEENE): a comprehensive life cycle impact assessment method for resource accounting.

    Science.gov (United States)

    Dewulf, J; Bösch, M E; De Meester, B; Van der Vorst, G; Van Langenhove, H; Hellweg, S; Huijbregts, M A J

    2007-12-15

    The objective of the paper is to establish a comprehensive resource-based life cycle impact assessment (LCIA) method which is scientifically sound and that enables to assess all kinds of resources that are deprived from the natural ecosystem, all quantified on one single scale, free of weighting factors. The method is based on the exergy concept. Consistent exergy data on fossils, nuclear and metal ores, minerals, air, water, land occupation, and renewable energy sources were elaborated, with well defined system boundaries. Based on these data, the method quantifies the exergy "taken away" from natural ecosystems, and is thus called the cumulative exergy extraction from the natural environment (CEENE). The acquired data set was coupled with a state-of-the art life cycle inventory database, ecoinvent. In this way, the method is able to quantitatively distinguish eight categories of resources withdrawn from the natural environment: renewable resources, fossil fuels, nuclear energy, metal ores, minerals, water resources, land resources, and atmospheric resources. Third, the CEENE method is illustrated for a number of products that are available in ecoinvent, and results are compared with common resource oriented LCIA methods. The application to the materials in the ecoinvent database showed that fossil resources and land use are of particular importance with regard to the total CEENE score, although the other resource categories may also be significant.

  15. UBIQUITOUS POLLUTANTS FROM CUMULATIVE ...

    Science.gov (United States)

    The occurrence of pharmaceuticals and personal care products (PPCPS) as environmental pollutants is a multifaceted issue whose scope continues to become better delineated since the escalation of concerted attention beginning in the 1980s. PPCPs typically occur as trace environmental pollutants (primarily in surface but also in ground waters) as a result of their widespread, continuous, combined usage in a broad range of human and veterinary therapeutic activities and practices. With respect to the risk-assessment paradigm, the growing body of published work has focused primarily on the origin and occurrence of these substances. Comparatively less is known about human and ecological exposure, and even less about the known or even potential hazards associated with exposure to these anthropogenic substances, many of which are highly bioactive. The continually growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on water supplies and resultant potential for human or ecological exposure be minimized. This has prompted the more recent investigations on waste treatment processes for one of the major sources of environmental disposition, namely sewage. Despite the paucity of health effects data for long-term, simultaneous exposure to multiple xenobiotics (particularly PPCPS) at low doses (a major toxicological issue that can be described by the

  16. Quantifying Chronic Stress Exposure for Cumulative Risk Assessment: Lessons Learned from a Case Study of Allostatic Load

    Science.gov (United States)

    Although multiple methods of quantifying environmental chemical exposures have been validated for use in human health risk assessment, quantifying chronic stress exposure is more challenging. Stress is a consequence of perceiving an “exposure” (e.g., violence, poverty) as more th...

  17. Cumulative inflammatory load is associated with short leukocyte telomere length in the Health, Aging and Body Composition Study.

    Directory of Open Access Journals (Sweden)

    Aoife O'Donovan

    Full Text Available BACKGROUND: Leukocyte telomere length (LTL is an emerging marker of biological age. Chronic inflammatory activity is commonly proposed as a promoter of biological aging in general, and of leukocyte telomere shortening in particular. In addition, senescent cells with critically short telomeres produce pro-inflammatory factors. However, in spite of the proposed causal links between inflammatory activity and LTL, there is little clinical evidence in support of their covariation and interaction. METHODOLOGY/PRINCIPAL FINDINGS: To address this issue, we examined if individuals with high levels of the systemic inflammatory markers interleukin-6 (IL-6, tumor necrosis factor-α (TNF-α and C-reactive protein (CRP had increased odds for short LTL. Our sample included 1,962 high-functioning adults who participated in the Health, Aging and Body Composition Study (age range: 70-79 years. Logistic regression analyses indicated that individuals with high levels of either IL-6 or TNF-α had significantly higher odds for short LTL. Furthermore, individuals with high levels of both IL-6 and TNF-α had significantly higher odds for short LTL compared with those who had neither high (OR = 0.52, CI = 0.37-0.72, only IL-6 high (OR = 0.57, CI = 0.39-0.83 or only TNF-α high (OR = 0.67, CI = 0.46-0.99, adjusting for a wide variety of established risk factors and potential confounds. In contrast, CRP was not associated with LTL. CONCLUSIONS/SIGNIFICANCE: Results suggest that cumulative inflammatory load, as indexed by the combination of high levels of IL-6 and TNF-α, is associated with increased odds for short LTL. In contrast, high levels of CRP were not accompanied by short LTL in this cohort of older adults. These data provide the first large-scale demonstration of links between inflammatory markers and LTL in an older population.

  18. Sensor based soil health assessment

    Science.gov (United States)

    Quantification and assessment of soil health involves determining how well a soil is performing its biological, chemical, and physical functions relative to its inherent potential. Due to high cost, labor requirements, and soil disturbance, traditional laboratory analyses cannot provide high resolut...

  19. Learning curve of transvaginal ultrasound for the diagnosis of endometriomas assessed by the cumulative summation test (LC-CUSUM).

    Science.gov (United States)

    Bazot, Marc; Daraï, Emile; Biau, David J; Ballester, Marcos; Dessolle, Lionel

    2011-01-01

    A specific statistical tool (the cumulative summation test for learning curve or LC-CUSUM) was used to monitor the learning curve of four trainees for the diagnosis of endometriomas by transvaginal ultrasound. A large intertrainee variability in the learning curves was found, justifying a tailored training to learn this diagnosis.

  20. Scientific Opinion on the identification of pesticides to be included in cumulative assessment groups on the basis of their toxicological profile

    Directory of Open Access Journals (Sweden)

    EFSA Panel on Plant Protection Products and their Residues (PPR

    2013-07-01

    Full Text Available The European Food Safety Authority asked the Panel on Plant Protection Products and their Residues to develop an Opinion on the identification of pesticides to be included in cumulative assessment groups (CAGs on the basis of their toxicological profile. In 2008, the PPR Panel adopted an Opinion on the suitability of existing methodologies for cumulative risk assessment of pesticides and a tiered approach was proposed, which was applied to a selected group of triazole pesticides in 2009. The present Opinion suggests a methodology for grouping of pesticides based on phenomenological effects and provides CAGs for the thyroid and nervous system. This approach can be applied even when the underlying biochemical events mediating the effects are not understood, and is based on a standardised and thorough review of Draft Assessment Reports (DARs supporting the approval of all pesticides in Europe, and on recommendations from the European Commission. Pesticidal active substances exhibiting neurotoxic properties were allocated to CAGs for acute effects on motor, sensory and autonomic divisions of the nervous system and neurochemical endpoints. Chronic effects across the same divisions/endpoints and neuropathological effects were collated. Active substances having adverse effects on the thyroid system were allocated to CAGs for effects either on C-cells/the calcitonin system or on follicular cells/the T3/T4 system. The PPR Panel notes that the resulting groups encompass many pesticides and also that individual pesticides could appear in several groups and therefore the data entries for performing cumulative risk assessment (CRA are of considerable magnitude. Although some CAGs contain a large number of pesticides, little indication of cumulative risk may be inferred from the size of CAGs per se. The PPR Panel recommends that the methodology is implemented for all major organ/systems but the approach used should be considered specific for pesticides.

  1. 国内外累积性环境风险评估研究进展%Research Progress of Cumulative Environmental Risk Assessment at Home and Abroad

    Institute of Scientific and Technical Information of China (English)

    袁鹏; 李文秀; 彭剑峰; 宋永会; 许伟宁

    2015-01-01

    随着环境风险评估的重点由单一源、单一传播途径、单受体转向多来源、多传播途径、多受体的评估,累积性环境风险评估逐渐成为当前研究热点。通过概念辨析和文献调研的方法,综述了美国累积性环境风险评估的发展历史、评估流程,并对国内外累积性环境风险评估方法、应用研究进展进行了评述。指出了目前国内开展累积性环境风险评估存在的方法不完善、基础科研工作不足、宏观环境管理政策亟待加强等问题。建议应尽快明确累积性环境风险评估概念与管理要求,制订累积性环境风险评估的流程、框架与技术指南,加强基础数据库建立和实践探索,为长效的环境风险管理提供决策依据。%With the focuses of environmental risk assessment gradually evolving from assessment of single source or stressor, single exposure route and single risk receptor toward integrated assessment involving several sources or stressors, multiple exposure routes and multiple receptors in recent years, the cumulative risk assessment has become a study hot spot.Through concepts discrimination and literatures search, the development history and assessment procedure in the US, and the methods and practices of cumulative risk assessment both at home and abroad were reviewed.It was pointed out that there were several problems in conducting cumulative risk assessment in China, such as lack of assessment methods, lack of basic scientific data and urgent need of reinforcement of macro-environmental management policy and so on.It was suggests that the concept and management requirements of cumulative environmental risk assessment should be defined, the evaluation process, framework and technical guide be formulated, and the construction of foundational databases and practical explorations be reinforced as soon as possible,which can provide the decision support for the long-term effective environmental

  2. What is Health Impact Assessment?

    Directory of Open Access Journals (Sweden)

    Ahmet Soysal

    2010-12-01

    Full Text Available Health Impact Assessment (HIA was disseminated by World Health Organization (WHO European Region in Gothenburg consensus paper in 1999. In this consensus, HIA is defined as ‘a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of population and the distribution of those effects within the population’. HIA was accepted as a goal for 4th phase of healthy city projects between 2003- 2008. HIA is a new process for our country and especially municipal boroughs, local authorities interest with it. There is no legal base for HIA in our country. EIA practices conducted since 1993 showed us that, environmental and public health was postponed. Functional and decisive implementation of HAI depends on legal basis and national acceptance. If legal basis is supplied, society must take care about it, work for strict application and have to put a crimp in going back. [TAF Prev Med Bull 2010; 9(6.000: 689-694

  3. Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths.

    Science.gov (United States)

    Ferguson, Kristin M

    2012-08-01

    Despite the growing integration of supported employment within the mental health system in the United States as well as the widespread use of social enterprises abroad, the fields of mental health and social enterprises remain largely separate in the USA. The mental health field currently lacks a response that strengthens homeless youths' existing human and social capital, provides them with marketable job skills and employment, and impacts their mental health. To address this gap, this paper establishes a case for using social enterprises with homeless youths, drawing on both global precedents and findings from a mixed-methods study of a social enterprise intervention with homeless youths. Recommendations are offered for how to integrate social enterprises with mental health treatment as well as how to evaluate their impact on mental health outcomes.

  4. The Contribution of Health Technology Assessment, Health Needs Assessment, and Health Impact Assessment to the Assessment and Translation of Technologies in the Field of Public Health Genomics

    DEFF Research Database (Denmark)

    Rosenkotter, N.; Vondeling, H.; Blancquaert, I.

    2011-01-01

    or to identify infrastructural needs. HIA delivers information on the impact of technologies in a wider scope and promotes informed decision making. HTA, HNA and HIA provide a partly overlapping and partly unique set of methodologies and infrastructure for the translation and assessment of genomic health...... into the impact on public health and health care practice of those technologies that are actually introduced. This paper aims to give an overview of the major assessment instruments in public health [ health technology assessment (HTA), health needs assessment (HNA) and health impact assessment (HIA)] which could......The European Union has named genomics as one of the promising research fields for the development of new health technologies. Major concerns with regard to these fields are, on the one hand, the rather slow and limited translation of new knowledge and, on the other hand, missing insights...

  5. Assessing cumulative impacts of forest development on the distribution of furbearers using expert-based habitat modeling.

    Science.gov (United States)

    Bridger, M C; Johnson, C J; Gillingham, M P

    2016-03-01

    Cumulative impacts of anthropogenic landscape change must be considered when managing and conserving wildlife habitat. Across the central-interior of British Columbia, Canada, industrial activities are altering the habitat of furbearer species. This region has witnessed unprecedented levels of anthropogenic landscape change following rapid development in a number of resource sectors, particularly forestry. Our objective was to create expert-based habitat models for three furbearer species: fisher (Pekania pennanti), Canada lynx (Lynx canadensis), and American marten (Martes americana) and quantify habitat change for those species. We recruited 10 biologist and 10 trapper experts and then used the analytical hierarchy process to elicit expert knowledge of habitat variables important to each species. We applied the models to reference landscapes (i.e., registered traplines) in two distinct study areas and then quantified the change in habitat availability from 1990 to 2013. There was strong agreement between expert groups in the choice of habitat variables and associated scores. Where anthropogenic impacts had increased considerably over the study period, the habitat models showed substantial declines in habitat availability for each focal species (78% decline in optimal fisher habitat, 83% decline in optimal lynx habitat, and 79% decline in optimal marten habitat). For those traplines with relatively little forest harvesting, the habitat models showed no substantial change in the availability of habitat over time. The results suggest that habitat for these three furbearer species declined significantly as a result of the cumulative impacts of forest harvesting. Results of this study illustrate the utility of expert knowledge for understanding large-scale patterns of habitat change over long time periods.

  6. Assessing Health Professional Education: Workshop Summary

    Science.gov (United States)

    Cuff, Patricia A.

    2014-01-01

    "Assessing Health Professional Education" is the summary of a workshop hosted by the Institute of Medicine's Global Forum on Innovation in Health Professional Education to explore assessment of health professional education. At the event, Forum members shared personal experiences and learned from patients, students, educators, and…

  7. The Soft Cumulative Constraint

    CERN Document Server

    Petit, Thierry

    2009-01-01

    This research report presents an extension of Cumulative of Choco constraint solver, which is useful to encode over-constrained cumulative problems. This new global constraint uses sweep and task interval violation-based algorithms.

  8. Health effects of risk-assessment categories

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, C.F.; Rybicka, K.; Knutson, A.; Morris, S.C.

    1983-10-01

    Environmental and occupational health effects associated with exposures to various chemicals are a subject of increasing concern. One recently developed methodology for assessing the health impacts of various chemical compounds involves the classification of similar chemicals into risk-assessment categories (RACs). This report reviews documented human health effects for a broad range of pollutants, classified by RACs. It complements other studies that have estimated human health effects by RAC based on analysis and extrapolation of data from animal research.

  9. Establishment of Health Technology Assessment in Iran

    Directory of Open Access Journals (Sweden)

    Shila Doaee

    2012-06-01

    Full Text Available Objective: Health Technology Assessment (HTA aims at informing healthcare policymakers, managers and practitioners of the "clinical consequences, but also the economic, ethical, and other social implications of the diffusion and use of a specific procedure or technique on medical practice". So considering the policy-oriented nature of HTA that calls for a close integration into the functioning and governance of health systems the present study focuses on executive processes and function of the HTA office of Iran.Materials and methods: Data of this review study were collected through documented sources and observations from 2007 to 2010.Results: Health Technology Assessment began its activities as a secretariat in the Deputy of Health in 2007 and it continues as a Health Technology Assessment Office at the Management of Health Technology Assessment, Standardization, and Tariff at the Deputy of curative affairs of MOHME in the beginning of 2010.14 Technology of modern medical equipment and 8 pharmaceutical medicine are assessed, Now many of measures for HTA establishment  such as cooperation National Institute of Health Research (NIHR, Holding scientific committee meetings, Establishing  the  Master's degree of  health technology assessment ,Building capacities for health technology assessment through education in major universities of the country.Conclusion: pay attention to health technology assessment, selection and application of proper technologies in the frameworks of policy-making and managerial strategies and make efforts to develop it with the support of the governmental in Iran is necessary.

  10. Exposure to phthalates in 5-6 years old primary school starters in Germany--a human biomonitoring study and a cumulative risk assessment.

    Science.gov (United States)

    Koch, Holger M; Wittassek, Matthias; Brüning, Thomas; Angerer, Jürgen; Heudorf, Ursel

    2011-06-01

    We determined the internal exposure of 111 German primary school starters by analyzing urinary metabolites of six phthalates: butyl benzyl phthalate (BBzP), di-iso-butyl phthalate (DiBP), di-n-butyl phthalate (DnBP), di (2-ethylhexyl) phthalate (DEHP), di-iso-nonyl phthalate (DiNP) and di-iso-decylphthalate (DiDP). From the urinary metabolite levels, we calculated daily intakes and related these values to Tolerable Daily Intake (TDI) values. By introducing the concept of a relative cumulative Tolerable Daily Intake (TDI(cum)) value, we tried to account for the cumulative exposure to several of the above-mentioned phthalates. The TDI(cum) was derived as follows: the daily intake (DI) calculated from the metabolite level was divided by the TDI for each phthalate; this ratio was multiplied by 100% indicating the TDI percentage for which the DI accounted. Finally the % TDIs of the different phthalates were totalled to get the TDI(cum). A TDI(cum) above 100% is a potential cause for concern. We confirmed the ubiquitous exposure of the children to all phthalates investigated. Exposures were within range of levels previously reported for GerES, albeit slightly lower. Regarding daily intakes, two children exceeded the TDI for DnBP, whereas one child closely approached the TDI for DEHP. 24% of the children exceeded the TDI(cum) for the three most critical phthalates: DEHP, DnBP and DiBP. Furthermore, 54% of the children had total exposures that used up more than 50% the TDI(cum). Therefore, the overall exposure to a number of phthalates, and the knowledge that these phthalates (and other anti-androgens) act in a dose-additive manner, urgently warrants a cumulative risk assessment approach.

  11. Health Behaviour and Health Assessment: Evidence from German Microdata

    Directory of Open Access Journals (Sweden)

    Brit S. Schneider

    2012-01-01

    Full Text Available The importance of the individual’s health behaviour for the health production process is beyond controversy. Health relevant behaviour can be viewed as a key variable in the health production process. Changes in the behaviour may influence individual’s assessment of health. Following this idea, we use German microdata to identify determinants of smoking, drinking, and obesity and their impact on health. Our empirical approach allows for the simultaneity of behaviours and self-reported health. In addition, we account for endogeneity of health behaviours and take aspects of reporting heterogeneity of self-reported health into account. We find that health behaviour is directly related to the socioeconomic status and observe gender-specific differences in the determinants of drinking, smoking, and heavy body weight in particular. The influence on health is also gender specific. While we do not find any impact of smoking, overweight is relevant only for males and no clear pattern for alcohol exists.

  12. Assessing cumulative watershed stressors: Using LIDAR to assess the amount of open lands and young forest associated with in-channel erosion for North Shore tributaries

    Science.gov (United States)

    Hydrologists with the US Forest Service have demonstrated the cumulative impacts of land use change, particularly additional open lands and young forest (< 15 yrs) on bank full flows and in-channel erosion. Mapping these impacts has been difficult due to challenges associated ...

  13. Cumulative environmental effects. Summary

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    This report presents a compilation of knowledge about the state of the environment and human activity in the Norwegian part of the North Sea and Skagerrak. The report gives an overview of pressures and impacts on the environment from normal activity and in the event of accidents. This is used to assess the cumulative environmental effects, which factors have most impact and where the impacts are greatest, and to indicate which problems are expected to be most serious in the future. The report is intended to provide relevant information that can be used in the management of the marine area in the future. It also provides input for the identification of environmental targets and management measures for the North Sea and Skagerrak.(Author)

  14. EPA Workshop on Epigenetics and Cumulative Risk ...

    Science.gov (United States)

    Agenda Download the Workshop Agenda (PDF) The workshop included presentations and discussions by scientific experts pertaining to three topics (i.e., epigenetic changes associated with diverse stressors, key science considerations in understanding epigenetic changes, and practical application of epigenetic tools to address cumulative risks from environmental stressors), to address several questions under each topic, and included an opportunity for attendees to participate in break-out groups, provide comments and ask questions. Workshop Goals The workshop seeks to examine the opportunity for use of aggregate epigenetic change as an indicator in cumulative risk assessment for populations exposed to multiple stressors that affect epigenetic status. Epigenetic changes are specific molecular changes around DNA that alter expression of genes. Epigenetic changes include DNA methylation, formation of histone adducts, and changes in micro RNAs. Research today indicates that epigenetic changes are involved in many chronic diseases (cancer, cardiovascular disease, obesity, diabetes, mental health disorders, and asthma). Research has also linked a wide range of stressors including pollution and social factors with occurrence of epigenetic alterations. Epigenetic changes have the potential to reflect impacts of risk factors across multiple stages of life. Only recently receiving attention is the nexus between the factors of cumulative exposure to environmental

  15. Health Economic Assessment: A Methodological Primer

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2009-11-01

    Full Text Available This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs, an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis, and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments.

  16. The contribution of health technology assessment, health needs assessment, and health impact assessment to the assessment and translation of technologies in the field of public health genomics.

    Science.gov (United States)

    Rosenkötter, N; Vondeling, H; Blancquaert, I; Mekel, O C L; Kristensen, F B; Brand, A

    2011-01-01

    The European Union has named genomics as one of the promising research fields for the development of new health technologies. Major concerns with regard to these fields are, on the one hand, the rather slow and limited translation of new knowledge and, on the other hand, missing insights into the impact on public health and health care practice of those technologies that are actually introduced. This paper aims to give an overview of the major assessment instruments in public health [health technology assessment (HTA), health needs assessment (HNA) and health impact assessment (HIA)] which could contribute to the systematic translation and assessment of genomic health applications by focussing at population level and on public health policy making. It is shown to what extent HTA, HNA and HIA contribute to translational research by using the continuum of translational research (T1-T4) in genomic medicine as an analytic framework. The selected assessment methodologies predominantly cover 2 to 4 phases within the T1-T4 system. HTA delivers the most complete set of methodologies when assessing health applications. HNA can be used to prioritize areas where genomic health applications are needed or to identify infrastructural needs. HIA delivers information on the impact of technologies in a wider scope and promotes informed decision making. HTA, HNA and HIA provide a partly overlapping and partly unique set of methodologies and infrastructure for the translation and assessment of genomic health applications. They are broad in scope and go beyond the continuum of T1-T4 translational research regarding policy translation.

  17. The internationalization of health technology assessment.

    Science.gov (United States)

    Menon, D; Marshall, D

    1996-01-01

    Health technology assessment as a formalized set of activities has a relatively short history. At its current stage of development, it is clear that it has global dimensions and impact. In this paper we review the history of health technology assessment, its development as a form of health services research, and its "institutionalization." We then identify the reasons for its internationalization, review current international initiatives, and propose actions to be taken to improve cooperation among countries.

  18. Direct releases to the surface and associated complementary cumulative distribution functions in the 1996 performance assessments for the Waste Isolation Pilot Plant: Direct brine release

    Energy Technology Data Exchange (ETDEWEB)

    STOELZEL,D.M.; O' BRIEN,D.G.; GARNER,J.W.; HELTON,JON CRAIG; JOHNSON,J.D.; SCOTT,L.N.

    2000-05-19

    The following topics related to the treatment of direct brine releases to the surface environment in the 1996 performance assessment for the Waste Isolation Pilot Plant (WIPP) are presented (1) mathematical description of models, (2) uncertainty and sensitivity analysis results arising from subjective (i.e., epistemic) uncertainty for individual releases, (3) construction of complementary cumulative distribution functions (CCDFs) arising from stochastic (i.e., aleatory) uncertainty, and (4) uncertainty and sensitivity analysis results for CCDFs. The presented analyses indicate that direct brine releases do not constitute a serious threat to the effectiveness of the WIPP as a disposal facility for transuranic waste. Even when the effects of uncertain analysis inputs are taken into account, the CCDFs for direct brine releases fall substantially to the left of the boundary line specified in the US Environmental Protection Agency's standard for the geologic disposal of radioactive waste (4O CFR 191.40 CFR 194).

  19. The application of Cumulative Sum control chart in public health surveillance%CUSUM控制图法在公共卫生监测中的应用

    Institute of Scientific and Technical Information of China (English)

    刘普林; 胡权

    2010-01-01

    The Cumulative Sum control chart (CUSUM)techniques have been applied widely in public health surveillance in resent years since it was used in the study from industrial quality control to medical problems. Particularly,studies on early aberration alarm and procedure surveillance have been conducted extensively at abroad but there are few in China. The application of CUSUM techniques in public health surveillance in these international studies is reviewed in this article.%CUSUM控制图法从工业及制造业质量控制领域引入医学领域以来,在公共卫生监测中的应用研究越来越广泛,特别是在异常信息监测预警及过程监测控制等方面国外开展较多,但在我国还未见相关研究报道.此文就国际上CUSUM控制图法在公共卫生监测中的应用研究进展进行了综述.

  20. The emerging threats of climate change on tropical coastal ecosystem services, public health, local economies and livelihood sustainability of small islands: Cumulative impacts and synergies.

    Science.gov (United States)

    Hernández-Delgado, E A

    2015-12-15

    Climate change has significantly impacted tropical ecosystems critical for sustaining local economies and community livelihoods at global scales. Coastal ecosystems have largely declined, threatening the principal source of protein, building materials, tourism-based revenue, and the first line of defense against storm swells and sea level rise (SLR) for small tropical islands. Climate change has also impacted public health (i.e., altered distribution and increased prevalence of allergies, water-borne, and vector-borne diseases). Rapid human population growth has exacerbated pressure over coupled social-ecological systems, with concomitant non-sustainable impacts on natural resources, water availability, food security and sovereignty, public health, and quality of life, which should increase vulnerability and erode adaptation and mitigation capacity. This paper examines cumulative and synergistic impacts of climate change in the challenging context of highly vulnerable small tropical islands. Multiple adaptive strategies of coupled social-ecological ecosystems are discussed. Multi-level, multi-sectorial responses are necessary for adaptation to be successful.

  1. The Relationship between Cumulative Credits and Student Learning Outcomes: A Cross-Sectional Assessment of Information Literacy and Communication Skills

    Science.gov (United States)

    Thonney, Teresa; Montgomery, Joe C.

    2015-01-01

    This article relates the efforts of faculty at one community college to define standards for achievement of two SLOs (critical thinking and effective communication) and to gather and analyze evidence of how well students meet those standards. Faculty from 13 disciplines assessed writing samples from 265 students. We found that, in general,…

  2. Assessment factors for human health risk assessment: A discussion paper

    NARCIS (Netherlands)

    Vermeire, T.; Stevenson, H.; Pieters, M.N.; Rennen, M.; Slob, W.; Hakkert, B.C.

    1999-01-01

    The general goal of this discussion paper is to contribute toward the further harmonization of human health risk assessment. It first discusses the development of a formal, harmonized set of assessment factors. The status quo with regard to assessment factors is reviewed, that is, the type of factor

  3. Cumulative human impacts on marine predators

    DEFF Research Database (Denmark)

    Maxwell, Sara M; Hazen, Elliott L; Bograd, Steven J

    2013-01-01

    Stressors associated with human activities interact in complex ways to affect marine ecosystems, yet we lack spatially explicit assessments of cumulative impacts on ecologically and economically key components such as marine predators. Here we develop a metric of cumulative utilization and impact...

  4. Assessment of health risks of policies

    Energy Technology Data Exchange (ETDEWEB)

    Ádám, Balázs, E-mail: badam@cmss.sdu.dk [Unit for Health Promotion Research, Faculty of Health Sciences, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg (Denmark); Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, P.O. Box 9, H-4012 Debrecen (Hungary); Molnár, Ágnes, E-mail: MolnarAg@smh.ca [Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, P.O. Box 9, H-4012 Debrecen (Hungary); Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael' s Hospital, Victoria 209, Rm. 3-26.22, M5B 1C6 Toronto, Ontario (Canada); Ádány, Róza, E-mail: adany.roza@sph.unideb.hu [Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, P.O. Box 9, H-4012 Debrecen (Hungary); Bianchi, Fabrizio, E-mail: Fabriepi@ifc.cnr.it [Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Council of Research, Moruzzi 1, 56124 Pisa (Italy); Bitenc, Katarina, E-mail: katarina.bitenc@ivz-rs.si [National Institute of Public Health, Trubarjeva 2, SI-1000 Ljubljana (Slovenia); Chereches, Razvan, E-mail: razvan.m.chereches@gmail.com [Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Strada Mihail Kogalniceanu 1, 3400 Cluj (Romania); Cori, Liliana, E-mail: liliana.cori@ifc.cnr.it [Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Council of Research, Moruzzi 1, 56124 Pisa (Italy); Fehr, Rainer, E-mail: rainer.fehr@uni-bielefeld.de [NRW Centre for Health, Westerfeldstr. 35-37, 33611 Bielefeld (Germany); Kobza, Joanna, E-mail: koga1@poczta.onet.pl [Public Health Department, Silesian Medical University, 18 Medykow Street, 40-752 Katowice (Poland); Kollarova, Jana, E-mail: janakollarova@yahoo.com [Department of Health Promotion, Regional Public Health Authority, Ipelska 1, 04011 Kosice (Slovakia); and others

    2014-09-15

    The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessment with special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals. - Highlights: • Methodological guide for the assessment of health risks of policies is introduced. • The tool is developed based on the experiences from several case studies. • The combined tool consists of a textual guidance and a checklist. • The top-down approach is followed through the levels of the full impact chain. • The guide provides assistance for the health impact assessment of policy proposals.

  5. An Assessment of Environmental Health Needs

    Science.gov (United States)

    Macatangay, Ariel V.

    2013-01-01

    Environmental health fundamentally addresses the physical, chemical, and biological risks external to the human body that can impact the health of a person by assessing and controlling these risks in order to generate and maintain a health-supportive environment. In manned spacecraft, environmental health risks are mitigated by a multi-disciplinary effort, employing several measures including active and passive controls, by establishing environmental standards (SMACs, SWEGs, microbial and acoustics limits), and through environmental monitoring. Human Health and Performance (HHP) scientists and Environmental Control and Life Support (ECLS) engineers consider environmental monitoring a vital component to an environmental health management strategy for maintaining a healthy crew and achieving mission success. ECLS engineers use environmental monitoring data to monitor and confirm the health of ECLS systems, whereas HHP scientists use the data to manage the health of the human system. Because risks can vary between missions and change over time, environmental monitoring is critical. Crew health risks associated with the environment were reviewed by agency experts with the goal of determining risk-based environmental monitoring needs for future NASA manned missions. Once determined, gaps in environmental health knowledge and technology, required to address those risks, were identified for various types of exploration missions. This agency-wide assessment of environmental health needs will help guide the activities/hardware development efforts to close those gaps and advance the knowledge required to meet NASA manned space exploration objectives. Details of the roadmap development and findings are presented in this paper.

  6. [Health research and health technology assessment in Chile].

    Science.gov (United States)

    Espinoza, Manuel Antonio; Cabieses, Báltica; Paraje, Guillermo

    2014-01-01

    Health research is considered an essential element for the improvement of population health and it has been recommended that a share of the national health budget should be allocated to develop this field. Chile has undertaken efforts in the last decades in order to improve the governmental structure created to promote the development of health research, which has increased human resources and funding opportunities. On the other hand, the sustained economic growth of Chile in the last decades suggests that the health expenditure will maintain its increasing trend in the following years. This additional funding could be used to improve coverage of current activities performed in the health system, but also to address the incorporation of new strategies. More recently, health technology assessment (HTA) has been proposed as a process to support decisions about allocation of resources based on scientific evidence. This paper examines the relationship between the development of health research and the HTA process. First, it presents a brief diagnosis of the situation of health research in Chile. Second, it reviews the conceptual basis and the methods that account for the relationship between a HTA process and the development of health research. In particular, it emphasizes the relevance of identifying information gaps where funding additional research can be considered a good use of public resources. Finally, it discusses the challenges and possible courses of action that Chile could take in order to guarantee the continuous improvement of an articulated structure for health research and HTA.

  7. Bearing Health Assessment Based on Chaotic Characteristics

    Directory of Open Access Journals (Sweden)

    Chen Lu

    2013-01-01

    Full Text Available Vibration signals extracted from rotating parts of machinery carry a lot of useful information about the condition of operating machine. Due to the strong non-linear, complex and non-stationary characteristics of vibration signals from working bearings, an accurate and reliable health assessment method for bearing is necessary. This paper proposes to utilize the selected chaotic characteristics of vibration signal for health assessment of a bearing by using self-organizing map (SOM. Both Grassberger-Procaccia algorithm and Takens' theory are employed to calculate the characteristic vector which includes three chaotic characteristics, such as correlation dimension, largest Lyapunov exponent and Kolmogorov entropy. After that, SOM is used to map the three corresponding characteristics into a confidence value (CV which represents the health state of the bearing. Finally, a case study based on vibration datasets of a group of testing bearings was conducted to demonstrate that the proposed method can reliably assess the health state of bearing.

  8. The relation of risk assessment and health impact assessment

    DEFF Research Database (Denmark)

    Ádám, Balázs; Gulis, Gabriel

    2013-01-01

    as a powerful tool for the evaluation of potential health consequences of planned measures. It is often discussed whether HIA is not just another term or form of risk assessment and what is their relation. Our aim is to discuss similarities and differences between the two methods so as to clarify......The level and distribution of health risks in a society is substantially influenced by measures of various policies, programmes or projects. Risk assessment can evaluate the nature, likelihood and severity of an adverse effect. Health impact assessment (HIA) provides similar function when used...... standardised scientific methods to characterise the probability and magnitude of harm caused by a hazard, preferably in a quantitative manner. In turn, HIA is a process to assess future impacts of recent proposals and is dominated by qualitative evaluation. It makes a projection for a future scenario rather...

  9. Spatial and temporal assessment of cumulative disturbance impacts due to military training, burning, haying, and their interactions on land condition of Fort Riley.

    Science.gov (United States)

    Wang, Guangxing; Murphy, Dana; Oller, Adam; Howard, Heidi R; Anderson, Alan B; Rijal, Santosh; Myers, Natalie R; Woodford, Philip

    2014-07-01

    The effects of military training activities on the land condition of Army installations vary spatially and temporally. Training activities observably degrade land condition while also increasing biodiversity and stabilizing ecosystems. Moreover, other anthropogenic activities regularly occur on military lands such as prescribed burns and agricultural haying-adding to the dynamics of land condition. Thus, spatially and temporally assessing the impacts of military training, prescribed burning, agricultural haying, and their interactions is critical to the management of military lands. In this study, the spatial distributions and patterns of military training-induced disturbance frequency were derived using plot observation and point observation-based method, at Fort Riley, Kansas from 1989 to 2001. Moreover, spatial and variance analysis of cumulative impacts due to military training, burning, haying, and their interactions on the land condition of Fort Riley were conducted. The results showed that: (1) low disturbance intensity dominated the majority of the study area with exception of concentrated training within centralized areas; (2) high and low values of disturbance frequency were spatially clustered and had spatial patterns that differed significantly from a random distribution; and (3) interactions between prescribed burning and agricultural haying were not significant in terms of either soil erosion or disturbance intensity although their means and variances differed significantly between the burned and non-burned areas and between the hayed and non-hayed areas.

  10. Mental health assessment of rape offenders.

    Science.gov (United States)

    Sarkar, Jaydip

    2013-07-01

    There is an urgent need for development of methods of assessment and management of sex offenders (rapists, child sex offenders, other sexual offenders, and murderers) to mount a society-wide battle against the scourge of sexual offences in India. This paper provides an overview of theories, models, and assessment methods of rapists. It draws upon literature from psychiatry, psychology, criminology, probation, and ethics to provide a framework for understanding reasons behind rape, how mental health issues are implicated, what mental health professionals can do to contribute to crime management, and why this is ethically right and proper.

  11. National Built Environment Health Impact Assessment Model ...

    Science.gov (United States)

    Behavioral (activity, diet, social interaction) and exposure (air pollution, traffic injury, and noise) related health impacts of land use and transportation investment decisions are becoming better understood and quantified. Research has shown relationships between density, mix, street connectivity, access to parks, shops, transit, presence of sidewalks and bikeways, and healthy food with physical activity, obesity, cardiovascular disease, type II diabetes, and some mental health outcomes. This session demonstrates successful integration of health impact assessment into multiple scenario planning tool platforms. Detailed evidence on chronic disease and related costs associated with contrasting land use and transportation investments are built into a general-purpose module that can be accessed by multiple platforms. Funders, researchers, and end users of the tool will present a detailed description of the key elements of the approach, how it has been applied, and how will evolve. A critical focus will be placed on equity and social justice inherent within the assessment of health disparities that will be featured in the session. Health impacts of community design have significant cost benefit implications. Recent research is now extending relationships between community design features and chronic disease to health care costs. This session will demonstrate the recent application of this evidence on health impacts to the newly adopted Los Angeles Regional Transpo

  12. Health technology assessment and thyroid surgery.

    Science.gov (United States)

    Lucchini, R; Sanguinetti, A; Monacelli, M; Triola, R; Avenia, S; Conti, C; Santoprete, S; Avenia, N

    2013-01-01

    The growth of technological innovation, the request for assistance, the rising patient's expectations and the interest of the industry have led to a rise in the cost of health care systems. In this context the role of the National Health System is not to delay the development or adoption of new technologies, but rather to drive the development selecting priorities and promoting its use. Health Technology Assessment (HTA) is a multidisciplinary and multidimensional approach for analyzing the medical-clinical, social, organizational, economic, ethical and legal implications of a technology (devices, drugs, procedures) through the assessment of multiple parameters such as effectiveness, safety, costs of the social and organizational impact. A health technology assessment is a comprehensive, systematic evaluation of the prerequisites for estimating the consequences of using health technology. Main characteristic of HTA is that the problem is tackled using an approach focused on four main elements: - technology; - patient; - organization; - economy. The authors have applied the HTA method for the analysis of the ultrasonic focus dissector on thyroid surgery. They compared the cost of the surgical procedure using the ultrasonic dissector and without it in a case study of 440 patients who underwent thyroidectomy.

  13. Risk assessment in support of plant health

    DEFF Research Database (Denmark)

    Jeger, Michael; Schans, Jan; Lövei, Gabor L.

    2012-01-01

    types and plants in the environment. There has been an increasing trend towards producing scientific opinions which are full pest risk assessments for the whole EU territory. In its work, and as a contribution to the wider development of risk assessment methodology, the Panel has developed a series......-evaluation of quantitative pathway analyses, and in statistical modelling of experimental data. A Plant Health Network has been established to facilitate interaction with EU Member States, especially in relation to data collection and co-ordination of risk assessment activities. At the current time a revision of the EU...

  14. Playing it safe: Assessing cumulative impact and social vulnerability through an environmental justice screening method in the South Coast Air Basin, California

    OpenAIRE

    Justin Scoggins; Rachel Morello-Frosch; Sadd, James L.; Manuel Pastor; Bill Jesdale

    2011-01-01

    Regulatory agencies, including the U.S. Environmental Protection Agency (US EPA) and state authorities like the California Air Resources Board (CARB), have sought to address the concerns of environmental justice (EJ) advocates who argue that chemical-by-chemical and source-specific assessments of potential health risks of environmental hazards do not reflect the multiple environmental and social stressors faced by vulnerable communities. We propose an Environmental Justice Screening Method (E...

  15. Identification and Quantification of Cumulative Factors that Increase Environmental Exposures and Impacts

    Science.gov (United States)

    Evaluating the combined adverse effects of multiple stressors upon human health is an imperative component of cumulative risk assessment (CRA)1. In addition to chemical stressors, other non-chemical factors are also considered. For examples, smoking will elevate the risks of havi...

  16. Cumulative fatigue damage models

    Science.gov (United States)

    Mcgaw, Michael A.

    1988-01-01

    The problem of calculating expected component life under fatigue loading conditions is complicated by the fact that component loading histories contain, in many cases, cyclic loads of widely varying amplitudes. In such a case a cumulative damage model is required, in addition to a fatigue damage criterion, or life relationship, in order to compute the expected fatigue life. The traditional cumulative damage model used in design is the linear damage rule. This model, while being simple to use, can yield grossly unconservative results under certain loading conditions. Research at the NASA Lewis Research Center has led to the development of a nonlinear cumulative damage model, named the double damage curve approach (DDCA), that has greatly improved predictive capability. This model, which considers the life (or loading) level dependence of damage evolution, was applied successfully to two polycrystalline materials, 316 stainless steel and Haynes 188. The cumulative fatigue behavior of the PWA 1480 single-crystal material is currently being measured to determine the applicability of the DDCA for this material.

  17. The development of health technology assessment.

    Science.gov (United States)

    Banta, David

    2003-02-01

    The field of health technology assessment (HTA) is still relatively new, but it has shown remarkable growth over the last decade, having spread first from the United States to Europe, and now to the entire world. HTA seeks to couple evidence with decision-making, and thus has similarities to evidence-based health care and evidence-based policy-making. The early history of HTA, beginning around 1975, reveals a first period of synthesising available evidence-principally that dealing with efficacy and cost-effectiveness of health care interventions-so as to put it in a format helpful to health policy-makers, especially those in national governments. From 1985 or so, the focus of the second period was on seeking more effective links with these policy-makers, particularly in Europe. The most recent period, beginning in the late 1990s, has been increasingly devoted to more effective dissemination and implementation in order to influence administrators and clinicians. While early assessments tended to focus on large, expensive, machine-based technologies, the scope has gradually widened to include smaller technologies, 'softer' technologies (such as counselling), and health care needs. Actual assessments have also taken on broader issues, such as organisational, social, and ethical implications. In the Member States of the European Union (EU), HTA activities are increasingly visible, and almost all now have a national focus for HTA associated with the Ministry of Health or its equivalent. Central and Eastern European countries are also developing HTA activities. Most recently, HTA has been highlighted by health policy documents from the European Commission. It seems likely that HTA will in the future be institutionalised in some form as part of EU activities.

  18. Dose-Response Relationship between Cumulative Occupational Lead Exposure and the Associated Health Damages: A 20-Year Cohort Study of a Smelter in China.

    Science.gov (United States)

    Wu, Yue; Gu, Jun-Ming; Huang, Yun; Duan, Yan-Ying; Huang, Rui-Xue; Hu, Jian-An

    2016-03-16

    Long-term airborne lead exposure, even below official occupational limits, has been found to cause lead poisoning at higher frequencies than expected, which suggests that China's existing occupational exposure limits should be reexamined. A retrospective cohort study was conducted on 1832 smelting workers from 1988 to 2008 in China. These were individuals who entered the plant and came into continuous contact with lead at work for longer than 3 months. The dose-response relationship between occupational cumulative lead exposure and lead poisoning, abnormal blood lead, urinary lead and erythrocyte zinc protoporphyrin (ZPP) were analyzed and the benchmark dose lower bound confidence limits (BMDLs) were calculated. Statistically significant positive correlations were found between cumulative lead dust and lead fumes exposures and workplace seniority, blood lead, urinary lead and ZPP values. A dose-response relationship was observed between cumulative lead dust or lead fumes exposure and lead poisoning (p lead dust and fumes doses were 0.68 mg-year/m³ and 0.30 mg-year/m³ for lead poisoning, respectively. The BMDLs of workplace airborne lead concentrations associated with lead poisoning were 0.02 mg/m³ and 0.01 mg/m³ for occupational exposure lead dust and lead fume, respectively. In conclusion, BMDLs for airborne lead were lower than occupational exposure limits, suggesting that the occupational lead exposure limits need re-examination and adjustment. Occupational cumulative exposure limits (OCELs) should be established to better prevent occupational lead poisoning.

  19. Assessment of Public Health Infrastructure to Determine Public Health Preparedness

    Science.gov (United States)

    2006-03-01

    62 Confirmed Positive 39 92 42 Residences Abated 40 92 43 Rabies and Zoonosis Control 2 Animal Bite Investigation3 1,280 … … Pets...Shops Inspected 9 9 100 Notes: 1 LHER: Local Health Evaluation Report 2 Zoonosis : Diseases transmitted from animals to humans 3 Number of...5,984 5,984 Childhood Lead Poisoning Risk assessments 2 466 932 Residences abated 8 40 320 Rabies and Zoonosis Control 2 Animal

  20. Cumulative risk: toxicity and interactions of physical and chemical stressors.

    Science.gov (United States)

    Rider, Cynthia V; Boekelheide, Kim; Catlin, Natasha; Gordon, Christopher J; Morata, Thais; Selgrade, Maryjane K; Sexton, Kenneth; Simmons, Jane Ellen

    2014-01-01

    Recent efforts to update cumulative risk assessment procedures to incorporate nonchemical stressors ranging from physical to psychosocial reflect increased interest in consideration of the totality of variables affecting human health and the growing desire to develop community-based risk assessment methods. A key roadblock is the uncertainty as to how nonchemical stressors behave in relationship to chemical stressors. Physical stressors offer a reasonable starting place for measuring the effects of nonchemical stressors and their modulation of chemical effects (and vice versa), as they clearly differ from chemical stressors; and "doses" of many physical stressors are more easily quantifiable than those of psychosocial stressors. There is a commonly held belief that virtually nothing is known about the impact of nonchemical stressors on chemically mediated toxicity or the joint impact of coexposure to chemical and nonchemical stressors. Although this is generally true, there are several instances where a substantial body of evidence exists. A workshop titled "Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors" held at the 2013 Society of Toxicology Annual Meeting provided a forum for discussion of research addressing the toxicity of physical stressors and what is known about their interactions with chemical stressors, both in terms of exposure and effects. Physical stressors including sunlight, heat, radiation, infectious disease, and noise were discussed in reference to identifying pathways of interaction with chemical stressors, data gaps, and suggestions for future incorporation into cumulative risk assessments.

