Biological invasions are a population-level rather than a species-level phenomenon

Biological invasions pose a rapidly expanding threat to the persistence, functioning and service provisioning of ecosystems globally, and to socio-economic interests. The stages of successful invasions are driven by the same mechanism that underlies adaptive changes across species in general-via natural selection on intraspecific variation in traits that influence survival and reproductive performance (i.e., fitness). Surprisingly, however, the rapid progress in the field of invasion science has resulted in a predominance of species-level approaches (such as deny lists), often irrespective of natural selection theory, local adaptation and other population-level processes that govern successful invasions. To address these issues, we analyse non-native species dynamics at the population level by employing a database of European freshwater macroinvertebrate time series, to investigate spreading speed, abundance dynamics and impact assessments among populations. Our findings reveal substantial variability in spreading speed and abundance trends within and between macroinvertebrate species across biogeographic regions, indicating that levels of invasiveness and impact differ markedly. Discrepancies and inconsistencies among species-level risk screenings and real population-level data were also identified, highlighting the inherent challenges in accurately assessing population-level effects through species-level assessments. In recognition of the importance of population-level assessments, we urge a shift in invasive species management frameworks, which should account for the dynamics of different populations and their environmental context. Adopting an adaptive, region-specific and population-focused approach is imperative, considering the diverse ecological contexts and varying degrees of susceptibility. Such an approach could improve and refine risk assessments while promoting mechanistic understandings of risks and impacts, thereby enabling the development of more effective conservation and management strategies.

Environmental Risk Assessment in Community Care: A Scoping Review

Community care encompasses inherent risks for both clients and healthcare providers. Maintaining a safe environment for the delivery of care services ensures that any risk of unintentional or intentional personal harm is minimised. The aim of this scoping review is to (a) provide an overview of existing knowledge by summarising the current literature and (b) identify gaps pertaining to understanding and managing environmental risk in community care settings. Guided by the Population/Concept/Context approach and PRISMA guidelines, this paper used two questions to answer how a score-based tool for assessing client suitability in community care is developed and how an environmental screening tool assists with reducing risk to community care workers. Literature searches of CINAHL, PubMed (Medline), Web of Science and PsychINFO databases were conducted between September 2023 and November 2023. We included full text articles published from 2018 to 2023. The following four broad areas were identified as key components in the structure of an environmental screening tool: environmental factors, health factors, socioeconomic factors and cultural factors. The results of this review provide valuable information which can be utilised by care organisations to develop and/or refine tools to ensure the safety and wellbeing of workers within the community care sector.

Architecture and Development Framework for a Web-Based Risk Assessment and Management Platform Developed on WordPress to Address Opioid Overdose

The number of overdose-related fatalities continues to reach historic levels across Canada, despite ongoing efforts by authorities. To reduce mortality, a clinical trajectory ranging from preventative measures to crisis intervention, skill training to treatment, and risk assessment to risk management needs to be supported. The web-based Risk Assessment and Management Platform (RAMP) was developed to realize this concept and to empower people who use drugs through an integrated tool that allows them to better understand and manage their risk of overdose. This paper outlines the architecture and development of RAMP, which is built on the WordPress platform. WordPress components are mapped onto a 3-tier architecture that consists of presentation, application, and database layers. The architecture facilitates the development of a modular software that includes several features that are independent in functionality but interact with each other in an integrated platform. The relatively low coupling and high coherence of the features may reduce the cost of maintenance and increase flexibility of future developments. RAMP's architecture comprises a user interface, conceptual framework, and backend layers. The RAMP front end effectively uses some of the WordPress' features such as HTML5, CSS, and JavaScript to create a mobile, friendly, and scalable user interface. The RAMP backend uses several standard and custom WordPress plug-ins to support risk assessment and monitoring, with the goal of mitigating the impacts and eliminating risks together. A rule-based decision support system has been hard-coded to suggest relevant modules and goals to complement each user's lifestyle and goals based on their risk assessment. Finally, the backend uses the MySQL database management system and communicates with the RAMP framework layer via the data access layer to facilitate a timely and secure handling of information. Overall, RAMP is a modular system developed to identify and manage the risk of opioid overdose in the population of people who use drugs. Its modular design uses the WordPress architecture to efficiently communicate between layers and provide a base for external plug-ins. There is potential for the current system to adopt and address other related fields such as suicide, anxiety, and trauma. Broader implementation will support this concept and lead to the next level of functionality.

Safety and Effectiveness of the High-Sensitivity Cardiac Troponin HEART Pathway in Patients With Possible Acute Coronary Syndrome

BACKGROUND

The HEART Pathway (History, Electrocardiogram, Age, Risk factors, Troponin) can be used with high-sensitivity cardiac troponin to risk stratify emergency department patients with possible acute coronary syndrome. However, data on whether a high-sensitivity HEART Pathway (hs-HP) are safe and effective is lacking.

METHODS

An interrupted time series study was conducted at 5 North Carolina sites in 26 126 adult emergency department patients being investigated for possible acute coronary syndrome and without ST-segment-elevation myocardial infarction. Patients were accrued into 16-month preimplementation and postimplementation cohorts with a 6-month wash-in phase. Preimplementation (January 2019 to April 2020), the traditional HEART Pathway was used with 0- and 3-hour contemporary troponin measures (Siemens). In the postimplementation period (November 2020 to February 2022), a modified hs-HP was used with 0- and 2-hour high-sensitivity cardiac troponin (Beckman Coulter) measures. The primary safety and effectiveness outcomes were 30-day all-cause death or myocardial infarction and 30-day hospitalizations. These outcomes and early discharge rate (emergency department discharge without stress testing or coronary angiography) were determined from health records and death index data. Outcomes were compared preimplementation versus postimplementation using χ2 tests and multivariable logistic regression to adjust for potential confounders.

