Estimates of global and regional potential health gains from reducing multiple major risk factors

Background Estimates of the disease burden due to multiple risk factors can show the potential gain from combined preventive measures. But few such investigations have been attempted, and none on a global scale. Our aim was to estimate the potential health benefits from removal of multiple major risk factors. Methods We assessed the burden of disease and injury attributable to the joint effects of 20 selected leading risk factors in 14 epidemiological subregions of the world. We estimated population attributable fractions, defined as the proportional reduction in disease or mortality that would occur if exposure to a risk factor were reduced to an alternative level, from data for risk factor prevalence and hazard size. For every disease, we estimated joint population attributable fractions, for multiple risk factors, by age and sex, from the direct contributions of individual risk factors. To obtain the direct hazards, we reviewed publications and re-analysed cohort data to account for that part of hazard that is mediated through other risks. Results Globally, an estimated 47% of premature deaths and 39% of total disease burden in 2000 resulted from the joint effects of the risk factors considered. These risks caused a substantial proportion of important diseases, including diarrhoea (92%-94%), lower respiratory infections (55-62%), lung cancer (72%), chronic obstructive pulmonary disease (60%), ischaemic heart disease (83-89%), and stroke (70-76%). Removal of these risks would have increased global healthy life expectancy by 9.3 years (17%) ranging from 4.4 years (6%) in the developed countries of the western Pacific to 16.1 years (43%) in parts of sub-Saharan Africa. Interpretation Removal of major risk factors would not only increase healthy life expectancy in every region, but also reduce some of the differences between regions, The potential for disease prevention and health gain from tackling major known risks simultaneously would be substantial.

Assessing the cellular transmembrane electrical potential difference on the hepatic uptake of palmitate

Understanding the driving forces for the hepatic uptake of endogenous and exogenous substrates in isolated cells and organs is fundamental to describing the underlying hepatic physiology/pharmacology. In this study we investigated whether uptake of plasma protein-bound [H-3]-palmitate across the hepatocyte wall is governed by the transmembrane electrical potential difference (PD). Uptake was studied in isolated hepatocytes and isolated perfused rat livers (IPL). Protein-binding and vasoactive properties of the different perfusates were determined using in vitro heptane/buffer partitioning studies and the multiple indicator dilution (MID) technique in the IPL, respectively. Altering hepatocyte PD by perfusate ion substitution resulted in either a substantial depolarization (-14 +/- 1 mV, n = 12, mean +/- S.E., substituting choline for Na+) or hyperpolarization (-46 +/- 3 mV, n = 12, mean +/- S.E., substituting nitrate for Cl-). Perfusate ion substitution also affected the equilibrium binding constant for the palmitate-albumin complex. IPL studies suggested that, other than with gluconate buffer, hepatic [H-3]-palmitate extraction was not affected by the buffer used, implying PD was not a determinant of extraction. [H-3]-Palmitate extraction was much lower (p < 0.05) when gluconate was substituted for Cl- ion. This work contrasts with that for the extraction of [H-3]-alanine where hepatic extraction fraction was significantly reduced during depolarization. Changing the albumin concentration did not affect hepatocyte PD, and [H-3]-palmitate clearance into isolated hepatocytes was not affected by the buffers used. MID studies with vascular and extravascular references revealed that, with the gluconate substituted buffer, the extravascular volume possibly increased the diffusional path length thus explaining reduced [H-3]-palmitate extraction fraction in the IPL.

Risk taking from the participant's perspective: The case of driving and accident risk

Although perceived health risk plays a prominent role in theories of health behavior. its empirical role in risk taking is less clear. In Study 1 (N = 129), 2 measures of drivers' risk-taking behavior were found to be unrelated to self-estimates of accident concern but to be related to self-ratings of driving skill and the perceived thrill of driving. In Study 2 (N = 405), out of a wide range of potential influences, accident concern had the weakest relationship with risk taking. The authors concluded that although health risk is a key feature in many theories of health behavior and a central focus for researchers and policy makers, it may not be such a prominent factor for those actually taking the risk.

Doom and gloom or a time for optimism: Potential aspirants' views about school leadership - now and for the future

Principal recruitment has attracted national and international attention in recent years (eg. Barty et al, 2005 in Australia; Earley et al, 2002 in the UK; Brooking et al, 2003 in New Zealand; Williams, 2003 in Canada). Importantly, Australian research in both state and non-state schools suggests that potential principal aspirants are less enthusiastic than might be expected in their desire to become principals (D’Arbon et al, 2002; Cranston et al, 2004; Lacey, 2002). Given the importance of ensuring we have quality leaders for our schools in the future, the research reported here (which is on-going) examined the views of potential aspirants (primary and secondary deputy principals) from one large government education system in Australia about the principalship and their intentions in seeking promotion (or otherwise) to such positions and the reasons driving these intentions. Data were collected via the Aspiring Principals Questionnaire (APQ) – especially developed for the study – comprising 38 closed items mainly of a Likert-type format, 5 open-ended items linked to particular closed items allowing participants to add their own suggestions/ideas, expand/elaborate on responses; and 4 further more general open-ended items. A number of system-level policy and practice recommendations have been developed from the findings.

Signal detection theory in applied tasks: The case of hazard perception in driving

Fuzzy signal detection analysis can be a useful complementary technique to traditional signal detection theory analysis methods, particularly in applied settings. For example, traffic situations are better conceived as being on a continuum from no potential for hazard to high potential, rather than either having potential or not having potential. This study examined the relative contribution of sensitivity and response bias to explaining differences in the hazard perception performance of novices and experienced drivers, and the effect of a training manipulation. Novice drivers and experienced drivers were compared (N = 64). Half the novices received training, while the experienced drivers and half the novices remained untrained. Participants completed a hazard perception test and rated potential for hazard in occluded scenes. The response latency of participants to the hazard perception test replicated previous findings of experienced/novice differences and trained/untrained differences. Fuzzy signal detection analysis of both the hazard perception task and the occluded rating task suggested that response bias may be more central to hazard perception test performance than sensitivity, with trained and experienced drivers responding faster and with a more liberal bias than untrained novices. Implications for driver training and the hazard perception test are discussed.