  1. Health Technology Assessment: a field still maturing!

    Directory of Open Access Journals (Sweden)

    Renaldo N. Battista

    2005-06-01

    Full Text Available

    With this issue’s focus on Health Technology Assessment (HTA, the Italian Journal of Public Health has tackled an area of growing importance in today’s increasingly complex health care delivery systems.

    As the articles in this issue demonstrate, HTA has grown from a relatively narrow technical focus to a form of policy research underway in dozens of countries. Since its inception just over three decades ago,HTA has evolved through three distinct phases: the machine, the disease and the delivery mode, with the third of these still underway.

    As the focus has shifted from machines to disease conditions to service delivery approaches, HTA has drawn on research and modes of discourse from a growing variety of disciplines. Thus, despite the evolution that continues, HTA remains, at its core, both multidisciplinary and pragmatic, for the strengths of HTA arise from its integration of the efforts of actors in multiple, diverse disciplines with a view to producing knowledge that will assist decision-makers. The machine phase was marked by a focus on the technical performance of health technologies, often embodying innovative approaches to diagnosis or treatment of human illness.

    Given the newness and costliness of many technologies selected for assessment, a significant emphasis was placed on assessing the safety of these devices. Imaging technologies were the subject of assessment in many settings, perhaps in part because devices such as the CT scanner produced remarkable visual results that were heralded as affording breakthroughs in diagnosis and treatment. One need only look through the programs of early HTA conferences to see the emphasis on high cost, infrastructure-intensive health technologies that was the hallmark of the machine period.

  2. Cumulative dietary exposure of the population of Denmark to pesticides

    DEFF Research Database (Denmark)

    Jensen, Bodil Hamborg; Petersen, Annette; Nielsen, Elsa

    2015-01-01

    We used the Hazard Index (HI) method to carry out a cumulative risk assessment after chronic dietary exposure to all monitored pesticides in fruit, vegetables and cereals for various consumer groups in Denmark. Residue data for all the pesticides were obtained from the Danish monitoring programme...... that included processing factors and set non-detects to ½ LOR, but limited the correction (Model 3), gave the most realistic exposure estimate. With Model 3 the HI was calculated to be 0.44 for children and 0.18 for adults, indicating that there is no risk of adverse health effects following chronic cumulative...... exposure to the pesticides found in fruit, vegetables and cereals on the Danish market. The HI was below 1 even for consumers who eat more than 550 g of fruit and vegetables per day, corresponding to 1/3 of the population. Choosing Danish-produced commodities whenever possible could reduce the HI...

  3. Self-assessed dental health, oral health practices, and general health behaviors in Chinese urban adolescents

    DEFF Research Database (Denmark)

    Jiang, Han; Petersen, Poul Erik; Peng, Bin

    2005-01-01

    The objectives of this study were: to describe perceived dental health status and oral health-related knowledge, attitudes, and behavior in Chinese urban adolescents; to assess the associations of oral health variables with socio-economic status and school performance; and to analyse the relative...

  4. A dynamic human health risk assessment system.

    Science.gov (United States)

    Prasad, Umesh; Singh, Gurmit; Pant, A B

    2012-05-01

    An online human health risk assessment system (OHHRAS) has been designed and developed in the form of a prototype database-driven system and made available for the population of India through a website - www.healthriskindia.in. OHHRAS provide the three utilities, that is, health survey, health status, and bio-calculators. The first utility health survey is functional on the basis of database being developed dynamically and gives the desired output to the user on the basis of input criteria entered into the system; the second utility health status is providing the output on the basis of dynamic questionnaire and ticked (selected) answers and generates the health status reports based on multiple matches set as per advise of medical experts and the third utility bio-calculators are very useful for the scientists/researchers as online statistical analysis tool that gives more accuracy and save the time of user. The whole system and database-driven website has been designed and developed by using the software (mainly are PHP, My-SQL, Deamweaver, C++ etc.) and made available publically through a database-driven website (www.healthriskindia.in), which are very useful for researchers, academia, students, and general masses of all sectors.

  5. Ecosystem Health Assessment in Wuli Lake

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Using the method of trophic state-composite index (TSI-CI ) and the 12 months of monitoring data in 2010,we carry out initial exploration of the status of ecosystem health in Wuli Lake. First,we select four indicators,Chla,SD,TP and TN,to conduct trophic state assessment using weighted index method; then after selecting physical,chemical and biological indicators to conduct nondimensionalization processing,we calculate the composite index and conduct comprehensive assessment. The results show that in 2010,the status of ecosystem health in Wuli Lake was the best in July,worst in August; when the composite trophic state indicators with Chla as the representative increase or decrease significantly and cross different nutritional grades,TSI will significantly deviate from CI,and the relationship between the two in the other time is not prominent.

  6. Exploration Health Risks: Probabilistic Risk Assessment

    Science.gov (United States)

    Rhatigan, Jennifer; Charles, John; Hayes, Judith; Wren, Kiley

    2006-01-01

    Maintenance of human health on long-duration exploration missions is a primary challenge to mission designers. Indeed, human health risks are currently the largest risk contributors to the risks of evacuation or loss of the crew on long-duration International Space Station missions. We describe a quantitative assessment of the relative probabilities of occurrence of the individual risks to human safety and efficiency during space flight to augment qualitative assessments used in this field to date. Quantitative probabilistic risk assessments will allow program managers to focus resources on those human health risks most likely to occur with undesirable consequences. Truly quantitative assessments are common, even expected, in the engineering and actuarial spheres, but that capability is just emerging in some arenas of life sciences research, such as identifying and minimize the hazards to astronauts during future space exploration missions. Our expectation is that these results can be used to inform NASA mission design trade studies in the near future with the objective of preventing the higher among the human health risks. We identify and discuss statistical techniques to provide this risk quantification based on relevant sets of astronaut biomedical data from short and long duration space flights as well as relevant analog populations. We outline critical assumptions made in the calculations and discuss the rationale for these. Our efforts to date have focussed on quantifying the probabilities of medical risks that are qualitatively perceived as relatively high risks of radiation sickness, cardiac dysrhythmias, medically significant renal stone formation due to increased calcium mobilization, decompression sickness as a result of EVA (extravehicular activity), and bone fracture due to loss of bone mineral density. We present these quantitative probabilities in order-of-magnitude comparison format so that relative risk can be gauged. We address the effects of

  7. Assessing the performance of health technology assessment organizations: a framework.

    Science.gov (United States)

    Lafortune, Louise; Farand, Lambert; Mondou, Isabelle; Sicotte, Claude; Battista, Renaldo

    2008-01-01

    In light of growing demands for public accountability, the broadening scope of health technology assessment organizations (HTAOs) activities and their increasing role in decision-making underscore the importance for them to demonstrate their performance. Based on Parson's social action theory, we propose a conceptual model that includes four functions an organization needs to balance to perform well: (i) goal attainment, (ii) production, (iii) adaptation to the environment, and (iv) culture and values maintenance. From a review of the HTA literature, we identify specific dimensions pertaining to the four functions and show how they relate to performance. We compare our model with evaluations reported in the scientific and gray literature to confirm its capacity to accommodate various evaluation designs, contexts of evaluation, and organizational models and perspectives. Our findings reveal the dimensions of performance most often assessed and other important ones that, hitherto, remain unexplored. The model provides a flexible and theoretically grounded tool to assess the performance of HTAOs.

  8. Risk assessment and toxicology databases for health effects assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lu, P.Y.; Wassom, J.S. [Oak Ridge National Laboratory, TN (United States)

    1990-12-31

    Scientific and technological developments bring unprecedented stress to our environment. Society has to predict the results of potential health risks from technologically based actions that may have serious, far-reaching consequences. The potential for error in making such predictions or assessment is great and multiplies with the increasing size and complexity of the problem being studied. Because of this, the availability and use of reliable data is the key to any successful forecasting effort. Scientific research and development generate new data and information. Much of the scientific data being produced daily is stored in computers for subsequent analysis. This situation provides both an invaluable resource and an enormous challenge. With large amounts of government funds being devoted to health and environmental research programs and with maintenance of our living environment at stake, we must make maximum use of the resulting data to forecast and avert catastrophic effects. Along with the readily available. The most efficient means of obtaining the data necessary for assessing the health effects of chemicals is to utilize applications include the toxicology databases and information files developed at ORNL. To make most efficient use of the data/information that has already been prepared, attention and resources should be directed toward projects that meticulously evaluate the available data/information and create specialized peer-reviewed value-added databases. Such projects include the National Library of Medicine`s Hazardous Substances Data Bank, and the U.S. Air Force Installation Restoration Toxicology Guide. These and similar value-added toxicology databases were developed at ORNL and are being maintained and updated. These databases and supporting information files, as well as some data evaluation techniques are discussed in this paper with special focus on how they are used to assess potential health effects of environmental agents. 19 refs., 5 tabs.

  9. Cumulative Vehicle Routing Problems

    OpenAIRE

    Kara, &#;mdat; Kara, Bahar Yeti&#;; Yeti&#;, M. Kadri

    2008-01-01

    This paper proposes a new objective function and corresponding formulations for the vehicle routing problem. The new cost function defined as the product of the distance of the arc and the flow on that arc. We call a vehicle routing problem with this new objective function as the Cumulative Vehicle Routing Problem (CumVRP). Integer programming formulations with O(n2) binary variables and O(n2) constraints are developed for both collection and delivery cases. We show that the CumVRP is a gener...

  10. Cumulative Timers for Microprocessors

    Science.gov (United States)

    Battle, John O.

    2007-01-01

    It has been proposed to equip future microprocessors with electronic cumulative timers, for essentially the same reasons for which land vehicles are equipped with odometers (total-distance-traveled meters) and aircraft are equipped with Hobbs meters (total-engine-operating time meters). Heretofore, there has been no way to determine the amount of use to which a microprocessor (or a product containing a microprocessor) has been subjected. The proposed timers would count all microprocessor clock cycles and could only be read by means of microprocessor instructions but, like odometers and Hobbs meters, could never be reset to zero without physically damaging the chip.

  11. Assessing clinical competency in the health sciences

    Science.gov (United States)

    Panzarella, Karen Joanne

    To test the success of integrated curricula in schools of health sciences, meaningful measurements of student performance are required to assess clinical competency. This research project analyzed a new performance assessment tool, the Integrated Standardized Patient Examination (ISPE), for assessing clinical competency: specifically, to assess Doctor of Physical Therapy (DPT) students' clinical competence as the ability to integrate basic science knowledge with clinical communication skills. Thirty-four DPT students performed two ISPE cases, one of a patient who sustained a stroke and the other a patient with a herniated lumbar disc. Cases were portrayed by standardized patients (SPs) in a simulated clinical setting. Each case was scored by an expert evaluator in the exam room and then by one investigator and the students themselves via videotape. The SPs scored each student on an overall encounter rubric. Written feedback was obtained from all participants in the study. Acceptable reliability was demonstrated via inter-rater agreement as well as inter-rater correlations on items that used a dichotomous scale, whereas the items requiring the use of the 4-point rubric were somewhat less reliable. For the entire scale both cases had a significant correlation between the Expert-Investigator pair of raters, for the CVA case r = .547, p clinical competence, while done in the mind of the student, can be practiced, learned and assessed.

  12. Assessing Hmong farmers' safety and health.

    Science.gov (United States)

    de Castro, A B; Krenz, Jennifer; Neitzel, Richard L

    2014-05-01

    This pilot project investigated agricultural-related safety and health issues among Hmong refugees working on family-operated farms. Novel approaches, namely participatory rural appraisal and photovoice, were used to conduct a qualitative occupational hazard assessment with a group of Hmong farmers in Washington State. These two methods were useful in gathering participants' own perspectives about priority concerns. Several identified problems were related to musculoskeletal disorders, handling and operating heavy machinery, heat and cold stress, respiratory exposures, pest management, and socioeconomic and language concerns. Findings from this study provide insight into the work-related challenges that Hmong refugee farmers encounter and can serve as a basis for occupational health professionals to develop interventions to assist this underserved group.

  13. Assessment methods of cumulative exposure to pesticide residues in food%食品中农药残留的累积性暴露评估方法研究

    Institute of Scientific and Technical Information of China (English)

    姜官鑫; 沈国清; 唐雯佳

    2011-01-01

    The potential cumulative effect of pesticide residues has been drawn more and more attention by many national governments and consumers. A lot of research work on assessments of cumulative exposure to pesticide residues which have a common mechanism such as organophosphate and carbamate has been done by US,The Netherlands,Brazil,Denmark and other countries. The main assessment methods of cumulative exposure such as Hazard Index, Cumulative Risk Index, Reference Point Index, Margin of Exposure, Toxicity Equivalence Factors were reviewed ,and the influence of uncertain factors were analyzed.%食品中农药残留潜在的累积效应已受到许多国家政府部门以及消费者越来越多的关注.美国、荷兰、巴西、丹麦等国家都已分别对具有共同作用机制的有机磷类和氨基甲酸酯类农药残留的累积性暴露评估做了大量的研究工作.本文对危险指数(HI)、累积风险指数(CRI)、参考点指数(RPI)、暴露边界(MOE)以及毒性当量因子(TEF)等国外目前研究累积性暴露评估的主要方法进行了综述,并对不确定因素的影响进行了分析.

  14. Mobile technology for mental health assessment.

    Science.gov (United States)

    Areàn, Patricia A; Hoa Ly, Kien; Andersson, Gerhard

    2016-06-01

    Assessment and outcome monitoring are critical for the effective detection and treatment of mental illness. Traditional methods of capturing social, functional, and behavioral data are limited to the information that patients report back to their health care provider at selected points in time. As a result, these data are not accurate accounts of day-to-day functioning, as they are often influenced by biases in self-report. Mobile technology (mobile applications on smartphones, activity bracelets) has the potential to overcome such problems with traditional assessment and provide information about patient symptoms, behavior, and functioning in real time. Although the use of sensors and apps are widespread, several questions remain in the field regarding the reliability of off-the-shelf apps and sensors, use of these tools by consumers, and provider use of these data in clinical decision-making.

  15. Developing public sociology through health impact assessment.

    Science.gov (United States)

    Elliott, Eva; Williams, Gareth

    2008-11-01

    The renewed interest in 'public sociology' has sparked debate and discussion about forms of sociological work and their relationship to the State and civil society. Medical sociologists are accustomed to engaging with a range of publics and audiences inside and outside universities and are in a position to make an informed contribution to this debate. This paper describes how some of the debates about sociological work are played out through a 'health impact assessment' of a proposed housing renewal in a former coal mining community. We explore the dynamics of the health impact assessment process and relate it to wider debates, current in the social sciences, on the 'new knowledge spaces' within which contentious public issues are now being discussed, and the nature of different forms of expertise. The role of the 'public sociologist' in mediating the relationships between the accounts and interpretations of lay participants and the published 'evidence' is described as a process of mutual learning between publics, professionals and social scientists. It is argued that the continued existence and development of any meaningful 'professional sociology' requires an openness to a 'public sociology' which recognises and responds to new spaces of knowledge production.

  16. Health Technology Assessment and patient safety

    Directory of Open Access Journals (Sweden)

    Andrew Mulcahy

    2005-12-01

    Full Text Available

    Health Technology Assessment (HTA is a process used to evaluate the clinical effectiveness and costeffectiveness of health technologies by a systematic review of clinical, economic, and utilization research.

    Despite widespread investment in patient safety technologies in the U.K., U.S., and elsewhere, little HTA has been done to establish the clinical or cost-effectiveness of these technologies. The HTA and patient safety literature suggests there are four categories of patient safety HTA, including HTA for existing safety technologies, underutilized safety technologies, emerging safety technologies, as well as safety aspects of technologies with a non-safety primary purpose.

    Recent HTA and other research, including a 2002 evidencebased evaluation of patient safety technologies from the U.S. Agency for Health Research and Quality, provide an important foundation for a more comprehensive approach to patient safety HTA. However, HTA programs must address prioritization, methodology, and dissemination challenges introduced by patient safety technologies before significant progress can Te made.

  17. Lessons from San Francisco: health impact assessments have advanced political conditions for improving population health.

    Science.gov (United States)

    Bhatia, Rajiv; Corburn, Jason

    2011-12-01

    Health impact assessment is a structured decision support tool used to systematically characterize the anticipated health effects, both adverse and beneficial, of societal decisions. In San Francisco, the use of health impact assessments has not only produced evidence to inform health policy decision making but has also contributed to the political conditions needed to achieve optimal population health. Health impact assessments have helped increase public awareness of the determinants of health, routine monitoring of these determinants, cooperation among institutions, health-protective laws and regulations, and organizational networks for health advocacy and accountability. Drawing on more than a decade of local experience, we identify the direct and indirect effects of the assessments on the politics of governance as well as on health. We demonstrate that health impact assessment is both an analytic tool and a process that helps build the social institutions that can improve health.

  18. Is cumulated pyrethroid exposure associated with prediabetes?

    DEFF Research Database (Denmark)

    Hansen, Martin Rune; Jørs, Erik; Lander, Flemming;

    2014-01-01

    , cumulative exposure) was assessed from questionnaire data. Participants were asked about symptoms of diabetes. Blood samples were analyzed for glycosylated hemoglobin (HbA1c), a measure of glucose regulation. No association was found between pyrethroid exposure and diabetes symptoms. The prevalence...

  19. Bridging the gap between policy and science in assessing the health status of marine ecosystems

    Directory of Open Access Journals (Sweden)

    Angel Borja

    2016-09-01

    Full Text Available Human activities, both established and emerging, increasingly affect the provision of marine ecosystem services that deliver societal and economic benefits. Monitoring the status of marine ecosystems and determining how human activities change their capacity to sustain benefits for society requires an evidence-based Integrated Ecosystem Assessment approach that incorporates knowledge of ecosystem functioning and services. Although there are diverse methods to assess the status of individual ecosystem components, none assesses the health of marine ecosystems holistically, integrating information from multiple ecosystem components. Similarly, while acknowledging the availability of several methods to measure single pressures and assess their impacts, evaluation of cumulative effects of multiple pressures remains scarce. Therefore, an integrative assessment requires us to first understand the response of marine ecosystems to human activities and their pressures and then develop innovative, cost-effective monitoring tools that enable collection of data to assess the health status of large marine areas. Conceptually, combining this knowledge of effective monitoring methods with cost-benefit analyses will help identify appropriate management measures to improve environmental status economically and efficiently. The European project DEVOTES (DEVelopment Of innovative Tools for understanding marine biodiversity and assessing good Environmental Status specifically addressed these topics in order to support policy makers and managers in implementing the European Marine Strategy Framework Directive. Here, we synthesize our main innovative findings, placing these within the context of recent wider research, and identifying gaps and the major future challenges.

  20. Remote Sensing of Bioindicators for Forest Health Assessment

    Science.gov (United States)

    Kefauver, Shawn Carlisle

    The impacts of tropospheric ozone on forest health in Mediterranean type climates in California, USA and Catalonia, Spain were investigated using a combination of remote sensing, Geographic Information System (GIS), and field studies focused on sensitive bioindicator conifer species and ambient ozone monitoring. For the field validation of impacts of tropospheric ozone on conifer health, the Ozone Injury Index (OII) was applied to the bioindicator species Pinus ponderosa, Pinus jeffreyi, and Pinus uncinata. Combining these three tools, it was possible to build meaningful ecological models covering large areas to enhance our understanding of the biotic and abiotic interactions which affect forest health. Regression models predicting ozone injury improved considerably when incorporating ozone exposure with GIS related to plant water status, including water availability and water usage, as a proxies for estimating the stomatal conductance and ozone uptake R2=0.35, p = 0.016 in Catalonia, R2=0.36, p < 0.001 in Yosemite and R2=0.33, p = 0.007 in Sequoia/Kings Canyon National Parks in California). Individual OII components in Catalonia were modeled with improved success compared to the original full OII, in particular visible chlorotic mottling (R2=0.60, p < 0.001). The visual chlorotic mottling component of the OII was the most strongly correlated to remote sensing indices, in particular the photochemical reflectance index (PRI; R2=0.28, p=0.0044 for OIIVI-amount and R 2=0.33 and p=0.0016 for OIIVI -severity). Regression models assessing ozone injury to conifers using imaging spectroscopy techniques also improved when incorporating the GIS proxies of stomatal conductance (R 2=0.59, p<0.0001 for OII in California and R2=0.68, p<0.0001 for OIIVI in Catalonia). Finally, taking advantage of a time series of ambient ozone monitoring in Catalonia, it was found that all models improved when incorporating the cumulative exposure to ozone over a period of three years (R2=0.56, p

  1. Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners.

    Science.gov (United States)

    Springer, Andrew E; Evans, Alexandra E

    2016-01-01

    Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influence health behavior, and an implementation science perspective- one that seeks to interweave health promotion strategies into existing environmental assets, we present a basic framework for assessing environmental assets and review examples from the literature to illustrate the incorporation of environmental assets into health program design. Health promotion practitioners and researchers implicitly identify and apply environmental assets in the design and implementation of health promotion interventions;this paper provides foundation for greater intentionality in assessing environmental assets for health promotion planning.

  2. Acrylamide in Romanian food using HPLC-UV and a health risk assessment.

    Science.gov (United States)

    Oroian, Mircea; Amariei, Sonia; Gutt, Gheorghe

    2015-01-01

    The aim of this study was to investigate the level of acrylamide from coffee, potato chips and French fries in Romanian food. According to the European Food Safety Authority, coffee beans, potato chips and French fries have the highest levels of acrylamide. For this survey, 50 samples of coffee beans, 50 samples of potato chips and 25 samples of French fries were purchased from different producers from the Romanian market. Acrylamide levels have been quantified using high-performance liquid chromatography with a diode array detector (HPLC-DAD) method, using water as mobile phase. Health risk assessment was achieved by computing the average daily intake, hazard quotient, cumulative risk, carcinogenic risk and cancer risk. For coffee, potato chips and French fries, acrylamide was not shown to pose a health risk in Romanian food.

  3. Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners

    OpenAIRE

    Springer, Andrew E; Evans, Alexandra E.

    2016-01-01

    Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influenc...

  4. Health impact assessment of soil pollution

    Directory of Open Access Journals (Sweden)

    Koldo Cambra Contín

    2003-12-01

    Full Text Available The soil reflects every activity taking place on it, such as polluting industrial activities and waste disposal. Contaminated soils also may be the source of pollution of air (volatilization and suspension of particles, of surface and groundwater (leaching and running-off, and of vegetables grown there ( root and leaf absorption. The likelihood and extent of human exposure to soil contaminants depends on its accessibility to populations and, consequently, it can be altered dramatically when land use is changed at urban renewals.During the 90s health risk assessment was broadly used to evaluate the risk of contaminated soils and to set up maximum acceptable levels of pollutants in soil.

  5. Exploring Health Impact Assessment in Europe

    Directory of Open Access Journals (Sweden)

    Matthias Wismar

    2007-09-01

    Full Text Available

    Background: Health impact assessment (HIA prospectively judges the potential health impacts of pending decisions and feeds the assessment back into the decision making process. HIA is considered as a key tool for intersectoral collaboration. This article presents selected results of a mapping exercise on HIA in Europe. The mapping exercise is complemented by the presentation of a conceptual framework on the effectiveness of HIA and illustrative examples.

    Method: Two methodologies are employed in this article: First, the use of HIA across Europe is based on a survey conducted by 21 teams in 19 countries. A semi standardized questionnaire was employed, using a wide variety of sources. Second, for the discussion on the effectiveness of HIA, a conceptual framework using four types of effectiveness was employed. Results: HIA is a common practice only in a handful of European countries. In most of Europe, HIA is at an early developmental stage. The mapping exercise, however, provides evidence that HIA can work across all sectors and at all political level, although there is currently a focus on the local level. HIA is conducted in different countries by different sets of actors and organizations, reflecting the existing setup. The evidence on the effectiveness of HIA is still inconclusive. However, single case studies and upcoming evidence suggests that HIA has the capacity to inform and influence the decision making process.

    Conclusions: HIA can work and deliver. The variations in context across European countries have resulted in different forms of implementation and different dynamics of developing HIA.

  6. An Assessment of Integrated Health Management Frameworks

    Energy Technology Data Exchange (ETDEWEB)

    Lybeck, Nancy; Coble, Jamie B.; Tawfik, Magdy; Bond, Leonard J.

    2012-05-18

    In order to meet the ever increasing demand for energy, the United States nuclear industry is turning to life extension of existing nuclear power plants (NPPs). Economically ensuring the safe, secure, and reliable operation of aging NPPs presents many challenges. The 2009 Light Water Reactor Sustainability Workshop identified online monitoring of active and structural components as essential to better understanding and management of the challenges posed by aging NPPs. Additionally, there is increasing adoption of condition-based maintenance (CBM) for active components in NPPs. These techniques provide a foundation upon which a variety of advanced online surveillance, diagnostic, and prognostic techniques can be deployed to continuously monitor and assess the health of NPP systems and components. The next step in the development of advanced online monitoring is to move beyond CBM to estimating the remaining useful life of active components using prognostic tools. Deployment of prognostic health management (PHM) on the scale of an NPP requires the use of an integrated health management (IHM) framework - a software product (or suite of products) used to manage the necessary elements needed for a complete implementation of online monitoring and prognostics. This paper provides a thoughtful look at the desirable functions and features of IHM architectures. A full PHM system involves several modules, including data acquisition, system modeling, fault detection, fault diagnostics, system prognostics, and advisory generation (operations and maintenance planning). The standards applicable to PHM applications are indentified and summarized. A list of evaluation criteria for PHM software products, developed to ensure scalability of the toolset to an environment with the complexity of an NPP, is presented. Fourteen commercially available PHM software products are identified and classified into four groups: research tools, PHM system development tools, deployable architectures

  7. Study of occupation health risk assessment on Chinese coal mine

    Institute of Scientific and Technical Information of China (English)

    XIAO Guo-qing; YAN Xiang-nong

    2007-01-01

    Factors of occupation health hazard were identified and analyzed, and indexes system of occupation health risk assessment were established by applying fuzzy theory and system safety technique, the weights of index system were obtained by AHP, finally a reasonable mathematics model of occupation health risk assessment was accomplished by an example.

  8. Using Community Health Assessment to Teach and Explore Health Status Disparities

    Science.gov (United States)

    Sullivan, Marianne; Levine, Jack

    2014-01-01

    Introduction: Community health assessment (CHA) is a useful tool for identifying health status disparities at the community level. Developing the skills of master's level public health students to conduct CHA addresses a number of the Association of Schools of Public Health Core competencies for graduate public health education. Teaching…

  9. Structural Vibration Monitoring Using Cumulative Spectral Analysis

    Directory of Open Access Journals (Sweden)

    Satoru Goto

    2013-01-01

    Full Text Available This paper describes a resonance decay estimation for structural health monitoring in the presence of nonstationary vibrations. In structural health monitoring, the structure's frequency response and resonant decay characteristics are very important for understanding how the structure changes. Cumulative spectral analysis (CSA estimates the frequency decay by using the impulse response. However, measuring the impulse response of buildings is impractical due to the need to shake the building itself. In a previous study, we reported on system damping monitoring using cumulative harmonic analysis (CHA, which is based on CSA. The current study describes scale model experiments on estimating the hidden resonance decay under non-stationary noise conditions by using CSA for structural condition monitoring.

  10. A cross-cultural longitudinal examination of the effect of cumulative adversity on the mental and physical health of older adults.

    Science.gov (United States)

    Palgi, Yuval; Shrira, Amit

    2016-03-01

    Self-oriented adversity refers to traumatic events that primarily inflict the self, whereas other-oriented adversity refers to events that affect the self by primarily targeting others. The present study aimed to examine whether cultural background moderates the effects of self-oriented and other-oriented adversity on mental and physical health of older adults. Using longitudinal data from the Israeli component of the Survey of Health and Retirement, we focused on 370 Jews and 239 Arabs who reported their exposure to various adversities across the life span, and completed questionnaires regarding mental and physical health. Results showed that the effect of self-oriented adversity on health did not differ among Jews and Arabs. However, other-oriented adversity showed a stronger effect on Arabs' mental and physical health than on Jews' health. Our findings suggest that the accumulation of adverse events that affect the self by primarily targeting others may have a stronger impact in collectivist cultures than in individualist cultures.

  11. [Assessing forest ecosystem health I. Model, method, and index system].

    Science.gov (United States)

    Chen, Gao; Dai, Limin; Ji, Lanzhu; Deng, Hongbing; Hao, Zhanqing; Wang, Qingli

    2004-10-01

    Ecosystem health assessment is one of the main researches and urgent tasks of ecosystem science in 21st century. An operational definition on ecosystem health and an all-sided, simple, easy operational and standard index system, which are the foundation of assessment on ecosystem health, are necessary in obtaining a simple and applicable assessment theory and method of ecosystem health. Taking the Korean pine and broadleaved mixed forest ecosystem as an example, an originally creative idea on ecosystem health was put forward in this paper based on the idea of mode ecosystem set and the idea of forest ecosystem health, together with its assessment. This creative idea can help understand what ecosystem health is. Finally, a formula was deduced based on a new effective health assessment method--health distance (HD), which is the first time to be brought forward in China. At the same time, aiming at it's characteristics by status understanding and material health questions, a health index system of Korean pine and broadleaved mixed forest ecosystem was put forward in this paper, which is a compound ecosystem based on the compound properties of nature, economy and society. It is concrete enough to measure sub-index, so it is the foundation to assess ecosystem health of Korean pine and broadleaved mixed forest in next researches.

  12. Simulation-based assessments in health professional education: a systematic review

    Directory of Open Access Journals (Sweden)

    Ryall T

    2016-02-01

    Full Text Available Tayne Ryall,1 Belinda K Judd,2,3 Christopher J Gordon3 1Physiotherapy Department, Canberra Hospital, ACT Health, Canberra, ACT, 2Faculty of Health Sciences, 3Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia Introduction: The use of simulation in health professional education has increased rapidly over the past 2 decades. While simulation has predominantly been used to train health professionals and students for a variety of clinically related situations, there is an increasing trend to use simulation as an assessment tool, especially for the development of technical-based skills required during clinical practice. However, there is a lack of evidence about the effectiveness of using simulation for the assessment of competency. Therefore, the aim of this systematic review was to examine simulation as an assessment tool of technical skills across health professional education.Methods: A systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL, Education Resources Information Center (ERIC, Medical Literature Analysis and Retrieval System Online (Medline, and Web of Science databases was used to identify research studies published in English between 2000 and 2015 reporting on measures of validity, reliability, or feasibility of simulation as an assessment tool. The McMasters Critical Review for quantitative studies was used to determine methodological value on all full-text reviewed articles. Simulation techniques using human patient simulators, standardized patients, task trainers, and virtual reality were included.Results: A total of 1,064 articles were identified using search criteria, and 67 full-text articles were screened for eligibility. Twenty-one articles were included in the final review. The findings indicated that simulation was more robust when used as an assessment in combination with other assessment tools and when more than one simulation scenario was used. Limitations of the

  13. Health Security Intelligence: Assessing the Nascent Public Health Capability

    Science.gov (United States)

    2012-03-01

    Information Sharing System MOU Memorandum of Understanding NBIC National Biosurveillance Integration Center NCMI National Center for...definition, have come to the fore in the literature, biosurveillance and health security. Biosurveillance , as a term, is too limited to provide the...purposes. The Government Accountability Office (GAO) in a 2006 report on public health infrastructure described biosurveillance as, “…automated

  14. The Development of a Secondary School Health Assessment Model

    Science.gov (United States)

    Sriring, Srinual; Erawan, Prawit; Sriwarom, Monoon

    2015-01-01

    The objective of this research was to: 1) involved a survey of information relating to secondary school health, 2) involved the construction of a model of health assessment and a handbook for using the model in secondary school, 3) develop an assessment model for secondary school. The research included 3 phases. (1) involved a survey of…

  15. Cumulative Trauma Among Mayas Living in Southeast Florida.

    Science.gov (United States)

    Millender, Eugenia I; Lowe, John

    2016-01-04

    Mayas, having experienced genocide, exile, and severe poverty, are at high risk for the consequences of cumulative trauma that continually resurfaces through current fear of an uncertain future. Little is known about the mental health and alcohol use status of this population. This correlational study explored t/he relationship of cumulative trauma as it relates to social determinants of health (years in the United States, education, health insurance status, marital status, and employment), psychological health (depression symptoms), and health behaviors (alcohol use) of 102 Guatemalan Mayas living in Southeast Florida. The results of this study indicated that, as specific social determinants of health and cumulative trauma increased, depression symptoms (particularly among women) and the risk for harmful alcohol use (particularly among men) increased. Identifying risk factors at an early stage before serious disease or problems are manifest provides room for early screening leading to early identification, early treatment, and better outcomes.

  16. Healthy public policy--is health impact assessment the cornerstone?

    Science.gov (United States)

    Metcalfe, O; Higgins, C

    2009-04-01

    The 8th International Health Impact Assessment Conference, entitled 'Healthy public policy--is health impact assessment the cornerstone?', was hosted by the Institute of Public Health in Ireland (IPH). At the event, IPH sponsored a keynote speech to set the context of the conference and outline the importance of healthy public policy. This article presents an overview of healthy public policy and the barriers to its adoption in policy-making. Health impact assessment is one such tool to overcome the barriers, and the authors recommend the methodology as the cornerstone to healthy public policy.

  17. Cumulative Production Per Township - SaMiRa

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This dataset contains a selected township grid within the Sagebrush Mineral Resource Assessment project (SaMiRa) study area attributed with cumulative oil and gas...

  18. The public health dimension of disasters: health outcome assessment of disasters.

    NARCIS (Netherlands)

    Berg, B. van den; Grievink, L.; Gutschmidt, K.; Lang, T.; Palmer, S.; Ruijten, M.; Stumpel, R.; Yzermans, J.

    2008-01-01

    A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters. During the 15th World Congress on Disaster and Emergency Medicine in

  19. An instrument for broadened risk assessment in antenatal health care including non-medical issues

    Directory of Open Access Journals (Sweden)

    Amber Amanda Vos

    2015-03-01

    Full Text Available Introduction: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting.Methods: A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers.Results: The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined.Conclusion: The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.

  20. An instrument for broadened risk assessment in antenatal health care including non-medical issues

    Directory of Open Access Journals (Sweden)

    Amber Amanda Vos

    2015-03-01

    Full Text Available Introduction: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting. Methods: A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers. Results: The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined. Conclusion: The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.

  1. General health assessment in refugees claiming to have been tortured

    DEFF Research Database (Denmark)

    Draminsky Petersen, Hans; Christensen, Maria Elisabeth; Kastrup, Marianne;

    1994-01-01

    General health assessment of refugees claiming to have been previously exposed to torture takes place in a psychological atmosphere affected by the difficult situation of the refugee. Thirty-one refugees, mainly from the Middle East and Africa, were assessed as regards their physical and mental...... health. Assessment took place with the help of professional interpreters and was, during each interview, performed by two medical doctors using double-blind techniques. Based on a number of highly significant (P

  2. Learning about health: The pupils' and the school health nurses assessment of the health dialogue

    DEFF Research Database (Denmark)

    Borup, Ina K.

    Public health, health promotion, empowerment, experiential learning, HBSC, health survey, qualitative interviews, grounded theory, school children, adolescents, health dialouge, school health nurse......Public health, health promotion, empowerment, experiential learning, HBSC, health survey, qualitative interviews, grounded theory, school children, adolescents, health dialouge, school health nurse...

  3. Learning about health: The pupils' and the school health nurses assessment of the health dialogue

    DEFF Research Database (Denmark)

    Borup, Ina K.

    Public health, health promotion, empowerment, experiental learning, HBSC, health survey, qualitative interviews, grounded theory, school children, adolescents, health dialogue, school health nurse......Public health, health promotion, empowerment, experiental learning, HBSC, health survey, qualitative interviews, grounded theory, school children, adolescents, health dialogue, school health nurse...

  4. [Health impact assessment of building and investment projects].

    Science.gov (United States)

    Thriene, B

    2003-02-01

    For regional planning and approval procedures for building projects of a certain order of magnitude and power rating according to the German Federal Act on the Prevention of Emissions with Integrated Environmental Impact Assessment (EIA), the German public health departments, acting as public authorities, increasingly perform health impact assessments (HIA). The amended Act on Environmental Impact Assessment, the Decree on industrial plants which require approval (4th Federal Decree on Emission Prevention) and the Health Service Acts of the Federal States of Germany form the legal basis for the assessment of health issues with regard to approval procedures for building and investment projects. In the framework of the "Action Programme for the Environment and Health", the present article aims at making this process binding and to ensure responsibility and general involvement of the Public Health departments in all German Federal States. Future criteria, basic principles and procedures for single-case testing as well as assessment standards should meet these requirements. The Federal Ministry for the Environment and the Federal Ministry for Health should agree on Health Impact Assessment (HIA ) as well as on the relaxant stipulations in their procedures and general administrative regulations for implementing the Environmental Impact Assessment Act (EIA). Current EIA procedures focus on urban development and road construction, industrial investment projects, intensive animal husbandry plants, waste incineration plants, and wind energy farms. This paper illustrates examples meeting with varying degrees of public acceptance. However, being involved in the regional planning procedure for the project "Extension of the federal motorway A 14 from Magdeburg to Schwerin", the Public Health Service also shares global responsibility for health and climate protection. Demands for shortest routing conflict with objectives of environmental protection which should be given long

  5. 2011 Behavioral Health Risk Assessment Data Report (BH-RADR)

    Science.gov (United States)

    2015-09-01

    Approved for public release, distribution unlimited General Medicine: 500A, Public Health Data 2011 Behavioral Health Risk Assessment Data...REPORT DATE 30 SEP 2015 2. REPORT TYPE Annual 3. DATES COVERED 01 JAN 2011 - 31 DEC 2011 4. TITLE AND SUBTITLE 2011 Behavioral Health Risk...ABSTRACT This publication describes characteristics of Soldiers who completed a behavioral health (BH) screening at the two post-deployment Touch Points

  6. A new family of cumulative indexes for measuring scientific performance.

    Directory of Open Access Journals (Sweden)

    Marcin Kozak

    Full Text Available In this paper we propose a new family of cumulative indexes for measuring scientific performance which can be applied to many metrics, including h index and its variants (here we apply it to the h index, h(2 index and Google Scholar's i10 index. These indexes follow the general principle of repeating the index calculation for the same publication set. Using bibliometric data and reviewer scores for accepted and rejected fellowship applicants we examine how valid the cumulative variant is compared to the original variant. These analyses showed that the cumulative indexes result in higher correlations with the reviewer scores than their original variants. Thus, the cumulative indexes better reflect the assessments by peers than the original variants and are useful extensions of the original indexes. In contrast to many other measures of scientific performance proposed up to now, the cumulative indexes seem not only to be effective, but they are also easy to understand and calculate.

  7. The Health Assessment Longitudinal File imperative: foundation for improving the health of the force.

    Science.gov (United States)

    Kemper, Judith A; Donahue, Donald A; Harris, Judith S

    2003-08-01

    A smaller active duty force and an increased operational tempo have made the Reserve components (RC) essential elements in the accomplishment of the mission of the U.S. Army. One critical factor in meeting mission is maintaining the optimal health of each soldier. Baseline health data about the RC is currently not being collected, even though increasing numbers of reserve soldiers are being activated. The Annual Health Certification and Survey is being developed as a way to meet the RCs' statutory requirement for annual certification of health while at the same time generating and tracking baseline data on each reservist in a longitudinal health file, the Health Assessment Longitudinal File. This article discusses the Annual Health Certification Questionnaire/Health Assessment Longitudinal File, which will greatly enhance the Army's ability to accurately certify the health status of the RC and track health in relation to training, mission activities, and deployment.

  8. The differential impacts of episodic, chronic, and cumulative physical bullying and cyberbullying: the effects of victimization on the school experiences, social support, and mental health of rural adolescents.

    Science.gov (United States)

    Smokowski, Paul R; Evans, Caroline B R; Cotter, Katie L

    2014-01-01

    Few studies have examined the impacts of past, current, and chronic physical bullying and cyberbullying on youth, especially in rural settings. This study augments this scant literature by exploring the school experiences, social support, and mental health outcomes for rural, middle school youth. The participants for this 2-year longitudinal study were 3,127 youth from 28 middle schools. Participants were classified as nonvictims, past victims (i.e., victimized during Year 1 but not Year 2), current victims (i.e., victimized during Year 2 but not Year 1), and chronic victims (i.e., victimized during both Year 1 and Year 2). Findings illustrated that chronic victimization resulted in the lowest levels of school satisfaction, social support, future optimism, and self-esteem. Chronic victims also reported the highest levels of school hassles, perceived discrimination, peer rejection, anxiety, depression, and externalizing behaviors. In terms of episodic victimization, current year victimization was associated with worse outcomes than past year victimization. Implications and limitations were discussed.

  9. The effect evaluation of the cumulative assessment model in nursing safety control%累计考核管理模式在护理安全管理中应用的效果评价

    Institute of Scientific and Technical Information of China (English)

    谢惠兰; 罗敏; 欧阳庆; 刘玉娥; 成放群; 周利华; 胡碧波; 周扬飞; 张晓玲

    2014-01-01

    目的 探索累计考核管理模式在护理安全管理中的应用及效果评价.方法 在原有“累计扣分制”被动处罚式的管理模式的基础上逐步建立主动预防式的安全管理模式.以5个试点病房为研究对象,比较实施前后护士安全意识及患者安全文化的认知、不良事件主动报告、护理质量及患者满意度的变化情况.结果 5个试点病房的护理人员安全意识及患者安全文化的认知度提高,不良事件主动呈报率较前增多,护理质量及患者满意度提高.结论 通过建立累计考核管理模式改变了以前“扣分、批评、通报、处罚”的管理模式,强化了护士的安全认知和安全行为,构建了积极的患者安全文化氛围,采用“不惩罚”及“保密”的原则,系统地收集、分析、梳理、总结、共享不良事件信息,并着重分析系统层面、管理因素、环境因素的综合成因,逐步实现从系统的角度处理安全隐患的风险管理策略,达到前馈控制安全事件的发生,形成一个利用差错信息来提高护理质量和患者安全的主动预防式管理模式.%Objective To explore the application and the effect evaluation of cumulative assessment management model in nursing safety control.Methods The original passive punishment management such as "cumulative deduction model" was gradually transformed into active precaution safety management model.The objects of research were 5 wards that the cumulative assessment model was applied to.The results were used to compare the changes of the nurses' safety consciousness,patients' safety culture cognition,spontaneous reporting of the adverse events,nursing quality and patients satisfaction before and after the implementation of active precaution safety management.Results In the 5 wards,nurses' safety consciousness and patients' safety culture cognition were improved; the spontaneous reporting of the adverse events increased and the nursing

  10. Questioning reliability assessments of health information on social media.

    Science.gov (United States)

    Dalmer, Nicole K

    2017-01-01

    This narrative review examines assessments of the reliability of online health information retrieved through social media to ascertain whether health information accessed or disseminated through social media should be evaluated differently than other online health information. Several medical, library and information science, and interdisciplinary databases were searched using terms relating to social media, reliability, and health information. While social media's increasing role in health information consumption is recognized, studies are dominated by investigations of traditional (i.e., non-social media) sites. To more richly assess constructions of reliability when using social media for health information, future research must focus on health consumers' unique contexts, virtual relationships, and degrees of trust within their social networks.

  11. Questioning reliability assessments of health information on social media

    Science.gov (United States)

    Dalmer, Nicole K.

    2017-01-01

    This narrative review examines assessments of the reliability of online health information retrieved through social media to ascertain whether health information accessed or disseminated through social media should be evaluated differently than other online health information. Several medical, library and information science, and interdisciplinary databases were searched using terms relating to social media, reliability, and health information. While social media’s increasing role in health information consumption is recognized, studies are dominated by investigations of traditional (i.e., non-social media) sites. To more richly assess constructions of reliability when using social media for health information, future research must focus on health consumers’ unique contexts, virtual relationships, and degrees of trust within their social networks. PMID:28096748

  12. Prospect theory in the health domain: a quantitative assessment.

    Science.gov (United States)

    Attema, Arthur E; Brouwer, Werner B F; I'Haridon, Olivier

    2013-12-01

    It is well-known that expected utility (EU) has empirical deficiencies. Cumulative prospect theory (CPT) has developed as an alternative with more descriptive validity. However, CPT's full function had not yet been quantified in the health domain. This paper is therefore the first to simultaneously measure utility of life duration, probability weighting, and loss aversion in this domain. We observe loss aversion and risk aversion for gains and losses, which for gains can be explained by probabilistic pessimism. Utility for gains is almost linear. For losses, we find less weighting of probability 1/2 and concave utility. This contrasts with the common finding of convex utility for monetary losses. However, CPT was proposed to explain choices among lotteries involving monetary outcomes. Life years are arguably very different from monetary outcomes and need not generate convex utility for losses. Moreover, utility of life duration reflects discounting, causing concave utility.