RESULTS

Preimplementation and postimplementation cohorts included 12 317 and 13 809 patients, respectively, of them 52.7% (13 767/26 126) were female with a median age of 54 years (interquartile range, 42-66). Rates of 30-day death or MI were 6.8% (945/13 809) postimplementation and 7.7% (948/12 317) preimplementation (adjusted odds ratio, 1.00 [95% CI, 0.90-1.11]). hs-HP implementation was associated with 19.9% (95% CI, 18.7%-21.1%) higher early discharges (post versus pre: 63.6% versus 43.7%; adjusted odds ratio, 2.22 [95% CI, 2.10-2.35]). The hs-HP was also associated with 16.1% (95% CI, 14.9%-17.3%) lower 30-day hospitalizations (postimplementation versus preimplementation, 31.4% versus 47.5%; adjusted odds ratio, 0.51 [95% CI, 0.48-0.54]). Among early discharge patients, death or myocardial infarction occurred in 0.5% (41/8780) postimplementation versus 0.4% (22/5383) preimplementation (P=0.61).

CONCLUSIONS

hs-HP implementation is associated with increased early discharges without increasing adverse events. These findings support the use of a modified hs-HP to improve chest pain care.

Carpal tunnel syndrome severity, hand discomfort, and usability among three types of computer mouse

BACKGROUND

Numerous people use computer mice for long hours, especially in offices. Mouse users reported various pains and discomfort.

OBJECTIVE

The study aimed to assess three types of most common mice (vertical, traditional, flat) in Iran in terms of their effects on carpal tunnel syndrome, hand discomfort, and usability.

METHODS

The Boston Carpal Tunnel Syndrome questionnaire, the Cornell Hand Discomfort Questionnaire (CHDQ), System Usability Scale (SUS), and Workplace Ergonomic Risk Assessment (WERA) scores were used to assess vertical, traditional, and flat mice. In addition, the participant's hand position was analyzed by observation method.

RESULTS

Most participants had medium carpal tunnel syndrome severity; however, flat mouse users had a higher score, and the difference between mice was insignificant (p > 0.05). Most mouse users felt discomfort in their small and ring fingers, and the type of mouse significantly affected thumb discomfort level. More flat users felt Pain in the different parts of their hands. The flat mouse has the least SUS score. There was a significant difference between the three mice regarding SUS scores (p < 0.05). WERA mean values were acceptable for numerous mice. Adopting neutral wrist postures was more common among vertical, flat, and traditional mouse users, respectively; however, the flat mouse users tended to bend their fingers.

CONCLUSION

There are differences between vertical and traditional flat mice in terms of ergonomic indicators. Although more studies are needed, it seems that vertical mice are better in some indicators.

Contamination Status, Environmental Factor and Risk Assessment of Polychlorinated Biphenyls and Hexachlorobutadiene in Greenhouse and Open-Field Agricultural Soils across China

With the popularization and high-intensity utilization of greenhouse cultivation for crops growth, the pollution of greenhouse soils has been of concern. Therefore, a national-scale survey was conducted to investigate the contamination status, sources, influence factors and the risks of polychlorinated biphenyls (PCBs) and hexachlorobutadiene (HCBD) in greenhouse and nearby open-field soils. Contents of PCBs ranged from 10-6). This study provided a full insight on the contamination status and risks of PCBs and HCBD when guiding greenhouse agriculture activities.

Which first-trimester risk assessment method for preeclampsia is most suitable? A model-based impact study

BACKGROUND

Low-dose aspirin treatment reduces the risk of preeclampsia among high-risk pregnant women. Internationally, several first-trimester risk-calculation methods are applied.

OBJECTIVE

This study aimed to assess the costs and benefits of different first-trimester preeclampsia risk estimation algorithms: EXPECT (an algorithmic prediction model based on maternal characteristics), National Institute for Health and Care Excellence (a checklist of risk factors), and the Fetal Medicine Foundation (a prediction model using additional uterine artery Doppler measurement and laboratory testing) models, coupled with low-dose aspirin treatment, in comparison with no risk assessment.

STUDY DESIGN

We constructed a decision analytical model estimating the number of cases of preeclampsia with each strategy and the costs of risk assessment for preeclampsia and early aspirin treatment, expressed in euros (€) in a hypothetical population of 100,000 women. We performed 1-way sensitivity analyses to assess the impact of adherence rates on model outcomes.

RESULTS

Application of the EXPECT, National Institute for Health and Care Excellence, and Fetal Medicine Foundation models results in respectively 1.98%, 2.55%, and 1.90% of the women developing preeclampsia, as opposed to 3.00% of women in the case of no risk assessment. Overall, the net financial benefits of the EXPECT, National Institute for Health and Care Excellence, and Fetal Medicine Foundation models relative to no risk assessment are €144, €43, and €38 per patient, respectively. The respective percentages of women receiving aspirin treatment are 18.6%, 10.2%, and 6.0% for the 3 risk assessment methods.

CONCLUSION

The EXPECT and Fetal Medicine Foundation model are comparable with regard to numbers of prevented preeclampsia cases, and both are superior to the National Institute for Health and Care Excellence model and to no risk assessment. EXPECT is less resource-demanding and results in the highest cost savings, but also requires the highest number of women to be treated with aspirin. When deciding which strategy is preferable, cost savings and easier use have to be weighed against the degree of overtreatment, although low-dose aspirin has no clear disadvantages during pregnancy.

