Quantitative microbial risk assessment models for consumption of raw vegetables irrigated with reclaimed water

Quantitative microbial risk assessment models for estimating the annual risk of enteric virus infection associated with consuming raw vegetables that have been overhead irrigated with nondisinfected secondary treated reclaimed water were constructed. We ran models for several different scenarios of crop type, viral concentration in effluent, and time since last irrigation event. The mean annual risk of infection was always less for cucumber than for broccoli, cabbage, or lettuce. Across the various crops, effluent qualities, and viral decay rates considered, the annual risk of infection ranged from 10–3 to 10–1 when reclaimed-water irrigation ceased 1 day before harvest and from 10–9 to 10–3 when it ceased 2 weeks before harvest. Two previously published decay coefficients were used to describe the die-off of viruses in the environment. For all combinations of crop type and effluent quality, application of the more aggressive decay coefficient led to annual risks of infection that satisfied the commonly propounded benchmark of ≤10–4, i.e., one infection or less per 10,000 people per year, providing that 14 days had elapsed since irrigation with reclaimed water. Conversely, this benchmark was not attained for any combination of crop and water quality when this withholding period was 1 day. The lower decay rate conferred markedly less protection, with broccoli and cucumber being the only crops satisfying the 10–4 standard for all water qualities after a 14-day withholding period. Sensitivity analyses on the models revealed that in nearly all cases, variation in the amount of produce consumed had the most significant effect on the total uncertainty surrounding the estimate of annual infection risk. The models presented cover what would generally be considered to be worst-case scenarios: overhead irrigation and consumption of vegetables raw. Practices such as subsurface, furrow, or drip irrigation and postharvest washing/disinfection and food preparation could substantially lower risks and need to be considered in future models, particularly for developed nations where these extra risk reduction measures are more common.

Evaluating public risk preferences in forest land-use choices using multi-attribute utility theory

Forest policy decisions inherently involve multiple attributes and risk and uncertainty as they largely deal with complex biological, ecological, and socio-political systems. Identifying risk preferences and quantifying their inter-relationships and tradeoffs are useful in formulating better forest policy. Often, technocrats and experts deal with risky decisions, but ideally, stakeholder risk characteristics should be explicitly considered in making policy decisions. This paper analysed societal risk preferences on public forest land-use attributes using multi-attribute utility theory (MAUT). The results indicate significant risk-averse behaviour towards old-growth forest conservation and forest-based recreation but less risk-averse behaviour towards native timber extraction. Overall, the respondents preferred a more conservative forest land-use option, which is consistent with their risk attitudes. The method provides insights into risk preferences of forest stakeholders, which could lead to better understanding of forest management conflicts. Moreover, the method explicitly distinguishes the technical and value components of the decision and is useful in unravelling public risk preferences in multiple-use forest planning situations.

Knowledge, risk perceptions and condom usage in male sex workers from three Australian cities

The study identifies factors associated with knowledge and perception of risk of HIV/AIDS, as well as attitudes to and usage of condoms by a sample of male sex workers (MSW). One hundred and eighty-five male sex workers completed a self-reported questionnaire, including knowledge about HIV transmission, attitudes to condom use and perceptions and personal susceptibility to HIV and sexually transmitted infection (STI) risk, and a two-week diary recording use of condom during commercial sex encounters. The findings reveal that condom use was found in 77.7% of the encounters with clients and the majority of the respondents perceived themselves to be at no risk for HIV because of sex work. Independent sex workers from Melbourne and workers who owned their place of residence used condoms in a significant lower proportion. Generally speaking, knowledge about the risks associated with AIDS was high, with respondents showing lower knowledge about the risks associated with unprotected receptive or active oral sex. Participants held a positive attitude to condom use; most considered the provisions of condoms to be their responsibility rather than clients; and they were more worried about contracting an STI than HIV. Those who scored higher on the knowledge scale had more positive attitudes to condom use and those who had a more positive attitude to condom use recorded a perceived lower risk of contracting STI but not HIV. The study discusses the relevance of these findings for public health risk reduction and sexual health education campaigns.

Dietary portfolio approach to reducing the risk of cardiovascular disease : the polymeal revisited

Aims: The Polymeal was first proposed as a 'tastier and safer' alternative to a polypharmacy approach to cardiovascular disease risk reduction. The present study aimed to examine the affordability of the Polymeal, and to propose modifications based on economic considerations, and the latest scientific evidence, to achieve consistency with current public health recommendations.

Methods: Prices for each food component specified in the Polymeal were obtained from a major and independent supermarket chain in a representative middle socioeconomic demographic region of metropolitan Melbourne, Australia. Items included fish (114 g, four times/week), fruits and vegetables (400 g/day), dark chocolate (100 g/day), garlic (2.7 g/day), almonds (68 g/day) and red wine (150 mL/day). Prices were calculated using an average of the major brands, or the most commonly eaten fruits, vegetables or fish. Modifications of the Polymeal were proposed based on published research and public health recommendations since the Polymeal was first proposed.

Results: Average price of the Polymeal was AU$11.89 per day falling to AU$8.46 if the cheapest food items were chosen. Modifications to the Polymeal included: consuming fish oil capsules instead of fish, reduction in the quantity of dark chocolate and removal of red wine. These modifications halved the cost of the Polymeal, while choosing the cheapest food items further lowered the cost to AU$3.49 per day. Modification of the Polymeal gave substantial reductions in both energy and saturated fat (51% and 84%, respectively).