  13. Integrating a quantitative risk appraisal in a health impact assessment

    DEFF Research Database (Denmark)

    Adám, Balázs; Molnár, Agnes; Gulis, Gabriel;

    2013-01-01

    BACKGROUND: Although the quantification of health outcomes in a health impact assessment (HIA) is scarce in practice, it is preferred by policymakers, as it assists various aspects of the decision-making process. This article provides an example of integrating a quantitative risk appraisal in an ...... a practical example of applying quantification in an HIA, thereby promoting its incorporation into political decision making.......BACKGROUND: Although the quantification of health outcomes in a health impact assessment (HIA) is scarce in practice, it is preferred by policymakers, as it assists various aspects of the decision-making process. This article provides an example of integrating a quantitative risk appraisal...

  14. Cumulative dietary exposure of the population of Denmark to pesticides.

    Science.gov (United States)

    Jensen, Bodil Hamborg; Petersen, Annette; Nielsen, Elsa; Christensen, Tue; Poulsen, Mette Erecius; Andersen, Jens Hinge

    2015-09-01

    We used the Hazard Index (HI) method to carry out a cumulative risk assessment after chronic dietary exposure to all monitored pesticides in fruit, vegetables and cereals for various consumer groups in Denmark. Residue data for all the pesticides were obtained from the Danish monitoring programme during the period 2004-2011. Food consumption data were obtained from DANSDA (the DAnish National Survey of Diet and physical Activity) for the period 2005-2008. The calculations were made using three different models to cope with residues below the limit of reporting (LOR). We concluded that a model that included processing factors and set non-detects to ½ LOR, but limited the correction (Model 3), gave the most realistic exposure estimate. With Model 3 the HI was calculated to be 0.44 for children and 0.18 for adults, indicating that there is no risk of adverse health effects following chronic cumulative exposure to the pesticides found in fruit, vegetables and cereals on the Danish market. The HI was below 1 even for consumers who eat more than 550 g of fruit and vegetables per day, corresponding to 1/3 of the population. Choosing Danish-produced commodities whenever possible could reduce the HI by a factor of 2.

  15. History of the international societies in health technology assessment: International Society for Technology Assessment in Health Care and Health Technology Assessment International.

    Science.gov (United States)

    Banta, David; Jonsson, Egon; Childs, Paul

    2009-07-01

    The International Society for Technology Assessment in Health Care (ISTAHC) was formed in 1985. It grew out of the increasing awareness of the international dimensions of health technology assessment (HTA) and the need for new communication methods at the international level. The main function of ISTAHC was to present an annual conference, which gradually grew in size, and also to generally improve in quality from to year. ISTAHC overextended itself financially early in the first decade of the 2000s and had to cease its existence. A new society, Health Technology Assessment international (HTAi), based on many of the same ideas and people, grew up beginning in the year 2003. The two societies have played a large role in making the field of HTA visible to people around the world and providing a forum for discussion on the methods and role of HTA.

  16. Learning about health: The pupils' and the school health nurses' assessment of the health dialogue

    DEFF Research Database (Denmark)

    Borup, Ina K.

    Public health, health promotion, empowerment, experiential learning, health behaviour in school-aged children (HBSC), health survey, qualitative interviews, grounded theory, school children......Public health, health promotion, empowerment, experiential learning, health behaviour in school-aged children (HBSC), health survey, qualitative interviews, grounded theory, school children...

  17. Mental health assessment of rape offenders

    OpenAIRE

    Sarkar, Jaydip

    2013-01-01

    There is an urgent need for development of methods of assessment and management of sex offenders (rapists, child sex offenders, other sexual offenders, and murderers) to mount a society-wide battle against the scourge of sexual offences in India. This paper provides an overview of theories, models, and assessment methods of rapists. It draws upon literature from psychiatry, psychology, criminology, probation, and ethics to provide a framework for understanding reasons behind rape, how mental ...

  18. Regional comprehensive assessment on environment-health of China

    Institute of Scientific and Technical Information of China (English)

    WANGWuyi; LIRibang; LIAOYongfeng; LIHairong; YANGLinsheng; TANJianan

    2004-01-01

    The aim of the study was to assess the environment-health development in different regions of China. 175 indicators, such as average life expectancy at birth, emission intensity of waste gas, GDP etc. were chosen to describe various aspects of the environment, health and development of China. Of all the indicators, life expectancy can sufficiently reflect health situation of population. Consequently,life expectancy was identified as key indicator, and 42 out of 175 indicators were selected for establishing the environment-health indicator framework with three grades of integrative indices to assess the development of environment-health of China. Based on the hierarchical relation between various grades of indices, the comprehensive environment-health index was calculated and contributed to classify the environment-health situation of 30 provinces, municipalities and autonomous regions in China which were divided into five grades by four predefined limits. Comprehensive assessment indicates that the environment-health situation of the eastern and coastal areas is superior to that of inland which is the western regions with underdeveloped economy and rigorous natural condition.Especially, the Qinghai-Tibet and Yunnan-Guizhou plateaus in southwestern China are most vulnerable in the environment and population health. These fit in with the pattern of national socio-economic development, which fully shows that socio-economic context plays a dominant role in the improvement of envirnment-health in China

  19. Assessing Your Weight and Health Risk

    Science.gov (United States)

    ... 0–29.9 Obesity 30.0 and Above Waist Circumference Measuring waist circumference helps screen for possible health risks that come ... Risks of Obesity-Associated Diseases by BMI and Waist Circumference provides you with an idea of whether your ...

  20. The Contribution of Health Technology Assessment, Health Needs Assessment, and Health Impact Assessment to the Assessment and Translation of Technologies in the Field of Public Health Genomics

    NARCIS (Netherlands)

    Rosenköttera, N.; Vondeling, H.; Blancquaert, I.; Mekel, O.C.L.; Kristensen, F.B.; Brand, A.

    2011-01-01

    The European Union has named genomics as one of the promising research fields for the development of new health technologies. Major concerns with regard to these fields are, on the one hand, the rather slow and limited translation of new knowledge and, on the other hand, missing insights into the im

  1. Metrics for assessing improvements in primary health care.

    Science.gov (United States)

    Stange, Kurt C; Etz, Rebecca S; Gullett, Heidi; Sweeney, Sarah A; Miller, William L; Jaén, Carlos Roberto; Crabtree, Benjamin F; Nutting, Paul A; Glasgow, Russell E

    2014-01-01

    Metrics focus attention on what is important. Balanced metrics of primary health care inform purpose and aspiration as well as performance. Purpose in primary health care is about improving the health of people and populations in their community contexts. It is informed by metrics that include long-term, meaning- and relationship-focused perspectives. Aspirational uses of metrics inspire evolving insights and iterative improvement, using a collaborative, developmental perspective. Performance metrics assess the complex interactions among primary care tenets of accessibility, a whole-person focus, integration and coordination of care, and ongoing relationships with individuals, families, and communities; primary health care principles of inclusion and equity, a focus on people's needs, multilevel integration of health, collaborative policy dialogue, and stakeholder participation; basic and goal-directed health care, prioritization, development, and multilevel health outcomes. Environments that support reflection, development, and collaborative action are necessary for metrics to advance health and minimize unintended consequences.

  2. Early Stage Health Technology Assessment for Precision Biomarkers in Oral Health and Systems Medicine

    OpenAIRE

    Steuten, Lotte M.G.

    2016-01-01

    Health technology assessment (HTA) is a crucial science that influences the responsible and evidence-based transition of new discoveries from laboratory to applications in the clinic and society. HTA has recently moved “upstream” so as to assess technologies from their onset at their discovery, design, or planning phase. Biomarker research is relatively recent in oral health, but growing rapidly with investments made to advance dentistry and oral health and importantly, to build effective bri...

  3. "Lifetime Fitness for Health" Course Assessment: Implications for Curriculum Improvement

    Science.gov (United States)

    Cardinal, Bradley J.; Cardinal, Marita K.; Burger, Molly E.

    2005-01-01

    Every other year, comprehensive school health education programs and policies are assessed nationally using the School Health Education Profile (SHEP) survey (Grunbaum et al., 1998). The data are collected in modules that are completed by different stakeholders within the school system. As part of a cooperative agreement with the Centers for…

  4. Nutrition and health technology assessment: When two worlds meet

    NARCIS (Netherlands)

    M.J. Poley (Marten)

    2015-01-01

    textabstractThere is a growing recognition that nutrition may have a positive impact on public health and that it may reduce medical expenditures. Yet, such claims need to be substantiated by evidence. This evidence could be delivered by health technology assessment (HTA), which can be thought of as

  5. Residential mental health assessment within Dutch criminal cases : A discussion

    NARCIS (Netherlands)

    van der Leij, JBJ; Jackson, JL; Malsch, M; Nijboer, JF

    2001-01-01

    In Dutch criminal cases in which doubts arise about the defendant's mental health, a forensic assessment will be requested. This is provided either by the multidisciplinary staff of residential clinics who conduct forensic evaluations for the court, or by mental health professionals contracted on a

  6. Health Impact Assessment Schiphol airport. Overview of results until 1999

    NARCIS (Netherlands)

    Franssen EAM; Lebret E; Staatsen BAM; LBM

    1999-01-01

    This report provides an English overview of the current results of the Health Impact Assessment Schiphol (HIAS) research programme. This programme consists of a series of studies with different designs. Results are rather described for each separate health end-point than by the separate studies: an

  7. Methodology of constructive technology assessment in health care

    NARCIS (Netherlands)

    Douma, Kirsten F.L.; Karsenberg, Kim; Hummel, Marjan J.M.; Bueno-de-Mesquita, Jolien M.; Harten, van Wim H.

    2007-01-01

    Objectives: Technologies in health care are evolving quickly, with new findings in the area of biotechnological and genetic research being published regularly. A health technology assessment (HTA) is often used to answer the question of whether the new technology should be implemented into clinical

  8. Selection of reproductive health end points for environmental risk assessment.

    OpenAIRE

    Savitz, D A; Harlow, S D

    1991-01-01

    In addition to the challenges inherent in environmental health risk assessment, the study of reproductive health requires thorough consideration of the very definition of reproductive risk. Researchers have yet to determine which end points need to be considered to comprehensively evaluate a community's reproductive health. Several scientific issues should be considered in the selection of end points: the severity of the outcomes, with a trade-off between clinical severity and statistical or ...

  9. Cumulative stress and autonomic dysregulation in a community sample.

    Science.gov (United States)

    Lampert, Rachel; Tuit, Keri; Hong, Kwang-Ik; Donovan, Theresa; Lee, Forrester; Sinha, Rajita

    2016-05-01

    Whether cumulative stress, including both chronic stress and adverse life events, is associated with decreased heart rate variability (HRV), a non-invasive measure of autonomic status which predicts poor cardiovascular outcomes, is unknown. Healthy community dwelling volunteers (N = 157, mean age 29 years) participated in the Cumulative Stress/Adversity Interview (CAI), a 140-item event interview measuring cumulative adversity including major life events, life trauma, recent life events and chronic stressors, and underwent 24-h ambulatory ECG monitoring. HRV was analyzed in the frequency domain and standard deviation of NN intervals (SDNN) calculated. Initial simple regression analyses revealed that total cumulative stress score, chronic stressors and cumulative adverse life events (CALE) were all inversely associated with ultra low-frequency (ULF), very low-frequency (VLF) and low-frequency (LF) power and SDNN (all p stress and chronic stress each was significantly associated with SDNN and ULF even after the highly significant contributions of age and sex, with no other covariates accounting for additional appreciable variance. For VLF and LF, both total cumulative stress and chronic stress significantly contributed to the variance alone but were not longer significant after adjusting for race and health behaviors. In summary, total cumulative stress, and its components of adverse life events and chronic stress were associated with decreased cardiac autonomic function as measured by HRV. Findings suggest one potential mechanism by which stress may exert adverse effects on mortality in healthy individuals. Primary preventive strategies including stress management may prove beneficial.

  10. Assessing the value of structural health monitoring

    DEFF Research Database (Denmark)

    Thöns, S.; Faber, Michael Havbro

    2013-01-01

    or proven by past experiences but in general there appears to be no rational or systematic approach for assessing the value of SHM systems a-priory to their implementation. The present paper addresses the assessment of the value of SHM with basis in structural risk assessments and the Bayesian pre......-posterior decision analysis. The quantification of the value of SHM builds upon the quantification of the value of information (VoI) or rather the benefit of monitoring. The suggested approach involves a probabilistic representation of the loads and environmental conditions acting on structures as well...... of the uncertainty associated with the performance of SHM on the value of SHM. Moreover, in order to illustrate the potential of the application of approach for monitoring of structural systems an optimal strategy for SHM is determined for a system comprised of three welded details. © 2013 Taylor & Francis Group...

  11. An Assessment of Environmental Health Needs for Manned Spacecraft

    Science.gov (United States)

    Macatangay, Ariel V.

    2013-01-01

    Environmental health fundamentally addresses the physical, chemical, and biological risks external to the human body that can impact the health of a person by assessing and controlling these risks in order to generate and maintain a health-supportive environment. Environmental monitoring coupled with other measures including active and passive controls and the implementation of environmental standards (SMACs, SWEGs, microbial and acoustics limits) are used to ensure environmental health in manned spacecraft. NASA scientists and engineers consider environmental monitoring a vital component to an environmental health management strategy for maintaining a healthy crew and achieving mission success. Environmental monitoring data confirms the health of ECLS systems, in addition to contributing to the management of the health of human systems. Crew health risks associated with the environment were reviewed by agency experts with the goal of determining risk-based environmental monitoring needs for future NASA manned missions. Once determined, gaps in knowledge and technology, required to address those risks, were identified for various types of Exploration missions. This agency-wide assessment of environmental health needs will help guide the activities/hardware development efforts to close those gaps and advance the knowledge required to meet NASA manned space exploration objectives. Details of this assessment and findings are presented in this paper.

  12. An overview of the mental health system in Gaza: an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS)

    OpenAIRE

    Saymah, Dyaa; Tait, Lynda; Michail, Maria

    2015-01-01

    Background: Mental health system reform is urgently needed in Gaza to respond to increasing mental health consequences of conflict. Evidence from mental health systems research is needed to inform decision-making. We aimed to provide new knowledge on current mental health policy and legislation, and services and resource use, in Gaza to identify quality gaps and areas for urgent intervention. Methods: As part of a mixed methods study, we used the World Health Organization’s Assessment Inst...

  13. Frameworks to assess health systems governance: a systematic review.

    Science.gov (United States)

    Pyone, Thidar; Smith, Helen; van den Broek, Nynke

    2017-03-03

    Governance of the health system is a relatively new concept and there are gaps in understanding what health system governance is and how it could be assessed. We conducted a systematic review of the literature to describe the concept of governance and the theories underpinning as applied to health systems; and to identify which frameworks are available and have been applied to assess health systems governance. Frameworks were reviewed to understand how the principles of governance might be operationalized at different levels of a health system. Electronic databases and web portals of international institutions concerned with governance were searched for publications in English for the period January 1994 to February 2016. Sixteen frameworks developed to assess governance in the health system were identified and are described. Of these, six frameworks were developed based on theories from new institutional economics; three are primarily informed by political science and public management disciplines; three arise from the development literature and four use multidisciplinary approaches. Only five of the identified frameworks have been applied. These used the principal-agent theory, theory of common pool resources, North's institutional analysis and the cybernetics theory. Governance is a practice, dependent on arrangements set at political or national level, but which needs to be operationalized by individuals at lower levels in the health system; multi-level frameworks acknowledge this. Three frameworks were used to assess governance at all levels of the health system. Health system governance is complex and difficult to assess; the concept of governance originates from different disciplines and is multidimensional. There is a need to validate and apply existing frameworks and share lessons learnt regarding which frameworks work well in which settings. A comprehensive assessment of governance could enable policy makers to prioritize solutions for problems identified

  14. Do patient preferences for health information vary by health literacy or numeracy? A qualitative assessment.

    Science.gov (United States)

    Gaglio, Bridget; Glasgow, Russell E; Bull, Sheana S

    2012-01-01

    Seeking health information can be a complicated process for a patient. Patients must know the topic of interest, where to look or ask, how to assess and comprehend, and how to evaluate the credibility and trustworthiness of the sources. In this study, the authors describe preferences of patients with multiple risk factors for cardiovascular disease with varying health literacy and numeracy abilities for receiving health information. Participants were recruited from 2 health care systems. Health literacy and numeracy were assessed and participants completed an orally administered survey consisting of open-ended questions about obtaining health information and preferences for health information. In-depth interviews were conducted with a subset of participants. A diverse sample of 150 individuals (11.3% Latino, 37.3% African American, 44.7% with income less than $15,000/year) participated. Most participants had adequate functional health literacy, while 65% had low numeracy skills. Regardless of health literacy or numeracy ability, participants overwhelmingly preferred to receive health information during a face-to-face conversation with their health care provider. While individuals with adequate functional health literacy identified a variety of health information sources, actions are needed to ensure multiple modalities are available and are in plain, clear language that reinforces patients' understanding and application of information to health behavior.

  15. Models and Methods for Assessing Refugee Mental Health Needs.

    Science.gov (United States)

    Deinard, Amos S.; And Others

    This background paper on refugee needs assessment discusses the assumptions, goals, objectives, strategies, models, and methods that the state refugee programs can consider in designing their strategies for assessing the mental health needs of refugees. It begins with a set of background assumptions about the ethnic profile of recent refugee…

  16. Human Health Effects, Task Force Assessment, Preliminary Report.

    Science.gov (United States)

    Aronow, Wilbert S.; And Others

    Presented in this preliminary report is one of seven assessments conducted by a special task force of Project Clean Air, the Human Health Effects Task Force. The reports summarize assessments of the state of knowledge on various air pollution problems, particularly in California, and make tentative recommendations as to what the University of…

  17. Outcomes Assessment in Accredited Health Information Management Programs

    Science.gov (United States)

    Bennett, Dorine

    2010-01-01

    The purpose of this study was to determine the use and perceived usefulness of outcomes assessment methods in health information management programs. Additional characteristics of the outcomes assessment practices were recognized. The findings were evaluated for significant differences in results based on age of the program, type of institution,…

  18. Forensic mental health assessment in France: recommendations for quality improvement.

    Science.gov (United States)

    Combalbert, Nicolas; Andronikof, Anne; Armand, Marine; Robin, Cécile; Bazex, Hélène

    2014-01-01

    The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

  19. A new adaptive testing algorithm for shortening health literacy assessments

    Directory of Open Access Journals (Sweden)

    Currie Leanne M

    2011-08-01

    Full Text Available Abstract Background Low health literacy has a detrimental effect on health outcomes, as well as ability to use online health resources. Good health literacy assessment tools must be brief to be adopted in practice; test development from the perspective of item-response theory requires pretesting on large participant populations. Our objective was to develop a novel classification method for developing brief assessment instruments that does not require pretesting on large numbers of research participants, and that would be suitable for computerized adaptive testing. Methods We present a new algorithm that uses principles of measurement decision theory (MDT and Shannon's information theory. As a demonstration, we applied it to a secondary analysis of data sets from two assessment tests: a study that measured patients' familiarity with health terms (52 participants, 60 items and a study that assessed health numeracy (165 participants, 8 items. Results In the familiarity data set, the method correctly classified 88.5% of the subjects, and the average length of test was reduced by about 50%. In the numeracy data set, for a two-class classification scheme, 96.9% of the subjects were correctly classified with a more modest reduction in test length of 35.7%; a three-class scheme correctly classified 93.8% with a 17.7% reduction in test length. Conclusions MDT-based approaches are a promising alternative to approaches based on item-response theory, and are well-suited for computerized adaptive testing in the health domain.

  20. A consumer involvement model for health technology assessment in Canada.

    Science.gov (United States)

    Pivik, Jayne; Rode, Elisabeth; Ward, Christopher

    2004-08-01

    Similar to other health policy initiatives, there is a growing movement to involve consumers in decisions affecting their treatment options. Access to treatments can be impacted by decisions made during a health technology assessment (HTA), i.e., the rigorous assessment of medical interventions such as drugs, vaccines, devices, materials, medical and surgical procedures and systems. The purpose of this paper was to empirically assess the interest and potential mechanisms for consumer involvement in HTA by identifying what health consumer organizations consider meaningful involvement, examining current practices internationally and developing a model for involvement based on identified priorities and needs. Canadian health consumer groups representing the largest disease or illness conditions reported a desire for involvement in HTA and provided feedback on mechanisms for facilitating their involvement.

  1. River Health Assessment Based on Fuzzy Matter-element Model

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    [Objective] The study aimed to assess the health state of rivers by using fuzzy matter-element model.[Method] Based on fuzzy matter-element analysis theory,the assessment model of river health was established,then a modified method to calculate the superior subordinate degree was put forward according to Hamming distance.Afterwards,a multi-level evaluation model,which contained the assessment indicators about hydrological features,ecological characteristics,environmental traits and service function,was set ...

  2. Assessment of health impacts in electricity generation and use

    Energy Technology Data Exchange (ETDEWEB)

    Morris, S.C.

    1995-11-01

    This paper describes the health effects of concern associated with electricity generation, information from which health effects can be estimated, and how the boundaries of analysis are determined. It also describes advances, new approaches, and trends in the risk assessment process. It discusses the application of these advances to comparative risk studies. Trends in the risk assessment process include more explicit characterization of quantitative uncertainty, the broader application and acceptance of Monte Carlo analysis and other numerical methods to the propagation of uncertainties through the analysis, greater realism in risk assessment, and the application of greatly increased computational capabilities.

  3. Assessing human health risk in the USDA forest service

    Energy Technology Data Exchange (ETDEWEB)

    Hamel, D.R. [Department of Agriculture-Forest Service, Washington, DC (United States)

    1990-12-31

    This paper identifies the kinds of risk assessments being done by or for the US Department of Agriculture (USDA) Forest Service. Summaries of data sources currently in use and the pesticide risk assessments completed by the agency or its contractors are discussed. An overview is provided of the agency`s standard operating procedures for the conduct of toxicological, ecological, environmental fate, and human health risk assessments.

  4. Assessment in health psychology: Introduction to the special issue.

    Science.gov (United States)

    Butt, Zeeshan

    2016-09-01

    For the past 27 years, has been committed to publishing empirical research relevant to clinical assessment of basic and applied cognition, personality, interpersonal behavior, psychopathology, forensics, and biological psychology. There is growing interest in the use of patient-centered outcomes in medical/surgical care and for measuring health care performance. Patient-centered outcome measures complement traditional clinical outcomes of morbidity and mortality, capturing the patient's perspective regarding their health and its treatment. In this issue, we highlight 11 articles that address different aspects of such work. The articles in this special issue represent both the depth and breadth of the opportunities that exist for psychological assessment in the health setting. While there are countless patient-centered measures currently in use to measure health and health outcomes, the evidence base for their use can be quite variable (Butt, 2016). The hope is that future issues of will highlight more work in this area. (PsycINFO Database Record

  5. [Assessing and evaluating physical activity during counseling in health care].

    Science.gov (United States)

    Hagströmer, Maria; Wisén, Anita; Hassmén, Peter

    2015-01-01

    To make individualized counseling possible, valid and reliable measures of physical activity are necessary. In health care, quality must be continuously secured and developed. Follow-up of life-style habits such as physical activity does not differ from monitoring of other treatment in the health care setting.  After counseling and appropriate period of time, evaluation should be done to assess if there has been any change in the physical activity level. For assessment and evaluation of physical activity in routine clinical practice the National Board for Health and Social Welfare indicator questions regarding physical activity are recommended. For a more detailed assessment and evaluation of physical activity and sedentary behavior comprehensive validated instruments/diaries should be used. For precise and objective assessment and evaluation of both physical activity and sedentary behavior, movement sensors are recommended.

  6. Airborne infection control in India: Baseline assessment of health facilities

    Science.gov (United States)

    Parmar, Malik M.; Sachdeva, K.S.; Rade, Kiran; Ghedia, Mayank; Bansal, Avi; Nagaraja, Sharath Burugina; Willis, Matthew D.; Misquitta, Dyson P.; Nair, Sreenivas A.; Moonan, Patrick K.; Dewan, Puneet K.

    2016-01-01

    Background Tuberculosis transmission in health care settings represents a major public health problem. In 2010, national airborne infection control (AIC) guidelines were adopted in India. These guidelines included specific policies for TB prevention and control in health care settings. However, the feasibility and effectiveness of these guidelines have not been assessed in routine practice. This study aimed to conduct baseline assessments of AIC policies and practices within a convenience sample of 35 health care settings across 3 states in India and to assess the level of implementation at each facility after one year. Method A multi-agency, multidisciplinary panel of experts performed site visits using a standardized risk assessment tool to document current practices and review resource capacity. At the conclusion of each assessment, facility-specific recommendations were provided to improve AIC performance to align with national guidelines. Result Upon initial assessment, AIC systems were found to be poorly developed and implemented. Administrative controls were not commonly practiced and many departments needed renovation to achieve minimum environmental standards. One year after the baseline assessments, there were substantial improvements in both policy and practice. Conclusion A package of capacity building and systems development that followed national guidelines substantially improved implementation of AIC policies and practice. PMID:26970461

  7. Editorial: Lead Risk Assessment and Health Effects.

    Science.gov (United States)

    Mielke, Howard W

    2016-06-14

    In 1980, Clair C. Patterson stated: "Sometime in the near future it probably will be shown that the older urban areas of the United States have been rendered more or less uninhabitable by the millions of tons of poisonous industrial lead residues that have accumulated in cities during the past century". We live in the near future about which this quote expressed concern. This special volume of 19 papers explores the status of scientific evidence regarding Dr. Patterson's statement on the habitability of the environments of communities. Authors from 10 countries describe a variety of lead issues in the context of large and small communities, smelter sites, lead industries, lead-based painted houses, and vehicle fuel treated with lead additives dispersed by traffic. These articles represent the microcosm of the larger health issues associated with lead. The challenges of lead risk require a concerted global action for primary prevention.

  8. Editorial: Lead Risk Assessment and Health Effects

    Directory of Open Access Journals (Sweden)

    Howard W. Mielke

    2016-06-01

    Full Text Available In 1980, Clair C. Patterson stated: “Sometime in the near future it probably will be shown that the older urban areas of the United States have been rendered more or less uninhabitable by the millions of tons of poisonous industrial lead residues that have accumulated in cities during the past century”. We live in the near future about which this quote expressed concern. This special volume of 19 papers explores the status of scientific evidence regarding Dr. Patterson’s statement on the habitability of the environments of communities. Authors from 10 countries describe a variety of lead issues in the context of large and small communities, smelter sites, lead industries, lead-based painted houses, and vehicle fuel treated with lead additives dispersed by traffic. These articles represent the microcosm of the larger health issues associated with lead. The challenges of lead risk require a concerted global action for primary prevention.

  9. Case Report Form for oral health assessments: methodological considerations

    Directory of Open Access Journals (Sweden)

    Joana Christina Carvalho

    2012-01-01

    Full Text Available Information on the oral health condition of the target population is required to enable the development of policy strategies for oral health promotion. This information needs to be substantiated by reliable data obtained through regular oral health assessments. Countries around the world have set up oral health data-registration systems that monitor the oral health of the population. These systems are either integrated in the public oral health care service or in national surveys conducted on a regular basis. This paper describes the conception and development of a Case Report Form for oral health assessments and introduces a recently developed electronic data-registration system for data capture in oral health surveys. The conception and development of a Case Report Form poses a number of challenges to be overcome. In addition to ensuring the scientific quality of its contents, several requirements need to be met. In the framework of national oral health surveys, handwritten data capture has proven accurate, but entails an important workload related to the printing and transporting of the forms, data transfer and storage of the forms, as well as the time required to perform these tasks. On the other hand, electronic data capture enables time saving and better performance. However, the advantages of this system may not be fully acknowledged by general practitioners, and their motivation to employ information and communication technologies may need to be encouraged. In the long term, the inclusion of electronic data registration in university training is probably the best strategy to achieve this.

  10. Health Impact Assessment: a useful tool for decision makers

    Directory of Open Access Journals (Sweden)

    Livia Turco

    2007-09-01

    Full Text Available Health Impact Assessment is defined as ‘the combination of procedures, methods and tools through which it is possible to evaluate a policy, a program or a development plan concerning possible effects on public health and their distribution in the general population’. In a constructive debate this definition points out some interesting observations: - health is not the result of health policies alone, but it is often defined by the attention given to it in other contexts; - health is however the result of policies and it therefore must deserve the attention of Decision Makers; - health must not be taken into consideration without taking into account an evaluation of its distribution and its determinants within a population. Particular attention must therefore be paid into inequalities; - following the Council of the European Union recent conclusions on Health in All Policies we have to consider that everyday environments such as day-care centers, schools,workplaces,neighborhoods and the commute between them have significant effects on health and that health, in turn, has an effect on the economy by enabling active and productive participation in working life. In the past 20 years huge progress has been achieved in the epidemiological contest to define risks. Nowadays, it is known that a low cultural level lowers the capacity to respond to prevention, that elevated pollution levels do represent a health risk, and that the scarce social relationships that elderly people have in our society have strong consequences on their health and their quality of life.

  11. Some insights on grassland health assessment based on remote sensing.

    Science.gov (United States)

    Xu, Dandan; Guo, Xulin

    2015-01-29

    Grassland ecosystem is one of the largest ecosystems, which naturally occurs on all continents excluding Antarctica and provides both ecological and economic functions. The deterioration of natural grassland has been attracting many grassland researchers to monitor the grassland condition and dynamics for decades. Remote sensing techniques, which are advanced in dealing with the scale constraints of ecological research and provide temporal information, become a powerful approach of grassland ecosystem monitoring. So far, grassland health monitoring studies have mostly focused on different areas, for example, productivity evaluation, classification, vegetation dynamics, livestock carrying capacity, grazing intensity, natural disaster detecting, fire, climate change, coverage assessment and soil erosion. However, the grassland ecosystem is a complex system which is formed by soil, vegetation, wildlife and atmosphere. Thus, it is time to consider the grassland ecosystem as an entity synthetically and establish an integrated grassland health monitoring system to combine different aspects of the complex grassland ecosystem. In this review, current grassland health monitoring methods, including rangeland health assessment, ecosystem health assessment and grassland monitoring by remote sensing from different aspects, are discussed along with the future directions of grassland health assessment.

  12. Some Insights on Grassland Health Assessment Based on Remote Sensing

    Directory of Open Access Journals (Sweden)

    Dandan Xu

    2015-01-01

    Full Text Available Grassland ecosystem is one of the largest ecosystems, which naturally occurs on all continents excluding Antarctica and provides both ecological and economic functions. The deterioration of natural grassland has been attracting many grassland researchers to monitor the grassland condition and dynamics for decades. Remote sensing techniques, which are advanced in dealing with the scale constraints of ecological research and provide temporal information, become a powerful approach of grassland ecosystem monitoring. So far, grassland health monitoring studies have mostly focused on different areas, for example, productivity evaluation, classification, vegetation dynamics, livestock carrying capacity, grazing intensity, natural disaster detecting, fire, climate change, coverage assessment and soil erosion. However, the grassland ecosystem is a complex system which is formed by soil, vegetation, wildlife and atmosphere. Thus, it is time to consider the grassland ecosystem as an entity synthetically and establish an integrated grassland health monitoring system to combine different aspects of the complex grassland ecosystem. In this review, current grassland health monitoring methods, including rangeland health assessment, ecosystem health assessment and grassland monitoring by remote sensing from different aspects, are discussed along with the future directions of grassland health assessment.

  13. Rapid assessment of infrastructure of primary health care facilities – a relevant instrument for health care systems management

    OpenAIRE

    2015-01-01

    Background Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health informatio...

  14. Survey of Ambient Air Pollution Health Risk Assessment Tools.

    Science.gov (United States)

    Anenberg, Susan C; Belova, Anna; Brandt, Jørgen; Fann, Neal; Greco, Sue; Guttikunda, Sarath; Heroux, Marie-Eve; Hurley, Fintan; Krzyzanowski, Michal; Medina, Sylvia; Miller, Brian; Pandey, Kiran; Roos, Joachim; Van Dingenen, Rita

    2016-09-01

    Designing air quality policies that improve public health can benefit from information about air pollution health risks and impacts, which include respiratory and cardiovascular diseases and premature death. Several computer-based tools help automate air pollution health impact assessments and are being used for a variety of contexts. Expanding information gathered for a May 2014 World Health Organization expert meeting, we survey 12 multinational air pollution health impact assessment tools, categorize them according to key technical and operational characteristics, and identify limitations and challenges. Key characteristics include spatial resolution, pollutants and health effect outcomes evaluated, and method for characterizing population exposure, as well as tool format, accessibility, complexity, and degree of peer review and application in policy contexts. While many of the tools use common data sources for concentration-response associations, population, and baseline mortality rates, they vary in the exposure information source, format, and degree of technical complexity. We find that there is an important tradeoff between technical refinement and accessibility for a broad range of applications. Analysts should apply tools that provide the appropriate geographic scope, resolution, and maximum degree of technical rigor for the intended assessment, within resources constraints. A systematic intercomparison of the tools' inputs, assumptions, calculations, and results would be helpful to determine the appropriateness of each for different types of assessment. Future work would benefit from accounting for multiple uncertainty sources and integrating ambient air pollution health impact assessment tools with those addressing other related health risks (e.g., smoking, indoor pollution, climate change, vehicle accidents, physical activity).

  15. Electro-cumulation CNF project

    CERN Document Server

    Grishin, V G

    2000-01-01

    bound or free ion current within solid substances; non-plain symmetry; cumulation of the ion interaction. Experimental result: an Ice SuperPolarization. Cold nuclear fusion ? At http://www.shortway.to/to2084 . Keywords: ion, current, solid, symmetry, cumulation, cold nuclear fusion, polarization, depolarization, ionic conductor, superionic conductor, ice, crystal, strain, V-center, V-centre, doped crystal, interstitial impurity, intrinsic color center, high pressure technology, Bridgman, experiment, crowdion, dielectric, proton, layer, defect, lattice, dynamics, electromigration, mobility, muon catalysis, concentration, doping, dopant, conductivity, pycnonuclear reaction, permittivity, dielectric constant, point defects, interstitials, polarizability, imperfection, defect centers, glass, epitaxy, sodium hydroxide, metallic substrate, crystallization, point, tip, susceptibility, ferroelectric, ordering, force, correlation, collective, shift, distortion, coalescence, crowdions, electrolysis.

  16. Cumulant expansions for atmospheric flows

    CERN Document Server

    Ait-Chaalal, Farid; Meyer, Bettina; Marston, J B

    2015-01-01

    The equations governing atmospheric flows are nonlinear, and consequently the hierarchy of cumulant equations is not closed. But because atmospheric flows are inhomogeneous and anisotropic, the nonlinearity may manifests itself only weakly through interactions of mean fields with disturbances such as thermals or eddies. In such situations, truncations of the hierarchy of cumulant equations hold promise as a closure strategy. We review how truncations at second order can be used to model and elucidate the dynamics of turbulent atmospheric flows. Two examples are considered. First, we study the growth of a dry convective boundary layer, which is heated from below, leading to turbulent upward energy transport and growth of the boundary layer. We demonstrate that a quasilinear truncation of the equations of motion, in which interactions of disturbances among each other are neglected but interactions with mean fields are taken into account, can successfully capture the growth of the convective boundary layer. Seco...

  17. Rapid Health and Needs assessments after disasters: a systematic review

    Directory of Open Access Journals (Sweden)

    Yzermans CJ

    2010-06-01

    Full Text Available Abstract Background Publichealth care providers, stakeholders and policy makers request a rapid insight into health status and needs of the affected population after disasters. To our knowledge, there is no standardized rapid assessment tool for European countries. The aim of this article is to describe existing tools used internationally and analyze them for the development of a workable rapid assessment. Methods A review was conducted, including original studies concerning a rapid health and/or needs assessment. The studies used were published between 1980 and 2009. The electronic databasesof Medline, Embase, SciSearch and Psychinfo were used. Results Thirty-three studies were included for this review. The majority of the studies was of US origin and in most cases related to natural disasters, especially concerning the weather. In eighteen studies an assessment was conducted using a structured questionnaire, eleven studies used registries and four used both methods. Questionnaires were primarily used to asses the health needs, while data records were used to assess the health status of disaster victims. Conclusions Methods most commonly used were face to face interviews and data extracted from existing registries. Ideally, a rapid assessment tool is needed which does not add to the burden of disaster victims. In this perspective, the use of existing medical registries in combination with a brief questionnaire in the aftermath of disasters is the most promising. Since there is an increasing need for such a tool this approach needs further examination.

  18. Assessment of Cumulative Trauma Disorder (CTD) Risk for 3 Different Tasks Constructing and Repairing Multi-Layer Insulation (MLI) Blankets, Preparing the Dough for a Pizza, and Operating the Becton-Dickinson FACSAria Flow Cytometer

    Science.gov (United States)

    Gentzler, Marc; Kline, Martin; Palmer, Andrew; Terrone, Mark

    2007-01-01

    The Cumulative Trauma Disorder (CTD) risks for three different tasks using McCauley-Bell and Badiru's (1993) formula based on task, personal, and organizational factors were examined. For the Multi-Layer Insulation (MLI) blanket task, the results showed that the task, personal, and organizational risks were at about the same level. The personal risk factors for this task were evaluated using a hypothetical female employee age 52. For the pizza dough task, it was shown that the organizational risk was particularly high, with task related factors also at quite dangerous levels. On the other hand, there was a very low level of personal risk factors, based on a female age 17. The flow cytometer task was assessed with three different participants, a11 of whom had quite disparate levels of personal risk, which slightly affected the overall CTD risk. This reveals how individual difference variables certainly need to be considered. The task and organizational risks for this task were rated at about the same moderate level. The overall CTD risk averaged across the three participants was .335, indicating some risk. Compruing across the tasks revealed that the pizza dough task created the greatest overall CTD risk by far (.568), with the MLI (.325) and flow cytometer task (.335) having some risk associated with them. Future research should look into different tasks for more of a comparison

  19. Identification of Cumulative Assessment Groups of Pesticides

    DEFF Research Database (Denmark)

    Nielsen, Elsa; Nørhede, Pia; Boberg, Julie

    The present document has been produced and adopted by the bodies identified above as author(s). In accordance with Article 36 of Regulation (EC) No 178/2002, this task has been carried out exclusively by the author(s) in the context of a grant agreement between the European Food Safety Authority...... and the author(s). The present document is published complying with the transparency principle to which the European Food Safety Authority is subject. It may not be considered as an output adopted by EFSA. EFSA reserves its rights, view and position as regards the issues addressed and the conclusions reached...

  20. Expanding Health Technology Assessments to Include Effects on the Environment.

    Science.gov (United States)

    Marsh, Kevin; Ganz, Michael L; Hsu, John; Strandberg-Larsen, Martin; Gonzalez, Raquel Palomino; Lund, Niels

    2016-01-01

    There is growing awareness of the impact of human activity on the climate and the need to stem this impact. Public health care decision makers from Sweden and the United Kingdom have started examining environmental impacts when assessing new technologies. This article considers the case for incorporating environmental impacts into the health technology assessment (HTA) process and discusses the associated challenges. Two arguments favor incorporating environmental impacts into HTA: 1) environmental changes could directly affect people's health and 2) policy decision makers have broad mandates and objectives extending beyond health care. Two types of challenges hinder this process. First, the nascent evidence base is insufficient to support the accurate comparison of technologies' environmental impacts. Second, cost-utility analysis, which is favored by many HTA agencies, could capture some of the value of environmental impacts, especially those generating health impacts, but might not be suitable for addressing broader concerns. Both cost-benefit and multicriteria decision analyses are potential methods for evaluating health and environmental outcomes, but are less familiar to health care decision makers. Health care is an important and sizable sector of the economy that could warrant closer policy attention to its impact on the environment. Considerable work is needed to track decision makers' demands, augment the environmental evidence base, and develop robust methods for capturing and incorporating environmental data as part of HTA.

  1. An economic assessment of population health risk in region

    Directory of Open Access Journals (Sweden)

    Nina Vladimirovna Zaytseva

    2012-06-01

    Full Text Available This paper proposes a method of economic assessment of population health risk as a tool of life qualitymanagement and qualityof labor resources in the region (as factors of a region’s economic security. The technique is based on the cost of reducing the period of disability in the implementation of population health risk and takes into account the effects of risk prevention on levels of the budgetary system of the Russian Federation. The method intends to support making decisions on planning measures to reduce population health risk at the level of regions, territories and separate objects to assess their cost-performance, optimization of investment and operating costs to reduce the population health risk and sustainable development of the territory

  2. Dynamic population health modeling for quantitative health impact assessment : Methodological foundation and selected applications

    NARCIS (Netherlands)

    S.K. Lhachimi (Stefan)

    2011-01-01

    textabstractHealth Impact Assessment (HIA) – the evaluation policies, projects, or proposals concerning their effects on human health – becomes increasingly common practice at the local, national, and EU-level. So far, no standard tool exists to aid the quantification step in HIA. This thesis propos

  3. "Sexual Health Assessment" for Mental Health and Medical Practitioners: Teaching Notes

    Science.gov (United States)

    Barratt, Barnaby B.; Rand, Marsha A.

    2009-01-01

    The importance of including sexual health assessment (SHA) within the biopsychosocial evaluations of mental health and medical practice is discussed, and various protocols available in the extant literature are reviewed. Six principles for SHA are presented as well as a model protocol consisting of six basic lines of questioning with specific…

  4. Counseling Health Psychology: Assessing Health Psychology Training within Counseling Psychology Doctoral Programs

    Science.gov (United States)

    Raque-Bogdan, Trisha L.; Torrey, Carrie L.; Lewis, Brian L.; Borges, Nicole J.

    2013-01-01

    Training directors of American Psychological Association-approved counseling psychology doctoral programs completed a questionnaire assessing (a) student and faculty involvement in health-related research, practice, and teaching; (b) health-related research conducted by students and faculty; and (c) programs' expectations and ability to…

  5. Environmental Health and Aging: Activity, Exposure and Biological Models to Improve Risk Assessment and Health Promotion

    Science.gov (United States)

    The US Environmental Protection Agency (EPA) and other public health agencies are concerned that the environmental health of America’s growing population of older adults has not been taken into consideration in current approaches to risk assessment. The reduced capacity to respo...

  6. E-health readiness assessment: promoting "hope" in the health-care institutions of Pakistan.

    Science.gov (United States)

    Khoja, Shariq; Scott, Richard; Gilani, Salman

    2008-01-01

    e-Health readiness refers to the preparedness of health-care institutions to implement programmes that involve use of Information and Communication Technology (ICT) in provision and management of health services. Level of readiness depends on a number of factors that lead to success or failure of e-health programmes, and thus increase or decrease hope of achieving the desired results. This report presents results from in-depth interviews conducted during a larger study and presents views of managers and health-care providers from various institutions in Pakistan about the usefulness of e-health readiness assessment tools. Participants emphasized the need for implementing e-health programmes in the country, while appreciating the need for readiness assessment tools, and the way these tools could avoid failures related to implementation of e-health programmes. Participants also linked e-health readiness with the process of change management, essential for sustainable implementation of e-health programmes in the health-care institutions of developing countries.

  7. Cumulative Paired φ-Entropy

    Directory of Open Access Journals (Sweden)

    Ingo Klein

    2016-07-01

    Full Text Available A new kind of entropy will be introduced which generalizes both the differential entropy and the cumulative (residual entropy. The generalization is twofold. First, we simultaneously define the entropy for cumulative distribution functions (cdfs and survivor functions (sfs, instead of defining it separately for densities, cdfs, or sfs. Secondly, we consider a general “entropy generating function” φ, the same way Burbea et al. (IEEE Trans. Inf. Theory 1982, 28, 489–495 and Liese et al. (Convex Statistical Distances; Teubner-Verlag, 1987 did in the context of φ-divergences. Combining the ideas of φ-entropy and cumulative entropy leads to the new “cumulative paired φ-entropy” ( C P E φ . This new entropy has already been discussed in at least four scientific disciplines, be it with certain modifications or simplifications. In the fuzzy set theory, for example, cumulative paired φ-entropies were defined for membership functions, whereas in uncertainty and reliability theories some variations of C P E φ were recently considered as measures of information. With a single exception, the discussions in the scientific disciplines appear to be held independently of each other. We consider C P E φ for continuous cdfs and show that C P E φ is rather a measure of dispersion than a measure of information. In the first place, this will be demonstrated by deriving an upper bound which is determined by the standard deviation and by solving the maximum entropy problem under the restriction of a fixed variance. Next, this paper specifically shows that C P E φ satisfies the axioms of a dispersion measure. The corresponding dispersion functional can easily be estimated by an L-estimator, containing all its known asymptotic properties. C P E φ is the basis for several related concepts like mutual φ-information, φ-correlation, and φ-regression, which generalize Gini correlation and Gini regression. In addition, linear rank tests for scale that

  8. Nutrition and health technology assessment: when two worlds meet

    OpenAIRE

    Poley, Marten J.