Carcinogenic drug exposure among health-sector workers: the need for exposure assessment and surveillance

Antineoplastic drugs (ANDs) used for chemotherapy can cause secondary cancers in treated patients and can pose carcinogenic risks to health-sector workers anywhere along these drugs' life cycle in a facility, from production to patient administration. Several PAHO/WHO Collaborating Centers (CCs) have experience addressing these hazards in the health sector. The objectives of this report are four-fold: 1) Provide an overview of longstanding research and prevention efforts, led by PAHO/WHO and its Occupational Health CCs, aimed at reducing the burden of occupational cancer in the Americas; 2) Discuss how robust AND exposure assessment and educational/outreach work by PAHO CCs can form the basis of exposure mitigation efforts among health-sector workers; 3) Through the presentation of original AND exposure assessment data from a pharmaceutical compounding facility in Chile, highlight relatively inexpensive methods by which such data can be generated; and 4) Discuss how effective, periodic environmental surveillance in healthcare facilities results in the identification of AND contamination in the work environment and enables the implementation of low-cost, high-impact interventions to reduce the risk of occupational cancer in health-sector workers, including in limited-resource settings. The risk of health-sector worker exposure to ANDs and other hazardous drugs is an important issue for inclusion within PAHO/WHO's broader efforts at reducing the impact of occupational cancer in the Americas. This report demonstrates that a wide range of accessible AND-exposure mitigation strategies are feasible at both a facility and a national policy level across the hemisphere.

Understanding Escalation Through Intimate Partner Homicide Narratives

The study aims to expand our understanding of escalation from intimate partner violence to intimate partner homicide (IPH) by exploring the known circumstances leading up to a lethal event. The study draws on qualitative data from law enforcement reports and coroner/medical examiner reports within the National Violent Death Reporting System to identify themes preceding and surrounding IPH incidents. Findings support the utility of risk assessments in identifying escalation while illustrating the complex ways that violence between current or former intimate partners can escalate to lethality, particularly the role of separation and the use of firearms.

Differences in temperament and character inventory (TCI) profile between suicidal and nonsuicidal psychiatric outpatients

The purpose of this study was to identify personality traits associated with suicide attempt in a clinical sample. Temperament and character inventory (TCI) profiles of 759 patients who met the inclusion criteria among 1000 randomly selected hospital records collected. Of these 759 patients, 103 had a history of at least 1 actual suicide attempt (suicidal group) whereas 656 had no such history (nonsuicidal group). The suicidal group showed higher scores of novelty seeking (mean ± SD: 36.1 ± 1.2 vs 33.3 ± 0.5; P = .026) and harm avoidance (57.1 ± 1.5 vs 53.0 ± 0.6; P = .01) but lower scores of self-directedness (27.5 ± 1.5 vs 34.4 ± 0.6; P < .001) than the nonsuicidal group. Higher novelty seeking (OR [95% CI]: 1.031 [1.008-1.054]; P = .007) and lower self-directedness: 0.955 [0.927-0.983]; P = .002 were also associated with suicide attempts in the analysis of 7 personality scales. These findings suggest that patients who attempt suicide differ from nonattempters in terms of personality traits, especially in novelty seeking (NS), harm avoidance (HA), and self-directedness (SD). It is noteworthy that this study contains data from actual visits to the emergency room to evaluate suicide attempts. Abbreviations: CO = cooperativeness, Ha = harm avoidance, NS = novelty seeking, PS = persistence, RD = reward dependence, SD = self-directedness, ST = self-transcendence, TCI = temperament and character inventory.

Carcinogenic risk assessment and changes in Spirometric indices in casting and welding workers exposed to Metal fumes

INTRODUCTION

The aim of this study was to investigate exposure to dust, and metal fumes, changes in pulmonary function indices among industrial workers to estimate the carcinogenic and non-carcinogenic risk of exposure to occupational metal fume.<br /><br />Methods: This cross-sectional study was performed on 98 workers exposed to metal fumes. Air sampling was performed according to the NIOSH 0500 method and was analyzed by gravimetry and metal levels were analyzed by atomic absorption spectrometry. Spirometric results for 2010-2016 were collected. Carcinogenic and non-carcinogenic risk assessments were performed according to the US Environmental Protection Agency guidelines. Data were analyzed by SPSS 20 software.

RESULTS

The mean occupational exposure of the subjects to workplace dust and iron fumes was 15.95 ± 6.65 mg/m3 and 13.18 ± 3.06 mg/m3 respectively. During these 6 years, the FVC (P=0.04), PEFR (P=0.04), and FEV1 (P=0.03) indices decreased significantly among welders, but there was no significant difference between FEV1/ FVC indexes. Also, the mean of FEV1 and PEFR decreased significantly amongst casting workers, but FVC and FEV1/ FVC had no significant difference. Multivariate regression showed that in both jobs, BMI and work history were related to pulmonary function indices. The mean total excess ifetime carcinogenic risk (ELCR) of hexavalent chromium in the study population was 0.708 per 1000 people and the mean non-carcinogenic risk of hexavalent chromium was HQ = 19.62.

CONCLUSIONS

The results showed that exposure to metal fumes in casting and welding jobs reduces pulmonary function indices. Although the average occupational exposure to hexavalent chromium is lower than the recommended limit and the risk of carcinogenesis is within an acceptable range, the risk of non-carcinogenic effects among workers is significant Therefore, it is important to prevent this problem, by adequate ventilation and using respiratory masks.

The Clinical Nursing and Midwifery Dashboard (CNMD): A State-Wide Implementation

The clinical nursing and midwifery dashboard (CNMD) was built to provide a near real-time information and data visualisations for nurse unit managers (NUMs) and maternity unit managers (MUMs) within only a 5-15 minutes delay from when they enter data to the integrated electronic medical records (ieMR) system. The dashboard displays metrics and information about current adult inpatients in overnight wards. The aim is to support NUMs and MUMs to manage their daily workload and have continuous visibility of patients nursing risk and safety assessment documentation. A quantitative evaluation approach was conducted to measure the impact of the dashboard on key performance indicators. Statistical analysis was completed to compare risk assessment average completion times prior to and post CNMD implementation. The results of the evaluation were positive, and the statistical analysis shows significant reduction in the average time to complete different risk assessments with p-value<0.01.