    2015-01-01

    There is a growing recognition that nutrition may have a positive impact on public health and that it may reduce medical expenditures. Yet, such claims need to be substantiated by evidence. This evidence could be delivered by health technology assessment (HTA), which can be thought of as the evaluation of technologies for clinical effectiveness, cost-effectiveness, and ethical, legal, and social impacts. The application of HTA to the field of “nutrition interventions” is recent. So far, HTA a...

  9. Assessment and treatment of dizzy patients in primary health care.

    OpenAIRE

    Ekvall-Hansson, Eva

    2006-01-01

    Dizziness is a common reason for visits to primary health care, especially among elderly patients. From a physiotherapeutic perspective, this thesis aims to study the assessment and treatment of dizzy patients in primary health care. Interventions in papers I, III and IV comprised a vestibular rehabilitation programme. In paper I, patients with multisensory dizziness were randomized to intervention group or control group. At follow-up after six weeks and three months, the intervention ...

  10. Assessing health centre systems for guiding improvement in diabetes care

    Directory of Open Access Journals (Sweden)

    Robinson Gary

    2005-08-01

    Full Text Available Abstract Background Aboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death. There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to assess the status of systems for chronic illness care in Aboriginal community health centres, and to explore whether more developed systems were associated with better quality of diabetes care. Methods This cross-sectional study was conducted in 12 Aboriginal community health centres in the Northern Territory of Australia. Assessment of Chronic Illness Care scale was adapted to measure system development in health centres, and administered by interview with health centre staff and managers. Based on a random sample of 295 clinical records from attending clients with diagnosed type 2 diabetes, processes of diabetes care were measured by rating of health service delivery against best-practice guidelines. Intermediate outcomes included the control of HbA1c, blood pressure, and total cholesterol. Results Health centre systems were in the low to mid-range of development and had distinct areas of strength and weakness. Four of the six system components were independently associated with quality of diabetes care: an increase of 1 unit of score for organisational influence, community linkages, and clinical information systems, respectively, was associated with 4.3%, 3.8%, and 4.5% improvement in adherence to process standards; likewise, organisational influence, delivery system design and clinical information systems were related to control of HbA1c, blood pressure, and total cholesterol. Conclusion The state of development of health centre systems is reflected in quality of care outcome measures for patients. The health centre systems assessment tool should be useful in assessing and guiding development of systems for improvement of

  11. Reduction of inequalities in health: assessing evidence-based tools

    Directory of Open Access Journals (Sweden)

    Shea Beverley

    2006-09-01

    Full Text Available Abstract Background The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities. Methods This paper is based on a presentation that was given at the "Regional Consultation on Policy Tools: Equity in Population Health Reports," held in Toronto, Canada in June 2002. Results Five assessment tools were presented. 1. A database of systematic reviews on the effects of educational, legal, social, and health interventions to reduce unfair inequalities is being established through the Cochrane and Campbell Collaborations. 2 Decision aids and shared decision making can be facilitated in disadvantaged groups by 'health coaches' to help people become better decision makers, negotiators, and navigators of the health system; a pilot study in Chile has provided proof of this concept. 3. The CIET Cycle: Combining adapted cluster survey techniques with qualitative methods, CIET's population based applications support evidence-based decision making at local and national levels. The CIET map generates maps directly from survey or routine institutional data, to be used as evidence-based decisions aids. Complex data can be displayed attractively, providing an important tool for studying and comparing health indicators among and between different populations. 4. The Ottawa Equity Gauge is applying the Global Equity Gauge Alliance framework to an industrialised country setting. 5 The Needs-Based Health Assessment Toolkit, established to assemble information on which clinical and health policy decisions can be based, is being expanded to ensure a focus on distribution and average health indicators. Conclusion Evidence-based planning tools have much to offer the

  12. Environment, Safety and Health Progress Assessment of the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    1992-05-01

    This report documents the result of the US Department of Energy (DOE) Environment, Safety and Health (ES&H) Progress Assessment of the Hanford Site, in Richland, Washington. The assessment, which was conducted from May 11 through May 22, 1992, included a selective-review of the ES&H management systems and programs of the responsible DOE Headquarters Program Offices the DOE Richland Field Office, and the site contractors. The ES&H Progress Assessments are part of the Secretary of Energy`s continuing effort to institutionalize line management accountability and the self-assessment process throughout DOE and its contractor organizations. The purpose of the Hanford Site ES&H Progress Assessment is to provide the Secretary with an independent assessment of the adequacy and effectiveness of the DOE and contractor management structures, resources, and systems to address ES&H problems and requirements. They are not intended to be comprehensive compliance assessments of ES&H activities. The point of reference for assessing programs at the Hanford Site was, for the most part, the Tiger Team Assessment of the Hanford Site, which was conducted from May 21 through July 18, 1990. A summary of issues and progress in the areas of environment, safety and health, and management is included.

  13. Assessing community health among indigenous populations in Ecuador with a participatory approach: implications for health reform.

    Science.gov (United States)

    Puertas, B; Schlesser, M

    2001-04-01

    Health reform is an important movement in countries throughout the region of the Americas, which could profoundly influence how basic health services are provided and who receives them. Goals of health sector reform include to improve quality, correct inefficiencies, and reduce inequities in current systems. The latter may be especially important in countries with indigenous populations, which are thought to suffer from excess mortality and morbidity related to poverty. The purpose of this paper is to report the results of a community health assessment conducted in 26 indigenous communities in the Province of Cotopaxi in rural Ecuador. It is hoped that this information will inform the health reform movement by adding to the current understanding of the health and socioeconomic situation of indigenous populations in the region while emphasizing a participatory approach toward understanding the social forces impacting upon health. This approach may serve as a model for empowering people through collective action. Recommended health reform strategies include: 1) Develop a comprehensive plan for health improvement in conjunction with stakeholders in the general population, including representatives of minority groups; 2) Conduct research on the appropriate mix between traditional medicine, primary health care strategies, and high technology medical services in relation to the needs of the general population; 3) Train local health personnel and traditional healers in primary health care techniques; 4) Improve access to secondary and tertiary health services for indigenous populations in times of emergency; and 5) Advocate for intersectoral collaboration among government institutions as well as non-governmental organizations and the private sector.

  14. Health technology assessment. Evaluation of biomedical innovative technologies.

    Science.gov (United States)

    Turchetti, Giuseppe; Spadoni, Enza; Geisler, Eliezer Elie

    2010-01-01

    This article describes health technology assessment (HTA) as an evaluation tool that applies systematic methods of inquiry to the generation and use of health technologies and new products. The focus of this article is on the contributions of HTA to the management of the new product development effort in the biomedical organization. Critical success factors (CSFs) are listed, and their role in assessing success is defined and explained. One of the conclusions of this article is that HTA is a powerful tool for managers in the biomedical sector, allowing them to better manage their innovation effort in their continuing struggle for competitiveness and survival.

  15. Health impact assessment of transport policies in Rotterdam

    DEFF Research Database (Denmark)

    Tobollik, Myriam; Keuken, Menno; Sabel, Clive E;

    2016-01-01

    BACKGROUND: Green house gas (GHG) mitigation policies can be evaluated by showing their co-benefits to health. METHOD: Health Impact Assessment (HIA) was used to quantify co-benefits of GHG mitigation policies in Rotterdam. The effects of two separate interventions (10% reduction of private vehicle......: The evaluation of planned interventions, related to climate change policies, targeting only the transport sector can result in small co-benefits for health, if the analysis is limited to air pollution and noise. This urges to expand the analysis by including other impacts, e.g. physical activity and well...

  16. Assessing Proposals for New Global Health Treaties: An Analytic Framework.

    Science.gov (United States)

    Hoffman, Steven J; Røttingen, John-Arne; Frenk, Julio

    2015-08-01

    We have presented an analytic framework and 4 criteria for assessing when global health treaties have reasonable prospects of yielding net positive effects. First, there must be a significant transnational dimension to the problem being addressed. Second, the goals should justify the coercive nature of treaties. Third, proposed global health treaties should have a reasonable chance of achieving benefits. Fourth, treaties should be the best commitment mechanism among the many competing alternatives. Applying this analytic framework to 9 recent calls for new global health treaties revealed that none fully meet the 4 criteria. Efforts aiming to better use or revise existing international instruments may be more productive than is advocating new treaties.

  17. Cumulative Environmental Management Association : Wood Buffalo Region

    Energy Technology Data Exchange (ETDEWEB)

    Friesen, B. [Syncrude Canada Ltd., Edmonton, AB (Canada)

    2001-07-01

    The recently announced oil sands development of the Wood Buffalo Region in Alberta was the focus of this power point presentation. Both mining and in situ development is expected to total $26 billion and 2.6 million barrels per day of bitumen production. This paper described the economic, social and environmental challenges facing the resource development of this region. In addition to the proposed oil sands projects, this region will accommodate the needs of conventional oil and gas production, forestry, building of pipelines and power lines, municipal development, recreation, tourism, mining exploration and open cast mining. The Cumulative Environmental Management Association (CEMA) was inaugurated as a non-profit association in April 2000, and includes 41 members from all sectors. Its major role is to ensure a sustainable ecosystem and to avoid any cumulative impacts on wildlife. Other work underway includes the study of soil and plant species diversity, and the effects of air emissions on human health, wildlife and vegetation. The bioaccumulation of heavy metals and their impacts on surface water and fish is also under consideration to ensure the quality and quantity of surface water and ground water. 3 figs.

  18. Adaptive strategies for cumulative cultural learning.

    Science.gov (United States)

    Ehn, Micael; Laland, Kevin

    2012-05-21

    The demographic and ecological success of our species is frequently attributed to our capacity for cumulative culture. However, it is not yet known how humans combine social and asocial learning to generate effective strategies for learning in a cumulative cultural context. Here we explore how cumulative culture influences the relative merits of various pure and conditional learning strategies, including pure asocial and social learning, critical social learning, conditional social learning and individual refiner strategies. We replicate the Rogers' paradox in the cumulative setting. However, our analysis suggests that strategies that resolved Rogers' paradox in a non-cumulative setting may not necessarily evolve in a cumulative setting, thus different strategies will optimize cumulative and non-cumulative cultural learning.

  19. The Algebra of the Cumulative Percent Operation.

    Science.gov (United States)

    Berry, Andrew J.

    2002-01-01

    Discusses how to help students avoid some pervasive reasoning errors in solving cumulative percent problems. Discusses the meaning of ."%+b%." the additive inverse of ."%." and other useful applications. Emphasizes the operational aspect of the cumulative percent concept. (KHR)

  20. An approach for assessing human health vulnerability and public health interventions to adapt to climate change.

    Science.gov (United States)

    Ebi, Kristie L; Kovats, R Sari; Menne, Bettina

    2006-12-01

    Assessments of the potential human health impacts of climate change are needed to inform the development of adaptation strategies, policies, and measures to lessen projected adverse impacts. We developed methods for country-level assessments to help policy makers make evidence-based decisions to increase resilience to current and future climates, and to provide information for national communications to the United Nations Framework Convention on Climate Change. The steps in an assessment should include the following: a) determine the scope of the assessment; b) describe the current distribution and burden of climate-sensitive health determinants and outcomes; c) identify and describe current strategies, policies, and measures designed to reduce the burden of climate-sensitive health determinants and outcomes; d) review the health implications of the potential impacts of climate variability and change in other sectors; e) estimate the future potential health impacts using scenarios of future changes in climate, socioeconomic, and other factors; f) synthesize the results; and g) identify additional adaptation policies and measures to reduce potential negative health impacts. Key issues for ensuring that an assessment is informative, timely, and useful include stakeholder involvement, an adequate management structure, and a communication strategy.

  1. Baltic Sea biodiversity status vs. cumulative human pressures

    DEFF Research Database (Denmark)

    Andersen, Jesper H.; Halpern, Benjamin S.; Korpinen, Samuli

    2015-01-01

    been developed to capture the consequences of multiple stressors for biodiversity, but the ability of these assessments to accurately predict biodiversity status has never been tested or ground-truthed. This relationship has similarly been assumed for the Baltic Sea, especially in areas with impaired...... status, but has also never been documented. Here we provide a first tentative indication that cumulative human impacts relate to ecosystem condition, i.e. biodiversity status, in the Baltic Sea. Thus, cumulative impact assessments offer a promising tool for informed marine spatial planning, designation...

  2. The Relation between Adolescent Self Assessment of Health and Risk Behaviours: Could a Global Measure of Health Provide Indications of Health Risk Exposures?

    Science.gov (United States)

    Nkansah-Amankra, Stephen; Walker, Ashley Dawn

    2012-01-01

    Objective: Self-rated health (SRH) has become a key organizing construct for assessing multiple dimensions of populations' physical and psychosocial health functioning. However, it is unclear how adolescents' subjective self assessment of health reflects health risk exposures, co-occurring health risks (problem behaviours) and other pre-existing…

  3. "Buddha's Light" of Cumulative Particles

    CERN Document Server

    Kopeliovich, Vladimir B; Potashnikova, Irina K

    2014-01-01

    We show analytically that in the cumulative particles production off nuclei multiple interactions lead to a glory-like backward focusing effect. Employing the small phase space method we arrived at a characteristic angular dependence of the production cross section $d\\sigma \\sim 1/ \\sqrt {\\pi - \\theta}$ near the strictly backward direction. This effect takes place for any number $n\\geq 3 $ of interactions of rescattered particle, either elastic or inelastic (with resonance excitations in intermediate states), when the final particle is produced near corresponding kinematical boundary. Such a behaviour of the cross section near the backward direction is in qualitative agreement with some of available data.

  4. A Resource Cost Aware Cumulative

    Science.gov (United States)

    Simonis, Helmut; Hadzic, Tarik

    We motivate and introduce an extension of the well-known cumulative constraint which deals with time and volume dependent cost of resources. Our research is primarily interested in scheduling problems under time and volume variable electricity costs, but the constraint equally applies to manpower scheduling when hourly rates differ over time and/or extra personnel incur higher hourly rates. We present a number of possible lower bounds on the cost, including a min-cost flow, different LP and MIP models, as well as greedy algorithms, and provide a theoretical and experimental comparison of the different methods.

  5. Assessment of time management attitudes among health managers.

    Science.gov (United States)

    Sarp, Nilgun; Yarpuzlu, Aysegul Akbay; Mostame, Fariba

    2005-01-01

    These days, working people are finding it difficult to manage their time, get more done at work, and find some balance in their work and personal lives. Successful time management is often suggested to be a product of organizing skills, however, what works for one person may not work for others. Context current competence assessment formats for physicians, health professionals, and managers during their training years reliably test core knowledge and basic skills. However, they may underemphasize some important domains of professional medical practice. Thus, in addition to assessments of basic skills, new formats that assess clinical reasoning, expert judgment, management of ambiguity, professionalism, time management, learning strategies, and teamwork to promise a multidimensional assessment while maintaining adequate reliability and validity in classic health education and health care institutional settings are needed to be worked on. It should be kept in mind that institutional support, reflection, and mentoring must accompany the development of assessment programs. This study was designed to describe the main factors that consume time, effective hours of work, time management opportunities, and attitudes and behaviors of health professionals and managers on time management concept through assessment by the assessment tool Time Management Inquiry Form (TMIQ-F). The study was conducted at the State Hospital, Social Security Hospital, and University Hospital at Kirikkale, Turkey between October 1999 and January 2000, including 143 subjects defined as medical managers and medical specialists. According to the results, a manager should give priority to the concept of planning, which may be counted among the efficient time management techniques, and educate him/herself on time management.

  6. Reproductive Health Needs Assessment of Girl and Boy Teenagers

    Directory of Open Access Journals (Sweden)

    M Shakour

    2016-11-01

    Full Text Available Background & aim: Reproductive health of puberty is very important in the cycle of Life. Adolescence is a very important period of time in cycle of life and it is followed by physical, psychological and social changes. Therefore the aim of this study was needs assessment of reproductive health for adolescence as a first and principal step in curriculum planning for health services. Methods: This study was qualitative like the most needs assessments and the method was content analysis. Data gathering was done by semi structured interview. We used two focus groups (7and 10persons for needs assessment of reproductive health between girls, and personal interview with 10 boys. We did content analysis and then extracted the main themes and sub themes. Results: Adolescent girls had diverse needs in four groups: experiences related to menstruation and hygiene, social needs, sexual needs and psychological needs. Also adolescent boys had three groups of needs like physical changes, psychological and sexual needs. In physical needs group they had some needs like no knowledge of symptoms of adolescence, no knowledge of hygiene related to puberty. In psychological needs group they had some needs like feeling depression and in sexual needs group they had some needs like tendency to make contacts with girls, no knowledge of communication with people with different sex. Conclusion: Education and the systematic planning in reproductive health matters are necessary for parents, teachers and adolescents, and they are known as the prior needs.

  7. Reimbursement of pharmaceuticals: Reference pricing versus health technology assessment

    NARCIS (Netherlands)

    M. Drummond (Michael); B. Jönsson (Bengt); F.F.H. Rutten (Frans); T. Stargardt (Tom)

    2011-01-01

    textabstractReference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market a

  8. Integrating ethics in health technology assessment: many ways to Rome

    NARCIS (Netherlands)

    Hofmann, B.; Oortwijn, W.; Lysdahl, K. Bakke; Refolo, P.; Sacchini, D.; Wilt, G.J. van der; Gerhardus, A.

    2015-01-01

    OBJECTIVES: The aim of this study was to identify and discuss appropriate approaches to integrate ethical inquiry in health technology assessment (HTA). METHODS: The key question is how ethics can be integrated in HTA. This is addressed in two steps: by investigating what it means to integrate ethic

  9. Mapping of health technology assessment in selected countries

    NARCIS (Netherlands)

    Oortwijn, W.; Broos, P.; Vondeling, H.; Banta, D.; Todorova, L.

    2013-01-01

    Objectives: The aim of this study was to develop and apply an instrument to map the level of health technology assessment (HTA) development at country level in selected countries. We examined middle-income countries (Argentina, Brazil, India, Indonesia, Malaysia, Mexico, and Russia) and countries we

  10. Assessing Health Literacy in Deaf American Sign Language Users.

    Science.gov (United States)

    McKee, Michael M; Paasche-Orlow, Michael K; Winters, Paul C; Fiscella, Kevin; Zazove, Philip; Sen, Ananda; Pearson, Thomas

    2015-01-01

    Communication and language barriers isolate Deaf American Sign Language (ASL) users from mass media, health care messages, and health care communication, which, when coupled with social marginalization, places them at a high risk for inadequate health literacy. Our objectives were to translate, adapt, and develop an accessible health literacy instrument in ASL and to assess the prevalence and correlates of inadequate health literacy among Deaf ASL users and hearing English speakers using a cross-sectional design. A total of 405 participants (166 Deaf and 239 hearing) were enrolled in the study. The Newest Vital Sign was adapted, translated, and developed into an ASL version (ASL-NVS). We found that 48% of Deaf participants had inadequate health literacy, and Deaf individuals were 6.9 times more likely than hearing participants to have inadequate health literacy. The new ASL-NVS, available on a self-administered computer platform, demonstrated good correlation with reading literacy. The prevalence of Deaf ASL users with inadequate health literacy is substantial, warranting further interventions and research.

  11. Soil Health Assessment Approaches and the Cornell Framework

    Science.gov (United States)

    van Es, Harold

    2016-04-01

    Soil health constraints beyond nutrient limitations and excesses currently limit agroecosystem productivity and sustainability, resilience to drought and extreme rainfall, and progress in soil and water conservation. With mounting pressure to produce food, feed, fiber, and even fuel for an increasing population, the concept of soil health is gaining national and international attention. Multiple regional, national, and global efforts are now leveraging that work to reach new stakeholder audiences, so that soil health management is expanding into mainstream agriculture. Each grower is generally faced with a unique situation in the choice of management options to address soil health constraints and each system affords its own set of opportunities or limitations to soil management. A more comprehensive understanding of soil health status can better guide farmers' management decisions. Until recently, there has not been a formalized decision making process for implementing a soil health management system that alleviates field-specific constrains identified through standard measurements and then maintains improved soil health. This presentation will discuss current US-based efforts related to soil health assessment, including efforts to build national consensus on appropriate methods for simple (inexpensive) and comprehensive tests. This includes the Cornell Soil Health Management Planning and Implementation Framework. The most relevant components of the framework are 1) measurement of indicators that represent critical soil processes, 2) scoring of measured values that allows for interpretation, and 3) linkage of identified constraints with management practices. Land managers can monitor changes over time through further assessment, and adapt management practices to achieve chosen goals. We will discuss the full tests and approaches for simplification.

  12. Medical health care professionals' assessments of oral health needs in children with disabilities: a qualitative study.

    Science.gov (United States)

    Hallberg, Ulrika; Klingberg, Gunilla

    2005-10-01

    Good collaboration between medical and dental care is essential to provide not only good oral health care, but also more holistic care for children with disabilities. The aim was to explore and describe medical health care professionals' assessments and considerations of orofacial problems and treatment needs in children with disabilities and in their families. In-depth interviews focusing on orofacial function were carried out with 17 medical health care employees. Interviews were transcribed verbatim and analysed in open and focused (selective) coding processes according to grounded theory. A core category was identified and named focusing on basic needs, showing that oral health care assessment was not on the agenda of medical health care professionals, but was instead viewed as a responsibility of parents or dentists. This study shows that oral health issues are not fully integrated in the medical care of children with disabilities. The omission of oral health issues from the medical agenda implies a risk of oral health problems in children with disabilities. To put the oral cavity and oral health on the medical agenda, dentists need to influence the undergraduate training of medical professionals and to initiate co-operation with the medical care system.

  13. Assessment of health promotion content in undergraduate physiotherapy curricula

    Directory of Open Access Journals (Sweden)

    Kebogile Mokwena

    2015-04-01

    Full Text Available Background: The integration of health promotion in the treatment of patients should be included in all academic curricula in primary training of health professionals. However, the extent to which health promotion is included in the various curricula at undergraduate level is not known.Objective: To assess the extent to which health promotion content is integrated in undergraduate physiotherapy training programmes in South Africa. Method: This was a qualitative and descriptive study, using in-depth interviews with representatives of physiotherapy academic departments.Results: All universities have some content of health promotion, with the weighting varying between 12% and 40%. Health promotion is taught at various levels of study, and health promotion training blocks are in both urban and rural settings and include communities, schools and old-age homes. The theories of advocacy, enabling and mediation are covered, but there is limited practical training on these elements. There are limited human resources trained in health promotion, as well as a lack of clear processes of developing and reviewing teaching and training materials.Conclusion: There is lack of consensus on the weighting of health promotion, the level at which it is taught and how it is evaluated across universities. Challenges to integrate health promotion in physiotherapy curricula include lack of frequent curricula reviews, inadequate training of lecturers and lack of conducive practical sites.The physiotherapy profession needs to reach a consensus on minimum standards for integration of health promotion in undergraduate training, and the physiotherapy professional board has the potential to provide the required leadership.

  14. Development and Implementation of Health Technology Assessment: A Policy Study

    Directory of Open Access Journals (Sweden)

    P Abooee

    2013-01-01

    Full Text Available Background: To provide an overview of the development of health technology assessment (HTA in Iran since 2007, and to facilitate further development of HTA and its integration into policy making.Methods: Data of this study were collected through key documents (e.g. literature, laws, and other official documentation and analyzed by experts of opinion in form of qualitative methods.Results: Health technology assessment entered to the political agenda in Iran only in 2007 with a strong impetus of an evidence-based medicine movement with the bellow objectives: Institutionalization of evidence-based decision making in Ministry of Health, Creating an localization for structural HTA in Health system of Iran, Setting up training courses in order to educate capable manpower to full up the capacity of the universities, Establishment of a new field in HTA subject in medical universities for MSc and PhD degree, International communication about HTA through national website and possible participation in international Congress.Conclusion: HTA has been established in the healthcare system of Iran but what is needed is a clear political will to push forward the objectives of HTA in Iran. Similar to other countries, advance the regulation on the adoption of new health technologies to improve not only technical or allocate efficiency, but also health equity.

  15. Migrants, health, and happiness: Evidence that health assessments travel with migrants and predict well-being.

    Science.gov (United States)

    Ljunge, Martin

    2016-09-01

    Health assessments correlate with health outcomes and subjective well-being. Immigrants offer an opportunity to study persistent social influences on health where the social conditions are not endogenous to individual outcomes. This approach provides a clear direction of causality from social conditions to health, and in a second stage to well-being. Natives and immigrants from across the world residing in 30 European countries are studied using survey data. The paper applies within country analysis using both linear regressions and two stage least squares. Natives' and immigrants' individual characteristics have similar predictive power for health, except Muslim immigrants who experience a sizeable health penalty. Average health reports in the immigrant's birth country have a significant association with the immigrant's current health. Almost a quarter of the birth country health variation is brought by the immigrants, while conditioning on socioeconomic characteristics. There is no evidence of the birth country predictive power declining neither as the immigrant spends more time in the residence country nor over the life course. The second stage estimates indicate that a one standard deviation improvement in health predicts higher happiness by 1.72 point or 0.82 of a standard deviation, more than four times the happiness difference of changing employment status from unemployed to employed. Studying life satisfaction yields similar results. Health improvements predict substantial increases in individual happiness.

  16. [Cumulative trauma disorders: work or professional disease?].

    Science.gov (United States)

    de Carvalho, Marcus Vitor Diniz; Cavalcanti, Francisco Ivo Dantas; Soriano, Evelyne Pessoa; de Miranda, Hênio Ferreira

    2009-06-01

    This study aimed at reviewing the Brazilian legislation applied to occupational health. It refers to the diseases embodied in the Repetition Strain Injury (RSI) and Cumulative Trauma Disorders (CTD) regarded as work or professional diseases. This analysis allowed to perform the historical evolution of legislation concerning the issue, noting that the state of the art of regulation on RSI-CTD is anchored in specific regulation present in the Normative Instruction 98/2003, that establishes the diagnostic criteria and classification of RSI-CTD. It was concluded that according to the existing legislation in Brazil, the pathologies related to RSI-CTD are considered as work diseases and their legal effects are similar to the work-related accidents.

  17. A paradox of cumulative culture.

    Science.gov (United States)

    Kobayashi, Yutaka; Wakano, Joe Yuichiro; Ohtsuki, Hisashi

    2015-08-21

    Culture can grow cumulatively if socially learnt behaviors are improved by individual learning before being passed on to the next generation. Previous authors showed that this kind of learning strategy is unlikely to be evolutionarily stable in the presence of a trade-off between learning and reproduction. This is because culture is a public good that is freely exploited by any member of the population in their model (cultural social dilemma). In this paper, we investigate the effect of vertical transmission (transmission from parents to offspring), which decreases the publicness of culture, on the evolution of cumulative culture in both infinite and finite population models. In the infinite population model, we confirm that culture accumulates largely as long as transmission is purely vertical. It turns out, however, that introduction of even slight oblique transmission drastically reduces the equilibrium level of culture. Even more surprisingly, if the population size is finite, culture hardly accumulates even under purely vertical transmission. This occurs because stochastic extinction due to random genetic drift prevents a learning strategy from accumulating enough culture. Overall, our theoretical results suggest that introducing vertical transmission alone does not really help solve the cultural social dilemma problem.

  18. Testing a health impact assessment tool by assessing community opinion about a public park.

    Science.gov (United States)

    Hengpraprom, Sarunya; Bualert, Surat; Sithisarankul, Pornchai

    2012-01-01

    The purpose of this study was to assess a health impact assessment (HIA) tool to determine the perceived health impact by the public of a public park. The authors conducted a cross-sectional study from March to April, 2011, using this HIA questionnaire to collect data and through focus group discussions. We also assessed community concerns about the park and obtained recommendations of how to mitigate possible negative aspects of the parks. Four aspects were listed as possible benefits of the park: physical, mental, social, and spiritual health. The negative aspects mentioned by participants were that a park could be a potential place of assembly for teenagers, a place for theft and crime and accidents among children. The HIA tool used for this research seemed appropriate. The next challenge is to use this tool to assess a more controversial project.

  19. Implementation of health impact assessment in Danish municipal context

    DEFF Research Database (Denmark)

    Kraemer, Stella R. J.; Nikolajsen, Louise Theilgaard; Gulis, Gabriel

    2014-01-01

    Aims: Implementation of Health Impact Assessment (HIA) in Danish municipalities has been analyzed using the Roger's Diffusion of Innovation Theory. Municipalities were chosen from among those who presented their health policies on websites according to the status of inclusion of HIA into health...... and organizational structure of a municipality, and a lack of capacities were enlisted as most relevant. The last one is a crucial factor of an internal social system of a municipality. With regards to communication channels, reporting and presentation skills of implementers and doers are of key importance....... Conclusions: Systematic and sustainable capacity building is needed to achieve high level implementation of HIA in Danish municipalities. Development of validated tools, most importantly screening tools with focus on priorities of national public health policy would enhance implementation on municipal level....

  20. Finding Qualitative Research Evidence for Health Technology Assessment.

    Science.gov (United States)

    DeJean, Deirdre; Giacomini, Mita; Simeonov, Dorina; Smith, Andrea

    2016-08-01

    Health technology assessment (HTA) agencies increasingly use reviews of qualitative research as evidence for evaluating social, experiential, and ethical aspects of health technologies. We systematically searched three bibliographic databases (MEDLINE, CINAHL, and Social Science Citation Index [SSCI]) using published search filters or "hedges" and our hybrid filter to identify qualitative research studies pertaining to chronic obstructive pulmonary disease and early breast cancer. The search filters were compared in terms of sensitivity, specificity, and precision. Our screening by title and abstract revealed that qualitative research constituted only slightly more than 1% of all published research on each health topic. The performance of the published search filters varied greatly across topics and databases. Compared with existing search filters, our hybrid filter demonstrated a consistently high sensitivity across databases and topics, and minimized the resource-intensive process of sifting through false positives. We identify opportunities for qualitative health researchers to improve the uptake of qualitative research into evidence-informed policy making.

  1. Particulate matter in urban areas: health-based economic assessment.

    Science.gov (United States)

    El-Fadel, M; Massoud, M

    2000-08-10

    The interest in the association between human health and air pollution has grown substantially in recent years. Based on epidemiological studies in several countries, there is conclusive evidence of a link between particulate air pollution and adverse health effects. Considering that particulate matter may be the most serious pollutant in urban areas and that pollution-related illness results in financial and non-financial welfare losses, the main objective of this study is to assess the economic benefits of reducing particulate air pollution in Lebanese urban areas. Accordingly, the extent and value of health benefits due to decreasing levels of particulate in the air are predicted. Health impacts are expressed in both physical and monetary terms for saved statistical lives, and productivity due to different types of morbidity endpoints. Finally, the study concludes with a range of policy options available to mitigate particulate air pollution in urban areas.

  2. Proposal for a state health technology assessment program.

    Science.gov (United States)

    Colmenares, Phil

    2012-08-01

    Evidence suggests that a significant number of medical technologies are of little or no benefit to patients. Under current budgetary pressures, state health care programs cannot afford continued spending on unnecessary medical care without further cuts in enrollment. Limiting coverage of high-tech care only to indications supported by good clinical evidence would help save state health care dollars. However, there is currently no public process to formally evaluate new medical interventions in Wisconsin. In fact, new therapies often are introduced into clinical practice, and covered by state health insurance programs, even when there is weak or questionable evidence of clinical effectiveness. This article proposes the creation of a state Health Technology Assessment program in Wisconsin to systematically evaluate new tests or treatments, and to promote evidence-based coverage decisions. Such a program would help limit wasteful spending on unnecessary technologies, reinforce good clinical practice, and protect patients from the risks of interventions that have not been proven effective.

  3. 78 FR 15023 - Office of Health Assessment and Translation Webinar on the Assessment of Data Quality in Animal...

    Science.gov (United States)

    2013-03-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Office of Health Assessment and Translation Webinar on the... quality in animal studies. The Office of Health Assessment and Translation (OHAT), Division of...

  4. Early Stage Health Technology Assessment for Precision Biomarkers in Oral Health and Systems Medicine.

    Science.gov (United States)

    Steuten, Lotte M G

    2016-01-01

    Health technology assessment (HTA) is a crucial science that influences the responsible and evidence-based transition of new discoveries from laboratory to applications in the clinic and society. HTA has recently moved "upstream" so as to assess technologies from their onset at their discovery, design, or planning phase. Biomarker research is relatively recent in oral health, but growing rapidly with investments made to advance dentistry and oral health and importantly, to build effective bridges between oral health and systems medicine since what happens in oral health affects systems pathophysiology, and vice versa. This article offers a synthesis of the latest trends and approaches in early phase HTA, with a view to near future applications in oral health, systems medicine, and biomarker-guided precision medicine. In brief, this review underscores that demonstrating health outcomes of biomarkers and next-generation diagnostics is particularly challenging because they do not always influence long-term outcomes directly, but rather impact subsequent care processes. Biomarker testing costs are typically less of a barrier to uptake in practice than the biomarker's impact on longer term health outcomes. As a single biomarker or next-generation diagnostic in oral health can inform decisions about numerous downstream diagnosis-treatment combinations, early stage "upstream" HTA is crucial in prioritizing the most valuable diagnostic applications to pursue first. For the vast array of oral health biomarkers currently developed, early HTA is necessary to timely and iteratively assess their comparative effectiveness and anticipate the inevitable questions about value for money from regulators and payers.

  5. Health Impact Assessment of an oil drilling project in California

    Directory of Open Access Journals (Sweden)

    Lindsay C. McCallum

    2016-04-01

    Full Text Available Objectives: The Health Impact Assessment (HIA was conducted to evaluate the potential community health implications of a proposed oil drilling and production project in Hermosa Beach, California. The HIA considered 17 determinants of health that fell under 6 major categories (i.e., air quality, water and soil quality, upset conditions, noise and light emissions, traffic, and community livability. Material and Methods: This paper attempts to address some of the gaps within the HIA practice by presenting the methodological approach and results of this transparent, comprehensive HIA; specifically, the evaluation matrix and decision-making framework that have been developed for this HIA and form the basis of the evaluation and allow for a clear conclusion to be reached in respect of any given health determinant (i.e., positive, negative, neutral. Results: There is a number of aspects of the project that may positively influence health (e.g., increased education funding, ability to enhance green space, and at the same time there have been potential negative effects identified (e.g., odor, blowouts, property values. Except for upset conditions, the negative health outcomes have been largely nuisance-related (e.g., odor, aesthetics without irreversible health impacts. The majority of the health determinants, that had been examined, have revealed that the project would have no substantial effect on the health of the community. Conclusions: Using the newly developed methodology and based on established mitigation measures and additional recommendations provided in the HIA, the authors have concluded that the project will have no substantial effect on community health. This approach and methodology will assist practitioners, stakeholders and decision-makers in advancing the HIA as a useful, reproducible, and informative tool.

  6. Interview: Health technology assessment in Asia: an emerging trend.

    Science.gov (United States)

    Yang, Bong-min

    2012-05-01

    Bong-min Yang, PhD (in economics), is Professor and former Dean of the School of Public Health at the Seoul National University, South Korea. Professor Yang has led research and written many papers in health economics and healthcare systems in Korea and Asia. His recent research and publications focus on the field of economic evaluation and outcomes research. He played a key role in the introduction of a formal health technology assessment system within Korean healthcare. He is currently serving as Executive Director, Institute of Health and Environment, Seoul National University. In addition to his research and publications, Professor Yang is Associate Editor for Journal of Comparative Effectiveness Research, is co-editor-in-chief for Value in Health Regional Issues, and is currently chair of the Management Advisory Board of Value in Health and a member of the editorial board of the Journal of Medical Economics. He has been a policy consultant to China, Japan, Indonesia, Hong Kong, Malaysia, Taiwan, Thailand and India. He has also worked as a short-term consultant at the WHO, ADB, UNDP and the World Bank. For the Korean government, he served as Chairperson of the Health Insurance Reform Committee, and Chairperson of the Drug Pricing and Reimbursement Committee. He is currently serving as Chair of the International Society of Pharmacoeconomics and Outcomes Research-Asia Consortium, and a member of the Board of Directors of the International Society of Pharmacoeconomics and Outcomes Research.

  7. An assessment of fiscal space for health in Bhutan.

    Science.gov (United States)

    Sharma, Jayendra

    2016-07-01

    Several factors are expected to put a strain on health financing in Bhutan. In a predominantly public-financed healthcare, ensuring that the health system gains sufficient fiscal space to ensure the sustainability of its financing is a critical policy concern. This fiscal space assessment bases its analysis on national surveys and statistics, international databases and review of official documents and reports. Assuming that the government health spending will continue to respond in the same way to growth as in the period 2002-2012, Bhutan can expect to see a robust increase in government investments in health. If elasticity of health expenditure with respect to GDP does not change significantly, projections indicate that per-capita government spending for health could more than double in the period 2012 to 2019. This increase from Ngultrum 2632 in 2012 to Ngultrum 6724 in 2019 could correspond to government health spending from 2.65% of GDP to 3.98% of GDP in the respective years. The country, however, needs to closely monitor and ensure that government investment in healthcare keeps pace with the growth of the national economy. Along with this, supplementary resources for healthcare could be explored through earmarked taxes and by generating efficiency gains. Copyright © 2015 John Wiley & Sons, Ltd.

  8. Who comes to a workplace health risk assessment?

    Science.gov (United States)

    Dobbins, T A; Simpson, J M; Oldenburg, B; Owen, N; Harris, D

    1998-01-01

    Workplace health promotion initiatives have proliferated, but there are difficulties in recruiting employees of lower socioeconomic status and at higher risk of disease. A survey of health behaviors and attitudes was administered in 20 worksites and the opportunity to attend a health risk assessment promoted. Those more likely to attend were women, those of higher occupational prestige, and those from a non-English-speaking background. After adjustment for these variables, the only health behavior associated with attendance was smoking status. Perceived risk of lung cancer was significant, even after adjustment for smoking status. Stage of readiness to change health behaviors was associated with attendance, with those in the preparation stage being more likely to attend than those in the precontemplation stage. However, this association was statistically significant only for fruit and vegetable consumption. There was no relation between attendance and support for health promotion, perceived general health, or other perceived risk of disease. These findings suggest that additional risk communication strategies and environmental support are required to involve those with less prestigious occupations.

  9. The Effects of Parental Health Shocks on Adult Offspring Smoking Behavior and Self-Assessed Health.

    Science.gov (United States)

    Darden, Michael; Gilleskie, Donna

    2016-08-01

    An important avenue for smoking deterrence may be through familial ties if adult smokers respond to parental health shocks. In this paper, we merge the Original Cohort and the Offspring Cohort of the Framingham Heart Study to study how adult offspring smoking behavior and subjective health assessments vary with elder parent smoking behavior and health outcomes. These data allow us to model the smoking behavior of adult offspring over a 30-year period contemporaneously with parental behaviors and outcomes. We find strong 'like father, like son' and 'like mother, like daughter' correlations in smoking behavior. We find that adult offspring significantly curtail their own smoking following an own health shock; however, we find limited evidence that offspring smoking behavior is sensitive to parent health, with the notable exception that women significantly reduce both their smoking participation and intensity following a smoking-related cardiovascular event of a parent. We also model the subjective health assessment of adult offspring as a function of parent health, and we find that women report significantly worse health following the smoking-related death of a parent. Copyright © 2015 John Wiley & Sons, Ltd.

  10. Exposure assessment in studies on health effects of traffic exhaust

    Energy Technology Data Exchange (ETDEWEB)

    Setaelae, S. [Association for the Pulmonary Disabled, Helsinki (Finland); Jaakkola, J.J.K. [Helsinki Univ. (Finland). Dept. of Public Health

    1995-12-31

    A main source of outdoor air pollution is road traffic, which produces a complex mixture of nitrogen oxides, carbon monoxide, volatile hydrocarbons, airborne particles and some other compounds. Traffic exhaust affects also the concentrations of ozone and other photo chemical oxidants. In earlier studies those components have had remarkable health effects. Several studies on occupational exposure to automobile exhaust have been published and several studies have been observed an association between both outdoor and indoor pollutant levels and health outcomes. However, there are only a few epidemiological studies in which traffic exhaust, a complex mixture, has been studied in its entirety. During recent years, interesting epidemiological studies of the health effects of this complex mixture have been published. Human exposure assessment for traffic exhaust can be categorized according to the environment of exposure (indoors, outdoors, in-traffic) or to the method of exposure assessment (direct or indirect methods). In this presentation the methods are further categorized into (1) traffic activity, (2) air concentration measurements, and (3) dispersion models, in order to better understand the advantages and disadvantages of different approaches. The objective of this presentation is to make a critical review of exposure assessments in the epidemiological studies on health effects of traffic exhaust. (author)

  11. Can migration health assessments become a mechanism for global public health good?

    Science.gov (United States)

    Wickramage, Kolitha; Mosca, Davide

    2014-09-26

    Migrant health assessments (HAs) consist of a medical examination to assess a migrant's health status and to provide medical clearance for work or residency based on conditions defined by the destination country and/or employer. We argue that better linkages between health systems and migrant HA processors at the country level are needed to shift these from being limited as an instrument of determining non-admissibility for purposes of visa issuance, to a process that may enhance public health. The importance of providing appropriate care and follow-up of migrants who "fail" their HA and the need for global efforts to enable data-collection and research on HAs are also highlighted.

  12. The Stanford Health Assessment Questionnaire: Dimensions and Practical Applications

    Directory of Open Access Journals (Sweden)

    Fries James F

    2003-06-01

    Full Text Available Abstract The ability to effectively measure health-related quality-of-life longitudinally is central to describing the impacts of disease, treatment, or other insults, including normal aging, upon the patient. Over the last two decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements, such as erythrocyte sedimentation rate, lipid profiles, or radiographs, to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ, published in 1980, was among the first instruments based on generic, patient-centered dimensions. The HAQ was designed to represent a model of patient-oriented outcome assessment and has played a major role in many diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA, quantification of NSAID gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. Evidenced by its use over the past two decades in diverse settings, the HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It is available in more than 60 languages and is supported by a bibliography of more than 500 references. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. In this article, information regarding the HAQ's development, content, dissemination and reference sources for its uses, translations, and validations are provided.

  13. Acquired and Participatory Competencies in Health Professions Education: Definition and Assessment in Global Health.

    Science.gov (United States)

    Eichbaum, Quentin

    2016-09-06

    Many health professions education programs in high-income countries (HICs) have adopted a competency-based approach to learning. Although global health programs have followed this trend, defining and assessing competencies has proven problematic, particularly in resource-constrained settings of low- and middle-income countries (LMICs) where HIC students and trainees perform elective work. In part, this is due to programs failing to take sufficient account of local learning, cultural, and health contexts.A major divide between HIC and LMIC settings is that the learning contexts of HICs are predominantly individualist, whereas those of LMICs are generally collectivist. Individualist cultures view learning as something that the individual acquires independent of context and can possess; collectivist cultures view learning as arising dynamically from specific contexts through group participation.To bridge the individualist-collectivist learning divide, the author proposes that competencies be classified as either acquired or participatory. Acquired competencies can be transferred across contexts and assessed using traditional psychometric approaches; participatory competencies are linked to contexts and require alternative assessment approaches. The author proposes assessing participatory competencies through the approach of self-directed assessment seeking, which includes multiple members of the health care team as assessors.The proposed classification of competencies as acquired or participatory may apply across health professions. The author suggests advancing participatory competencies through mental models of sharing. In global health education, the author recommends developing three new competency domains rooted in participatory learning, collectivism, and sharing: resourceful learning; transprofessionalism and transformative learning; and social justice and health equity.

  14. Forest ecosystem health assessment and analysis in China

    Institute of Scientific and Technical Information of China (English)

    XIAOFengjin; OUYANGHua; ZHANGQiang; FUBojie; ZHANGZhicheng

    2004-01-01

    Based on more than 300 forest sample plots surveying data and forestry statistical data, remote sensing information from the NOAA AVHRR database and the daily meteorological data of 300 stations, we selected vigor, organization and resilience as the indicators to assess large-scale forest ecosystem health in China and analyzed the spatial pattern of forest ecosystem health and influencing factors. The results of assessment indicated that the spatial pattern of forest ecosystem health showed a decreasing trend along latitude gradients and longitude gradients. The healthy forests are mainly distributed in natural forests, tropical rainforests and seasonal rainforests; secondarily orderly in northeast national forest zone, subtropical forest zonation and southwest forest zonation; while the unhealthy forests were mainly located in warm temperate zone and Xinjiang-Mongolia forest zone. The coefficient of correction between Forest Ecosystem Health Index (FEHI) and annual average precipitation was 0.58 (p<0.01), while the coefficient of correlation between FEHI and annual mean temperatures was 0.49 (p<0.01), which identified that the precipitation and temperatures affect the pattern of FEHI, and the precipitation's effect was stronger than the temperature's. We also measured the correlation coefficient between FEHI and NPP, biodiversity and resistance, which were 0.64, 0.76 and 0.81 (p<0.01) respectively. The order of effect on forest ecosystem health was vigor, organization and resistance.

  15. Human health risk assessment of heavy metals in urban stormwater.

    Science.gov (United States)

    Ma, Yukun; Egodawatta, Prasanna; McGree, James; Liu, An; Goonetilleke, Ashantha

    2016-07-01

    Toxic chemical pollutants such as heavy metals (HMs) are commonly present in urban stormwater. These pollutants can pose a significant risk to human health and hence a significant barrier for urban stormwater reuse. The primary aim of this study was to develop an approach for quantitatively assessing the risk to human health due to the presence of HMs in stormwater. This approach will lead to informed decision making in relation to risk management of urban stormwater reuse, enabling efficient implementation of appropriate treatment strategies. In this study, risks to human health from heavy metals were assessed as hazard index (HI) and quantified as a function of traffic and land use related parameters. Traffic and land use are the primary factors influencing heavy metal loads in the urban environment. The risks posed by heavy metals associated with total solids and fine solids (heavy metal does not pose a significant risk, the presence of multiple heavy metals could be detrimental to human health. These findings suggest that stormwater guidelines should consider the combined risk from multiple heavy metals rather than the threshold concentration of an individual species. Furthermore, it was found that risk to human health from heavy metals in stormwater is significantly influenced by traffic volume and the risk associated with stormwater from industrial areas is generally higher than that from commercial and residential areas.

  16. Stakeholder participation in health impact assessment: A multicultural approach

    Energy Technology Data Exchange (ETDEWEB)

    Negev, Maya, E-mail: mayane@tau.ac.il [Hartog School of Government and Policy, Faculty of Social Sciences, Tel Aviv University, P.O.B. 39040, Tel Aviv 69978 (Israel); Davidovitch, Nadav, E-mail: nadavd@bgu.ac.il [Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University, P.O.B. 653, Be' er Sheva 84105 (Israel); Garb, Yaakov, E-mail: ygarb@bgu.ac.il [Swiss Institute for Dryland Environmental Research, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Sede Boqer 84990 (Israel); Tal, Alon, E-mail: alontal@bgu.ac.il [Mitrani Department of Dryland Ecology, Swiss Institute for Dryland Environmental Research, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Sede Boqer 84990 (Israel)

    2013-11-15

    The literature on impact assessment (HIA) registers the importance of stakeholder participation in the assessment process, but still lacks a model for engaging stakeholders of diverse ethnic, professional and sectorial backgrounds. This paper suggests that the multicultural approach can contribute to HIA through a revision of the generic 5-step HIA model, and its implementation in a metropolitan plan in Southern Israel. The health issue scoped by the stakeholders in the HIA is related to land uses in the vicinity of the national hazardous industry and hazardous waste site. The stakeholders were representatives of the diverse populations at stake, including rural Bedouins and Jewish city dwellers, as well as representatives from the public sector, private sector, non-governmental organizations and academia. The case study revealed that a multicultural stakeholder participation process helps to uncover health issues known to the community which were not addressed in the original plan, and provides local knowledge regarding health conditions that is especially valuable when scientific data is uncertain or absent. It enables diverse stakeholders to prioritize the health issues that will be assessed. The case study also reveals ways in which the model needs revisions and improvements such as in recruitment of diverse participants. This paper presents a multicultural model of HIA and discusses some of the challenges that are faced when HIA is implemented in the context of current decision-making culture. -- Highlights: • We revised the generic HIA model in light of the multicultural approach. • We tested the model in a case study of zoning a hazardous industry site. • Multicultural stakeholder participation uncovers health issues known to communities. • It enables community prioritization of health issues. • We present a model for multicultural stakeholder participation in HIA.

  17. Health Equity Assessment Toolkit (HEAT: software for exploring and comparing health inequalities in countries

    Directory of Open Access Journals (Sweden)

    Ahmad Reza Hosseinpoor

    2016-10-01

    Full Text Available Abstract Background It is widely recognised that the pursuit of sustainable development cannot be accomplished without addressing inequality, or observed differences between subgroups of a population. Monitoring health inequalities allows for the identification of health topics where major group differences exist, dimensions of inequality that must be prioritised to effect improvements in multiple health domains, and also population subgroups that are multiply disadvantaged. While availability of data to monitor health inequalities is gradually improving, there is a commensurate need to increase, within countries, the technical capacity for analysis of these data and interpretation of results for decision-making. Prior efforts to build capacity have yielded demand for a toolkit with the computational ability to display disaggregated data and summary measures of inequality in an interactive and customisable fashion that would facilitate interpretation and reporting of health inequality in a given country. Methods To answer this demand, the Health Equity Assessment Toolkit (HEAT, was developed between 2014 and 2016. The software, which contains the World Health Organization’s Health Equity Monitor database, allows the assessment of inequalities within a country using over 30 reproductive, maternal, newborn and child health indicators and five dimensions of inequality (economic status, education, place of residence, subnational region and child’s sex, where applicable. Results/Conclusion HEAT was beta-tested in 2015 as part of ongoing capacity building workshops on health inequality monitoring. This is the first and only application of its kind; further developments are proposed to introduce an upload data feature, translate it into different languages and increase interactivity of the software. This article will present the main features and functionalities of HEAT and discuss its relevance and use for health inequality monitoring.

  18. Health actions prompted by health assessments for people with intellectual disability exceed actions recorded in general practitioners' records.

    Science.gov (United States)

    Byrne, Jacqueline H; Ware, Robert S; Lennox, Nicholas G

    2015-01-01

    People with intellectual disability experience inadequate health care and have unmet health needs that can go unidentified or be poorly managed. Health assessments have been shown to significantly increase short-term clinical activity for people with intellectual disability. The aim of this study was to more accurately quantify the effect of health assessments for people with intellectual disability by comparing health actions recorded in health assessment booklets to actions recorded in general practitioners' (GPs) records in the 12-month period following the health assessment. Participants were people with intellectual disability who had received a Comprehensive Health Assessment Program (CHAP), living in the community. The CHAP is a health assessment that is demonstrated to significantly increase health actions, compared with usual care, for people with intellectual disability. Data collected from three randomised controlled trials conducted in South-East Queensland, Australia, from 2000 to 2010 were pooled and analysed. The health assessment booklet contained significantly more information on health actions than GPs' records. Notably, hearing tests (risk ratio (RR) = 5.9; 95% confidence interval (CI) = 4.7-7.4), breast checks (RR = 3.9; 95% CI = 2.7-5.7), and skin examinations (RR = 7.9; 95% CI = 5.9-10.7) were more likely to be recorded in the CHAP booklet. Health assessments increase health actions for people with intellectual disability to a significantly greater extent than previously demonstrated.

  19. Complex health care interventions: Characteristics relevant for ethical analysis in health technology assessment.

    Science.gov (United States)

    Lysdahl, Kristin Bakke; Hofmann, Bjørn

    2016-01-01

    Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA) literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1) multiple and changing perspectives, 2) indeterminate phenomena, 3) uncertain causality, 4) unpredictable outcome, and 5) ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.

  20. Developing a tool for assessing public health law in countries.

    Science.gov (United States)

    Kim, So Yoon; Lee, Yuri; Sohn, Myongsei; Hahm, Ki-Hyun

    2012-09-01

    At present, the World Health Organization (WHO) is in the process of developing a tool designed to assess the status of public health legislation in a given country. An Expert Consultation on Public Health Law was convened in Manila, Philippines, in May 2011. The participants agreed that the tool could serve as a guide for a regional approach to assist Member States in assessing the scope, completeness, and adequacy of their public health law. Given the broad definition of "public health" and the laws that affect health, directly or indirectly, the participants further agreed to narrow the field to 4 areas based on significant WHO works/policies, each organized into an independent module: (1) International Digest on Health Law, (2) Primary Health Care, (3) International Health Regulations 2005, and (4) Framework Convention on Tobacco Control. The tool would be drafted in a questionnaire format that asks the respondent to determine whether primary and/or subsidiary legislation exists in the country on a specific topic and, if so, to cite the relevant law, describe the pertinent points, and attach and/or link to the full text where available. The participants agreed that the respondents should include government officials and/or academics with legal competency. Version 1 of the tool was piloted in the Philippines, the Republic of Korea, Samoa, and Vanuatu. At a 2nd Expert Consultation on Public Health Law, convened in Incheon, Republic of Korea, in October 2011, in conjunction with the 43rd Conference of the Asia-Pacific Academic Consortium on Public Health, the participants determined that the tool was generally usable, certain concerns notwithstanding, such as the risk of standardizing compliance with WHO policies. The agreed next step is to finalize the analysis tool by August 2012, marking the end of stage I in the development process. Stage II will consist of team building and networking of responsible officers and/or professionals in the countries. The tool

  1. Health risk assessment of exposures to a high molecular weight plasticizer present in automobile interiors.

    Science.gov (United States)

    Perez, Angela L; Liong, Monty; Plotkin, Kevin; Rickabaugh, Keith P; Paustenbach, Dennis J

    2017-01-01

    This study provides an exposure and risk assessment of diundecyl phthalate (DUP), a high molecular weight phthalate plasticizer present in automobile interiors. Total daily intake of DUP was calculated from DUP measured in wipe samples from vehicle seats from six automobiles. Four of the vehicles exhibited atypical visible surface residue on the seats. Two vehicles with no visible surface residue were sampled as a comparison. DUP was the predominant organic compound identified in each of the wipes from all seats. A risk assessment of DUP via oral, dermal, and inhalation routes resulting from contact with automobile seats was conducted. The mean, standard deviation, and maximum DUP concentrations on the seats with visible surface residue were 6983 ± 7823 μg/100 cm(2) and 38300 μg/100 cm(2), respectively. The mean and 95th percentile of the mean for daily cumulative dose of DUP for all exposure routes for the seats with no visible surface residue ranged from 7 × 10(-4) to 4 × 10(-3) mg/kg-day and from 8 × 10(-4) to 5 × 10(-3) mg/kg-day, respectively. For seats with visible surface residue, cumulative doses ranged from 2 × 10(-3) to 2 × 10(-2) mg/kg-day and from 4 × 10(-3) to 2 × 10(-2) mg/kg-day, respectively. The estimated daily intake (contact or absorbed dose) of DUP from automobile seats were far lower than the NOAELs reported in and derived from animal studies, and are well below the reported Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) Derived No Effect Levels (DNELs) for the general population. Based on this analysis, using virtually any benchmark for evaluating safety, exposure to DUP via automobile seat covers did not pose a measureable increased health-risk in any population under any reasonably plausible exposure scenario.

  2. Ethical assessment of national health insurance system of Korea.

    Science.gov (United States)

    Lee, Yuri; Kim, Soyoon; Kim, Ganglip

    2012-09-01

    The current adverse effects of the health insurance system in Korea are considered to be problems that arise from an insufficient reflection of the notion of respecting human rights. The ethical principles most commonly suggested and used in public health are the 4 principles suggested by Beauchamp and Childress in 1994. From the perspective of the community, these 4 principles of medical ethics can be expanded to resolve problems surrounding existing social systems from a socialistic standpoint. This article describes a flexible, easy-to-use model for incorporating the 4 medical ethics principles into the National Health Insurance System (NHIS). First, the principle of respect for autonomy involves respecting the decision-making capacities of autonomous medical consumers and providers and enabling individuals to make reasoned and informed choices. Second is the principle of good practice. The government and medical institutions should act in a way that benefits the health care consumers. The principle of prohibiting bad practice involves avoiding causing health problems. The National Health Insurance Corporation and health care providers should not harm the health care consumers. Finally, the principle of justice is concerned with distributing benefits, risks, and costs fairly-that is, the notion that patients in similar positions should be treated in a similar manner. If these problems are solved, health system quality could be better and more accessible and sustainable. The ethical assessment of the NHIS could be a trial to match the 4 medical ethics principles and the NHIS. It can be applied internationally to relevant policy makers in different settings.

  3. Health impact and damage cost assessment of pesticides in Europe.

    Science.gov (United States)

    Fantke, Peter; Friedrich, Rainer; Jolliet, Olivier

    2012-11-15

    Health impacts from pesticide use are of continuous concern in the European population, requiring a constant evaluation of European pesticide policy. However, health impacts have never been quantified accounting for specific crops contributing differently to overall human exposure as well as accounting for individual substances showing distinct environmental behavior and toxicity. We quantify health impacts and related damage costs from exposure to 133 pesticides applied in 24 European countries in 2003 adding up to almost 50% of the total pesticide mass applied in that year. Only 13 substances applied to 3 crop classes (grapes/vines, fruit trees, vegetables) contribute to 90% of the overall health impacts of about 2000 disability-adjusted life years in Europe per year corresponding to annual damage costs of 78 million Euro. Considering uncertainties along the full impact pathway mainly attributable to non-cancer dose-response relationships and residues in treated crops, we obtain an average burden of lifetime lost per person of 2.6 hours (95% confidence interval between 22 seconds and 45.3 days) or costs per person over lifetime of 12 Euro (95% confidence interval between 0.03 Euro and 5142 Euro), respectively. 33 of the 133 assessed substances accounting for 20% of health impacts in 2003 are now banned from the European market according to current legislation. The main limitation in assessing human health impacts from pesticides is related to the lack of systematic application data for all used substances. Since health impacts can be substantially influenced by the choice of pesticides, the need for more information about substance application becomes evident.

  4. Assessment of environmental health in the 2012 East Azerbaijan earthquake

    Directory of Open Access Journals (Sweden)

    Farin Fatemi

    2013-09-01

    Material and Methods: Through multi-stages stratified sampling, we selected 8 and 4 villages from the earthquake zones of Heris and Varzaghan respectively. The collecting data tools in this research were the WHO checklist in 7 categories, 14 subcategories, and 37 environmental health activities and also the minimum standards of Sphere Project checklist. The status of environmental health in each village was assessed using the mentioned checklists. This study was carried out with attendance of research team in earthquake zones 21 days after the occurrence of earthquake. Results: Among the 37 environmental health activities, 7 activities were the joint ones, which Environmental Health Department had to carry it out with the coordination of other related organizations. In other words, the environmental health has the supervising role in these activities. Totally, such activities had more nonconformities compared with the activities in which environmental health was administered as the main responder. The details of results have been expressed in the full text. Conclusion: Providing intra-sector coordination, prioritizing the needs of the affected population and considering the principles of community based management in the natural disaster are proposed as the recommendations of this study.

  5. Enriching Mental Health Mobile Assessment and Intervention with Situation Awareness

    Directory of Open Access Journals (Sweden)

    Ariel Soares Teles

    2017-01-01

    Full Text Available Current mobile devices allow the execution of sophisticated applications with the capacity for identifying the user situation, which can be helpful in treatments of mental disorders. In this paper, we present SituMan, a solution that provides situation awareness to MoodBuster, an ecological momentary assessment and intervention mobile application used to request self-assessments from patients in depression treatments. SituMan has a fuzzy inference engine to identify patient situations using context data gathered from the sensors embedded in mobile devices. Situations are specified jointly by the patient and mental health professional, and they can represent the patient’s daily routine (e.g., “studying”, “at work”, “working out”. MoodBuster requests mental status self-assessments from patients at adequate moments using situation awareness. In addition, SituMan saves and displays patient situations in a summary, delivering them for consultation by mental health professionals. A first experimental evaluation was performed to assess the user satisfaction with the approaches to define and identify situations. This experiment showed that SituMan was well evaluated in both criteria. A second experiment was performed to assess the accuracy of the fuzzy engine to infer situations. Results from the second experiment showed that the fuzzy inference engine has a good accuracy to identify situations.

  6. Assessment, authorization and access to medicaid managed mental health care.

    Science.gov (United States)

    Masland, Mary C; Snowden, Lonnie R; Wallace, Neal T

    2007-11-01

    Examined were effects on access of managed care assessment and authorization processes in California's 57 county mental health plans. Primary data on managed care implementation were collected from surveys of county plan administrators; secondary data were from Medicaid claims and enrollment files. Using multivariate fixed effects regression, we found that following implementation of managed care, greater access occurred in county plans where assessments and treatment were performed by the same clinician, and where service authorizations were made more rapidly. Lower access occurred in county plans where treating clinicians authorized services themselves. Results confirm the significant effects of managed care processes on outcomes and highlight the importance of system capacity.

  7. Assessment of Mobile Health Nursing Intervention Knowledge among Community Health Nurses in Oyo State, Nigeria.

    Science.gov (United States)

    Titilayo, Odetola D; Okanlawon, F A

    2014-09-01

    Maternal mortality is high in Nigeria especially in rural areas due to knowledge deficit about expected care and labour process, socio-cultural belief, health care workers' attitude, physical and financial barriers to quality health care access. Mobile health (m-health) technology which is the use of mobile telecommunication devices in health care delivery reduces costs, improves care access, removes time and distance barriers and facilitates patient-provider communications needed to make appropriate health decisions. Previous studies empowering nurses with m-health knowledge resulted in improved uptake of health care services. There exists a literature dearth about knowledge and perception of nurses in Nigeria. This study became expedient to empower nurses working at the grassroots with the knowledge of m-health and assess the impact of educational training on their perception of its effectiveness. This quasi-experimental study carried out in four randomly selected LGAs across Oyo South Senatorial district involved participants at experimental (20 nurses) and control levels (27 nurses). A validated 25-item questionnaire explored nurses' perception, knowledge and perceived effectiveness of m-health in improving uptake of maternal health services in Nigeria among both groups before intervention. Intervention group nurses had a training equipping them with knowledge of m-health nursing intervention (MNHI) for a period of one week. Their perception, knowledge and perceived effectiveness were re-assessed at three-months and six-months after MHNI. Data were analyzed using Chi-square and repeated measures ANOVA at 5% significance level. In the EG, knowledge score significantly increased from 21.9±4.5 at baseline to 23.6±4.6 and 23.2±5.6 at three-month and six-month respectively while there was no significant difference in knowledge score among CG over the study period. A very significant difference was shown in the knowledge and perception of mobile health and its

  8. Qualia: A Prescription for Developing a Quality Health Threat Assessment

    Science.gov (United States)

    2008-12-01

    Figure 10. Health Threat Assessment Strategy Canvas . (From: Kim and Mauborgne, 2005, p. 29...cost (p. 13). The development of a blue ocean strategy canvas includes consideration of four factors. These factors answer the questions, “What...is that of a starfish as opposed to that of a spider . The starfish organization represents a network of nodes that will continue to thrive if a leg

  9. Assessment of an anomaly detector for jet engine health monitoring

    OpenAIRE

    Sebastien Borguet; Olivier Léonard

    2011-01-01

    The goal of module performance analysis is to reliably assess the health of the main components of an aircraft engine. A predictive maintenance strategy can leverage this information to increase operability and safety as well as to reduce costs. Degradation undergone by an engine can be divided into gradual deterioration and accidental events. Kalman filters have proven very efficient at tracking progressive deterioration but are poor performers in the face of abrupt events. Adaptive estimati...

  10. Adopting a Clinical Assessment Framework in Older Adult Mental Health.

    Science.gov (United States)

    Hung, Lillian; Lee, Patience Anne; Au-Yeung, Andy T; Kucherova, Irina; Harrigan, MaryLou

    2016-07-01

    Obtaining new knowledge accepted and used by practitioners remains a slow process. A dearth of knowledge translation research exists that explores how to effectively move knowledge to practice in the field of older adult mental health. The current article reports findings of a knowledge translation study that examined what factors enabled the adoption of a new clinical assessment framework, P.I.E.C.E.S.™, into practice in an older adult tertiary mental health unit. Theoretical insights of appreciative inquiry were used to guide the study. Qualitative methods were used, including focus groups with 20 staff and individual interviews with three leaders. The appreciative inquiry approach helped researchers successfully facilitate knowledge translation. Enabling factors included: (a) fostering positive energy to make continuous improvement, (b) working with team members across disciplines at all levels, and (c) using knowledge translation tools to enable and sustain the new practice. [Journal of Psychosocial Nursing and Mental Health Services, 54 (7), 26-31.].

  11. Complexity theory and geographies of health: a critical assessment.

    Science.gov (United States)

    Gatrell, Anthony C

    2005-06-01

    The interest of social scientists in complexity theory has developed rapidly in recent years. Here, I consider briefly the primary characteristics of complexity theory, with particular emphasis given to relations and networks, non-linearity, emergence, and hybrids. I assess the 'added value' compared with other, existing perspectives that emphasise relationality and connectedness. I also consider the philosophical underpinnings of complexity theory and its reliance on metaphor. As a vehicle for moving away from reductionist accounts, complexity theory potentially has much to say to those interested in research on health inequalities, spatial diffusion, emerging and resurgent infections, and risk. These and other applications in health geography that have invoked complexity theory are examined in the paper. Finally, I consider some of the missing elements in complexity theory and argue that while it is refreshing to see a fruitful line of theoretical debate in health geography, we need good empirical work to illuminate it.

  12. Approaches to integrated monitoring for environmental health impact assessment

    Directory of Open Access Journals (Sweden)

    Liu Hai-Ying

    2012-11-01

    Full Text Available Abstract Although Integrated Environmental Health Monitoring (IEHM is considered an essential tool to better understand complex environmental health issues, there is no consensus on how to develop such a programme. We reviewed four existing frameworks and eight monitoring programmes in the area of environmental health. We identified the DPSEEA (Driving Force-Pressure-State-Exposure-Effect-Action framework as most suitable for developing an IEHM programme for environmental health impact assessment. Our review showed that most of the existing monitoring programmes have been designed for specific purposes, resulting in narrow scope and limited number of parameters. This therefore limits their relevance for studying complex environmental health topics. Other challenges include limited spatial and temporal data availability, limited development of data sharing mechanisms, heterogeneous data quality, a lack of adequate methodologies to link disparate data sources, and low level of interdisciplinary cooperation. To overcome some of these challenges, we propose a DPSEEA-based conceptual framework for an IEHM programme that would enable monitoring and measuring the impact of environmental changes on human health. We define IEHM as ‘a systemic process to measure, analyse and interpret the state and changes of natural-eco-anthropogenic systems and its related health impact over time at the same location with causative explanations across the various compartments of the cause-effect chain’. We develop a structural work process to integrate information that is based on existing environmental health monitoring programmes. Such a framework allows the development of combined monitoring systems that exhibit a large degree of compatibility between countries and regions.

  13. Fuzzy assessment of health information system users' security awareness.

    Science.gov (United States)

    Aydın, Özlem Müge; Chouseinoglou, Oumout

    2013-12-01

    Health information systems (HIS) are a specific area of information systems (IS), where critical patient data is stored and quality health service is only realized with the correct use and efficient dissemination of this data to health workers. Therefore, a balance needs to be established between the levels of security and flow of information on HIS. Instead of implementing higher levels and further mechanisms of control to increase the security of HIS, it is preferable to deal with the arguably weakest link on HIS chain with respect to security: HIS users. In order to provide solutions and approaches for transforming users to the first line of defense in HIS but also to employ capable and appropriate candidates from the pool of newly graduated students, it is important to assess and evaluate the security awareness levels and characteristics of these existing and future users. This study aims to provide a new perspective to understand the phenomenon of security awareness of HIS users with the use of fuzzy analysis, and to assess the present situation of current and future HIS users of a leading medical and educational institution of Turkey, with respect to their security characteristics based on four different security scales. The results of the fuzzy analysis, the guide on how to implement this fuzzy analysis to any health institution and how to read and interpret these results, together with the possible implications of these results to the organization are provided.

  14. Optical methodology for the health assessment of power transformers

    Science.gov (United States)

    Palmer, John A.; Wang, Xianghui; Shoureshi, Rahmat A.; Mander, Arthur A.; Torgerson, Duane

    2000-06-01

    Among the most critical components in the electric power system is the power transformer. As such, a significant body of research has been put forward to attempt to anticipate the needs for maintenance to be performed. Traditional health assessment has required sampling of oil for submission to a laboratory for analysis, but this has been deemed undesirable in light of budgetary constraints on maintenance staffing, and new predictive maintenance philosophies for substation equipment. A number of processes have been developed in recent years for online health assessment of transformers, most of which have focused on dissolved gas analysis. This paper describes a novel optical methodology for on-line transformer health assessment that utilizes an ultraviolet absorption measurement to identify the degradation of the transformer oil. An optical system was selected because of its immunity to the electromagnetic noise typical of substations, and because of the minimal impact that non-conducting materials have on the insulation system design of the transformer. The system is designed to identify deterioration and premature aging resulting from overheating, low level arcing or excessive exposure to atmospheric air. The system consists of a light source, filter, guide and detection components, and a very simple computational requirement. The measurements performed with the prototype system are validated with a high precision spectrophotometry measurement and an independent oil-testing laboratory.

  15. The Health Technology Assessment of companion diagnostics: experience of NICE.

    Science.gov (United States)

    Byron, Sarah K; Crabb, Nick; George, Elisabeth; Marlow, Mirella; Newland, Adrian

    2014-03-15

    Companion diagnostics are used to aid clinical decision making to identify patients who are most likely to respond to treatment. They are becoming increasingly important as more new pharmaceuticals receive licensed indications that require the use of a companion diagnostic to identify the appropriate patient subgroup for treatment. These pharmaceuticals have proven benefit in the treatment of some cancers and other diseases, and also have potential to precisely tailor treatments to the individual in the future. However, the increasing use of companion diagnostics could place a substantial burden on health system resources to provide potentially high volumes of testing. This situation, in part, has led policy makers and Health Technology Assessment (HTA) bodies to review the policies and methods used to make reimbursement decisions for pharmaceuticals requiring companion diagnostics. The assessment of a pharmaceutical alongside the companion diagnostic used in the clinical trials may be relatively straightforward, although there are a number of challenges associated with assessing pharmaceuticals where a range of alternative companion diagnostics are available for use in routine clinical practice. The UK HTA body, the National Institute for Health and Care Excellence (NICE), has developed policy for considering companion diagnostics using its Technology Appraisal and Diagnostics Assessment Programs. Some HTA bodies in other countries have also adapted their policies and methods to accommodate the assessment of companion diagnostics. Here, we provide insight into the HTA of companion diagnostics for reimbursement decisions and how the associated challenges are being addressed, in particular by NICE. See all articles in this CCR Focus section, "The Precision Medicine Conundrum: Approaches to Companion Diagnostic Co-development."

  16. Assessing the role of GPs in Nordic health care systems.

    Science.gov (United States)

    Quaye, Randolph K

    2016-05-03

    Purpose This paper examines the changing role of general practitioners (GPs) in Nordic countries of Sweden, Norway and Denmark. It aims to explore the "gate keeping" role of GPs in the face of current changes in the health care delivery systems in these countries. Design/methodology/approach Data were collected from existing literature, interviews with GPs, hospital specialists and representatives of Danish regions and Norwegian Medical Association. Findings The paper contends that in all these changes, the position of the GPs in the medical division of labor has been strengthened, and patients now have increased and broadened access to choice. Research limitations/implications Health care cost and high cancer mortality rates have forced Nordic countries of Sweden, Norway and Denmark to rethink their health care systems. Several attempts have been made to reduce health care cost through market reform and by strenghtening the position of GPs. The evidence suggests that in Norway and Denmark, right incentives are in place to achieve this goal. Sweden is not far behind. The paper has limitations of a small sample size and an exclusive focus on GPs. Practical implications Anecdotal evidence suggests that physicians are becoming extremely unhappy. Understanding the changing status of primary care physicians will yield valuable information for assessing the effectiveness of Nordic health care delivery systems. Social implications This study has wider implications of how GPs see their role as potential gatekeepers in the Nordic health care systems. The role of GPs is changing as a result of recent health care reforms. Originality/value This paper contends that in Norway and Denmark, right incentives are in place to strengthen the position of GPs.

  17. ARIES: System for Health effects Assessment in industrial risk

    Energy Technology Data Exchange (ETDEWEB)

    Rabago, I.; Vidania, R. de; Inmaculada, S.

    1992-07-01

    In this work we present a general description of ARIES*, a tool designed in order to support the assessment of expected health effects derived from an accidental release of toxic compounds. ARIES includes two sequential and complementary steps. The first one (a quantitative phase) is being developed. for inhalation exposures, using numerical models, empirical correlations, physiological parameters and toxicological index, to estimate short term consequences over the exposed population. Next it will be published a new report were It will be described with detail the procedure designed to the quantitative assessment of the exposure. The system starts the assessment process with values of external concentrations which are processed, together with different exposure values (existing for humans and scaled up irom animals), as inputs for different kinds of models. From these, and other physiological values ARIES calculates the inhaled equivalent doses and the expected associated effects as a function of the exposure limes. Once overcome this first step, ARIES is complemented with an additional system that executes the selection of relevant information from toxicological data bases (qualitative phase). The system works , applying a string of filters and searches that displays selected Information, giving an additional support to the assessment. Both steps, just referred, are integrated into a logical informatics support. The informatics code is developed in dbase language even for the design of the procedure as for the mathematical models linked to the system ( extrapolation, dose inhaled models, etc.) to execute the numerical analysis of the assessment. The system has been designed in order to include progressively new chemicals and the improvements obtained in the development of mathematical models related with dose-effect relationships. At this moment, is programmed a first prototype of ARIES that can be executed in PC's and it can run for several products

  18. Utilization and Limitations of the American College Health Association's National College Health Assessment Instrument: A Systematic Review

    Science.gov (United States)

    Rahn, Rhonda N.; Pruitt, Buster; Goodson, Patricia

    2016-01-01

    Objective: To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II. Participants and Methods: The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument…

  19. Transport policy and health inequalities: a health impact assessment of Edinburgh's transport policy.

    Science.gov (United States)

    Gorman, D; Douglas, M J; Conway, L; Noble, P; Hanlon, P

    2003-01-01

    Health impact assessment (HIA) can be used to examine the relationships between inequalities and health. This HIA of Edinburgh's transport policy demonstrates how HIA can examine how different transport policies can affect different population groupings to varying degrees. In this case, Edinburgh's economy is based on tourism, financial services and Government bodies. These need a good transport infrastructure, which maintains a vibrant city centre. A transport policy that promotes walking, cycling and public transport supports this and is also good for health. The HIA suggested that greater spend on public transport and supporting sustainable modes of transport was beneficial to health, and offered scope to reduce inequalities. This message was understood by the City Council and influenced the development of the city's transport and land-use strategies. The paper discusses how HIA can influence public policy.

  20. A joint urban planning and public health framework: contributions to health impact assessment.

    Science.gov (United States)

    Northridge, Mary E; Sclar, Elliott

    2003-01-01

    A joint urban planning and public health perspective is articulated here for use, in health impact assessment. Absent a blueprint for a coherent and supportive structure on which to test our thinking, we are bound to fall flat. Such a perspective is made necessary by the sheer number of people living in cities throughout the world, the need for explicit attention to land use and transportation systems as determinants of population health, and the dearth of useful indicators of the built environment for monitoring progress. If explicit attention is not paid to the overarching goals of equality and democracy, they have little if any chance of being realized in projects, programs, and policies that shape the built environment and therefore the public's health.

  1. Health technology assessment demonstrates efficient health promotion bu Transcendental Meditation (TM)

    DEFF Research Database (Denmark)

    Larsen, Torben

    2002-01-01

    -practitioners and controls without specific health promotion. The TM-group has a relative high level of education. TM is organized as a private, standardised dissemination of the original, Indoeuropean mantrameditation. This standardisation creates economies-of-scale 1) using local instructors with a short education, 2......BACKGROUND/OBJECTIVES: Health Technology Assessment of mantrameditation implemented as Transcendental Meditation (TM) METHODS: MEDLINE contains October 2001 335 titles on 'Transcendental Meditation' including various metaanalyses and a series of randomised, controlled trials: In summary......-actualisation; (3) Independence of stimulantia including tobacco and alcohol; (4) Cardiologic health. RESULTS: This health promotion is explained by a cybernetic model based on 'The Limbic System'. A sample of records collected by the Internet shows significant compliance between the self-reports of TM...

  2. Health impact assessment of quality wine production in Hungary.

    Science.gov (United States)

    Adám, Balázs; Molnár, Agnes; Bárdos, Helga; Adány, Róza

    2009-12-01

    Alcohol-related health outcomes show strikingly high incidence in Hungary. The effects of alcohol consumption are influenced not only by the quantity, but also the quality of drinks; therefore, wine production can have an important effect on public health outcomes. Nevertheless, the Hungarian wine sector faces several vital problems and challenges influenced by the country's accession to the European Union and by the need for restructuring. A comprehensive health impact assessment (HIA) based on the evaluation of the Hungarian legislation related to the wine sector has been carried out, aiming to assess the impact of the production of quality wine versus that of table wine, using a range of public health and epidemiological research methods and data as well as HIA guidelines. The study finds that the toxic effects of alcohol can be reduced with an increased supply of quality wine and with decreased overall consumption due to higher cost, although this might drive some people to seek illegal sources. Quality wine production allows for improved use of land, creates employment opportunities and increases the incomes of producers and local communities; however, capital-scarce producers unable to manage restructuring may lose their source of subsistence. The supply of quality wine can promote social relations, contribute to a healthy lifestyle and reduce criminality related to alcohol's influence and adulteration. In general, the production and supply of quality wine can have an overall positive impact on health. Nevertheless, because of the several possible negative effects expected without purposeful restructuring, recommendations for the maximization of favourable outcomes and suggestions for monitoring the success of the analysis have been provided.

  3. Assessing ozone-related health impacts under a changing climate.

    Science.gov (United States)

    Knowlton, Kim; Rosenthal, Joyce E; Hogrefe, Christian; Lynn, Barry; Gaffin, Stuart; Goldberg, Richard; Rosenzweig, Cynthia; Civerolo, Kevin; Ku, Jia-Yeong; Kinney, Patrick L

    2004-11-01

    Climate change may increase the frequency and intensity of ozone episodes in future summers in the United States. However, only recently have models become available that can assess the impact of climate change on O3 concentrations and health effects at regional and local scales that are relevant to adaptive planning. We developed and applied an integrated modeling framework to assess potential O3-related health impacts in future decades under a changing climate. The National Aeronautics and Space Administration-Goddard Institute for Space Studies global climate model at 4 degrees x 5 degrees resolution was linked to the Penn State/National Center for Atmospheric Research Mesoscale Model 5 and the Community Multiscale Air Quality atmospheric chemistry model at 36 km horizontal grid resolution to simulate hourly regional meteorology and O3 in five summers of the 2050s decade across the 31-county New York metropolitan region. We assessed changes in O3-related impacts on summer mortality resulting from climate change alone and with climate change superimposed on changes in O3 precursor emissions and population growth. Considering climate change alone, there was a median 4.5% increase in O3-related acute mortality across the 31 counties. Incorporating O3 precursor emission increases along with climate change yielded similar results. When population growth was factored into the projections, absolute impacts increased substantially. Counties with the highest percent increases in projected O3 mortality spread beyond the urban core into less densely populated suburban counties. This modeling framework provides a potentially useful new tool for assessing the health risks of climate change.

  4. Hygienic environmental assessment and health of children in Penza

    Directory of Open Access Journals (Sweden)

    Yu.V. Korochkina

    2015-09-01

    Full Text Available Assessment of the carcinogenic risk from air pollution, the chemical composition of the drinking water and the content of contaminants in food showed that the total cancer risk for both inhalation and oral routes of administering priority pollutants and contaminants into the body of Penza children and adolescents complies with the maximum permissible level. The greatest risk of non-carcinogenic impact associated with air pollution is generated in respect of the respiratory system, eyes and immune system. The maximum hazard indices associated with the consumption of drinking water, are set for blood, hormone system and kidneys. The risk of negative impacts associated with the receipt of food contaminants is observed in respect of the hematopoietic and cardiovascular systems. Application of risk assessment methodology to study the effects of chemicals polluting the environment on health has allowed to justify preventive measures aimed at reducing the risk to the health of children and adolescents, as well as increased monitoring researches of environmental objects to isolate areas of high risk to children's health.

  5. Mental health learning needs assessment: competency-based instrument for best practice.

    Science.gov (United States)

    McKnight, Sylvia E

    2013-06-01

    A learning needs assessment focused on psychiatric/mental health nursing competency development is a central component of nursing education in specialty mental health nursing practice. The provision of education for mental health nursing relies on the underlying assumption that the learning needs of experienced mental health nurses have been assessed and educational programs implemented to address educational needs for competency in professional practice. Few professional learning needs assessments have been developed to identify learning needs in mental health nursing practice. The majority of available professional learning needs assessments focus on medical nursing practice applications rather than the psychosocial aspects of a mental health assessment. The mental health field addresses very different assessment criteria such as knowledge of suicide assessment and therapeutic interventions. The purpose of this article is to present and describe the process of developing a learning needs assessment focused on competency development for the specialty practice of mental health nursing that addresses and resolves complex learning needs.

  6. Complex health care interventions: Characteristics relevant for ethical analysis in health technology assessment

    Directory of Open Access Journals (Sweden)

    Lysdahl, Kristin Bakke

    2016-03-01

    Full Text Available Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1 multiple and changing perspectives, 2 indeterminate phenomena, 3 uncertain causality, 4 unpredictable outcome, and 5 ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.

  7. The Latvian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

    Science.gov (United States)

    Rumba, I; Ruperto, N; Bikis, E; Remberga, S; Saulite, I; Plotkina, N; Viksna, A; Krauca, M; Breca, I; Vikmanis, U

    2001-01-01

    We report herein the results of the cross-cultural adaptation and validation into the Latvian language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Latvian CHAQ CHQ were fully validated with 1 forward and 1 backward translations. A total of 141 subjects were enrolled: 80 patients with JIA (16% systemic onset, 32.5% polyarticular onset, 19% extended oligoarticular subtype, and 32.5% persistent oligoarticular subtype) and 61 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Latvian version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

  8. The Mexican version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

    Science.gov (United States)

    Duarte, C; Ruperto, N; Goycochea, M V; Maldonado, R; Beristain, R; De Inocencio, J; Burgos-Vargas, R

    2001-01-01

    We report herein the results of the cross-cultural adaptation and validation into the Mexican language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Mexican CHAQ was already published and therefore it was revalidated while the Mexican CHQ was derived from the European Spanish version with changing of the few words whose use is different in the 2 countries. A total of 182 subjects were enrolled: 89 patients with JIA (26% systemic onset, 47% polyarticular onset, 13.5% extended oligoarticular subtype, and 13.5% persistent oligoarticular subtype) and 93 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, and polyarticular onset subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, and polyarticular onset having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Mexican version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

  9. Prioritizing health: a systematic approach to scoping determinants in health impact assessment

    Directory of Open Access Journals (Sweden)

    Lindsay McCallum

    2016-08-01

    Full Text Available The determinants of health are those factors that have the potential to affect health, either positively or negatively, and include a range of personal, social, economic, and environmental factors. In the practice of Health Impact Assessment (HIA, the stage at which the determinants of health are considered for inclusion is during the scoping step. The scoping step is intended to identify how the HIA will be carried out and to set the boundaries (e.g., temporal and geographical for the assessment. There are several factors that can help to inform the scoping process, many of which are considered in existing HIA tools and guidance; however, a systematic method of prioritizing determinants was found to be lacking. In order to analyze existing HIA scoping tools that are available, a systematic literature review was conducted including both primary and grey literature. A total of 10 HIA Scoping tools met the inclusion/exclusion criteria and were carried forward for comparative analysis. The analysis focused on minimum elements and practice standards of HIA scoping that have been established in the field. The analysis determined that existing approaches lack a clear, systematic method of prioritization of health determinants for inclusion in HIA. This finding led to the development of a Systematic HIA Scoping tool that addressed this gap. The decision matrix tool uses factors such as impact, public concern and data availability to prioritize health determinants. Additionally, the tool allows for identification of data gaps and provides a transparent method for budget allocation and assessment planning. In order to increase efficiency and improve utility, the tool was programmed into Microsoft Excel. Future work in the area of HIA methodology development is vital to the ongoing success of the practice and utilization of HIA as a reliable decision-making tool.

  10. Health Technology Assessment (HTA in a changing social and health care context

    Directory of Open Access Journals (Sweden)

    Alìcia Granados

    2005-06-01

    Full Text Available

    Health Technology Assessment (HTA has been defined in different ways, nevertheless it can be described briefly as a multidisciplinary process of analysis dealing with evidence and context to inform decision making in health care.

    For decades HTA and related fields, aimed to produce and encourage the use of scientific evidence to inform decision making, at all levels of the health care system, from policy making and management to clinical decision making [1,2]. Scientific evidence involved in the HTA process may refer to efficacy, effectiveness, safety, needs, appropriateness, efficiency, equity, acceptability and some other issues related to the effect of the introduction, use and diffusion of medical technologies on health and health care. The evaluation, with formal rules, of the quality of available scientific information is an important step of the HTA process as are the skills required for literature searching.The source of scientific information should not be limited to clinical literature, but also exploit other areas of knowledge such as epidemiology, social sciences,economics,health services research among others [1].

    The best method to be used in the HTA analysis process obviously depends on the uncertainties to be assessed. It could range from the synthesis and/or integration of scientific information to production of primary data.

    The latter is the option of choice when there is insufficient existing evidence or its quality is poor. The assessments often require a multidisciplinary and multi-method approach, the former, of course, must be chosen after translating the uncertainty into sound research questions.

  11. Health Technology Assessment (HTA in a changing social and health care context

    Directory of Open Access Journals (Sweden)

    Alicia Granados

    2003-05-01

    Full Text Available

    Health Technology Assessment (HTA has been defined in different ways, nevertheless it can be described briefly as a multidisciplinary process of analysis dealing with evidence and context to inform decision making in health care. For decades HTA and related fields, aimed to produce and encourage the use of scientific evidence to inform decision making, at all levels of the health care system, from policy making and management to clinical decision making [1,2].

    Scientific evidence involved in the HTA process may refer to efficacy, effectiveness, safety, needs, appropriateness, efficiency, equity, acceptability and some other issues related to the effect of the introduction, use and diffusion of medical technologies on health and health care. The evaluation, with formal rules, of the quality of a

    vailable scientific information is an important step of the HTA process as are the skills required for literature searching. The source of scientific information should not be limited to clinical literature, but also exploit other areas of knowledge such as epidemiology, social sciences,economics,health services research among others [1].The best method to be used in the HTA analysis process obviously depends on the uncertainties to be assessed. It could range from the synthesis and/or integration of scientific information to production of primary data.The latter is the option of choice when there is insufficient existing evidence or its quality is poor.

    The assessments often require a multidisciplinary and multi-method approach, the former, of course,must be chosen after translating the uncertainty into sound research questions.

     

  12. Applying ethological and health indicators to practical animal welfare assessment.

    Science.gov (United States)

    Wemelsfelder, F; Mullan, S

    2014-04-01

    There is a growing effort worldwide to develop objective indicators for animal welfare assessment, which provide information on an animal's quality of life, are scientifically trustworthy, and can readily be used in practice by professionals. Animals are sentient beings capable of positive and negative emotion, and so these indicators should be sensitive not only to their physical health, but also to their experience of the conditions in which they live. This paper provides an outline of ethological research aimed at developing practical welfare assessment protocols. The first section focuses on the development and validation of welfare indicators generally, in terms of their relevance to animal well-being, their interobserver reliability, and the confidence with which the prevalence of described features can be estimated. Challenges in this work include accounting for the ways in which welfare measures may fluctuate over time, and identifying measures suited to monitoring positive welfare states. The second section focuses more specifically on qualitative welfare indicators, which assess the 'whole animal' and describe the expressive qualities of its demeanour (e.g. anxious, content). Such indicators must be validated in the same way as other health and behaviour indicators, with the added challenge of finding appropriate methods of measurement. The potential contribution of qualitative indicators, however, is to disclose an emotional richness in animals that helps to interpret information provided by other indicators, thus enhancing the validity of welfare assessment protocols. In conclusion, the paper emphasises the importance of integrating such different perspectives, showing that new knowledge of animals and new ways of relating to animals are both needed for the successful development of practical welfare assessment tools.

  13. Health effects assessment of chemical exposures: ARIES methodology

    Energy Technology Data Exchange (ETDEWEB)

    Sierra, L; Montero, M.; Rabago, I.; Vidania, R.

    1995-07-01

    In this work, we present ARIES* update: a system designed in order to facilitate the human health effects assessment produced by accidental release of toxic chemicals. The first version of ARIES was developed in relation to 82/501/EEC Directive about mayor accidents in the chemical industry. So, the first aim was the support of the effects assessment derived for the chemicals included into this directive. From this establishment, it was considered acute exposures for high concentrations. In this report, we present the actual methodology for considering other type of exposures, such as environmental and occupational. Likewise other versions, the methodology comprises two approaches: quantitative and qualitative assessments. Quantitative assessment incorporates the mathematical algorithms useful to evaluate the effects produced by the most important routes of exposure: inhalation, ingestion, eye contact and skin absorption, in a short, medium and long term. It has been included models that realizes an accurate quantification of doses, effects,... and so on, such as simple approaches when the available information is not enough. Qualitative assessment, designed in order to complement or replace the previous one, is incorporated into an informatics system, developed in Clipper. It executes and displays outstanding and important toxicological information of about 100 chemicals. This information comes from ECDIN (Environmental Chemicals Data and Information Network) database through a collaboration with JRC-ISPRA working group. (Author) 24 refs.