Human Health Risk Assessments and Characterization of Nanomaterials: Are We Ready for the Next (Active) Generations?

Driven by the concept of the 'four generations of nanomaterials', the current state of the knowledge on risk assessment of future generation is explored for active nanomaterials. Through case studies, we identify challenges and evaluate the preparedness of characterization methods, available risk assessment modeling tools, and analytical instrumentation for such future generation active nanomaterials with dynamic hybrid structures of biotic-abiotic and organic-inorganic combinations. Currently available risk assessment tools and analytical instrumentation were found to be lacking the risk preparedness and characterization readiness for active nanomaterials, respectively. Potential future developments in risk assessment modeling tools and analytical techniques can be based upon this work which shall ensure long-term safety of the next generation of nanomaterials.

The chemical composition and heavy metal content of sesame oil produced by different methods: A risk assessment study

The oil was extracted from sesame seed with two extraction methods. Traditional (Ardeh oil) and industrial method (cold pressing method: virgin and refined sesame oil) oil extraction was studied to compare the quality and heavy metal content of extracted oils. The chemical properties (fatty acid composition, peroxide, anisidine, acid values, and TOTOX) and heavy metal contents were investigated. The Hazard Quotient (HQ) and Hazard Index (HI) of heavy metal intakes were calculated. The results demonstrated that the predominant fatty acid in oil samples was oleic, linoleic, palmitic, and stearic acids. It was indicated the peroxide, anisidine, acid values, and TOTOX of oil samples were as the order of Ardeh oil > virgin sesame oil > refined sesame oil. The reduction pattern of Pb > Zn >Cu > Cd >As was reported in sesame seed. Although the oil refining had been greatly reduced the Pb of oil sample, but it had yet been much higher than the permissible levels set by Codex Alimentarius. The HQ and HI of all heavy metals were less than one, but they were higher in Ardeh oil compared to others. It is necessary to monitor the presence of heavy metal contaminants and the quality of imported sesame seeds prior to oil preparation.

The effect of different work-rest schedules on ergonomic risk in poultry slaughterhouse workers

BACKGROUND:

Rest breaks are an organizational measure to reduce the high risk of upper limb work-related musculoskeletal disorders (UL-WMSDs) to which slaughterhouse workers are subject.

OBJECTIVE:

To analyze the effect of different work-rest schedules on ergonomic risk in poultry slaughterhouse workers.

METHODS:

A total of 36 repetitive tasks was selected in a Brazilian slaughterhouse. Using the Occupational Repetitive Action (OCRA) Checklist, the level of exposure of workers to risk factors of UL-WMSDs in two work-rest schedules was evaluated. In the real condition, 6 rest breaks of 10 minutes were performed, and in the simulated condition, 3 rest breaks of 20 minutes.

RESULTS:

The right side of the body presented a higher score on the OCRA Checklist (72%of the tasks) than the left side (p = 0.037) in the real condition. Additionally, the OCRA score (18.3±2.5) was significantly lower (p < 0.001) than the simulated condition (21.9±3.0). It was verified that the risk level in simulated condition remained the same in 13 (36%) tasks, while in 23 (64%) tasks there was an increase in the risk level.

CONCLUSIONS:

Work-rest schedule of 6 breaks of 10 minutes was better than 3 breaks of 20 minutes to reduce the risk of UL-WMSDs in poultry slaughterhouse workers.

Consumption of miRNA-Mediated Insect-Resistant Transgenic Rice Pollen Does Not Harm Apis mellifera Adults

RNAi-based insect-resistant genetically engineered (IRGE) crops represent a promising approach for pest management by suppressing gene expressions or translation. A developed microRNA-mediated IRGE rice line expressing endogenous Chilo suppressalis Csu-novel-260 shows significant resistance to target pests. The nontarget insect Apis mellifera is an important pollinator used as a surrogate species for the ecological risk assessment of IRGE plants. To simulate a worst-case scenario, the full-length C. suppressalis and A. mellifera disembodied (dib) cDNAs were cloned. The dib 3'-untranslated regions shared 58.06% nucleotide sequence similarity between C. suppressalis and A. mellifera. No potential Csu-novel-260 binding site in Amdib was detected through the bioinformatics analysis. A dietary RNAi toxicity assay of the impacts of ingested Csu-novel-260 on A. mellifera adults showed that the survival rates of RNAi-treated A. mellifera did not significantly differ from those in the blank control (CK) and negative control (NC) treatments. The Csu-novel-260 uptake by A. mellifera peaked at 8 days postfeeding and then gradually decreased. The Amdib expression was not affected by the RNAi assay days or treatments. These results suggest that A. mellifera adults are not susceptible to high doses of Csu-novel-260 in the dietary RNAi assay and that the impact of miRNA-mediated IRGE plants on A. mellifera is negligible.

Oral health among older adults in nursing homes: A survey in a national quality register, the Senior Alert

Aim

To investigate the extent to which the Revised Oral Assessment Guide–Jönköping (ROAG‐J) is used by nursing staff routinely in nursing homes in Sweden and to describe oral health status of the residents.

Design

An observational, retrospective register‐based study.

Methods

Data from different validated health assessments instruments, including ROAG‐J, for the period 2011–2016 were obtained from the Web‐based national quality register Senior Alert. The basis for the analyses was 190,016 assessments.