  14. Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

    Directory of Open Access Journals (Sweden)

    Tiago Ricardo Moreira

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02, separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88, having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71, spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51, having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62, and reporting some (OR = 2.17; 95%CI 1.66–2.84 or a lot of (OR = 2.74; 95%CI 2.04–3.68 trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84. CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

  15. [An assessment of fiscal space for public health in Peru].

    Science.gov (United States)

    Matus-López, Mauricio; Toledo, Lorena Prieto; Pedraza, Camilo Cid

    2016-08-01

    Objective To assess the fiscal space for public health in Peru so as to attain the goal of raising health spending to 6% of gross domestic product, as agreed upon by member countries of the Pan American Health Organization in 2014. Methods The main sources of fiscal space were identified by means of a thorough literature review. Technical feasibility was determined from statistics and national and international surveys and by reviewing various documents and official reports. Political feasibility was ascertained by studying policy guidelines. Results The sources showing the greatest technical and political feasibility are economic growth, a broadening of the personal income tax base, and an increase in tobacco-specific taxes. Decreasing informality in the job market and increasing contributory coverage are considered to be less politically feasible, but there is ample technical space for these measures. Conclusions There is enough fiscal space to allow for an increase in public health spending. Nevertheless, the 6% target will be reached only if the timeline is extended, tax revenues are increased, and informality in the job market is reduced.

  16. Advancing Efforts to Achieve Health Equity: Equity Metrics for Health Impact Assessment Practice

    Directory of Open Access Journals (Sweden)

    Jonathan Heller

    2014-10-01

    Full Text Available Equity is a core value of Health Impact Assessment (HIA. Many compelling moral, economic, and health arguments exist for prioritizing and incorporating equity considerations in HIA practice. Decision-makers, stakeholders, and HIA practitioners see the value of HIAs in uncovering the impacts of policy and planning decisions on various population subgroups, developing and prioritizing specific actions that promote or protect health equity, and using the process to empower marginalized communities. There have been several HIA frameworks developed to guide the inclusion of equity considerations. However, the field lacks clear indicators for measuring whether an HIA advanced equity. This article describes the development of a set of equity metrics that aim to guide and evaluate progress toward equity in HIA practice. These metrics also intend to further push the field to deepen its practice and commitment to equity in each phase of an HIA. Over the course of a year, the Society of Practitioners of Health Impact Assessment (SOPHIA Equity Working Group took part in a consensus process to develop these process and outcome metrics. The metrics were piloted, reviewed, and refined based on feedback from reviewers. The Equity Metrics are comprised of 23 measures of equity organized into four outcomes: (1 the HIA process and products focused on equity; (2 the HIA process built the capacity and ability of communities facing health inequities to engage in future HIAs and in decision-making more generally; (3 the HIA resulted in a shift in power benefiting communities facing inequities; and (4 the HIA contributed to changes that reduced health inequities and inequities in the social and environmental determinants of health. The metrics are comprised of a measurement scale, examples of high scoring activities, potential data sources, and example interview questions to gather data and guide evaluators on scoring each metric.

  17. Cumulate Fragments in Silicic Ignimbrites

    Science.gov (United States)

    Bachmann, O.; Ellis, B. S.; Wolff, J.

    2014-12-01

    Increasingly, studies are concluding that silicic ignimbrites are the result of the amalgamation of multiple discrete magma batches. Yet the existence of discrete batches presents a conundrum for magma generation and storage; if silicic magma batches are not generated nearly in situ in the upper crust, they must traverse, and reside within, a thermally hostile environment with large temperature gradients, resulting in low survivability in their shallow magmatic hearths. The Snake River Plain (Idaho, USA) is a type example of this 'multi-batch' assembly with ignimbrites containing multiple populations of pyroxene crystals, glass shards, and crystal aggregates. The ubiquitous crystal aggregates hint at a mechanism to facilitate the existence of multiple, relatively small batches of rhyolite in the upper crust. These aggregates contain the same plagioclase, pyroxene, and oxide mineral compositions as single phenocrysts of the same minerals in their host rocks, but they have significantly less silicic bulk compositions and lack quartz and sanidine, which occur as single phenocrysts in the deposits. This implies significant crystallization followed by melt extraction from mushy reservoir margins. The extracted melt then continues to evolve (crystallizing sanidine and quartz) while the melt-depleted margins provide an increasingly rigid and refractory network segregating the crystal-poor batches of magma. The hot, refractory, margins insulate the crystal-poor lenses, allowing (1) extended residence in the upper crust, and (2) preservation of chemical heterogeneities among batches. In contrast, systems that produce cumulates richer in low-temperature phases (quartz, K-feldspars, and/or biotite) favour remelting upon recharge, leading to less segregation of eruptible melt pockets and the formation of gradationally zoned ignimbrites. The occurrence of similar crystal aggregates from a variety of magmatic lineages suggests the generality of this process.

  18. Air pollutants and health outcomes: Assessment of confounding by influenza

    Science.gov (United States)

    Thach, Thuan-Quoc; Wong, Chit-Ming; Chan, King-Pan; Chau, Yuen-Kwan; Neil Thomas, G.; Ou, Chun-Quan; Yang, Lin; Peiris, Joseph S. M.; Lam, Tai-Hing; Hedley, Anthony J.

    2010-04-01

    We assessed confounding of associations between short-term effects of air pollution and health outcomes by influenza using Hong Kong mortality and hospitalization data for 1996-2002. Three measures of influenza were defined: (i) intensity: weekly proportion of positive influenza viruses, (ii) epidemic: weekly number of positive influenza viruses ≥4% of the annual number for ≥2 consecutive weeks, and (iii) predominance: an epidemic period with co-circulation of respiratory syncytial virus influenza on associations between nitrogen dioxide (NO 2), sulfur dioxide (SO 2), particulate matter with aerodynamic diameter ≤10 μm (PM 10) and ozone (O 3) and health outcomes including all natural causes mortality, cardiorespiratory mortality and hospitalization. Generalized additive Poisson regression model with natural cubic splines was fitted to control for time-varying covariates to estimate air pollution health effects. Confounding with influenza was assessed using an absolute difference of >0.1% between unadjusted and adjusted excess risks (ER%). Without adjustment, pollutants were associated with positive ER% for all health outcomes except asthma and stroke hospitalization with SO 2 and stroke hospitalization with O 3. Following adjustment, changes in ER% for all pollutants were 0.1% for mortality from stroke with NO 2 and SO 2, cardiac or heart disease with NO 2, PM 10 and O 3, lower respiratory infections with NO 2 and O 3 and mortality from chronic obstructive pulmonary disease with all pollutants. Changes >0.1% were seen for acute respiratory disease hospitalization with NO 2, SO 2 and O 3 and acute lower respiratory infections hospitalization with PM 10. Generally, influenza does not confound the observed associations of air pollutants with all natural causes mortality and cardiovascular hospitalization, but for some pollutants and subgroups of cardiorespiratory mortality and respiratory hospitalization there was evidence to suggest confounding by influenza.

  19. Application of ecological momentary assessment in workplace health evaluation.

    Science.gov (United States)

    Engelen, Lina; Chau, Josephine Y; Burks-Young, Sarah; Bauman, Adrian

    2016-08-31

    Issue addressed: Ecological momentary assessment (EMA) involves repeated sampling of current behaviours and experiences in real-time at random intervals. EMA is an innovative measurement method for program evaluation, using mobile technology (e.g. smartphones) to collect valid contextual health promotion data with good compliance. The present study examined the feasibility of using EMA for measuring workplace health outcomes.Methods: Twenty-two office-based adults were prompted at four random times per work-day during a 5-day period to respond to a short survey via a smartphone application. The prompting stopped when participants had either responded 12 times or the 5-day period had ended. The questions pertained to posture, task currently being undertaken, social interactions, musculoskeletal issues, mood, and perceptions of engagement and creativity.Results: In total 156 responses were collected. Nine participants completed all 12 surveys; the average completion rate was 58% (7/12). The average completion time was initially 50s and reduced to 24s during the later surveys. On average the participants were sitting and standing in 79% and 14% of survey instances, respectively. The participants reported they were working alone at their desks in 68% of instances. Reported productivity and stress were on average 6 and 3 out of 10, respectively, but varied up to 6-8 points within one person, hence the method appears sensitive to temporal variations in perceptions and mood.Conclusion: Given the rich real-time data, minimal participant burden and use of readily available technology, EMA has substantial potential in workplace health promotion evaluation through the measurement of participants' well being, activities, and behaviour change.So what?: An in-the-moment method using readily available mobile technology to assess participants' perceptions, mood and activity that provides rich information with minimal participant burden is a promising way to evaluate future health

  20. 78 FR 12764 - Draft Office of Health Assessment and Translation Approach for Systematic Review and Evidence...

    Science.gov (United States)

    2013-02-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Draft Office of Health Assessment and Translation Approach... comments on the Draft Office of Health Assessment and Translation (OHAT) Approach for Systematic Review...

  1. Assessment of mercury health risks to adults from coal combustion

    Energy Technology Data Exchange (ETDEWEB)

    Lipfert, F.W.; Moskowitz, P.D.; Fthenakis, V.M.; DePhillips, M.P.; Viren, J.; Saroff, L.

    1994-05-01

    The U.S. Environmental Protection Agency (EPA) is preparing, for the U.S. Congress, a report evaluating the need to regulate mercury (Hg) emissions from electric utilities. This study, to be completed in 1995, will have important health and economic implications. In support of these efforts, the U.S. Department of Energy, Office of Fossil Energy, sponsored a risk assessment project at Brookhaven National Laboratory (BNL) to evaluate methylmercury (MeHg) hazards independently. In the BNL study, health risks to adults resulting from Hg emissions from a hypothetical 1000 MW{sub e} coal-fired power plant were estimated using probabilistic risk assessment techniques. The approach draws on the extant knowledge in each of the important steps in the calculation chain from emissions to health effects. Estimated results at key points in the chain were compared with actual measurements to help validate the modeled estimates. Two cases were considered: the baseline case (no local impacts), and the impact case (maximum local power-plant impact). The BNL study showed that the effects of emissions of a single power plant may double the background exposures to MeHg resulting from consuming fish obtained from a localized area near the power plant. Many implicit and explicit sources of uncertainty exist in this analysis. Those that appear to be most in need of improvement include data on doses and responses for potentially sensitive subpopulations (e.g., fetal exposures). Rather than considering hypothetical situations, it would also be preferable to assess the risks associated with actual coal-fired power plants and the nearby sensitive water bodies and susceptible subpopulations. Finally, annual total Hg emissions from coal burning and from other anthropogenic sources are still uncertain; this makes it difficult to estimate the effects of U.S. coal burning on global Hg concentration levels, especially over the long term.

  2. Vegan lifestyle behaviors: an exploration of congruence with health-related beliefs and assessed health indices.

    Science.gov (United States)

    Dyett, Patricia A; Sabaté, Joan; Haddad, Ella; Rajaram, Sujatha; Shavlik, David

    2013-08-01

    This study aimed to investigate health belief as a major motive for diet and lifestyle behaviors of 100 vegans in the United States; and to determine congruence with selected health and nutrition outcomes. Response data from an administered questionnaire was analyzed. Statistical analyses determined the most common factors influencing diet choice; the number of vegans practicing particular lifestyle behaviors; body mass index; and prevalence of self-reported chronic disease diagnoses. Nutrient intakes were analyzed and assessed against Dietary Reference Intakes. Health was the most reported reason for diet choice (47%). In the health belief, animal welfare, and religious/other motive categories, low percentages of chronic disease diagnoses were reported: 27%, 11%, and 15%, respectively. There were no significant differences in health behaviors and indices among vegan motive categories, except for product fat content choices. Within the entire study population, health-related vegan motive coincided with regular exercise; 71% normal BMI (mean=22.6); minimal alcohol and smoking practices; frequently consumed vegetables, nuts, and grains; healthy choices in meal types, cooking methods, and low-fat product consumption; and adequate intakes for most protective nutrients when compared to reference values. But incongruence was found with 0% intake adequacy for vitamin D; and observation of excessive sodium use.

  3. Health Risk Assessment for Cyanobacterial Toxins in Seafood

    Directory of Open Access Journals (Sweden)

    Andrew Humpage

    2012-03-01

    Full Text Available Cyanobacteria (blue-green algae are abundant in fresh, brackish and marine waters worldwide. When toxins produced by cyanobacteria are present in the aquatic environment, seafood harvested from these waters may present a health hazard to consumers. Toxicity hazards from seafood have been internationally recognised when the source is from marine algae (dinoflagellates and diatoms, but to date few risk assessments for cyanobacterial toxins in seafood have been presented. This paper estimates risk from seafood contaminated by cyanobacterial toxins, and provides guidelines for safe human consumption.

  4. Assessing framing assumptions in quantitative health impact assessments: a housing intervention example.

    Science.gov (United States)

    Mesa-Frias, Marco; Chalabi, Zaid; Foss, Anna M

    2013-09-01

    Health impact assessment (HIA) is often used to determine ex ante the health impact of an environmental policy or an environmental intervention. Underpinning any HIA is the framing assumption, which defines the causal pathways mapping environmental exposures to health outcomes. The sensitivity of the HIA to the framing assumptions is often ignored. A novel method based on fuzzy cognitive map (FCM) is developed to quantify the framing assumptions in the assessment stage of a HIA, and is then applied to a housing intervention (tightening insulation) as a case-study. Framing assumptions of the case-study were identified through a literature search of Ovid Medline (1948-2011). The FCM approach was used to identify the key variables that have the most influence in a HIA. Changes in air-tightness, ventilation, indoor air quality and mould/humidity have been identified as having the most influence on health. The FCM approach is widely applicable and can be used to inform the formulation of the framing assumptions in any quantitative HIA of environmental interventions. We argue that it is necessary to explore and quantify framing assumptions prior to conducting a detailed quantitative HIA during the assessment stage.

  5. A Health Impact Assessment Framework for Assessing Vulnerability and Adaptation Planning for Climate Change

    Directory of Open Access Journals (Sweden)

    Helen Brown

    2014-12-01

    Full Text Available This paper presents a detailed description of an approach designed to investigate the application of the Health Impact Assessment (HIA framework to assess the potential health impacts of climate change. A HIA framework has been combined with key climate change terminology and concepts. The fundamental premise of this framework is an understanding of the interactions between people, the environment and climate. The diversity and complexity of these interactions can hinder much needed action on the critical health issue of climate change. The objectives of the framework are to improve the methodology for understanding and assessing the risks associated with potential health impacts of climate change, and to provide decision-makers with information that can facilitate the development of effective adaptation plans. While the process presented here provides guidance with respect to this task it is not intended to be prescriptive. As such, aspects of the process can be amended to suit the scope and available resources of each project. A series of working tables has been developed to assist in the collation of evidence throughout the process. The framework has been tested in a number of locations including Western Australia, Solomon Islands, Vanuatu and Nauru.

  6. A health impact assessment framework for assessing vulnerability and adaptation planning for climate change.

    Science.gov (United States)

    Brown, Helen; Spickett, Jeffery; Katscherian, Dianne

    2014-12-01

    This paper presents a detailed description of an approach designed to investigate the application of the Health Impact Assessment (HIA) framework to assess the potential health impacts of climate change. A HIA framework has been combined with key climate change terminology and concepts. The fundamental premise of this framework is an understanding of the interactions between people, the environment and climate. The diversity and complexity of these interactions can hinder much needed action on the critical health issue of climate change. The objectives of the framework are to improve the methodology for understanding and assessing the risks associated with potential health impacts of climate change, and to provide decision-makers with information that can facilitate the development of effective adaptation plans. While the process presented here provides guidance with respect to this task it is not intended to be prescriptive. As such, aspects of the process can be amended to suit the scope and available resources of each project. A series of working tables has been developed to assist in the collation of evidence throughout the process. The framework has been tested in a number of locations including Western Australia, Solomon Islands, Vanuatu and Nauru.

  7. Risk assessment of genetically modified crops for nutrition and health.

    Science.gov (United States)

    Magaña-Gómez, Javier A; de la Barca, Ana M Calderón

    2009-01-01

    The risk assessment of genetically modified (GM) crops for human nutrition and health has not been systematic. Evaluations for each GM crop or trait have been conducted using different feeding periods, animal models, and parameters. The most common result is that GM and conventional sources induce similar nutritional performance and growth in animals. However, adverse microscopic and molecular effects of some GM foods in different organs or tissues have been reported. Diversity among the methods and results of the risk assessments reflects the complexity of the subject. While there are currently no standardized methods to evaluate the safety of GM foods, attempts towards harmonization are on the way. More scientific effort is necessary in order to build confidence in the evaluation and acceptance of GM foods.

  8. Health Technology Assessment of Magnetic Resonance Imaging in Shanxi Province

    Institute of Scientific and Technical Information of China (English)

    Yueze Liu; Jianwen Cao; Zuxun Lu

    2004-01-01

    Assess the current status of MRI in Shanxi province by health technology assessment method to provide suggestion and guidelines for future government decisions on the procurement and installation of new high-tech medical equipments. All of the 21 hospitals installed MRIs were surveyed.The results showed that 1 ) Diffusion of MRI is consistent with the economic development in different regional districts and hospital levels in Shanxi province. 2) There are better monetary returns of MRI in higher level hospitals than lower level hospitals. 3) Most MRIs in Shanxi province had been running at a loss, and the first class tertiary level hospitals had been making profit from providing MRI services to patients. 4) Better cost-benefit accorded with higher hospital level, more patients serviced etc. 5 ) The biggest investment risk is the initial purchase and installation of MRI. 6) Positive rates and veracity of MRI diagnosis were higher. 7) MRI is a safe equipment.

  9. An Integrated Approach to Assess Exposure and Health-Risk from Polycyclic Aromatic Hydrocarbons (PAHs in a Fastener Manufacturing Industry

    Directory of Open Access Journals (Sweden)

    Hsin-I Hsu

    2014-09-01

    Full Text Available An integrated approach was developed to assess exposure and health-risk from polycyclic aromatic hydrocarbons (PAHs contained in oil mists in a fastener manufacturing industry. One previously developed model and one new model were adopted for predicting oil mist exposure concentrations emitted from metal work fluid (MWF and PAHs contained in MWF by using the fastener production rate (Pr and cumulative fastener production rate (CPr as predictors, respectively. By applying the annual Pr and CPr records to the above two models, long-term workplace PAH exposure concentrations were predicted. In addition, true exposure data was also collected from the field. The predicted and measured concentrations respectively served as the prior and likelihood distributions in the Bayesian decision analysis (BDA, and the resultant posterior distributions were used to determine the long-term exposure and health-risks posed on workers. Results show that long term exposures to PAHs would result in a 3.1%, 96.7%, and 73.4% chance of exceeding the PEL-TWA (0.2 mg/m3, action level (0.1 mg/m3, and acceptable health risk (10−3, respectively. In conclusion, preventive measures should be taken immediately to reduce workers’ PAH exposures.

  10. Should mental health assessments be integral to domestic violence research?

    Science.gov (United States)

    Satyanarayana, Veena A; Chandra, Prabha S

    2009-01-01

    Research on sensitive issues such as abuse and violence in vulnerable populations poses several ethical dilemmas. An important aspect is the impact of such enquiries on one's mental health. This paper discusses specific ethical issues related to mental health based on violence research conducted and reviewed by the authors. Research on violence among women includes the possibility that some revelations are occurring for the first time and are likely to be emotionally charged. Further, the very act of disclosure may involve emotional risks for the respondent. Psychological distress may be present prior to, during, or following the study. Hence assessing mental health parameters becomes essential and integral to research of this nature. Several issues in methodology are also important in mitigating the level of distress. Research on sensitive issues should either use measures developed in the same culture or those with adequate adaptation. The order of questions, language and method of termination of the interview may often make a difference to its psychological impact. While focus group discussions and semi structured interview schedules are most suited, questionnaires with a less structured and rigid approach may also be used. Preludes may be introduced to facilitate transition between different sections of an interview schedule and to provide a rationale for further enquiry. Obtaining informed consent in violence research should be a process rather than a one-time formality. Reports of adverse events are likely in violence research and hence such studies must include mental health intervention, ongoing follow up, documentation and appropriate referral services. Finally, since the researcher and the subject of the research are both affected in a study of this nature, adequate sensitisation, ongoing training and supervision of research staff are essential. Based on findings from ongoing research on violence and from review of other studies done in India, the paper

  11. Assessing Community Health Risks: Proactive Vs Reactive Sampling

    Directory of Open Access Journals (Sweden)

    Sarah Taylor

    2009-01-01

    Full Text Available Problem statement: A considerable number of native birds died in the West Australian coastal town of Esperance and surroundings during late 2006 and early 2007, which raised community concerns about environmental contamination. Forensic investigations of dead birds suggested that lead may have been the causative agent. At the time, lead and nickel, as well as iron ore and other materials, were being exported through the Port of Esperance (port. Government agencies undertook a targeted environmental sampling programme to identify the exposure sources and the extent of contamination. Results of ambient air monitoring, blood lead level investigations and analysis of metals in rainwater tanks suggested widespread contamination of the Esperance town site with lead and nickel. The Department of Environment and Conservation (DEC retained Golder Associates Pty Ltd., (Golder to undertake a human health and ecological risk assessment (risk assessment using the information collected through the investigation of lead and nickel contamination in Esperance. The quantity and quality of exposure data are an important contributor to the uncertainty associated with the outcomes of a risk assessment. Conclusion: As the data were collected essentially as part of the emergency response to the events in Esperance, there was some uncertainty about the suitability and completeness of the data for risk assessment. The urgent nature of the emergency response meant that sampling was opportunistic and not necessarily sufficient or suitable for risk assessment from a methodical and scientific perspective. This study demonstrated the need for collecting ‘meaningful and reliable’ data for assessing risks from environmental contamination.

  12. Cumulative psychosocial stress, coping resources, and preterm birth.

    Science.gov (United States)

    McDonald, Sheila W; Kingston, Dawn; Bayrampour, Hamideh; Dolan, Siobhan M; Tough, Suzanne C

    2014-12-01

    Preterm birth constitutes a significant international public health issue, with implications for child and family well-being. High levels of psychosocial stress and negative affect before and during pregnancy are contributing factors to shortened gestation and preterm birth. We developed a cumulative psychosocial stress variable and examined its association with early delivery controlling for known preterm birth risk factors and confounding environmental variables. We further examined this association among subgroups of women with different levels of coping resources. Utilizing the All Our Babies (AOB) study, an ongoing prospective pregnancy cohort study in Alberta, Canada (n = 3,021), multinomial logistic regression was adopted to examine the independent effect of cumulative psychosocial stress and preterm birth subgroups compared to term births. Stratified analyses according to categories of perceived social support and optimism were undertaken to examine differential effects among subgroups of women. Cumulative psychosocial stress was a statistically significant risk factor for late preterm birth (OR = 1.73; 95 % CI = 1.07, 2.81), but not for early preterm birth (OR = 2.44; 95 % CI = 0.95, 6.32), controlling for income, history of preterm birth, pregnancy complications, reproductive history, and smoking in pregnancy. Stratified analyses showed that cumulative psychosocial stress was a significant risk factor for preterm birth at psychosocial stress on the risk for early delivery.

  13. Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

    Energy Technology Data Exchange (ETDEWEB)

    ORAU' s Oak Ridge Institute for Science Education (HCTT-CHE)

    2011-04-14

    The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster - readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that - help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. This tool has been reviewed by a variety of key subject matter experts from federal, state, and local agencies and organizations. It also has been piloted with various communities that consist of different population sizes, to include large urban to small rural communities.

  14. Advanced korean industrial safety and health policy with risk assessment.

    Science.gov (United States)

    Kwon, Hyuckmyun; Cho, Jae Hyun; Moon, Il; Choi, Jaewook; Park, Dooyong; Lee, Youngsoon

    2010-09-01

    This article describes a systematic roadmap master plan for advanced industrial safety and health policy in Korea, with an emphasis on. Since Korean industries had first emergence of industrial safety and health policy in 1953, enormous efforts have been made on upgrading the relevant laws in order to reflect real situation of industrial work environment in accordance with rapid changes of Korean and global business over three decades. Nevertheless, current policy has major defects; too much techniques-based articles, diverged contents in less organization, combined enforcement and punishments and finally enforcing regulations full of commands and control. These deficiencies have make it difficult to accommodate changes of social, industrial and employment environment in customized fashion. The approach to the solution must be generic at the level of paradigm-shift rather than local modifications and enhancement. The basic idea is to establish a new system integrated with a risk assessment scheme, which encourages employers to apply to their work environment under comprehensive responsibility. The risk assessment scheme is designed to enable to inspect employers' compliances afterwards. A project comprises four yearly phases based on applying zones; initially designating and operating a specified risk zone, gradually expanding the special zones during a period of 3 years (2010-2012) and the final zone expanded to entire nation. In each phase, the intermediate version of the system is updated through a process of precise and unbiased validation in terms of its operability, feasibility and sustainability with building relevant infrastructures as needed.

  15. [Quality of health care, accreditation, and health technology assessment in Croatia: role of agency for quality and accreditation in health].

    Science.gov (United States)

    Mittermayer, Renato; Huić, Mirjana; Mestrović, Josipa

    2010-12-01

    Avedis Donabedian defined the quality of care as the kind of care, which is expected to maximize an inclusive measure of patient welfare, after taking into account the balance of expected gains and losses associated with the process of care in all its segments. According to the World Medical Assembly, physicians and health care institutions have an ethical and professional obligation to strive for continuous quality improvement of services and patient safety with the ultimate goal to improve both individual patient outcomes as well as population health. Health technology assessment (HTA) is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner, with the aim to formulate safe and effective health policies that are patient focused and seek to achieve the highest value. The Agency for Quality and Accreditation in Health was established in 2007 as a legal, public, independent, nonprofit institution under the Act on Quality of Health Care. The Agency has three departments: Department of Quality and Education, Department of Accreditation, and Department of Development, Research, and Health Technology Assessment. According to the Act, the Agency should provide the procedure of granting, renewal and cancellation of accreditation of healthcare providers; proposing to the Minister, in cooperation with professional associations, the plan and program for healthcare quality assurance, improvement, promotion and monitoring; proposing the healthcare quality standards as well as the accreditation standards to the Minister; keeping a register of accreditations and providing a database related to accreditation, healthcare quality improvement, and education; providing education in the field of healthcare quality assurance, improvement and promotion; providing the HTA procedure and HTA database, supervising the healthcare insurance

  16. Why ethics should be part of health technology assessment.

    Science.gov (United States)

    Hofmann, Bjørn Morten

    2008-01-01

    From the heydays of HTA in the 1970s, it has been argued that ethics should be a part of HTA. Despite more than 30 years with repeated intentions, only few HTA reports include ethical analysis, and there is little agreement on methods for integrating ethics. This poses the question of why it is so important to integrate ethics in HTA? The article analyzes ten arguments for making ethics part of HTA. The validity of the arguments depend on what we mean by "integrating," "ethics," and "HTA." Some of the counterarguments explain why it has taken so long to integrate ethics in HTA and why there are so many ethical approaches. Nevertheless, some of the arguments for making ethics part of HTA appear to be compelling. Health care is a moral endeavor, and the vast potential of technology poses complex moral challenges. A thorough assessment of technology would include reflection on these moral aspects. Ethics provides such a moral reflection. Health technology is a way to improve the life of human individuals. This involves questions of what "the good life" is, and hence ethical issues. Trying to ignore such questions may inflict with the moral foundation of health care: to help people. Additionally, HTA is an evaluation, and as such also a reflection on values. Hence, there is a profound affinity between HTA and ethics. Accordingly, ethics cannot be "integrated" in HTA as ethics is already a constitutive part of HTA. However, ethics can be acknowledged and emphasized.

  17. Residential mental health assessment within Dutch criminal cases: a discussion.

    Science.gov (United States)

    van der Leij, J B; Jackson, J L; Malsch, M; Nijboer, J F

    2001-01-01

    In Dutch criminal cases in which doubts arise about the defendant's mental health, a forensic assessment will be requested. This is provided either by the multidisciplinary staff of residential clinics who conduct forensic evaluations for the court, or by mental health professionals contracted on a part-time basis by district courts. This article discusses the procedures applied in such cases as well as the relevant legal provisions. It focuses particularly on the clinical observation, evaluation, and reporting that is carried out over a number of weeks in the residential setting of the Pieter Baan Centrum. Specific attention is paid to procedures applied in this clinic. It is suggested that Dutch procedures for the use of mental health expertise can best be characterized by three aspects: multidisciplinary observation and reporting, the use of a sliding scale for indicating degree of responsibility, and, finally, the involvement and payment of experts by the state as such, rather than by the prosecution and/or the defense.

  18. [Citizen participation in the context of health technology assessment].

    Science.gov (United States)

    Freile-Gutiérrez, Berenice

    2014-01-01

    Citizen participation is important in all economic sectors of the democratic world, as it is also in the field of health. This is due to the significant value of life and therefore enjoying this in a healthy condition. This paper seeks to provide an overview of public participation in the context of Health Technology Assessments (HTA), covering from conceptualization to practical experiences. Within the existing literature, the definitions and methodological aspects of the topic discussed are reviewed, as well as how citizen participation in HTA agencies is manifested, presenting barriers as well as enablers for public involvement. In the Chilean case, where there are no public participation experiences in the context of HTA, a review of these initiatives in the health care sector is performed. In light with the studies examined, it is concluded that there is much to advance in the concreteness of citizen participation in HTA's agencies; efforts at institutional level as well as from community organizations are needed. This review can be useful as an antecedent for countries that are considering incorporating HTA in the future.

  19. Health Workforce Development: A Needs Assessment Study in French Speaking African Countries

    Science.gov (United States)

    Chastonay, Philippe; Moretti, Roberto; Zesiger, Veronique; Cremaschini, Marco; Bailey, Rebecca; Pariyo, George; Kabengele, Emmanuel Mpinga

    2013-01-01

    In 2006, WHO alerted the world to a global health workforce crisis, demonstrated through critical shortages of health workers, primarily in Sub-Saharan Africa (WHO in World Health Report, 2006). The objective of our study was to assess, in a participative way, the educational needs for public health and health workforce development among potential…

  20. Teaching Community Health Assessment Skills in a Problem-based Format.

    Science.gov (United States)

    Sass, Pamela; Edelsack, Pyser

    2001-01-01

    Describes a four-week rotation at the State University of New York Health Science Center in Brooklyn in which medical residents are taught community health assessment using a problem-based format. They use demographic and health data to create rates they believe will help to illuminate the health status and health issues of their assigned…

  1. Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

    Energy Technology Data Exchange (ETDEWEB)

    HCTT-CHE

    2011-04-14

    The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster—readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that—help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners' (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. While the purpose of the CAT is to further prepare the community for an influenza pandemic, its framework is an extension of the traditional all-hazards approach to planning and preparedness. As such, the information gathered by the tool is useful in preparation for most widespread public health emergencies. This tool is primarily intended for use by those involved in healthcare emergency preparedness (e.g., community planners, community disaster preparedness coordinators, 9-1-1 directors, hospital emergency preparedness coordinators). It is divided into sections based on the core agency partners, which may be involved in the community's influenza pandemic influenza response.

  2. A Systematic Methodology for Gearbox Health Assessment and Fault Classification

    Directory of Open Access Journals (Sweden)

    Jay Lee

    2011-01-01

    Full Text Available A systematic methodology for gearbox health assessment and fault classification is developed and evaluated for 560 data sets of gearbox vibration data provided by the Prognostics and Health Management Society for the 2009 data challenge competition. A comprehensive set of signal processing and feature extraction methods are used to extract over 200 features, including features extracted from the raw time signal, time synchronous signal, wavelet decomposition signal, frequency domain spectrum, envelope spectrum, among others. A regime segmentation approach using the tachometer signal, a spectrum similarity metric, and gear mesh frequency peak information are used to segment the data by gear type, input shaft speed, and braking torque load. A health assessment method that finds the minimum feature vector sum in each regime is used to classify and find the 80 baseline healthy data sets. A fault diagnosis method based on a distance calculation from normal along with specific features correlated to different fault signatures is used to diagnosis specific faults. The fault diagnosis method is evaluated for the diagnosis of a gear tooth breakage, input shaft imbalance, bent shaft, bearing inner race defect, and bad key, and the method could be further extended for other faults as long as a set of features can be correlated with a known fault signature. Future work looks to further refine the distance calculation algorithm for fault diagnosis, as well as further evaluate other signal processing method such as the empirical mode decomposition to see if an improved set of features can be used to improve the fault diagnosis accuracy.

  3. Assessing the Physical Activity of Health Volunteers Based on the Pender’s Health Promotion Model

    Directory of Open Access Journals (Sweden)

    Rahimian M.* MSc,

    2015-12-01

    Full Text Available Aims Physical inactivity has been identified as the 4th leading risk factor for global mortality causing an estimated of 3.2million deaths per year. This study aimed to assess the physical activity of health volunteers with Pender’s Health Promotion Model. Instrument & Methods This cross-sectional analytical study was performed on 80 health volunteers in Torbat-e-Jam City, Iran, in 2015. A researcher-made questionnaire with the following sections was used to gather data; perceived benefits, perceived barriers, selfefficacy, interpersonal influences, positive emotion, commitment, modeling and competing preferences. SPSS 16 sofware was used to analyze data by independent T, Pearson’s correlation coefficient and linear regression tests. Findings There was no significant difference between the scores according to educational levels, age groups, BMI score, marital status, habitat and experience as a health volunteer duration. Physical activity had positive correlation with perceived benefits, self-efficacy, commitment, positive emotion and situational influences and a negative correlation with perceived barriers. Situational influences, as the strongest predictor of the physical activity, predicted 35.1% of it and then positive emotions predicted 34.7% and self-efficacy predicted 23.4% of physical activity. Conclusion The level of physical activity in health volunteers of Torbat-e-Jam City, Iran, is not appropriate and is less than moderate.

  4. Assessing the Impact of a Human Rights-Based Approach across a Spectrum of Change for Women's, Children's, and Adolescents' Health.

    Science.gov (United States)

    Thomas, Rebekah; Kuruvilla, Shyama; Hinton, Rachel; Jensen, Steven L B; Magar, Veronica; Bustreo, Flavia

    2015-12-10

    Global momentum around women's, children's, and adolescents' health, coupled with the ambitious and equalizing agenda of the Sustainable Development Goals (SDGs), has exposed a tension between the need for comprehensive, multi-actor, rights-based approaches that seek to "close the gaps" and a growing economic and political imperative to demonstrate efficiency, effectiveness, and returns on specific investments. To address this challenge, this paper proposes a framework to measure "results" in a way that offers a more nuanced understanding of the impact of human rights-based approaches and their complexity, as well as their contextual, multi-sectoral, and evolving nature. We argue that the impact of human rights-based approaches is best measured across a spectrum of change-at the individual, programmatic, structural, and societal levels. Such an analysis would allow for more accurate assessments of the cumulative effect of these changes. The paper also underscores the long-overdue need to better define the parameters of a human rights-based approach to health. This is an important part of the research agenda on human rights and health in the context of the SDGs and the Global Strategy for Women's, Children's and Adolescents' Health, and amid calls for better measurement and greater accountability for resources, results, and rights at all levels. While this paper focuses on women's, children's, and adolescents' health, the proposed framework can apply as readily to other areas of health and provides a new frame of reference for assessing the impact of human rights-based approaches.

  5. Drug delivery system innovation and Health Technology Assessment: Upgrading from Clinical to Technological Assessment.

    Science.gov (United States)

    Panzitta, Michele; Bruno, Giorgio; Giovagnoli, Stefano; Mendicino, Francesca R; Ricci, Maurizio

    2015-11-30

    Health Technology Assessment (HTA) is a multidisciplinary health political instrument that evaluates the consequences, mainly clinical and economical, of a health care technology; the HTA aim is to produce and spread information on scientific and technological innovation for health political decision making process. Drug delivery systems (DDS), such as nanocarriers, are technologically complex but they have pivotal relevance in therapeutic innovation. The HTA process, as commonly applied to conventional drug evaluation, should upgrade to a full pharmaceutical assessment, considering the DDS complexity. This is useful to study more in depth the clinical outcome and to broaden its critical assessment toward pharmaceutical issues affecting the patient and not measured by the current clinical evidence approach. We draw out the expertise necessary to perform the pharmaceutical assessment and we propose a format to evaluate the DDS technological topics such as formulation and mechanism of action, physicochemical characteristics, manufacturing process. We integrated the above-mentioned three points in the Evidence Based Medicine approach, which is data source for any HTA process. In this regard, the introduction of a Pharmaceutics Expert figure in the HTA could be fundamental to grant a more detailed evaluation of medicine product characteristics and performances and to help optimizing DDS features to overcome R&D drawbacks. Some aspects of product development, such as manufacturing processes, should be part of the HTA as innovative manufacturing processes allow new products to reach more effectively patient bedside. HTA so upgraded may encourage resource allocating payers to invest in innovative technologies and providers to focus on innovative material properties and manufacturing processes, thus contributing to bring more medicines in therapy in a sustainable manner.

  6. Nigeria's National Health Act: An assessment of health professionals' knowledge and perception

    Directory of Open Access Journals (Sweden)

    Osahon Enabulele

    2016-01-01

    Full Text Available Background: Nigeria's National Health Act 2014 (NHA 2014 was signed into law on October 31, 2014. It provides a legal framework for the regulation, development, and management of Nigeria's Health System. This study assessed the knowledge and perception of the NHA 2014 by health professionals. Materials and Methods: This was a descriptive, cross-sectional, questionnaire-based study conducted in December 2015, in Ota, Ogun State, Nigeria. Data entry and analysis were done using the Statistical Package for the Social Sciences version 16 (IBM SPSS, Chicago, IL, USA statistical software, with Pearson's Chi-square, which is used to determine the associations between variables. Statistical significance was set at a P < 0.05. Results: The study population comprised 130 health professionals (medical doctors/dentists, nurses, pharmacists, laboratory scientists, and other health-related professionals in attendance at a medical conference. The respondents' age ranged from 21 to 75 years with a mean age of 44.53 ± 12.46 years. Medical practitioners accounted for 82.3% of the respondents. Although most (79.2% respondents had a good perception of the NHA 2014 with majority (86.2% claiming they were aware of the act, majority (73.8% exhibited poor knowledge of the act. A little more than half (53.1% of the respondents believed that the NHA 2014 will help to reduce strike actions in the health sector. Conclusion: Although health professionals in Nigeria have good awareness and perception of the NHA 2014, their knowledge of the Act is poor.

  7. Nanomaterials safety assessment: contribution from the Portuguese National Institute of Health (INSA) research

    OpenAIRE

    2015-01-01

    The National Health Institute Doutor Ricardo Jorge (INSA) is a public organization of the Portuguese Ministry of Health, which develops a triple role as State Laboratory in the health sector, National Reference Laboratory and National Health Observatory. All operative units composing the departments develop multidisciplinary programs in problem areas of Public Health, namely performing R&D, health monitoring, training, laboratory external quality assessment and general health services. INS...

  8. Endocrine disruptor phthalates in bottled water: daily exposure and health risk assessment in pregnant and lactating women.

    Science.gov (United States)

    Jeddi, Maryam Zare; Rastkari, Noushin; Ahmadkhaniha, Reza; Yunesian, Masud

    2016-09-01

    Over the last decade, the consumption of water bottled in polyethylene terephthalate (PET) has considerably increased, raising concerns over water quality and packaged materials. This study aims to investigate the levels of the anti-androgenic phthalates including bis-(2-ethylhexyl) phthalate (DEHP), dibutyl phthalate (DBP), and benzyl butyl phthalate (BBP), in bottled water and its corresponding health risks in pregnant and lactating women. The phthalate levels were measured in six different brands of bottled water exposed to temperatures ranging between -18 and 40 °C and sunlight for 45 days. The phthalate was quantified using the gas chromatography-mass spectrometry (GC-MS). In addition, the non-carcinogenic effects were assessed using hazard quotient (HQ) approach, and cumulative health risk assessment was performed on the basis of hazard index (HI) calculation. In order to assess the carcinogenic risk due to the possible carcinogen DEHP (group 2B), the excess lifetime cancer risk (ELCR) was used. DEHP and DBP contaminants were detected at different storage conditions in all of the bottled water samples during the storage time. BBP was only detected at high temperature (≥25 °C) and outdoor conditions. The maximum concentrations of all phthalates were observed when water samples were kept at 40 °C. In contrast, storage at freezing conditions had no significant effect on the concentration level of all phthalates. The estimated intake by women was between 0.0021 μg/kg/day for BBP and 0.07 μg/kg/day for DEHP. The highest HQ for phthalate intake via bottled water consumption was much lower than 1 (HQ bottled water are not a health concern for pregnant and lactating women. Consequently, PET-bottled water is not a major contributor to phthalate intake for most individuals.

  9. Pesticide assessment: Protecting public health on the home turf.

    Science.gov (United States)

    Sears, Meg; Walker, C Robin; van der Jagt, Richard Hc; Claman, Paul

    2006-04-01

    Pesticide regulation is examined in the context of Health Canada's Pest Management Regulatory Agency's assessment of the chlorophenoxy herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) for turf. 2,4-D is the most common herbicide used to kill weeds in grass.The medical literature does not uniformly indicate harms from herbicides. However, the balance of epidemiological research suggests that 2,4-D can be persuasively linked to cancers, neurological impairment and reproductive problems. These may arise from 2,4-D itself, from breakdown products or dioxin contamination, or from a combination of chemicals.Regulators rely largely on toxicology, but experiments may not replicate exposures from 2,4-D application to lawns because environmental breakdown products (eg, 2,4-dichlorophenol) may not accumulate and selected herbicides are possibly less contaminated. Dioxins are bioaccumulative chemicals that may cause cancer, harm neurological development, impair reproduction, disrupt the endocrine system and alter immune function. No dioxin analyses were submitted to the Pest Management Regulatory Agency, and the principal contaminants of 2,4-D are not among the 17 congeners covered in pesticide regulation. Independent assessment of all dioxins is needed, in tissues and in the environment.The 2,4-D assessment does not approach standards for ethics, rigour or transparency in medical research. Canada needs a stronger regulator for pesticides. Potentially toxic chemicals should not be registered when more benign solutions exist, risks are not clearly quantifiable or potential risks outweigh benefits. Until landscaping pesticides are curtailed nationally, local bylaws and Quebec's Pesticide Code are prudent measures to protect public health. Physicians have a role in public education regarding pesticides.

  10. [Assessing the impact of the environment on human health].

    Science.gov (United States)

    Locatelli, Marine

    2016-05-01

    In public health, nurses are concerned with the global health of populations. A recently qualified nurse, interested in this area of health, enhanced her skills with a master's degree specialising in the links between the environment and health.

  11. Obstetrician-assessed maternal health at pregnancy predicts offspring future health.

    Directory of Open Access Journals (Sweden)

    Debbie A Lawlor

    Full Text Available BACKGROUND: We aimed to examine the association between obstetrician assessment of maternal physical health at the time of pregnancy and offspring cardiovascular disease risk. METHODS AND PRINCIPAL FINDINGS: We examined this association in a birth cohort of 11,106 individuals, with 245,000 person years of follow-up. We were concerned that any associations might be explained by residual confounding, particularly by family socioeconomic position. In order to explore this we used multivariable regression models in which we adjusted for a range of indicators of socioeconomic position and we explored the specificity of the association. Specificity of association was explored by examining associations with other health related outcomes. Maternal physical health was associated with cardiovascular disease: adjusted (socioeconomic position, complications of pregnancy, birthweight and childhood growth at mean age 5 hazard ratio comparing those described as having poor or very poor health at the time of pregnancy to those with good or very good health was 1.55 (95%CI: 1.05, 2.28 for coronary heart disease, 1.91 (95%CI: 0.99, 3.67 for stroke and 1.57 (95%CI: 1.13, 2.18 for either coronary heart disease or stroke. However, this association was not specific. There were strong associations for other outcomes that are known to be related to socioeconomic position (3.61 (95%CI: 1.04, 12.55 for lung cancer and 1.28 (95%CI:1.03, 1.58 for unintentional injury, but not for breast cancer (1.10 (95%CI:0.48, 2.53. CONCLUSIONS AND SIGNIFICANCE: These findings demonstrate that a simple assessment of physical health (based on the appearance of eyes, skin, hair and teeth of mothers at the time of pregnancy is a strong indicator of the future health risk of their offspring for common conditions that are associated with poor socioeconomic position and unhealthy behaviours. They do not support a specific biological link between maternal health across her life course and

  12. Environmental health risk assessment and management for global climate change

    Science.gov (United States)

    Carter, P.