Results

About half of all residents had underwent at least one annual ROAG‐J assessment (2014–2016). During the period 2011–2016, 42% of the residents (n = 92,827) were registered to have oral health problems. Significantly more oral health problems were found for men and for those with younger age, poorer physical condition, neurophysiological problems, underweight, impaired mobility and many medications. In conclusion, poorer oral health was found for more care‐dependent individuals, which shows a need of preventive actions.

Pooled cohort risk equation and subclinical cerebrovascular diseases

BACKGROUND AND PURPOSE

In 2013, the American College of Cardiology/American Heart Association (ACC/AHA) introduced a novel pooled cohort risk (PCR) model for atherosclerotic cardiovascular disease. In this study, we evaluated the relationship between the PCR score and cerebral large- and small-vessel diseases (cLVD and cSVD) in a healthy population, METHODS: We assessed consecutive health check-up volunteers from 2006 to 2013. We calculated the estimated 10-year atherosclerotic cardiovascular disease risk as the PCR score based on the 2013 ACC/AHA guidelines. We evaluated both cSVD/cLVD, including the prevalence of cLVD, lacunes and cerebral microbleed (CMB), and the volume of white matter hyperintensity (WMH). In addition to PCR score, the risk factors that were associated with outcome variables at P < 0.10 in univariate analysis were included for further multivariable linear or regression analyses.

RESULTS

A total of 2720 participants were evaluated (mean age, 57 years, male sex, 54%). In multivariable analysis, PCR score was associated with WMH volume [β = 0.361; 95% confidence interval (CI), 0.320-0.402, P < 0.001], cLVD [adjusted odds ratio (aOR), 1.66; 95% CI, 1.29-2.16, P < 0.001], lacunes (aOR, 1.80; 95% CI, 1.52-2.14, P < 0.001) and CMBs (aOR, 1.75; 95% CI, 1.40-2.19, P < 0.001). Furthermore, PCR score also showed dose-response tendencies according to the burden of cLVD, WMH, lacunes and CMB.

CONCLUSIONS

A higher PCR score based on the ACC/AHA guidelines is closely associated with a higher prevalence and burden of cLVD and cSVD.

[Contaminant Characteristics and Ecological Risk Assessments of Heavy Metals from River Networks in the Western Area of the Wangyu River]

To study the pollution characteristics and ecological risks of heavy metals in the western area of the Wangyu River, water and surface sediment samples of five rivers were investigated. The concentration and chemical fractions of eight heavy metals (Ni, Cu, Cr, Zn, As, Cd, Pb, and Hg) were analyzed, the pollution sources of heavy metals were studied using multivariate statistical analysis, and various ecological risk assessments were applied to identify the level of heavy metal contaminants. The results showed that the concentration of heavy metals in water was low, except for Hg, which was lower than the Class I standard of Surface Water Environmental Quality Standard. The content of heavy metals in surface sediments was high, except for Hg, which was significantly higher than the environmental background values. The partition coefficient of heavy metals in water-sediments showed that Cd, As, and Hg had strong re-emission potential. The I_geo indicated that Cu, Zn, and Cd were in a high pollution state as a whole. The RI showed that Cd was the main ecological risk factor in the study area. The RRSP indicated that the degree of pollution by Ni, Zn, and As was low because of its high residual fraction ratio, which was difficult to release under natural conditions. However, the degree of pollution by Cd was high because it had the highest content of weak acid extractable fraction among all the heavy metals. Therefore, it is necessary to pay more attention to Cd contamination. The source analysis of heavy metals showed that the western area of the Wangyu River was mainly affected by the pollution emissions from the surrounding machinery factories.

Differences in Cardiovascular Risk Factors in College Students: Midwest Versus Southwest

PURPOSE

This study was designed to identify underlying cardiovascular risk factors among college students including lifestyle characteristics, health behaviors and knowledge, and perception of the risk factors.

METHOD

College students (N = 293), aged 19-36 years, enrolled at either a Midwestern or a Southwestern University in the United States, responded to three questionnaires: sociodemographic, knowledge of cardiovascular risk factors, and perception of cardiovascular risk factors. Anthropometric measures collected included blood pressure (BP), glucose, lipid panel, height, weight, and body mass index (BMI).

RESULTS

There were significant regional and gender differences in cardiovascular disease (CVD) risk among Southwestern and Midwestern college students. Students from the Southwest had a higher risk of developing CVD in 30 years compared to those in the Midwest; they also had a higher perceived risk. Males were more at risk of developing CVD than females but had a lower perceived risk than females. Dietary habits were similar between the two populations, and we found no significant differences in BMI. The two regions varied in BP levels, but the Midwestern students had significantly higher prevalence of elevated BP and Stage 2 hypertension.

CONCLUSION

Our data suggest that college students are a high-risk population and tend to underestimate and misperceive their risk for developing CVD.

A Sample of Predominately African American Domestic Violence Victims' Responses to Objective Risk Assessments

One area of significant concern for researchers of domestic violence is identifying the utility of objective risk assessment tools on diverse samples. This study included a sample of predominately African American women (n = 57) living in a domestic violence shelter. The study compared the Danger Assessment (DA) and the Ontario Domestic Assault Risk Assessment (ODARA) to evaluate their responses of their risk for re-abuse. Results revealed a moderate to strong correlation between the DA and ODARA (r = .73). Offender's age, habitation, and pregnancy status were not related to the victim's perceptions of risk for future abuse. Implications of these findings are discussed.