    2014-12-01

    This environmental health risk assessment and management approach for atmospheric greenhouse gas (GHG) pollution is based almost entirely on IPCC AR5 (2014) content, but the IPCC does not make recommendations. Large climate model uncertainties may be large environmental health risks. In accordance with environmental health risk management, we use the standard (IPCC-endorsed) formula of risk as the product of magnitude times probability, with an extremely high standard of precaution. Atmospheric GHG pollution, causing global warming, climate change and ocean acidification, is increasing as fast as ever. Time is of the essence to inform and make recommendations to governments and the public. While the 2ºC target is the only formally agreed-upon policy limit, for the most vulnerable nations, a 1.5ºC limit is being considered by the UNFCCC Secretariat. The Climate Action Network International (2014), representing civil society, recommends that the 1.5ºC limit be kept open and that emissions decline from 2015. James Hansen et al (2013) have argued that 1ºC is the danger limit. Taking into account committed global warming, its millennial duration, multiple large sources of amplifying climate feedbacks and multiple adverse impacts of global warming and climate change on crops, and population health impacts, all the IPCC AR5 scenarios carry extreme environmental health risks to large human populations and to the future of humanity as a whole. Our risk consideration finds that 2ºC carries high risks of many catastrophic impacts, that 1.5ºC carries high risks of many disastrous impacts, and that 1ºC is the danger limit. IPCC AR4 (2007) showed that emissions must be reversed by 2015 for a 2ºC warming limit. For the IPCC AR5 only the best-case scenario RCP2.6, is projected to stay under 2ºC by 2100 but the upper range is just above 2ºC. It calls for emissions to decline by 2020. We recommend that for catastrophic environmental health risk aversion, emissions decline

  13. Nonlinear cumulative damage model for multiaxial fatigue

    Institute of Scientific and Technical Information of China (English)

    SHANG De-guang; SUN Guo-qin; DENG Jing; YAN Chu-liang

    2006-01-01

    On the basis of the continuum fatigue damage theory,a nonlinear uniaxial fatigue cumulative damage model is first proposed.In order to describe multiaxial fatigue damage characteristics,a nonlinear multiaxial fatigue cumulative damage model is developed based on the critical plane approach,The proposed model can consider the multiaxial fatigue limit,mean hydrostatic pressure and the unseparated characteristic for the damage variables and loading parameters.The recurrence formula of fatigue damage model was derived under multilevel loading,which is used to predict multiaxial fatigue life.The results showed that the proposed nonlinear multiaxial fatigue cumulative damage model is better than Miner's rule.

  14. Risk management assessment of Health Maintenance Organisations participating in the National Health Insurance Scheme

    Science.gov (United States)

    Campbell, Princess Christina; Korie, Patrick Chukwuemeka; Nnaji, Feziechukwu Collins

    2014-01-01

    Background: The National Health Insurance Scheme (NHIS), operated majorly in Nigeria by health maintenance organisations (HMOs), took off formally in June 2005. In view of the inherent risks in the operation of any social health insurance, it is necessary to efficiently manage these risks for sustainability of the scheme. Consequently the risk-management strategies deployed by HMOs need regular assessment. This study assessed the risk management in the Nigeria social health insurance scheme among HMOs. Materials and Methods: Cross-sectional survey of 33 HMOs participating in the NHIS. Results: Utilisation of standard risk-management strategies by the HMOs was 11 (52.6%). The other risk-management strategies not utilised in the NHIS 10 (47.4%) were risk equalisation and reinsurance. As high as 11 (52.4%) of participating HMOs had a weak enrollee base (less than 30,000 and poor monthly premium and these impacted negatively on the HMOs such that a large percentage 12 (54.1%) were unable to meet up with their financial obligations. Most of the HMOs 15 (71.4%) participated in the Millennium development goal (MDG) maternal and child health insurance programme. Conclusions: Weak enrollee base and poor monthly premium predisposed the HMOs to financial risk which impacted negatively on the overall performance in service delivery in the NHIS, further worsened by the non-utilisation of risk equalisation and reinsurance as risk-management strategies in the NHIS. There is need to make the scheme compulsory and introduce risk equalisation and reinsurance. PMID:25298605

  15. Risk management assessment of Health Maintenance Organisations participating in the National Health Insurance Scheme

    Directory of Open Access Journals (Sweden)

    Princess Christina Campbell

    2014-01-01

    Full Text Available Background: The National Health Insurance Scheme (NHIS, operated majorly in Nigeria by health maintenance organisations (HMOs, took off formally in June 2005. In view of the inherent risks in the operation of any social health insurance, it is necessary to efficiently manage these risks for sustainability of the scheme. Consequently the risk-management strategies deployed by HMOs need regular assessment. This study assessed the risk management in the Nigeria social health insurance scheme among HMOs. Materials and Methods: Cross-sectional survey of 33 HMOs participating in the NHIS. Results: Utilisation of standard risk-management strategies by the HMOs was 11 (52.6%. The other risk-management strategies not utilised in the NHIS 10 (47.4% were risk equalisation and reinsurance. As high as 11 (52.4% of participating HMOs had a weak enrollee base (less than 30,000 and poor monthly premium and these impacted negatively on the HMOs such that a large percentage 12 (54.1% were unable to meet up with their financial obligations. Most of the HMOs 15 (71.4% participated in the Millennium development goal (MDG maternal and child health insurance programme. Conclusions: Weak enrollee base and poor monthly premium predisposed the HMOs to financial risk which impacted negatively on the overall performance in service delivery in the NHIS, further worsened by the non-utilisation of risk equalisation and reinsurance as risk-management strategies in the NHIS. There is need to make the scheme compulsory and introduce risk equalisation and reinsurance.

  16. Continuously Cumulating Meta-Analysis and Replicability.

    Science.gov (United States)

    Braver, Sanford L; Thoemmes, Felix J; Rosenthal, Robert

    2014-05-01

    The current crisis in scientific psychology about whether our findings are irreproducible was presaged years ago by Tversky and Kahneman (1971), who noted that even sophisticated researchers believe in the fallacious Law of Small Numbers-erroneous intuitions about how imprecisely sample data reflect population phenomena. Combined with the low power of most current work, this often leads to the use of misleading criteria about whether an effect has replicated. Rosenthal (1990) suggested more appropriate criteria, here labeled the continuously cumulating meta-analytic (CCMA) approach. For example, a CCMA analysis on a replication attempt that does not reach significance might nonetheless provide more, not less, evidence that the effect is real. Alternatively, measures of heterogeneity might show that two studies that differ in whether they are significant might have only trivially different effect sizes. We present a nontechnical introduction to the CCMA framework (referencing relevant software), and then explain how it can be used to address aspects of replicability or more generally to assess quantitative evidence from numerous studies. We then present some examples and simulation results using the CCMA approach that show how the combination of evidence can yield improved results over the consideration of single studies.

  17. Body burdens: an integrated approach to health risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Gasper, J. R.; Dauzvardis, P. A.

    1979-01-01

    Monitoring, modeling, and laboratory data are being integrated with physiological data in order to assess the impact of the release of environmental contaminants on the human receptor. The methodology described in this paper is intended primarily for use as a screening method to identify relative health risks. Comparison of body burdens and critical organ burdens can identify the relative contribution from different sources of exposure, exposure pathways, and routes of entry. These two burdens may be used in conjunction with monitoring data and environmental modeling techniques to assess the relative risk of effluent releases from natural and industrial sources or from different effluent control technologies or waste disposal methods. The relative impact of different levels of regional economic growth or regulatory plans can also be assessed. Body burdens may also serve to indicate where effluent control efforts will be most successful in reducing impacts on humans. The example projects the relative contributions to body burdens of arsenic, cadmium, chromium, mercury and lead resulting from background air and water quality, effluent releases from a coal-fired steam electric power plant, and from diet.

  18. HEALTH ASSESSMENT OF 1,3-BUTADIENE | Science ...

    Science.gov (United States)

    This assessment was conducted to review the new information that has become available since EPA's 1985 health assessment of 1,3-butadiene.1,3-Butadiene is a gas used commercially in the production of styrene-butadiene rubber, plastics, and thermoplastic resins. The major environmental source of 1,3-butadiene is the incomplete combustion of fuels from mobile sources (e.g., automobile exhaust). Tobacco smoke can be a significant source of 1,3-butadiene in indoor air.This assessment concludes that 1,3-butadiene is carcinogenic to humans by inhalation, based on the total weight of evidence. The specific mechanisms of 1,3-butadiene-induced carcinogenesis are unknown; however, it is virtually certain that the carcinogenic effects are mediated by genotoxic metabolites of 1,3-butadiene.Animal data suggest that females may be more sensitive than males for cancer effects; nevertheless, there are insufficient data from which to draw any conclusions on potentially sensitive subpopulations.The human incremental lifetime unit cancer (incidence) risk estimate is based on extrapolation from leukemias observed in an occupational epidemiologic study. A twofold adjustment to the epidemiologic-based unit cancer risk is then applied to reflect evidence from the rodent bioassays suggesting that the epidemiologic-based estimate may underestimate total cancer risk from 1,3-butadiene exposure in the general population. 1,3-Butadiene also causes a variety of reproductive and develop

  19. The impact of inclusion criteria in health economic assessments.

    Science.gov (United States)

    Richter, Anke; Thieda, Patricia; Thaler, Kylie; Gartlehner, Gerald

    2011-05-01

    The debate surrounding whether the findings of efficacy studies are applicable to real-world treatment situations is ongoing. The issue of lack of applicability due to a lack of clinical heterogeneity could be addressed by employing less restrictive inclusion criteria. Given that health economic assessments based on cost-effectiveness measures are required by many governments and insurance providers, the impact of this choice may be far reaching. The objective of this article was to explore the use of a pilot study to examine the impact of inclusion criteria on cost-effectiveness results and clinical heterogeneity. A health economic assessment was conducted using QRISK®2 and simulation modelling of different population groups within the pilot study in Lower Austria. Patients were referred by their family physicians to 'Active Prevention' (Vorsorge Aktiv), a community-based lifestyle intervention focused on exercise and nutritional programmes. Cardiovascular risk factors were recorded before and after the intervention and translated to cardiovascular events. As expected, enforcing restrictive inclusion criteria produced stronger and more irrefutable computations - in the expected number of events, the number of deaths, the incremental cost per life-year saved and in the 95% confidence interval. These findings provide insight into the issues surrounding clinical heterogeneity and the need for restrictive inclusion criteria. This is not a full health economic assessment of the intervention. While inclusion criteria provide stronger results by limiting populations to those who would benefit the most, they must be enforced, both within and outside the clinical trial setting. Enforcement has costs, both monetary and arising from unintended negative consequences of enforcement mechanisms. All these considerations will affect the results realized by the payer organization. A pilot study can reveal whether an intervention may be cost effective 'enough' without restrictive

  20. Combining environment and health information systems for the assessment of atmospheric pollution on human health.

    Science.gov (United States)

    Skouloudis, Andreas N; Kassomenos, Pavlos

    2014-08-01

    The use of emerging technologies for environmental monitoring with satellite and in-situ sensors have become essential instruments for assessing the impact of environmental pollution on human health, especially in areas that require high spatial and temporal resolution. This was until recently a rather difficult problem. Regrettably, with classical approaches the spatial resolution is frequently inadequate in reporting environmental causes and health effects in the same time scale. This work examines with new tools different levels of air-quality with sensor monitoring with the aim to associate those with severe health effects. The process established here facilitates the precise representation of human exposure with the population attributed in a fine spatial grid and taking into account environmental stressors of human exposure. These stressors can be monitored with innovative sensor units with a temporal resolution that accurately describes chronic and acute environmental burdens. The current understanding of the situation in densely populated areas can be properly analyzed, before commitments are made for reductions in total emissions as well as for assessing the effects of reduced trans-boundary fluxes. In addition, the data processed here with in-situ sensors can assist in establishing more effective regulatory policies for the protection of vulnerable population groups and the satellite monitoring instruments permit abatement strategies that are close to real-time over large geographical areas.

  1. TESTING FOR DIFFERENCES BETWEEN CUMULATIVE DISTRIBUTION FUNCTIONS FROM COMPLEX ENVIRONMENTAL SAMPLING SURVEYS

    Science.gov (United States)

    The U.S. Environmental Protection Agency's Environmental Monitoring and Assessment Program (EMAP) employs the cumulative distribution function (cdf) to measure the status of quantitative variables for resources of interest. The ability to compare cdf's for a resource from, say,...

  2. Assessment of an Anomaly Detector for Jet Engine Health Monitoring

    Directory of Open Access Journals (Sweden)

    Sebastien Borguet

    2011-01-01

    Full Text Available The goal of module performance analysis is to reliably assess the health of the main components of an aircraft engine. A predictive maintenance strategy can leverage this information to increase operability and safety as well as to reduce costs. Degradation undergone by an engine can be divided into gradual deterioration and accidental events. Kalman filters have proven very efficient at tracking progressive deterioration but are poor performers in the face of abrupt events. Adaptive estimation is considered as an appropriate solution to this deficiency. This paper reports the evaluation of the detection capability of an adaptive diagnosis tool on the basis of simulated scenarios that may be encountered during the operation of a commercial turbofan engine. The diagnosis tool combines a Kalman filter and a secondary system that monitors the residuals. This auxiliary component implements a generalised likelihood ratio test in order to detect abrupt events.

  3. Air quality monitoring in NIS (SERBIA) and health impact assessment.

    Science.gov (United States)

    Nikic, Dragana; Bogdanovic, Dragan; Nikolic, Maja; Stankovic, Aleksandra; Zivkovic, Nenad; Djordjevic, Amelija

    2009-11-01

    The aim of this study is to indicate the significance of air quality monitoring and to determine the air quality fields for the assessment of air pollution health effects, with special attention to risk population. Radial basis function network was used for air quality index mapping. Between 1991 and 2005, on the territory of Nis, several epidemiological studies were performed on risk groups (pre-school children, school children, pregnant women and persons older than 65). The total number of subjects was 5837. The exposed group comprised individuals living in the areas with unhealthy AQI, while the control group comprised individuals living in city areas with good or moderate AQI. It was determined that even relatively low levels of air pollution had impact on respiratory system and the occurrence of anaemia, allergy and skin symptoms.

  4. Calculating Cumulative Binomial-Distribution Probabilities

    Science.gov (United States)

    Scheuer, Ernest M.; Bowerman, Paul N.

    1989-01-01

    Cumulative-binomial computer program, CUMBIN, one of set of three programs, calculates cumulative binomial probability distributions for arbitrary inputs. CUMBIN, NEWTONP (NPO-17556), and CROSSER (NPO-17557), used independently of one another. Reliabilities and availabilities of k-out-of-n systems analyzed. Used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. Used for calculations of reliability and availability. Program written in C.

  5. Role of health education in promoting health in Libya: Evaluation of the existing situation and assessment of future needs

    OpenAIRE

    Elfituri, Abdulbaset Ali

    2000-01-01

    This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University. A variety of programmes of health education are designed, addressing promotion of health of the Libyan community. These programmes employ various communication methods and use different education media. This research is the first to evaluate the national programmes of health education in Libya and to determine future needs. It compares health officials' assessments with those of the gener...

  6. Cumulative cultural evolution: the role of teaching.

    Science.gov (United States)

    Castro, Laureano; Toro, Miguel A

    2014-04-21

    In humans, cultural transmission occurs usually by cumulative inheritance, generating complex adaptive behavioral features. Cumulative culture requires key psychological processes (fundamentally imitation and teaching) that are absent or impoverished in non-human primates. In this paper we analyze the role that teaching has played in human cumulative cultural evolution. We assume that a system of cumulative culture generates increasingly adaptive behaviors, that are also more complex and difficult to imitate. Our thesis is that, as cultural traits become more complex, cumulative cultural transmission requires teaching to ensure accurate transmission from one generation to the next. In an increasingly complex cultural environment, we consider that individuals commit errors in imitation. We develop a model of cumulative cultural evolution in a changing environment and show that these errors hamper the process of cultural accumulation. We also show that a system of teaching between parents and offspring that increases the fidelity of imitation unblocks the accumulation and becomes adaptive whenever the gain in fitness compensates the cost of teaching.

  7. Human cumulative culture: a comparative perspective.

    Science.gov (United States)

    Dean, Lewis G; Vale, Gill L; Laland, Kevin N; Flynn, Emma; Kendal, Rachel L

    2014-05-01

    Many animals exhibit social learning and behavioural traditions, but human culture exhibits unparalleled complexity and diversity, and is unambiguously cumulative in character. These similarities and differences have spawned a debate over whether animal traditions and human culture are reliant on homologous or analogous psychological processes. Human cumulative culture combines high-fidelity transmission of cultural knowledge with beneficial modifications to generate a 'ratcheting' in technological complexity, leading to the development of traits far more complex than one individual could invent alone. Claims have been made for cumulative culture in several species of animals, including chimpanzees, orangutans and New Caledonian crows, but these remain contentious. Whilst initial work on the topic of cumulative culture was largely theoretical, employing mathematical methods developed by population biologists, in recent years researchers from a wide range of disciplines, including psychology, biology, economics, biological anthropology, linguistics and archaeology, have turned their attention to the experimental investigation of cumulative culture. We review this literature, highlighting advances made in understanding the underlying processes of cumulative culture and emphasising areas of agreement and disagreement amongst investigators in separate fields.

  8. Health technology assessment in Australia: a role for clinical registries?

    Science.gov (United States)

    Scott, Anna Mae

    2016-03-31

    Objective Health technology assessment (HTA) is a process of assessing evidence to inform policy decisions about public subsidy of new drugs and medical procedures. Where evidence is uncertain but the technology itself is promising, funders may recommend funding on an interim basis. It is unknown whether evidence from clinical registries is used to resolve uncertainties identified in interim-funded decisions made by Australian HTA bodies. Therefore, the present study evaluated the role of evidence from clinical registries in resolving evidence uncertainties identified by the Medical Services Advisory Committee (MSAC).Methods All HTAs considered by MSAC between 1998 and 2015 were reviewed and assessments that recommended interim funding were identified. The MSAC website was searched to identify reassessments of these recommendations and sources of evidence used to resolve the uncertainties were identified.Results Of 173 HTA reports considered by MSAC, 17 (10%) contained an interim funding recommendation. Eight recommendations cited uncertainty around safety, 15 cited uncertainty around clinical effectiveness and 13 cited uncertainty around economics (cost-effectiveness and/or budget impact). Of the 17 interim funding recommendations, 11 (65%) have been reassessed. Only two reassessments relied on clinical registry evidence to resolve evidence gaps identified at the time of the interim funding recommendation.Conclusions Clinical registries are underused as a source of evidence for resolving uncertainties around promising new health technologies in Australia. An open dialogue between stakeholders on the role of registries in this context is needed.What is known about the topic? HTA is a process of assessing the evidence to inform policy decisions about public subsidy of new health technologies (e.g. pharmaceuticals, diagnostic tests, medical procedures). Where evidence is uncertain but the technology under evaluation is promising, funders may recommend the funding of

  9. 2002 progress report and public health assessment study

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-10-01

    Clean Air Hamilton focuses on improving air quality in the City by providing advice to City Council. The actions and activities of Clean Air Hamilton directly benefit residents. The activities relate to natural areas and corridors; reducing and managing waste; consuming less energy; changing our modes of transportation; land use issues in urban areas; and, personal health and well-being. The report includes an assessment of human health impacts caused by air pollution in Hamilton. It uses the most recent science and Hamilton air quality data as a basis. The results indicate that approximately 100 people die prematurely each year in Hamilton, while approximately 620 people require admission to hospitals for respiratory and cardiovascular problems related to exposure to pollutants. The second Upwind Downwind Conference was held in February 2002, sponsored by Clean Air Hamilton. All three levels of government view Clean Air Hamilton as a success. The City of Hamilton was awarded the prestigious 2000 Dubai International Award for Best Practices in Improving Living Environment as a result of Clean Air Hamilton's community process in local air quality improvement. 47 refs., tabs., 1 fig.

  10. Ethics-based decision-making and health impact assessment.

    Science.gov (United States)

    Tannahill, Andrew; Douglas, Margaret J

    2014-03-01

    To compare the use of health impact assessment (HIA) and the decision-making triangle (DMT) framework for evidence-informed, ethics-based decision-making and consider implications for practice. We compared HIA and the DMT approach with reference to: their use of evidence and theory; their application of ethical principles or values; and how they aid decision-making. A good fit between the HIA and DMT approaches was found. Ways in which they could be of benefit to each other were identified. The DMT approach and HIA are highly compatible: they are rooted in largely shared ethical principles or values; both involve appropriate use of evidence and theory; and both are concerned with enhancing the quality of decision-making in the interests of population health. The DMT approach and HIA are of potential value to each other: established HIA methods and tools can be of practical help in using the DMT approach; and the DMT framework provides insights to how HIA methods and processes could be improved and the vision of 'impacts that matter' widened.

  11. Public health risk assessment of groundwater contamination in Batman, Turkey.

    Science.gov (United States)

    Nalbantcilar, M Tahir; Pinarkara, Sukru Yavuz

    2016-08-01

    In this study, a comprehensive analysis of groundwater was performed to assess contamination and phenol content in Batman, Turkey, particularly in residential areas near agriculture, livestock and oil industry facilities. From these areas, where potentially contaminated groundwater used for drinking and irrigation threatens public health, 30 groundwater samples were collected and analyzed for heavy metal concentrations (Al, As, B, Ba, Ca, Cd, Cl, Co, Cr, Cu, Fe, Hg, Li, Mg, Mn, Mo, Na, Ni, NO3, P, Pb, phenol, S, Sb, Se, SO4, Sr, U, and Zn). Compared with the standards of the Environmental Protection Agency, Al, Fe, and Mn concentrations in groundwater exceeded secondary drinking water regulations, NO3 concentrations were high for maximum contaminant levels, and As, Pb, and U concentrations exceeded maximum contaminant level goals in all samples. Ni, Sb, and Se concentrations also exceeded limits set by the Turkish Standards Institution. Nearly all samples revealed concentrations of Se, Sb, Hg, and phenol due to nearby petroleum refineries, oil storage plants, and agricultural and livestock areas. The results obtained from this study indicate that the groundwater in Batman contains elements in concentrations that approach or exceed limits and thus threatens public health with increased blood cholesterol, decreased blood sugar, and circulatory problems.

  12. An Assessment of Integrated Health Management (IHM) Frameworks

    Energy Technology Data Exchange (ETDEWEB)

    N. Lybeck; M. Tawfik; L. Bond; J. Coble

    2012-05-01

    In order to meet the ever increasing demand for energy, the United States nuclear industry is turning to life extension of existing nuclear power plants (NPPs). Economically ensuring the safe, secure, and reliable operation of aging nuclear power plants presents many challenges. The 2009 Light Water Reactor Sustainability Workshop identified online monitoring of active and structural components as essential to the better understanding and management of the challenges posed by aging nuclear power plants. Additionally, there is increasing adoption of condition-based maintenance (CBM) for active components in NPPs. These techniques provide a foundation upon which a variety of advanced online surveillance, diagnostic, and prognostic techniques can be deployed to continuously monitor and assess the health of NPP systems and components. The next step in the development of advanced online monitoring is to move beyond CBM to estimating the remaining useful life of active components using prognostic tools. Deployment of prognostic health management (PHM) on the scale of a NPP requires the use of an integrated health management (IHM) framework - a software product (or suite of products) used to manage the necessary elements needed for a complete implementation of online monitoring and prognostics. This paper provides a thoughtful look at the desirable functions and features of IHM architectures. A full PHM system involves several modules, including data acquisition, system modeling, fault detection, fault diagnostics, system prognostics, and advisory generation (operations and maintenance planning). The standards applicable to PHM applications are indentified and summarized. A list of evaluation criteria for PHM software products, developed to ensure scalability of the toolset to an environment with the complexity of a NPP, is presented. Fourteen commercially available PHM software products are identified and classified into four groups: research tools, PHM system

  13. Development of the eHealth Literacy Assessment Toolkit, eHLA

    DEFF Research Database (Denmark)

    Lauritzen, Dorthe Furstrand; Kayser, Lars

    2015-01-01

    Assessment toolkit, eHLA, evaluating the user by seven scales: computer familiarity, confidence, incentive and performance as well as functional health literacy, health literacy self-assessment and health literacy performance, as a first step toward development of technology that accommodates the literacy...

  14. Information resources used in health risk assessment by the New Jersey Department of Environmental Protection

    Energy Technology Data Exchange (ETDEWEB)

    Post, G.B.; Baratta, M.; Wolfson, S.; McGeorge, L. [New Jersey Department of Environmental Protection, Trenton (United States)

    1990-12-31

    The New Jersey Department of Environmental Protection`s responsibilities related to health-based risk assessment are described, including its research projects and its development of health based compound specific standards and guidance levels. The resources used by the agency to support health risk assessment work are outlined.

  15. Statistical Pattern-Based Assessment of Structural Health Monitoring Data

    Directory of Open Access Journals (Sweden)

    Mohammad S. Islam

    2014-01-01

    Full Text Available In structural health monitoring (SHM, various sensors are installed at critical locations of a structure. The signals from sensors are either continuously or periodically analyzed to determine the state and performance of the structure. An objective comparison of the sensor data at different time ranges is essential for assessing the structural condition or excessive load experienced by the structure which leads to potential damage in the structure. The objectives of the current study are to establish a relationship between the data from various sensors to estimate the reliability of the data and potential damage using the statistical pattern matching techniques. In order to achieve these goals, new methodologies based on statistical pattern recognition techniques have been developed. The proposed methodologies have been developed and validated using sensor data obtained from an instrumented bridge and road test data from heavy vehicles. The application of statistical pattern matching techniques are relatively new in SHM data interpretation and current research demonstrates that it has high potential in assessing structural conditions, especially when the data are noisy and susceptible to environmental disturbances.

  16. Software Tools to Support the Assessment of System Health

    Science.gov (United States)

    Melcher, Kevin J.

    2013-01-01

    This presentation provides an overview of three software tools that were developed by the NASA Glenn Research Center to support the assessment of system health: the Propulsion Diagnostic Method Evaluation Strategy (ProDIMES), the Systematic Sensor Selection Strategy (S4), and the Extended Testability Analysis (ETA) tool. Originally developed to support specific NASA projects in aeronautics and space, these software tools are currently available to U.S. citizens through the NASA Glenn Software Catalog. The ProDiMES software tool was developed to support a uniform comparison of propulsion gas path diagnostic methods. Methods published in the open literature are typically applied to dissimilar platforms with different levels of complexity. They often address different diagnostic problems and use inconsistent metrics for evaluating performance. As a result, it is difficult to perform a one ]to ]one comparison of the various diagnostic methods. ProDIMES solves this problem by serving as a theme problem to aid in propulsion gas path diagnostic technology development and evaluation. The overall goal is to provide a tool that will serve as an industry standard, and will truly facilitate the development and evaluation of significant Engine Health Management (EHM) capabilities. ProDiMES has been developed under a collaborative project of The Technical Cooperation Program (TTCP) based on feedback provided by individuals within the aircraft engine health management community. The S4 software tool provides a framework that supports the optimal selection of sensors for health management assessments. S4 is structured to accommodate user ]defined applications, diagnostic systems, search techniques, and system requirements/constraints. One or more sensor suites that maximize this performance while meeting other user ]defined system requirements that are presumed to exist. S4 provides a systematic approach for evaluating combinations of sensors to determine the set or sets of

  17. Development of the eHealth Literacy Assessment Toolkit, eHLA

    DEFF Research Database (Denmark)

    Lauritzen, Dorthe Furstrand; Kayser, Lars

    2015-01-01

    In a world with rising focus on the use of eHealth, the match between the competences of the individual and the demands of eHealth systems becomes increasingly important, thus making assessment of eHealth literacy as a measure of user competences a vital element. We propose the eHealth Literacy...

  18. School-Based Mental Health Professionals' Bullying Assessment Practices: A Call for Evidence-Based Bullying Assessment Guidelines

    Science.gov (United States)

    Blake, Jamilia; Banks, Courtney S.; Patience, Brenda A.; Lund, Emily M.

    2014-01-01

    A sample of 483 school-based mental health professionals completed a survey about the training they have received related to conducting bullying assessments in schools, competence in conducting an assessment of bullying, and the bullying assessment methods they used. Results indicate that school counselors were usually informed about incidents of…

  19. Health technology assessment in the Balkans: opportunities for a balanced drug assessment system.

    Science.gov (United States)

    Dankó, Dávid; Petrova, Guenka

    2014-11-02

    Countries in the Balkan region use pharmaco-economic data for decisions about the inclusion of new pharmaceuticals into their positive drug lists, but no predefined frameworks are used and resources for health technology assessment (HTA) are limited. The goal of this analysis is to investigate into possible development directions for the HTA system in the region, and provide some practical recommendations for a sustainable model. For this purpose, the main factors currently influencing HTA in Balkan countries are briefly presented, and possible development strategies are compared. A resource-saving balanced assessment approach is proposed. It is aligned with available resources and capabilities, and helps access to new pharmaceuticals while ensuring the transparency of decision-making processes and the stability of the pharmaceutical budget.

  20. Predicting Cumulative Incidence Probability by Direct Binomial Regression

    DEFF Research Database (Denmark)

    Scheike, Thomas H.; Zhang, Mei-Jie

    Binomial modelling; cumulative incidence probability; cause-specific hazards; subdistribution hazard......Binomial modelling; cumulative incidence probability; cause-specific hazards; subdistribution hazard...

  1. The public health workforce: An assessment in the Netherlands

    NARCIS (Netherlands)

    Jambroes, M.

    2015-01-01

    The public health workforce is a key resource of population health. How many people work in public health in the Netherlands, what are their characteristics and who does what? Remarkably, such information about the size and composition of the public health workforce in the Netherlands is lacking. A

  2. Adapting developing country epidemiological assessment techniques to improve the quality of health needs assessments in developed countries

    Directory of Open Access Journals (Sweden)

    Handy Deirdre

    2005-04-01

    Full Text Available Abstract Background We were commissioned to carry out three health assessments in urban areas of Dublin in Ireland. We required an epidemiologically robust method that could collect data rapidly and inexpensively. We were dealing with inadequate health information systems, weak planning data and a history of inadequate recipient involvement in health service planning. These problems had also been identified by researchers carrying out health assessments in developing countries. This paper reports our experience of adapting a cluster survey model originally developed by international organisations to assess community health needs and service coverage in developing countries and applying our adapted model to three urban areas in Dublin, Ireland Methods We adapted the model to control for socio-economic heterogeneity, to take account of the inadequate population list, to ensure a representative sample and to account for a higher prevalence of degenerative and chronic diseases. We employed formal as well as informal communication methods and adjusted data collection times to maximise participation. Results The model we adapted had the capacity to ascertain both health needs and health care delivery needs. The community participated throughout the process and members were trained and employed as data collectors. The assessments have been used by local health boards and non-governmental agencies to plan and deliver better or additional services. Conclusion We were able to carry out high quality health needs assessments in urban areas by adapting and applying a developing country health assessment method. Issues arose relating to health needs assessment as part of the planning cycle and the role of participants in the process.

  3. Assessing adaptation to the health risks of climate change: what guidance can existing frameworks provide?

    Science.gov (United States)

    Füssel, Hans-Martin

    2008-02-01

    Climate change adaptation assessments aim at assisting policy-makers in reducing the health risks associated with climate change and variability. This paper identifies key characteristics of the climate-health relationship and of the adaptation decision problem that require consideration in climate change adaptation assessments. It then analyzes whether these characteristics are appropriately considered in existing guidelines for climate impact and adaptation assessment and in pertinent conceptual models from environmental epidemiology. The review finds three assessment guidelines based on a generalized risk management framework to be most useful for guiding adaptation assessments of human health. Since none of them adequately addresses all key challenges of the adaptation decision problem, actual adaptation assessments need to combine elements from different guidelines. Established conceptual models from environmental epidemiology are found to be of limited relevance for assessing and planning adaptation to climate change since the prevailing toxicological model of environmental health is not applicable to many climate-sensitive health risks.

  4. CRED REA Coral Health and Disease Assessment at Oahu, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 2 sites at Oahu...

  5. CRED REA Coral Health and Disease Assessment at Ta'u Island, American Samoa in 2008

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 9 sites at Ta'u...

  6. CRED REA Coral Health and Disease Assessment at Rota Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 6 sites at...

  7. CRED REA Coral Health and Disease Assessment at Niihau Island, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 6 sites at...

  8. CRED REA Coral Health and Disease Assessment at Asuncion Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  9. CRED REA Coral Health and Disease Assessment at Laysan Island, Northwestern Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  10. CRED REA Coral Health and Disease Assessment at Wake Atoll, Pacific Remote Island Areas in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 12 sites at...

  11. CRED REA Coral Health and Disease Assessment at Aguijan Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 1 sites at...

  12. CRED REA Coral Health and Disease Assessment at Maug Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 9 sites at Maug...

  13. CRED REA Coral Health and Disease Assessment at Johnston Atoll, Pacific Remote Island Areas in 2008

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 6 sites at...

  14. CRED REA Coral Health and Disease Assessment at Hawaii Island, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 17 sites at...

  15. CRED REA Coral Health and Disease Assessment at Saipan Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 8 sites at...

  16. CRED REA Coral Health and Disease Assessment at Pagan Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 9 sites at...

  17. CRED REA Coral Health and Disease Assessment at Midway Atoll, Northwestern Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 9 sites at...

  18. CRED REA Coral Health and Disease Assessment at Agrihan Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  19. CRED REA Coral Health and Disease Assessment at Jarvis Island, Pacific Remote Island Areas in 2008

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 9 sites at...

  20. CRED REA Coral Health and Disease Assessment at Maui Island, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 11 sites at...

  1. CRED REA Coral Health and Disease Assessment at Lisianski Island, Northwestern Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 9 sites at...

  2. CRED REA Coral Health and Disease Assessment at Uracas Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  3. CRED REA Coral Health and Disease Assessment at Lanai Island, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 6 sites at...

  4. CRED REA Coral Health and Disease Assessment at Tinian Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 5 sites at...

  5. CRED REA Coral Health and Disease Assessment at Guam, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 10 sites at...

  6. CRED REA Coral Health and Disease Assessment at Rose Island, American Samoa in 2008

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 12 sites at...

  7. CRED REA Coral Health and Disease Assessment at Molokai Island, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  8. CRED REA Coral Health and Disease Assessment at Tutuila Island, American Samoa in 2008

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 23 sites at...

  9. CRED REA Coral Health and Disease Assessment at Lehua Rock, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  10. CRED REA Coral Health and Disease Assessment at French Frigate Shoals, Northwestern Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 10 sites at...

  11. CRED REA Coral Health and Disease Assessment at Kaula Rock, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 2 sites at...

  12. CRED REA Coral Health and Disease Assessment at Ofu-Olosega Island, American Samoa in 2008

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 10 sites at...

  13. CRED REA Coral Health and Disease Assessment at Guguan Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  14. CRED REA Coral Health and Disease Assessment at Kauai Island, Main Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 4 sites at...

  15. CRED REA Coral Health and Disease Assessment at Necker Island, Northwestern Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 2 sites at...

  16. CRED REA Coral Health and Disease Assessment at Swains Atoll, American Samoa in 2008

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 8 sites at...

  17. CRED REA Coral Health and Disease Assessment at Kure Atoll, Northwestern Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 9 sites at Kure...

  18. CRED REA Coral Health and Disease Assessment at Alamagan Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  19. CRED REA Coral Health and Disease Assessment at Sarigan Island, Marianas Archipelago in 2007

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 3 sites at...

  20. CRED REA Coral Health and Disease Assessment at Kingman Reef, Pacific Remote Island Areas in 2008

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 11 sites at...

  1. CRED REA Coral Health and Disease Assessment at Maro Reef, Northwestern Hawaiian Islands in 2006

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Coral health and disease assessments were conducted along 2 consecutively placed 25-m transects, as part of Rapid Ecological Assessments conducted at 9 sites at Maro...

  2. Assessment vs. appraisal of ethical aspects of health technology assessment: can the distinction be upheld?

    Directory of Open Access Journals (Sweden)

    Sandman, Lars

    2014-11-01

    Full Text Available [english] An essential component of health technology assessment (HTA is the assessment of ethical aspects. In some healthcare contexts, tasks are strictly relegated to different expert groups: the HTA-agencies are limited to assessment of the technology and other actors within the health care sector are responsible for appraisal and recommendations. Ethical aspects of health technologies are considered with reference to values or norms in such a way that may be prescriptive, or offer guidance as to how to act or relate to the issue in question. Given this internal prescriptivity, the distinction between assessment and appraisal seems difficult to uphold, unless the scrutiny stops short of a full ethical analysis of the technology. In the present article we analyse the distinction between assessment and appraisal, using as an example ethical aspects of implementation of GPS-bracelets for people with dementia. It is concluded that for HTA-agencies with a strictly delineated assessment role, the question of how to deal with the internal prescriptivity of ethics may be confusing. A full ethical analysis might result in a definite conclusion as to whether the technology in question is ethically acceptable or not, thereby limiting choices for decision-makers, who are required to uphold certain ethical values and norms. At the same time, depending on the exact nature of such a conclusion, different action strategies can be supported. A positive appraisal within HTA could result in a decision on implementation, or of the technology, thereby making it available to patients, or decisions to and even the use of the technology (even if someone else will have to fund it. A neutral appraisal, giving no definite answer as to whether implementation is recommended or not, could result in a towards the technology. A negative appraisal could result in a decision to or even implementation. This paper presents an overview of the implications of different outcomes

  3. A framework for assessing the performance of health systems.

    Science.gov (United States)

    Murray, C. J.; Frenk, J.

    2000-01-01

    Health systems vary widely in performance, and countries with similar levels of income, education and health expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the understanding of health system performance. A first step is to define the boundaries of the health system, based on the concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution. Improving health means both increasing the average health status and reducing health inequalities. Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to health care. The measurement of performance relates goal attainment to the resources available. Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for personal and non-personal health services); and resource generation (including personnel, facilities and knowledge). By investigating these four functions and how they combine, it is possible not only to understand the proximate determinants of health system performance

  4. Scaling for Robust Assessment and Predictions of Aquatic Ecosystem Health

    Science.gov (United States)

    Abdul-Aziz, O.; Ishtiaq, K. S.

    2012-12-01

    This presentation demonstrates the development and applications of a unique scaling technique for robust assessment and predictions of aquatic ecosystem health. We developed scaling-based, robust empirical and semi-empirical models for standardizing grab samples of stream dissolved oxygen (DO) and for predicting (hindcasting and forecasting) stream DO time-series. A reference clock-time, single observation from the diurnal cycle is used as the scaling parameter to collapse hourly DO time-series of different days into a single diurnal curve, which is parameterized by developing an extended stochastic harmonic analysis (ESHA). The scaling technique was previously applied to develop an algorithm for converting grab samples of stream DO collected at any time of the day to a reference clock time. The research is extended to develop an algorithm for simulating the diurnal DO cycles at different stream sites from their corresponding single reference observations of the day. The scaling concept was tested for spatio-temporal robustness with hourly DO data for eight streams representing five distinct Level III Ecoregions of Minnesota. Estimated model parameters demonstrated notable robustness in time and space. Scaling is often used to develop robust modeling and application tools in many physical engineering disciplines. Presented research exemplifies utilization of the scaling concept in Ecological Engineering applications.

  5. Health information: what can mobile phone assessments add?

    Science.gov (United States)

    Stomberg, Margareta Warrén; Platon, Birgitta; Widén, Annette; Wallner, Ingegerd; Karlsson, Ove

    2012-01-01

    In healthcare, pain assessment is a key factor in effectively treating postoperative pain and reducing the risk of developing chronic pain. The overall aim of this study was to investigate whether a mobile phone support system can be used as a basis to continuously document patients' health information in real time and provide conditions for optimal, individual pain management after cholecystectomy and hysterectomy procedures.In this pilot study, two randomly selected groups of patients provided information about their pain for one week postoperatively. One group responded via cell phones, and the other, a control group, responded using paper-based questionnaires.The mobile phone system was found to provide a fast and safe basis for reporting pain postoperatively in real time. The results indicate that on days 3 and 4 the mobile phone group reported significantly higher levels of pain than the control group, and the cholecystectomy patients reported significantly more pain at movement on days 3 and 4 than the hysterectomy patients.The mobile phone approach is an adaptation to modern technology and the mobility of individuals. This technology is user friendly and requires minimal support. However, as the sample size was small (n = 37), further studies are needed before additional conclusions can be drawn.

  6. Subgroup analyses of clinical effectiveness to support health technology assessments.

    Science.gov (United States)

    Paget, Marie-Ange; Chuang-Stein, Christy; Fletcher, Christine; Reid, Carol

    2011-01-01

    Subgroup analysis is an integral part of access and reimbursement dossiers, in particular health technology assessment (HTA), and their HTA recommendations are often limited to subpopulations. HTA recommendations for subpopulations are not always clear and without controversies. In this paper, we review several HTA guidelines regarding subgroup analyses. We describe good statistical principles for subgroup analyses of clinical effectiveness to support HTAs and include case examples where HTA recommendations were given to subpopulations only. Unlike regulatory submissions, pharmaceutical statisticians in most companies have had limited involvement in the planning, design and preparation of HTA/payers submissions. We hope to change this by highlighting how pharmaceutical statisticians should contribute to payers' submissions. This includes early engagement in reimbursement strategy discussions to influence the design, analysis and interpretation of phase III randomized clinical trials as well as meta-analyses/network meta-analyses. The focus on this paper is on subgroup analyses relating to clinical effectiveness as we believe this is the first key step of statistical involvement and influence in the preparation of HTA and reimbursement submissions.

  7. Reimbursement of pharmaceuticals: reference pricing versus health technology assessment.

    Science.gov (United States)

    Drummond, Michael; Jönsson, Bengt; Rutten, Frans; Stargardt, Tom

    2011-06-01

    Reference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market access and cost. Four countries were studied: Germany, The Netherlands, Sweden and the United Kingdom. These countries have operated one, or both, of the two policies at certain points in time, sometimes in parallel. Drugs in four groups were considered: cholesterol-lowering agents, insulin analogues, biologic drugs for rheumatoid arthritis and "atypical" drugs for schizophrenia. Compared with HTA, reference pricing is a relatively blunt instrument for obtaining value for money from pharmaceuticals. Thus, its role in making reimbursement decisions should be limited to drugs which are therapeutically equivalent. HTA is a superior strategy for obtaining value for money because it addresses not only price but also the appropriate indications for the use of the drug and the relation between additional value and additional costs. However, given the relatively higher costs of conducting HTAs, the most efficient approach might be a combination of both policies.

  8. Transgender health: findings from two needs assessment studies in Philadelphia.

    Science.gov (United States)

    Kenagy, Gretchen P

    2005-02-01

    HIV/AIDS, suicide, violence, and barriers to health care access among transgender people were explored using two needs assessment surveys conducted in Philadelphia in 1997. A total of 182 people responded to a face-to-face interview or self-administered mail survey: 113 male-to-female individuals and 69 female-to-male individuals. About three-fifths of respondents had engaged in unprotected sexual activity during the past 12 months. The risk for HIV infection from unprotected sex was significantly higher among respondents of color than among white respondents. About one-third (30.1 percent) of respondents had attempted suicide. More than half of respondents had been forced to have sex, 56.3 percent had experienced violence in their homes, and 51.3 percent had been physically abused. Twenty-six percent of respondents had been denied medical care because they were transgender. These findings suggest that prevention services that specifically address HIV/AIDS, suicide, and violence among transgender people are urgently needed.

  9. Cumulative Culture and Future Thinking: Is Mental Time Travel a Prerequisite to Cumulative Cultural Evolution?

    Science.gov (United States)

    Vale, G. L.; Flynn, E. G.; Kendal, R. L.

    2012-01-01

    Cumulative culture denotes the, arguably, human capacity to build on the cultural behaviors of one's predecessors, allowing increases in cultural complexity to occur such that many of our cultural artifacts, products and technologies have progressed beyond what a single individual could invent alone. This process of cumulative cultural evolution…

  10. Nurses' Evaluation of Their Use and Mastery in Health Assessment Skills: Selected Iran's Hospitals

    OpenAIRE

    Adib-Hajbaghery, Mohsen; Safa, Azade

    2013-01-01

    Background: Health assessment skills are of the most important skills which nurses require. The more precise assessment, the better results would be obtained and the quality of patient care would be improved. However, in Iran, few studies have investigated nurses’ assessment skills. Objectives: This study was aimed to assessnurses' evaluation of the learned skills of health assessment and their use. Materials and Methods: This cross-sectional study was conducted on 200 nurses in Isfahan provi...