Spatial Distribution Variation and Probabilistic Risk Assessment of Exposure to Fluoride in Ground Water Supplies: A Case Study in an Endemic Fluorosis Region of Northwest Iran

Prevalence of fluorosis is a worldwide public health issue, especially in the West Azerbaijan province of Iran. The aim of this study was to investigate fluoride concentration in drinking water resources within Maku city, in both the warm and cold seasons, to perform a health risk assessment. Fluoride were measured using UV-visible spectrophotometry. The spatial distribution was calculated by the software ArcGIS and Hazard Quotients (HQs) were calculated according to the US EPA method. The fluoride concentrations ranged between 0.29 to 6.68 and 0.1 to 11.4 mg/L in the cold and warm seasons, respectively. Based on this report, 30.64 and 48.15% of the samples revealed a fluoride level higher than the permissible level in the cold and warm seasons, respectively. Moreover, results showed that the HQ value in the warm season for different age groups was higher than the HQ value in the cold season. In both seasons, the non-carcinogenic risks of fluoride for the four exposed populations varied according to the order: children > teenagers > adults > infants. The HQ values for three age groups (children, teenager and adults) for both seasons were higher than 1 with a high risk of fluorosis. The results of this study, support the requests that government authorities better manage water supplies to improve health quality.

Health Risk Assessment of Exposure to Heavy Metals and Aflatoxins via Dietary Intake of Dried Red Pepper from Marketplaces in Antalya, Southern Turkey

Red pepper is used as raw material in industry and as a seasoning in various foods. In this study, the cadmium, lead and arsenic content of 33 red pepper samples sold in open and sealed packages on different markets was investigated in terms of their synthetic color components, aflatoxin amounts and toxic elements, which have been declared as cancerous by the World Health Organization (WHO). According to the results, synthetic colorants, arsenic and cadmium were not detected in any of the samples, while lead was detected in 11 samples and aflatoxins were detected in eight of the samples. As a consequence of these investigations, a health risk analysis was carried out by taking into account the amount of consumption in the region. The B1 aflatoxin content in the samples, according to daily consumption data, exceeded the limits set by the European Commission (EC) by almost 150%.

Mapping Systematic Reviews on Forensic Psychiatric Care: A Systematic Review Identifying Knowledge Gaps

Background: Forensic psychiatric care treats mentally disordered offenders who suffer mainly from psychotic disorders, although comorbidities such as personality disorders, neurodevelopmental disorders, and substance abuse are common. A large proportion of these patients have committed violent crimes. Their care is involuntary, and their caregivers' mission is complex: not only to rehabilitate the patient, but also to consider their risk for reoffending and their risk to society. The objective of this overview of systematic reviews is to identify, appraise, and summarize the existing knowledge in forensic psychiatric care and identify knowledge gaps that require further research. Methods: We undertook a systematic literature search for systematic reviews in five defined domains considered important in daily clinical practice within the forensic psychiatric care: (1) diagnostic assessment and risk assessments; (2) pharmacological treatment; (3) psychological interventions; (4) psychosocial interventions, rehabilitation, and habilitation; and (5) restraint interventions. The target population was mentally disordered offenders (forensic psychiatric patients aged >15 years). Each abstract and full text review was assessed by two of the authors. Relevant reviews then were assessed for bias, and those with moderate or low risk of bias were included. Results: Of 38 systematic reviews meeting the inclusion criteria, only four had a moderate risk of bias. Two aimed to incorporate as many aspects of forensic psychiatric care as possible, one investigated non-pharmacological interventions to reduce aggression in forensic psychiatric care, and one focused on women with intellectual disabilities in forensic care. However, most of the primary studies included in these reviews had high risks of bias, and therefore, no conclusions could be drawn. All of our identified domains must be considered knowledge gaps. Conclusion: We could not answer any of our research questions within the five domains because of the high risk of bias in the primary studies in the included systematic reviews. There is an urgent need for more research on forensic psychiatric care since all of our studied domains were considered knowledge gaps.

Cardiovascular risk factors among college students: Knowledge, perception, and risk assessment

OBJECTIVE

To assess college students' knowledge and perception of cardiovascular risk factors and to screen for their cardiovascular risks.

PARTICIPANTS

The final sample that responded to recruitment consisted of 158 college students from a midwestern university.

METHODS

A cross-sectional, descriptive study was performed using convenience sampling.

RESULTS

College students were knowledgeable about cardiovascular risk factors but did not perceive themselves at risk for cardiovascular disease (CVD). Knowledge of cardiovascular risk factors was correlated with the lifetime risk estimates (ρ = .17, p = .048), and perception of cardiovascular risk was positively associated with 30-year CVD risk estimates (ρ = .16, p = .048). More than 50% of the participants had 1 or more cardiovascular risk factors.

CONCLUSIONS

High knowledge level of cardiovascular risk factors was not sufficient to lower cardiovascular risks within this study population, but changing perception of cardiovascular risk factors may play a bigger role in reducing long-term cardiovascular risks.

Polycyclic Aromatic Hydrocarbons In Edible Mushrooms from Niger Delta, Nigeria: Carcinogenic and Non-Carcinogenic Health Risk Assessment

In the oil-rich Niger Delta, hydrocarbon pollution and oil spillages, gas flaring and sundry anthropogenic activities constitute sources of polycyclic aromatic hydrocarbons (PAHs), with food contamination playing a major role in human exposure. In this study we assessed PAH levels in wild and cultivated edible mushroom species consumed by the general population from the oil producing Niger Delta, Nigeria. The concentrations of USEPA-16 PAHs were determined by gas chromatography and carcinogenic and non-carcinogenic health risks were calculated. The concentrations of USEPA-16 PAHs ranged from 0.02 mg/kg – 3.37 mg/kg. The dietary intake of carcinogenic and non-carcinogenic USEPA-16 PAHs (Naphthalene, Acenaphthylene, Acenaphthene, Anthracene, Phenanthrene, Flourene, Flouranthene, Pyrene, Benzo[a]Anthracene, Chrysene, Benzo[a]Pyrene, Benzo[b]Flouranthene, Benzo[K]Flouranthene, Benzo[g, h, i]Perylene, Dibenz[a, h]Anthracene and Ideno[1,2,3-cd]Pyrene) for adults, adolescents and seniors ranged from 0.00 – 0.05 mg/kg/day, 0.00 – 0.06 mg/kg/day and 0.00 – 0.07 mg/kg/day. The BaPeq ranged from 0.02 – 2.76 with margin of exposure MOE values of BaP ranging from 3,500,000 to 700,000, 3,500,000 and 3,500,000 to 7,000,000 for adults, adolescents and seniors indicating very insignificant health risk. The incremental lifetime cancer risk was within the safe range of 1.56x10-8 – 1.73x10-6 with the highest calculated risk found for wild Pleurotus ostreatus mushroom species from the study area.

Proactive Risk Assessments and the Continuity of Business Principles: Perspectives on This Novel, Combined Approach to Develop Guidance for the Permitted Movement of Agricultural Products during a Foot-and-Mouth Disease Outbreak in the United States

Animal diseases such as foot-and-mouth disease (FMD) have the potential to severely impact food animal production systems. Paradoxically, the collateral damage associated with the outbreak response may create a larger threat to the food supply, social stability, and economic viability of rural communities than the disease itself. When FMD occurs in domestic animals, most developed countries will implement strict movement controls in the area surrounding the infected farm(s). Historically, stopping all animal movements has been considered one of the most effective ways to control FMD and stop disease spread. However, stopping all movements in an area comes at a cost, as there are often uninfected herds and flocks within the control area. The inability to harvest uninfected animals and move their products to processing interrupts the food supply chain and has the potential to result in an enormous waste of safe, nutritious animal products, and create animal welfare situations. In addition, these adverse effects may negatively impact agriculture businesses and the related economy. Effective disease control measures and the security of the food supply thus require a balanced approach based on science and practicality. Evaluating the risks associated with the movement of live animals and products before an outbreak happens provides valuable insights for risk management plans. These plans can optimize animal and product movements while preventing disease spread. Food security benefits from emergency response plans that both control the disease and keep our food system functional. Therefore, emergency response plans must aim to minimize the unintended negative consequence to farmers, food processors, rural communities, and ultimately consumers.

From Brain Disease to Brain Health: Primary Prevention of Alzheimer's Disease and Related Disorders in a Health System Using an Electronic Medical Record-Based Approach

BACKGROUND

Alzheimer's disease and aging brain disorders are progressive, often fatal neurodegenerative diseases. Successful aging, modern lifestyles and behaviors have combined to result in an expected epidemic. Risks for these diseases include genetic, medical, and lifestyle factors; over 20 modifiable risks have been reported.

OBJECTIVES

We aim to primarily prevent Alzheimer's disease and related disorders through electronic medical record (EMR)-based screening, risk assessments, interventions, and surveillance.

DESIGN

We identified modifiable risks; developed human, systems and infrastructural resources; developed interventions; and targeted at-risk groups for the intervention.

SETTING

A Community Based Health System.

PARTICIPANTS

In year one (June 2015 to May 2016), 133 at-risk patients received brain health services with the goal of delaying or preventing Alzheimer's disease and related disorders.

MEASUREMENTS

We created mechanisms to identify patients at high risk of neurodegenerative disease; EMR-based structured clinical documentation support tools to evaluate risk factors and history; evidence-based interventions to modify risk; and the capacity for annual surveillance, pragmatic trials, and practice-based and genomic research using the EMR.

RESULTS

This paper describes our Center for Brain Health, our EMR tools, and our first year of healthy but at-risk patients.

CONCLUSION

We are translating research into primary prevention of Alzheimer's disease and related disorders in our health system and aim to shift the paradigm in Neurology from brain disease to brain health.

Knowledge of and Preparedness for Use of Environmental Assessments in Shelters During Disasters: Results of the 2013 State and Territorial Use of Shelter Assessments Survey

OBJECTIVE

Environmental health assessments of disaster shelters are critical for monitoring the living conditions of the occupants. However, knowledge and levels of utilization of these assessments have never been estimated in the United States or its territories. We aimed to conduct a cross-sectional survey to ascertain knowledge and Utilization of environmental health disaster shelter assessments.

METHODS

The State and Territorial Use of Shelter Assessments Survey (STUSA) of environmental health department directors (N=56) was carried out in 2013.

RESULTS

Survey responses were received from 55 of 56 targeted jurisdictions. Of those respondents, 92% of state jurisdictions and 100% of territories reported having knowledge about shelter assessments. However, only 40% of states and 60% of territories reported receiving formal training, and 53% of states and 50% of territories reported having operational procedures for shelter assessments. High levels of knowledge and familiarity and low levels of training and processes for operationalizing assessments were assessed.

CONCLUSIONS

Because environmental health assessments may provide useful information in disaster settings, we need to understand the barriers to their implementation. The results of these assessments may also help to validate their usefulness in protecting shelter occupants during disasters. (Disaster Med Public Health Preparedness. 2017;11:11-14).

A longitudinal qualitative study of health care personnel's perceptions of simultaneous implementation of three risk assessment scales on falls, malnutrition and pressure ulcers

AIMS AND OBJECTIVES

In this study, the aim was to understand health care personnel's expectations and experiences of participating in an intervention aimed at the implementation of three assessment scales for fall injuries, malnutrition and pressure ulcers, and the performance of preventive measures in these areas over the period of 18 months.

BACKGROUND

Fall injuries, malnutrition and pressure ulcers among older people are challenging issues for caregivers at different levels in the health care system.

DESIGN

A descriptive design with a qualitative approach was used to follow health care personnel before, during and after implementation of a care prevention intervention.