  11. Assessing the Education and Training Needs of Nebraska's Public Health Workforce

    Directory of Open Access Journals (Sweden)

    Brandon L Grimm

    2015-06-01

    Full Text Available IntroductionIn 2012, the Great Plains Public Health Training Center (Grant #UB6HP22821 conducted an online survey of state and local health departments and the American Indian (tribal clinics, tribal health departments and urban Indian clinic public health workforce across three professional levels. The objectives of the needs assessment were to, determine the competency levels of the state’s public health workforce, assess gaps in public health competencies, identify public health training interests, needs and preferences and, determine the barriers and motivators to participating in public health training.MethodsThe assessment was developed using the Council on Linkages Between Academia and Public Health Practice, Core Competencies for Public Health Professionals survey (Council of Linkages, 2010. The final assessment was created and piloted by numerous individuals representing practice and academia. ResultsRespondents identified cultural competency and communication skills as the two most important public health competency domains. Although the public health professionals perceived that they were least proficient in the area of policy development and program planning, participants identified the greatest needs for training in financial planning & management skills and analytical/assessment skills. In general, respondents preferred instructor-led interactive training sessions offered as onsite multi-day workshops or computer-based courses. Respondents identified obesity, health disparities, physical activity, chronic diseases and diabetes as the top five public health topical areas. ConclusionThese priorities align with State and National public health plans. The findings of the needs assessment were used to tailor educational opportunities to build the capacity of Nebraska’s public health system. Additionally, the results were used to develop workforce development plans for numerous local health departments throughout Nebraska.

  12. Current process and future path for health economic assessment of pharmaceuticals in France.

    Science.gov (United States)

    Toumi, Mondher; Rémuzat, Cécile; El Hammi, Emna; Millier, Aurélie; Aballéa, Samuel; Chouaid, Christos; Falissard, Bruno

    2015-01-01

    The Social Security Funding Law for 2012 introduced the Economic and Public Health Assessment Committee (Commission Evaluation Economique et de Santé Publique, or CEESP) in the Social Security Code as a specialised committee affiliated with the Haute Autorité de Santé in charge of providing recommendations and health economic opinions. This article provides an in-depth description of the CEESP's structure and working methods, and analyses the impact of health economic assessment on market access of drugs in France. It also points out the areas of uncertainty and the conflicting rules following the introduction of the health economic assessment in France. The authors also provide their personal opinion on the likely future of health economic assessment of drugs in France, including the possible merge of the CEESP and the Transparency Committee, the implementation of a French threshold, and the extension of health economic assessment to a larger number of products.

  13. Determinants of participation in a web-based health risk assessment and consequences for health promotion programs

    NARCIS (Netherlands)

    M.A.J. Niessen (Maurice); E.L. Laan (Eva); S.J.W. Robroek (Suzan); M.L.E. Essink-Bot (Marie-Louise); N. Peek (Niels); R.A. Kraaijenhagen (Roderik); C.K. van Kalken (Coen); A. Burdorf (Alex)

    2013-01-01

    textabstractBackground: The health risk assessment (HRA) is a type of health promotion program frequently offered at the workplace. Insight into the underlying determinants of participation is needed to evaluate and implement these interventions. Objective: To analyze whether individual characterist

  14. Environmental Health Risk Assessment and Countermeasures on a Fire Extinguisher

    Energy Technology Data Exchange (ETDEWEB)

    Park, J.K.; Jeong, D.W. [Korea Environment Institute, Seoul (Korea)

    2001-12-01

    Brominated flame retardants encompass a large number of different organic compounds sharing the common feature of containing bromine, which has an inhibitory effect on the development of fire. The substances are added to plastic materials, insulation foam, and other materials so as to enable the products to comply with fire safety requirements and wishes. The most problematic groups of compounds are polybrominated biphenyls(PBBs) and polybrominated diphenyl ethers(PBDEs). The objective of this project is to develop a management strategy for all problematic brominated flame retardants. A number of studies have shown that several of the brominated flame retardants occur in increasing concentrations in nature and in human beings. This is of concern because certain of the brominated flame retardants are suspected of having undesirable effects on the environment and health. The substances are generally very stable, especially so in the case of PBBs and PBDEs. These are strong reasons for hastening the phase-out of PBBs and PBDEs as group. Moreover, PBBs and PBDEs have attracted international attention. Within the OECD, business organisations have made voluntary agreements concerning PBBs and PBDEs. Rules of the EU forbid the use of PBBs in textiles coming into contact with the skin. The environmental and health risks of PBDEs are currently being evaluated as a part of an EU programme for existing substances. In Germany, PBBs and PBDEs are restricted through the Dioxin Ordinance and voluntary agreements with industry. Brominated flame retardants encompass a large number of different organic compounds sharing the common feature of containing bromine, which has an inhibitory effect on the development of fire. The substances are added to plastic materials, insulation foam, and other materials so as to enable the products to comply with fire safety requirements and wishes. The most problematic groups of compounds are polybrominated biphenyls(PBBs) and polybrominated diphenyl

  15. Environmental Health Risk Assessment and Countermeasures on a Fire Extinguisher

    Energy Technology Data Exchange (ETDEWEB)

    Park, J.K.; Jeong, D.W. [Korea Environment Institute, Seoul (Korea)

    2001-12-01

    Brominated flame retardants encompass a large number of different organic compounds sharing the common feature of containing bromine, which has an inhibitory effect on the development of fire. The substances are added to plastic materials, insulation foam, and other materials so as to enable the products to comply with fire safety requirements and wishes. The most problematic groups of compounds are polybrominated biphenyls(PBBs) and polybrominated diphenyl ethers(PBDEs). The objective of this project is to develop a management strategy for all problematic brominated flame retardants. A number of studies have shown that several of the brominated flame retardants occur in increasing concentrations in nature and in human beings. This is of concern because certain of the brominated flame retardants are suspected of having undesirable effects on the environment and health. The substances are generally very stable, especially so in the case of PBBs and PBDEs. These are strong reasons for hastening the phase-out of PBBs and PBDEs as group. Moreover, PBBs and PBDEs have attracted international attention. Within the OECD, business organisations have made voluntary agreements concerning PBBs and PBDEs. Rules of the EU forbid the use of PBBs in textiles coming into contact with the skin. The environmental and health risks of PBDEs are currently being evaluated as a part of an EU programme for existing substances. In Germany, PBBs and PBDEs are restricted through the Dioxin Ordinance and voluntary agreements with industry. Brominated flame retardants encompass a large number of different organic compounds sharing the common feature of containing bromine, which has an inhibitory effect on the development of fire. The substances are added to plastic materials, insulation foam, and other materials so as to enable the products to comply with fire safety requirements and wishes. The most problematic groups of compounds are polybrominated biphenyls(PBBs) and polybrominated diphenyl

  16. Health on the Net Foundation: assessing the quality of health web pages all over the world.

    Science.gov (United States)

    Boyer, Célia; Gaudinat, Arnaud; Baujard, Vincent; Geissbühler, Antoine

    2007-01-01

    The Internet provides a great amount of information and has become one of the communication media which is most widely used [1]. However, the problem is no longer finding information but assessing the credibility of the publishers as well as the relevance and accuracy of the documents retrieved from the web. This problem is particularly relevant in the medical area which has a direct impact on the well-being of citizens. In this paper, we assume that the quality of web pages can be controlled, even when a huge amount of documents has to be reviewed. But this must be supported by both specific automatic tools and human expertise. In this context, we present various initiatives of the Health on the Net Foundation informing the citizens about the reliability of the medical content on the web.

  17. Assessment of health policy in Costa Rica--some preliminary remarks.

    Science.gov (United States)

    Eriksson, C G; Mohs, E; Eriksson, B

    1991-01-01

    Costa Rica is one of the world's success stories in primary health care. During the past 20 years the country has experienced a demographic and epidemiological transition. However, during the 80's the economic recession severely affected the country. The social, economic, political and geographic contexts are important for the assessment of health policy. The longstanding democracy, investments in public education and health all contribute to the peace and stability. Assessment of health policy needs both a quantitative and qualitative approach. The policy-making process--how policies are made, translated into action and evaluated--is a research challenge. The national health policy 1986-1990 includes commitment to Health for All strategy; development of the National Health Care System; strengthening of the health care infrastructure; consolidation of health achievements and undertaking of new problems and approaches on integral care for the population; community participation in all health care system activities; and health care priorities. Important research issues are the relationship between the needs of the population and health policy development and the impacts of health policy on the health of the population. A comprehensive study of policy-making includes studies of policy content, process, output and evaluation of impacts (including economy of health policy), and analysis for policy, i.e. information for policy making, process and policy advocacy. Recent successful health policy issues are child health and HIV/AIDS, while water pollution and traffic accidents have been more problematic policy issues.

  18. Cumulative early life adversity predicts longevity in wild baboons.

    Science.gov (United States)

    Tung, Jenny; Archie, Elizabeth A; Altmann, Jeanne; Alberts, Susan C

    2016-04-19

    In humans and other animals, harsh circumstances in early life predict morbidity and mortality in adulthood. Multiple adverse conditions are thought to be especially toxic, but this hypothesis has rarely been tested in a prospective, longitudinal framework, especially in long-lived mammals. Here we use prospective data on 196 wild female baboons to show that cumulative early adversity predicts natural adult lifespan. Females who experience ≥3 sources of early adversity die a median of 10 years earlier than females who experience ≤1 adverse circumstances (median lifespan is 18.5 years). Females who experience the most adversity are also socially isolated in adulthood, suggesting that social processes partially explain the link between early adversity and adult survival. Our results provide powerful evidence for the developmental origins of health and disease and indicate that close ties between early adversity and survival arise even in the absence of health habit and health care-related explanations.

  19. Cumulative human threats on fish biodiversity components in Tunisian waters

    Directory of Open Access Journals (Sweden)

    F. BEN RAIS LASRAM

    2014-06-01

    Full Text Available Human activities are increasingly impacting biodiversity. To improve conservation planning measures in an ecosystem-based management context, we need to explore how the effects of these activities interact with different biodiversity components. In this study, we used a semi-quantitative method to assess the cumulative impacts of human activities on three biodiversity components (species richness, phylogenetic diversity, and functional diversity in Tunisia’s exclusive economic zone. For each of the nine activities considered, we developed an understanding of their effects from local studies and the expert opinion of stakeholders with country-specific experience. We mapped the cumulative effects and the three biodiversity components and then assessed the degree to which these elements overlapped using an overlap index. This is the first time such an assessment has been made for Tunisia’s marine ecosystems and our assessment highlight the inappropriateness of current conservation measures. The results of this study have specific application for the prioritization of future management actions.

  20. Pavlovian conditioning and cumulative reinforcement rate.

    Science.gov (United States)

    Harris, Justin A; Patterson, Angela E; Gharaei, Saba

    2015-04-01

    In 5 experiments using delay conditioning of magazine approach with rats, reinforcement rate was varied either by manipulating the mean interval between onset of the conditioned stimulus (CS) and unconditioned stimulus (US) or by manipulating the proportion of CS presentations that ended with the US (trial-based reinforcement rate). Both manipulations influenced the acquisition of responding. In each experiment, a specific comparison was made between 2 CSs that differed in their mean CS-US interval and in their trial-based reinforcement rate, such that the cumulative reinforcement rate-the cumulative duration of the CS between reinforcements-was the same for the 2 CSs. For example, a CS reinforced on 100% of trials with a mean CS-US interval of 60 s was compared with a CS reinforced on 33% of trials and a mean duration of 20 s. Across the 5 experiments, conditioning was virtually identical for the 2 CSs with matched cumulative reinforcement rate. This was true as long as the timing of the US was unpredictable and, thus, response rates were uniform across the length of the CS. We conclude that the effects of CS-US interval and of trial-based reinforcement rate are reducible entirely to their common effect on cumulative reinforcement rate. We discuss the implications of this for rate-based, trial-based, and real-time associative models of conditioning.

  1. Cumulative Disadvantage among the Highly Ambitious.

    Science.gov (United States)

    McClelland, Katherine

    1990-01-01

    Using a social reproduction theory framework, analyzes the process by which high school seniors aspiring to high-level positions are sorted out after graduation. Analyzes early educational attainments and changes in occupational expectations. Shows a process of cumulative disadvantage in which White males are more likely to achieve their goals.…

  2. 40 CFR 158.2083 - Experimental use permit biochemical pesticides human health assessment data requirements table.

    Science.gov (United States)

    2010-07-01

    ... pesticides human health assessment data requirements table. 158.2083 Section 158.2083 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS DATA REQUIREMENTS FOR PESTICIDES Biochemical Pesticides § 158.2083 Experimental use permit biochemical pesticides human health assessment...

  3. [Health assessment of Qi'ao Island mangrove wetland ecosystem in Pearl River Estuary].

    Science.gov (United States)

    Wang, Shu-Gong; Zheng, Yao-Hui; Peng, Yi-Sheng; Chen, Gui-Zhu

    2010-02-01

    Based on the theories of wetland ecosystem health and by using "Pressure-State-Response" model, a health assessment indicator system for Qi' ao Island mangrove wetland ecosystem in Pearl River Estuary was built, and the assessment indices, assessment criteria, indices weighted values, assessment grades, and assessment methods were established to assess the health state of this ecosystem. In 2008, the overall health index of this ecosystem was 0.6580, health level was of grade II (healthy), and the pressure, state, and response indices were 0.3469, 0.8718, and 0.7754, respectively, suggesting that this ecosystem was good in state and response, but still had definite pressure. As a provincial nature reserve, this ecosystem was to be further improved in its health level. However, the research on the health assessment of mangrove wetland ecosystem was still young. Further studies should be made on the selection of assessment indices, long-term oriented monitoring of these indices, and quantification of the relations between ecosystem health level and ecosystem services.

  4. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment

    Science.gov (United States)

    This assessment strengthens and expands our understanding of climate-related health impacts by providing a more definitive description of climate-related health burdens in the United States. It builds on the 2014 USGCRP National Climate Assessment and reviews and synthesizes key ...

  5. Assessment of health care by children and adolescents depends on when they respond to the questionnaire

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Kofoed, Poul-Erik

    2010-01-01

    The aim of this study was to examine the assessments and priorities by children and adolescents of health care in a paediatric outpatient clinic, to examine the influence of the time factor on the assessments and priorities by children and adolescents of health care, and to determine their prefer...

  6. Patient and public involvement in scope development for a palliative care health technology assessment in europe

    NARCIS (Netherlands)

    Brereton, L.; Goyder, E.; Ingleton, C.; Gardiner, C.; Chilcott, J.; Wilt, G.J. van der; Oortwijn, W.; Mozygemba, K.; Lysdahl, K.B.; Sacchini, D.; Lepper, W.

    2014-01-01

    BACKGROUND: Patient and Public Involvement (PPI) helps to ensure that study findings are useful to end users but is under-developed in Health Technology Assessment (HTA). "INTEGRATE-HTA, (a co-funded European Union project -grant agreement 30614) is developing new methods to assess complex health te

  7. 76 FR 52945 - Chlorpyrifos Registration Review; Preliminary Human Health Risk Assessment; Extension of Comment...

    Science.gov (United States)

    2011-08-24

    ... AGENCY Chlorpyrifos Registration Review; Preliminary Human Health Risk Assessment; Extension of Comment... availability of the chlorpyrifos registration review; preliminary human health risk assessment. This document extends the comment period for 30 days, from Tuesday, September 6, 2011 to Thursday, October 6,...

  8. Aluminium: Food-related health risk assessment of the consumers

    Directory of Open Access Journals (Sweden)

    О.V. Bagryantseva

    2016-03-01

    Full Text Available Aluminum is the most abundant metal in the lithosphere, constituting 8 % of the earth's crust. Aluminum enters the food from the various objects of environment such as water, food contact materials (packaging materials, cooking vessels, aluminum-containing food additives. In raw food products the content of aluminum is less than 5.7 mg/kg of the product. Normally, aluminum is not practically found in a human body. However, within the last decade various toxic effects of aluminum on human body have been revealed, and they are able to cause the risk of various diseases. The analysis of the available data has demonstrated that the excessive entry of aluminum in human body with food items is associated first of all with the content of aluminum-containing food additives, as well as with the use of materials and products made of aluminum and its alloys intended for contact with food. High level of aluminum consumption has been also detected among children of all ages. At the same time, today, theprovisional tolerable weekly intake (PTWI of aluminum for children is not established. To reduce negative effect of aluminum on human body it is necessary to: * exclude from the list of Annex 2 of the Technical Regulations of the Customs Union "Requirements for Food Additives, Flavorings and Technological Aids” (TR TS 029/2012 the following food additives – potassium aluminum silicate (E555, bentonite (E558, sodium aluminum silicate (E554, potassium aluminum silicate (E555, calcium aluminum silicate (E556, aluminum silicate (kaolin (E559; * to develop requirements for the aluminum content in food products intended for children nutrition; * to obtain data on aluminum content in food items sold on the domestic market and to assess health risks to consumers.

  9. A LITERATURE REVIEW OF ASSESSMENT AND MENTAL HEALTH, FROM THE BRAZILIAN VIRTUAL LIBRARY IN HEALTH ECONOMICS: RESULTS AND CHALLENGES.

    Directory of Open Access Journals (Sweden)

    Carla Estefania Albert

    2014-02-01

    Full Text Available This article presents a literature review of the literature on evaluation of mental health services from BVS ECO, without limited timeline. Design and Methods: A systematic review of texts in Spanish, Portuguese and English. It used certain preliminary criteria for inclusion and exclusion to identify relevant studies, using descriptors: evaluation, mental health evaluation/ assessment. Results: There were 48 articles of which 21 were excluded. The main theme of the publications was the verification of costs versus service complexity, and among the most recent publications, based on the type of treatment of psychological disorders. Conclusions: As a facilitator of research in Health Economics, BVS ECO should allow access to the full text and it is urgently to review the classification and inclusion of publications in the Base about evaluations inquiries. In terms of production, there is a tendency of articles over time, with detailing methodologies and objectives of border between health assessment and health economic evaluation.

  10. Relationships Between Animal Health Monitoring and the Risk Assessment Process

    Directory of Open Access Journals (Sweden)

    Salman MD

    2001-03-01

    Full Text Available Risk assessment is part of the risk analysis process as it is used in veterinary medicine to estimate risks related to international trade and food safety. Data from monitoring and surveillance systems (MO&SS are used throughout the risk assessment process for hazard identification, release assessment, exposure assessment and consequence assessment. As the quality of risk assessments depends to a large extent on the availability and quality of input data, there is a close relationship between MO&SS and risk assessment. In order to improve the quality of risk assessments, MO&SS should be designed according to minimum quality standards. Second, recent scientific developments on state-of-the-art design and analysis of surveys need to be translated into field applications and legislation. Finally, knowledge about the risk assessment process among MO&SS planners and managers should be promoted in order to assure high-quality data.

  11. SUBJECTIVE HEALTH ASSESSMENT AND HEALTH BEHAVIOUR OF ADULT INHABITANTS OF TOWNS LOCATED IN THE VICINITY OF WIND FARMS IN POLAND

    Directory of Open Access Journals (Sweden)

    Bożena Mroczek

    2010-06-01

    Full Text Available Background. The development of wind power industry is beneficial both for human beings and their environment, even so it causes anxiety of people living near wind farms. It is highly related to insufficient information on the effect of wind farms on human health. The aim of this study was to assess subjective health, existing problems and health behaviours demonstrated by the residents of places located near wind farms. Materials of methods. The study was performed in January and February 2009. The research tool was a questionnaire consisting of the Norwegian version of The SF-36 General Health Questionnaire, the Visual Analog Scale (VAS for health assessment, and author’s questions. Information was obtained from 343 respondents, whose average age was 45 years. Out of them 57% had a job, while 12% were unemployed. All respondents were country dwellers. Results: General health was assessed as excellent or very good by 30%, as bad by 10.8%. One-fourth of respondents observed the worsening of their health. Some 59.2% claimed that wind farms were over 1500 m from their houses; people living in the shortest distance form a wind mill (700 m constituted 8%. One-third thought that windmills were safe for health; 69.1% did not regard windmills beneficial to themselves, and 2.6% could not see any advantages for the local community. Overweight and obesity were found in 42.34%, and 96.8% suffered from chronic diseases. Conclusions: 1. Subjective quality of life assessment depends directly on internal conditions of an individual. Construction of wind farms is not evaluated as an investment that changes the life of an individual. It is thought to have no effect on the assessment of health or its worsening. 2. Risk behaviours in the group examined do not differ from those observed in the general population. The factors which make the behaviours different are gender, age below 65 and occupational inactivity.

  12. Evidence Based Assessment of Public Health Planning: A Case Study of the 2014 Crisis in Ukraine

    Science.gov (United States)

    2015-06-12

    Assessment of Public Health Planning: A Case Study of the 2014 Crisis in Ukraine 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT...armed conflict. As a result of the crisis , health care infrastructure was destroyed, health care workers fled, migrating patterns of vulnerable

  13. The University Environment: A Comprehensive Assessment of Health-Related Advertisements

    Science.gov (United States)

    Szymona, Katie; Quick, Virginia; Olfert, Melissa; Shelnutt, Karla; Kattlemann, Kendra K.; Brown-Esters, Onikia; Colby, Sarah E.; Beaudoin, Christina; Lubniewski, Jocelyn; Maia, Angelina Moore; Horacek, Tanya; Byrd-Bredbenner, Carol

    2012-01-01

    Purpose: Little is known about health-related advertising on university environments. Given the power of advertising and its potential effect on health behaviors, the purpose of this paper is to assess the health-related advertisement environment and policies on university campuses. Design/methodology/approach: In total, ten geographically and…

  14. Promoting Physical and Mental Health among College Students: A Needs Assessment

    Science.gov (United States)

    Bezyak, Jill; Clark, Alena

    2016-01-01

    Purpose: To conduct an initial needs assessment of physical and mental health behavior among college students to improve understanding of physical and mental health needs among future helping professionals. Method: A sample of 24 undergraduate students was used to provide a description of mental health, physical activity, and healthy eating…

  15. Problem structuring in health technology assessment : an argumentative approach to increase its usefulness

    NARCIS (Netherlands)

    Moret-Hartman, Margriet

    2008-01-01

    This thesis addresses the problem of the limited impact of Health Technology Assessment (HTA) research on health policy and clinical practice. HTA is a type of policy research that aims to provide information concerning medical technologies in order to support health care decision making. Although,

  16. Approaches to advancing quantitative human health risk assessment of environmental chemicals in the post-genomic era

    Energy Technology Data Exchange (ETDEWEB)

    Chiu, Weihsueh A., E-mail: chiu.weihsueh@epa.gov [National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington DC, 20460 (United States); Euling, Susan Y.; Scott, Cheryl Siegel; Subramaniam, Ravi P. [National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington DC, 20460 (United States)

    2013-09-15

    The contribution of genomics and associated technologies to human health risk assessment for environmental chemicals has focused largely on elucidating mechanisms of toxicity, as discussed in other articles in this issue. However, there is interest in moving beyond hazard characterization to making more direct impacts on quantitative risk assessment (QRA) — i.e., the determination of toxicity values for setting exposure standards and cleanup values. We propose that the evolution of QRA of environmental chemicals in the post-genomic era will involve three, somewhat overlapping phases in which different types of approaches begin to mature. The initial focus (in Phase I) has been and continues to be on “augmentation” of weight of evidence — using genomic and related technologies qualitatively to increase the confidence in and scientific basis of the results of QRA. Efforts aimed towards “integration” of these data with traditional animal-based approaches, in particular quantitative predictors, or surrogates, for the in vivo toxicity data to which they have been anchored are just beginning to be explored now (in Phase II). In parallel, there is a recognized need for “expansion” of the use of established biomarkers of susceptibility or risk of human diseases and disorders for QRA, particularly for addressing the issues of cumulative assessment and population risk. Ultimately (in Phase III), substantial further advances could be realized by the development of novel molecular and pathway-based biomarkers and statistical and in silico models that build on anticipated progress in understanding the pathways of human diseases and disorders. Such efforts would facilitate a gradual “reorientation” of QRA towards approaches that more directly link environmental exposures to human outcomes.

  17. Incorporating Preliminary Mental Health Assessment in the Initial Healthcare for Refugees in New Jersey.

    Science.gov (United States)

    Al-Obaidi, AbdulKareem; West, Bernadette; Fox, Anne; Savin, Daniel

    2015-07-01

    The study aims to assess the feasibility of introducing a mental health screening tool into the initial health care assessment for refugees in New Jersey, US. A semi-structured interview was conducted with a convenience sample of professionals providing refugee health care in New Jersey and in a number of other states. There is a widespread appreciation of the need to consider the mental and emotional issues of the refugees as a priority in healthcare services. A mental health screening tool is required for practice in NJ. Community resources should be coupled with early screening for better refugee mental health outcomes.

  18. Health impact assessment of air pollution using a dynamic exposure profile: Implications for exposure and health impact estimates

    Energy Technology Data Exchange (ETDEWEB)

    Dhondt, Stijn, E-mail: stijn.dhondt@vub.ac.be [Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels (Belgium); Beckx, Carolien, E-mail: Carolien.Beckx@vito.be [Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol (Belgium); Degraeuwe, Bart, E-mail: Bart.Degraeuwe@vito.be [Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol (Belgium); Lefebvre, Wouter, E-mail: Wouter.Lefebvre@vito.be [Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol (Belgium); Kochan, Bruno, E-mail: Bruno.Kochan@uhasselt.be [Transportation Research Institute, Hasselt University, Wetenschapspark 5 bus 6, 3590 Diepenbeek (Belgium); Bellemans, Tom, E-mail: Tom.Bellemans@uhasselt.be [Transportation Research Institute, Hasselt University, Wetenschapspark 5 bus 6, 3590 Diepenbeek (Belgium); Int Panis, Luc, E-mail: Luc.intpanis@vito.be [Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol (Belgium); Transportation Research Institute, Hasselt University, Wetenschapspark 5 bus 6, 3590 Diepenbeek (Belgium); Macharis, Cathy, E-mail: cjmachar@vub.ac.be [Department MOSI-Transport and Logistics, Vrije Universiteit Brussel, Pleinlaan 2, B-1050, Brussels (Belgium); Putman, Koen, E-mail: kputman@vub.ac.be [Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels (Belgium); Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels (Belgium)

    2012-09-15

    In both ambient air pollution epidemiology and health impact assessment an accurate assessment of the population exposure is crucial. Although considerable advances have been made in assessing human exposure outdoors, the assessments often do not consider the impact of individual travel behavior on such exposures. Population-based exposures to NO{sub 2} and O{sub 3} using only home addresses were compared with models that integrate all time-activity patterns-including time in commute-for Flanders and Brussels. The exposure estimates were used to estimate the air pollution impact on years of life lost due to respiratory mortality. Health impact of NO{sub 2} using an exposure that integrates time-activity information was on average 1.2% higher than when assuming that people are always at their home address. For ozone the overall estimated health impact was 0.8% lower. Local differences could be much larger, with estimates that differ up to 12% from the exposure using residential addresses only. Depending on age and gender, deviations from the population average were seen. Our results showed modest differences on a regional level. At the local level, however, time-activity patterns indicated larger differences in exposure and health impact estimates, mainly for people living in more rural areas. These results suggest that for local analyses the dynamic approach can contribute to an improved assessment of the health impact of various types of pollution and to the understanding of exposure differences between population groups. - Highlights: Black-Right-Pointing-Pointer Exposure to ambient air pollution was assessed integrating population mobility. Black-Right-Pointing-Pointer This dynamic exposure was integrated into a health impact assessment. Black-Right-Pointing-Pointer Differences between the dynamic and residential exposure were quantified. Black-Right-Pointing-Pointer Modest differences in health impact were found at a regional level. Black

  19. Proposals for enhanced health risk assessment and stratification in an integrated care scenario

    OpenAIRE

    Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David

    2016-01-01

    Objectives: Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to el...

  20. Assessing uncertainty in outsourcing clinical services at tertiary health centers.

    Science.gov (United States)

    Billi, John E; Pai, Chih-Wen; Spahlinger, David A

    2007-01-01

    When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract.

  1. Weight Care Project: Health professionals' attitudes and ability to assess body weight status - Study protocol

    LENUS (Irish Health Repository)

    Moorhead, Anne

    2011-03-31

    Abstract Background Health professionals working in primary care and public health have opportunities to address body weight status issues with their patients through face-to-face contact. The objectives of this all-Ireland project are: 1. to assess the attitudes, current practices\\/behaviours and knowledge of key health professional groups on body weight status; 2. to assess the health professional groups\\' ability to identify body weight status in both adults and children. The health professional groups are: (a) community related public health nurses; (b) school public health nurses; (c) GPs and practice nurses (primary care); and (d) occupational health nurses (workplace) from both Northern Ireland and the Republic of Ireland. Methods\\/Design This all-Ireland multi-disciplinary project follows a mixed methods approach using both quantitative and qualitative methodologies, and consists of four components: 1. Literature review - to explore the role of health professionals in managing obesity through spontaneous intervention in a variety of health promotion settings. 2. Telephone interviews and focus groups - to gain an in-depth insight into the views of health professionals in assessing body weight status. 3. Survey (primarily online but also paper-based) - to determine the attitudes, current practices\\/behaviours and knowledge of health professionals in assessing body weight status. 4. Online evaluation study - an online interactive programme will be developed to assess health professionals\\' ability to identify the body weight status of adults and children. Discussion This project will assess and report the attitudes, current practices\\/behaviours and knowledge of key health professional groups within Northern Ireland and the Republic of Ireland on body weight status, and their ability to identify body weight status in both adults and children. The results of this project will generate recommendations for clinical practice in managing obesity, which may

  2. Weight Care Project: Health professionals' attitudes and ability to assess body weight status - Study protocol

    Directory of Open Access Journals (Sweden)

    Murphy Kathy

    2011-03-01

    Full Text Available Abstract Background Health professionals working in primary care and public health have opportunities to address body weight status issues with their patients through face-to-face contact. The objectives of this all-Ireland project are: 1. to assess the attitudes, current practices/behaviours and knowledge of key health professional groups on body weight status; 2. to assess the health professional groups' ability to identify body weight status in both adults and children. The health professional groups are: (a community related public health nurses; (b school public health nurses; (c GPs and practice nurses (primary care; and (d occupational health nurses (workplace from both Northern Ireland and the Republic of Ireland. Methods/Design This all-Ireland multi-disciplinary project follows a mixed methods approach using both quantitative and qualitative methodologies, and consists of four components: 1. Literature review - to explore the role of health professionals in managing obesity through spontaneous intervention in a variety of health promotion settings. 2. Telephone interviews and focus groups - to gain an in-depth insight into the views of health professionals in assessing body weight status. 3. Survey (primarily online but also paper-based - to determine the attitudes, current practices/behaviours and knowledge of health professionals in assessing body weight status. 4. Online evaluation study - an online interactive programme will be developed to assess health professionals' ability to identify the body weight status of adults and children. Discussion This project will assess and report the attitudes, current practices/behaviours and knowledge of key health professional groups within Northern Ireland and the Republic of Ireland on body weight status, and their ability to identify body weight status in both adults and children. The results of this project will generate recommendations for clinical practice in managing obesity, which may

  3. Wetland ecosystem health assessment through integrating remote sensing and inventory data with an assessment model for the Hangzhou Bay, China.

    Science.gov (United States)

    Sun, Tengteng; Lin, Wenpeng; Chen, Guangsheng; Guo, Pupu; Zeng, Ying

    2016-10-01

    Due to rapid urbanization, industrialization and population growth, wetland area in China has shrunk rapidly and many wetland ecosystems have been reported to degrade during recent decades. Wetland health assessment could raise the public awareness of the wetland condition and guide policy makers to make reasonable and sustainable policies or strategies to protect and restore wetland ecosystems. This study assessed the health levels of wetland ecosystem at the Hangzhou Bay, China using the pressure-state-response (PSR) model through synthesizing remote sensing and statistical data. Ten ecological and social-economic indicators were selected to build the wetland health assessment system. Weights of these indicators and PSR model components as well as the normalized wetland health score were assigned and calculated based on the analytic hierarchy process (AHP) method. We analyzed the spatio-temporal changes in wetland ecosystem health status during the past 20years (1990-2010) from the perspectives of ecosystem pressure, state and response. The results showed that the overall wetland health score was in a fair health level, but displayed large spatial variability in 2010. The wetland health score declined from good health level to fair health level from 1990 to 2000, then restored slightly from 2000 to 2010. Overall, wetland health levels showed a decline from 1990 to 2010 for most administrative units. The temporal change patterns in wetland ecosystem health varied significantly among administrative units. Our results could help to clarify the administrative responsibilities and obligations and provide scientific guides not only for wetland protection but also for restoration and city development planning at the Hangzhou Bay area.

  4. [The operational role of the occupational health physician in the assessment and management of health risks related to night risks].

    Science.gov (United States)

    Mucci, Nicola; Giorgi, Gabriele; Gonnelli, Irene Margherita; Garbarino, Sergio; Cupelli, Vincenzo; Arcangelil, Giulio

    2016-01-01

    The operational role of the occupational health physician in the assessment and management of health risks related to night work. Night work, in the last 30-40 years, has been extended to almost all areas of employment. The potential effects on workers' health--related to the disruption of circadian rhythms--are now well defined and studied in the Literature. All issues about the protection of safety and health for night workers are governed by the Italian Legislative Decree no. 66/2003 and subsequent amendments. The management of night work hasn't been included into the main Law on Occupational Safety and Health (Italian Legislative Decree no. 81/2008 and subsequent amendments) and a coordination between the two disciplines is desirable. The occupational health physician, as a global consultant for the protection of all health issues into a company, has to evaluate the potential effects of night work on health, both individually and as a group of workers. In this way, the physician may use either traditional tools (history, physical examination, blood tests) or innovative tools (questionnaires, health promotion programs, interventions on shift schedules). In the management of night work is useful to employ schedules that respect both psychophysical integrity and social welfare of workers and the needs of the production. The occupational health physician plays a significant role in information and training of workers, both individually and as a group of workers, and in the organization of health promotion programs (whit a voluntary participation by the workers).

  5. Occupational health assessment of chromite toxicity among Indian miners

    Directory of Open Access Journals (Sweden)

    Alok Prasad Das

    2011-01-01

    Full Text Available Elevated concentration of hexavalent chromium pollution and contamination has contributed a major health hazard affecting more than 2 lakh mine workers and inhabitants residing in the Sukinda chromite mine of Odisha, India. Despite people suffering from several forms of ill health, physical and mental deformities, constant exposure to toxic wastes and chronic diseases as a result of chromite mining, there is a tragic gap in the availability of ′scientific′ studies and data on the health hazards of mining in India. Occupational Safety and Health Administration, Odisha State Pollution Control Board and the Odisha Voluntary Health Association data were used to compile the possible occupational health hazards, hexavalent chromium exposure and diseases among Sukinda chromite mines workers. Studies were reviewed to determine the routes of exposure and possible mechanism of chromium induced carcinogenicity among the workers. Our studies suggest all forms of hexavalent chromium are regarded as carcinogenic to workers however the most important routes of occupational exposure to Cr (VI are inhalation and dermal contact. This review article outlines the physical, chemical, biological and psychosocial occupational health hazards of chromite mining and associated metallurgical processes to monitor the mining environment as well as the miners exposed to these toxicants to foster a safe work environment. The authors anticipate that the outcome of this manuscript will have an impact on Indian chromite mining industry that will subsequently bring about improvements in work conditions, develop intervention experiments in occupational health and safety programs.

  6. Comprehensive health assessment for newly arrived refugee children in Australia

    NARCIS (Netherlands)

    Davidson, N; Skull, S; Chaney, G; Frydenberg, A; Isaacs, D; Kelly, P; Lampropoulos, B; Raman, S; Silove, D; Buttery, J; Smith, M; Steel, Z; Burgner, D

    2004-01-01

    Providing appropriate and responsive care to refugees from diverse backgrounds and with unique health needs is challenging. Refugee children may present with a wide range of conditions, which may be unfamiliar to health professionals in developed countries. Additionally, refugees may experience unfa

  7. Health assessment of toluene in California drinking water

    Energy Technology Data Exchange (ETDEWEB)

    Reed, N.; Reed, W.; Beltran, L.; Li, R.; Encomienda, I.

    1989-03-08

    This report reviews existing literature pertinent to the health risk posed by the use of toluene-contaminated drinking water. Also included in the study is an estimate of the toluene exposure of California residents based on the most recent data on toluene concentrations in California drinking water supplies. The concentration of toluene in drinking water that may cause adverse health effects is delineated.

  8. Health risk assessment for chemical exposures of military interest

    NARCIS (Netherlands)

    Langenberg, J.P.; Polhuijs, M.; Sijbranda, T.

    2016-01-01

    Participation in military operations is accompanied by health hazards resulting from exposure to chemical substances from natural and anthropogenic sources. Historically, focus on toxicological risks has been on the health effects of exposure to chemical warfare agents (CW A). In recent years the aw

  9. Integration of quantitative risk assessment in the health impact assessment of the recently amended Hungarian anti-smoking policy

    DEFF Research Database (Denmark)

    Ádám, Balázs; Molnár, Ágnes; Gulis, Gabriel

    2011-01-01

    . In the frame of the Risk Assessment from Policy to Impact Dimension EU project, quantitative assessment of several health outcomes has been integrated in the HIA of the recently prepared anti-smoking policy of Hungary, which had the primary goal of protecting non-smokers from environmental tobacco smoke...... experiences, while outcome assessment calculated measures of disease burden, like attributable death and disability adjusted life years, for a baseline and a predicted situation after the proposed changes take place. The major impact of the proposal was identified to decreases prevalence of active and passive...... population of Hungary. As demonstrated by the results, providing smoke-free public places has an unambiguous positive impact on the health of the public that has been confirmed by the quantified health gain. The demonstrated methodology offers a practicable example for applying quantitative risk assessment...

  10. Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand

    Directory of Open Access Journals (Sweden)

    Sidorenko Alexandra

    2007-12-01

    Full Text Available Abstract Background In recent years, interest in the study of inequalities in health has not stopped at quantifying their magnitude; explaining the sources of inequalities has also become of great importance. This paper measures socioeconomic inequalities in self-reported morbidity and self-assessed health in Thailand, and the contributions of different population subgroups to those inequalities. Methods The Health and Welfare Survey 2003 conducted by the Thai National Statistical Office with 37,202 adult respondents is used for the analysis. The health outcomes of interest derive from three self-reported morbidity and two self-assessed health questions. Socioeconomic status is measured by adult-equivalent monthly income per household member. The concentration index (CI of ill health is used as a measure of socioeconomic health inequalities, and is subsequently decomposed into contributing factors. Results The CIs reveal inequality gradients disadvantageous to the poor for both self-reported morbidity and self-assessed health in Thailand. The magnitudes of these inequalities were higher for the self-assessed health outcomes than for the self-reported morbidity outcomes. Age and sex played significant roles in accounting for the inequality in reported chronic illness (33.7 percent of the total inequality observed, hospital admission (27.8 percent, and self-assessed deterioration of health compared to a year ago (31.9 percent. The effect of being female and aged 60 years or older was by far the strongest demographic determinant of inequality across all five types of health outcome. Having a low socioeconomic status as measured by income quintile, education and work status were the main contributors disadvantaging the poor in self-rated health compared to a year ago (47.1 percent and self-assessed health compared to peers (47.4 percent. Residence in the rural Northeast and rural North were the main regional contributors to inequality in self

  11. Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation

    Science.gov (United States)

    Waugh, Declan T.; Potter, William; Limeback, Hardy; Godfrey, Michael

    2016-01-01

    The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population. PMID:26927146

  12. Cost-effectiveness analysis: adding value to assessment of animal health welfare and production.

    Science.gov (United States)

    Babo Martins, S; Rushton, J

    2014-12-01

    Cost-effectiveness analysis (CEA) has been extensively used in economic assessments in fields related to animal health, namely in human health where it provides a decision-making framework for choices about the allocation of healthcare resources. Conversely, in animal health, cost-benefit analysis has been the preferred tool for economic analysis. In this paper, the use of CEA in related areas and the role of this technique in assessments of animal health, welfare and production are reviewed. Cost-effectiveness analysis can add further value to these assessments, particularly in programmes targeting animal welfare or animal diseases with an impact on human health, where outcomes are best valued in natural effects rather than in monetary units. Importantly, CEA can be performed during programme implementation stages to assess alternative courses of action in real time.

  13. Assessment of health impacts of decreased smoking prevalence in Copenhagen

    DEFF Research Database (Denmark)

    Holm, Astrid Ledgaard; Brønnum-Hansen, Henrik; Robinson, Kirstine Magtengaard;

    2014-01-01

    , but models to estimate potential health effects of local interventions are lacking. The aim of the current study was to model the effects of decreased smoking prevalence in Copenhagen, Denmark. Methods: The DYNAMO-HIA model was applied to the population of Copenhagen, by using health survey data and data......-initiation rates, whereas an intervention targeting only initiation among youth had marginal effects on morbidity and mortality within the modelled time frame. Conclusions: By modifying the DYNAMO-HIA model, we were able to estimate the potential health effects of four interventions to reduce smoking prevalence...

  14. Avoiding Program-Induced Cumulative Overload (PICO).

    Science.gov (United States)

    Orr, Robin; Knapik, Joseph J; Pope, Rodney

    2016-01-01

    This article defines the concept of program-induced cumulative overload (PICO), provides examples, and advises ways to mitigate the adverse effects. PICO is the excessive cumulative physical workload that can be imparted to military personnel by a military training program with an embedded physical training component. PICO can be acute (accumulating within a single day) or chronic (accumulating across the entirety of the program) and results in adverse outcomes for affected personnel, including detrimental fatigue, performance degradation, injuries, or illness. Strategies to mitigate PICO include focusing administration and logistic practices during the development and ongoing management of a trainee program and implementing known musculoskeletal injury prevention strategies. More training is not always better, and trainers need to consider the total amount of physical activity that military personnel experience across both operational training and physical training if PICO is to be mitigated.

  15. Complexity and demographic explanations of cumulative culture.

    Directory of Open Access Journals (Sweden)

    Adrien Querbes

    Full Text Available Formal models have linked prehistoric and historical instances of technological change (e.g., the Upper Paleolithic transition, cultural loss in Holocene Tasmania, scientific progress since the late nineteenth century to demographic change. According to these models, cumulation of technological complexity is inhibited by decreasing--while favoured by increasing--population levels. Here we show that these findings are contingent on how complexity is defined: demography plays a much more limited role in sustaining cumulative culture in case formal models deploy Herbert Simon's definition of complexity rather than the particular definitions of complexity hitherto assumed. Given that currently available empirical evidence doesn't afford discriminating proper from improper definitions of complexity, our robustness analyses put into question the force of recent demographic explanations of particular episodes of cultural change.

  16. Cumulative carbon emissions and the Green Paradox

    OpenAIRE

    Ploeg, Frederick Van der

    2013-01-01

    The green paradox states that a gradually more ambitious climate policy such as a renewables subsidy or an anticipated carbon tax induces fossil fuel owners to extract more rapidly and accelerate global warming. However, if extraction becomes more costly as reserves are depleted, such policies also shorten the fossil fuel era, induce more fossil fuel to be left in the earth, and thus curb cumulative carbon emissions. These consequences are relevant, as global warming depends primarily on cumu...

  17. Resiliency and subjective health assessment. Moderating role of selected psychosocial variables

    Directory of Open Access Journals (Sweden)

    Michalina Sołtys

    2015-12-01

    Full Text Available Background Resiliency is defined as a relatively permanent personality trait, which may be assigned to the category of health resources. The aim of this study was to determine conditions in which resiliency poses a significant health resource (moderation, thereby broadening knowledge of the specifics of the relationship between resiliency and subjective health assessment. Participants and procedure The study included 142 individuals. In order to examine the level of resiliency, the Assessment Resiliency Scale (SPP-25 by N. Ogińska-Bulik and Z. Juczyński was used. Participants evaluated subjective health state by means of an analogue-visual scale. Additionally, in the research the following moderating variables were controlled: sex, objective health status, having a partner, professional activity and age. These data were obtained by personal survey. Results The results confirmed the relationship between resiliency and subjective health assessment. Multiple regression analysis revealed that sex, having a partner and professional activity are significant moderators of associations between level of resiliency and subjective health evaluation. However, statistically significant interaction effects for health status and age as a moderator were not observed. Conclusions Resiliency is associated with subjective health assessment among adults, and selected socio-demographic features (such as sex, having a partner, professional activity moderate this relationship. This confirms the significant role of resiliency as a health resource and a reason to emphasize the benefits of enhancing the potential of individuals for their psychophysical wellbeing. However, the research requires replication in a more homogeneous sample.

  18. Health Assessment of School Children II -- Screening Tests

    Science.gov (United States)

    Eisner, Victor; Oglesby, Allan

    1971-01-01

    The article concludes that adequate screening, and the use of expensive diagnostic procedures (such as medical referral) only for children who have failed a screening test, will result in the most effective use of school health time and funds. (Author)

  19. Health and the environment : assessing the impacts, addressing the uncertainties

    NARCIS (Netherlands)

    Knol, A.B.

    2010-01-01

    Environmental health problems have become increasingly complex. Climate change, increased urbanization or exposure to electromagnetic fields are highly divergent examples of issues about which no scientific consensus exists, for which no straightforward solutions are available and which are embedded

  20. National Built Environment Health Impact Assessment Model: Creation and Application

    Science.gov (United States)

    Behavioral (activity, diet, social interaction) and exposure (air pollution, traffic injury, and noise) related health impacts of land use and transportation investment decisions are becoming better understood and quantified. Research has shown relationships between density, mix,...