METHODS

Twelve health care personnel with different professions at the hospital, primary care and municipal care levels participated in a preventive care introduction. Seminars were held at four occasions, with assignments to be completed between seminars. Lectures and group discussions were performed, and three risk assessment scales were introduced. The participants were interviewed before, during and after the introduction. Manifest and latent content analysis were used.

RESULTS

The main results are presented in the theme 'Patient needs are visualised through a gradually developed shared understanding' and in five categories. The work approach of performing three risk assessments simultaneously was perceived as positive and central to ensuring quality of care; it was not, however, perceived as unproblematic.

CONCLUSION

The participants as well as health care team members showed a positive attitude towards and described the advantages of being given opportunities for shared understanding to improve patient safety and to provide structure for the provision of good care.

RELEVANCE TO CLINICAL PRACTICE

The managerial approach of listening to and acting on issues stressed by health care personnel is important to ensure ongoing and future improvement initiatives.

Dentists' decisions to conduct caries risk assessment in a Dental Practice-Based Research Network

OBJECTIVES

(i) To quantify the importance that dentists place on caries risk factors when developing a caries treatment plan and (ii) to test the hypothesis that the ratings of importance for specific factors are significantly associated with whether or not the dentist performs caries risk assessment (CRA).

METHODS

This study used a cross-sectional study design consisting of a questionnaire survey. The study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which seeks to engage dentists in investigating research questions and sharing experiences and expertise (n = 282). Participants (n = 189) were asked to rate the importance of caries risk factors when developing a caries treatment plan in both adult and pediatric patients.

RESULTS

Oral hygiene status was rated as the most important risk factor when developing a treatment plan in both adult and pediatric patients, whereas the use of fluorides was rated as the least important. Results of multiple logistic regression analysis showed that the odds ratios for the decision to perform CRA in the adult patient for past caries experience and use of fluorides were 2.61 (95% confidence interval [CI]: 1.29-5.29) and 1.85 (95% CI: 1.12-3.04), respectively, whereas that for oral hygiene was 3.84 (95% CI: 1.15-12.79) and use of fluorides 1.79 (95% CI: 1.06-3.03) in the pediatric patient.

CONCLUSIONS

These results suggest that enhancing dentists' concept of the importance of current use of fluorides when developing a treatment plan may increase the percentage of dentists who conduct CRA in both adult and pediatric patients (clinicaltrials.gov registration number: NCT01680848).

Risk assessments of lumpy skin diseases in Borena bull market chain and its implication for livelihoods and international trade

Risks of introduction of lumpy skin disease (LSD) through traded Borena bulls to market chain and its consequences were assessed. The assessment used the framework that has been recommended by the World Animal Health Organization (OIE) for risk analysis. Likelihoods for release and exposure were estimated by a qualitative scale ranging from negligible to very high, whereas the consequences which resulted from disease occurrences were assessed quantitatively. The likelihood of the introduction of LSD to the market chain through traded Borena bulls is found to be high (medium uncertainty), whereas the probability of exposure is very high (medium uncertainty). From the total of 11,189 bulls observed during outbreak investigation of LSD in six sites of feedlot operation in and around Adama, 681(6.1 %) and 204 (1.8 %) bulls were found to be affected and dead with LSD, respectively. The total economic loss due to LSD was estimated to be 667,785.6 USD. The risk estimates for LSD are greater than negligible; therefore, disease prevention and control strategy along the chain should be carefully considered by the Ethiopian veterinary services.

Include, differentiate and manage: gay male youth, stigma and healthcare utilization

In Canada, there has been a recent increase in HIV incidence among young men who have sex with men. However, gay male youth (GMY) may forego HIV testing due to fear of stigmatization. Therefore, the aim of this research was to explore the perceptions of stigma in health care within this population. The research was conducted through a series of semi-structured interviews with eight GMY aged 20-29, who frequented a gay-friendly clinic in downtown Ottawa, Canada. In a sub-analysis of the interviews utilizing the work of Hardt and Negri's three-part sequence - inclusion, differentiation and management - we found that homosexuality-related stigmatization affects the interaction between GMY and health professionals. Interview participants perceived HIV-related risk counselling as a manifestation of stigma. These findings reveal that the experience of stigma and stigmatization is not necessarily based on health professionals' intentions, but rather, on patients' perceptions of the interactions they have with health professionals. Specific modifications to the delivery of health care may help to overcome stigmatization.

Chemical contamination of green turtle (Chelonia mydas) eggs in peninsular Malaysia: implications for conservation and public health

BACKGROUND

Persistent organic pollutants (POPs)-such as organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDEs)-and heavy metals have been reported in sea turtles at various stages of their life cycle. These chemicals can disrupt development and function of wildlife. Furthermore, in areas such as Peninsular Malaysia, where the human consumption of sea turtle eggs is prevalent, egg contamination may also have public health implications.

OBJECTIVE

In the present study we investigated conservation and human health risks associated with the chemical contamination of green turtle (Chelonia mydas) eggs in Peninsular Malaysia.

METHODS

Fifty-five C. mydas eggs were collected from markets in Peninsular Malaysia and analyzed for POPs and heavy metals. We conducted screening risk assessments (SRAs) and calculated the percent of acceptable daily intake (ADI) for POPs and metals to assess conservation and human health risks associated with egg contamination.

RESULTS

C. mydas eggs were available in 9 of the 33 markets visited. These eggs came from seven nesting areas from as far away as Borneo Malaysia. SRAs indicated a significant risk to embryonic development associated with the observed arsenic concentrations. Furthermore, the concentrations of coplanar PCBs represented 3 300 times the ADI values set by the World Health Organization.

CONCLUSIONS

The concentrations of POPs and heavy metals reported in C. mydas eggs from markets in Peninsular Malaysia pose considerable risks to sea turtle conservation and human health.