Conclusion: The modified Polymeal is a more affordable variation of the Polymeal, which takes into account current scientific evidence and public health recommendations.

Pharmacist assessment of adherence, risk and treatment in cardiovascular disease (PAART CVD)

Cardiovascular disease (CVD) accounts for 18% of disease burden in Australia, and 35% of deaths. Evidence- based management of CVD risk requires systematic consideration of individual risk factors and overall CVD risk, and a balanced approach to lifestyle modification, the optimal use of medicines, and medicines adherence.

This project examines a pHot model for primary prevention of CVD in community pharmacy aimed at improving quality of care. Pharmacists from ten pharmacies received training in CVD risk factor management and facilitating patient lifestyle modification.

They recruited 70 participants aged 50-74 years, taking medicines for blood pressure (BP) or cholesterol, and without diabetes or CVD, At baseline, research assistants conducted a clinical assessment of anthropometric and biomedical risk factors, and conducted interviews to examine health behaviours, medicines use and related issues. Data was analysed by a consultant pharmacist and summary reports produced, with recommendations and targets for risk reduction. These were addressed by patients and their community pharmacists over five monthly sessions. At follow up, the relative risk reduction for CVD onset over the next five years was 24%, contributed to by reductions in mean systolic BP (-7mmHg), diastolic PP (-5 mmHg), total:HDL cholesterol ratio (—0.2), waist circumference (—2cm in males, —0.7cm in females) and other risk factors.

Several key health behaviours improved, including diet quality and physical activity levels. Prevalence of non-adherence to cardiovascular medicines dropped by 1 6% to 22%.

The potential health benefits from this intervention need to be confirmed via larger, controlled clinical trials. Overall, this appears to be a feasible and potentially effective public health measure.

Are firms hedging or speculating? The relationship between financial derivatives and firm risk

The focus of this article is an investigation of the relationship between the use of financial derivatives and firm risk using a sample of Australian firms. Our results suggest that this relationship is nonlinear in nature. Specifically, the use of financial derivatives is associated with a risk reduction for moderate derivative users. Derivative usage among extensive derivative users, on the other hand, appears to lead to an increase in firm risk. Nevertheless, compared to firms that do not make use of derivatives, there is no evidence that extensive derivative users are exposed to a risk level in excess of that of nonderivative users. The results are, therefore, indicative of a hedging motive behind the use of financial derivatives.

A pilot study evaluating multiple risk factor interventions by community pharmacists to prevent cardiovascular disease : The PAART CVD pilot project

Background: There is insufficient evidence for the efficacy of comprehensive multiple risk factor interventions by pharmacists in the primary prevention of cardiovascular disease (CVD). Given the proven benefits of pharmacist interventions for individual risk factors, it is essential that evidence for a comprehensive approach to care be generated so that pharmacists remain key members of the health care team for individuals at risk of initial onset of CVD. Objective: To establish the feasibility of an intervention delivered by community pharmacists to reduce the risk of primary onset of CVD.
Methods: A single-cohort intervention study was undertaken in 2008-2009. Twelve community pharmacists from 10 pharmacies who were trained to provide lifestyle and medicine management support to reduce CVD risk recruited 70 at-risk participants aged 50-74 years who were free from diabetes or CVD. Participants received a baseline assessment to establish CVD risk and health behaviors. An assessment report provided to patients and pharmacists was used to collaboratively establish treatment goals and, over 5 sessions, implement treatment strategies. Follow-up assessment at 6 months measured changes in baseline parameters. The primary outcome was the average change to overall 5-year risk of CVD onset.
Results: Sixty-seven participants were included in the analysis. The mean participant age was 60 years and 73% were female. We observed a 25% (95% CI 17 to 33) proportional risk reduction in overall CVD risk. Significant reductions also occurred in mean blood pressure (-11/-5 mm Hg) and waist circumference (-1.3 cm), with trends toward improvement for most other observed risk factors.
Conclusions: Findings support previous evidence of positive cardiovascular health outcomes following pharmacist intervention in other patient groups; we recommend generating randomized controlled trial evidence for a primary prevention population.

A cluster-randomised, controlled trial to assess the impact of a workplace osteoporosis prevention intervention on the dietary and physical activity behaviours of working women: study protocol

Background Osteoporosis is a debilitating disease and its risk can be reduced through adequate calcium consumption and physical activity. This protocol paper describes a workplace-based intervention targeting behaviour change in premenopausal women working in sedentary occupations. Method/Design A cluster-randomised design was used, comparing the efficacy of a tailored intervention to standard care. Workplaces were the clusters and units of randomisation and intervention. Sample size calculations incorporated the cluster design. Final number of clusters was determined to be 16, based on a cluster size of 20 and calcium intake parameters (effect size 250 mg, ICC 0.5 and standard deviation 290 mg) as it required the highest number of clusters. Sixteen workplaces were recruited from a pool of 97 workplaces and randomly assigned to intervention and control arms (eight in each). Women meeting specified inclusion criteria were then recruited to participate. Workplaces in the intervention arm received three participatory workshops and organisation wide educational activities. Workplaces in the control/standard care arm received print resources. Intervention workshops were guided by self-efficacy theory and included participatory activities such as goal setting, problem solving, local food sampling, exercise trials, group discussion and behaviour feedback. Outcomes measures were calcium intake (milligrams/day) and physical activity level (duration: minutes/week), measured at baseline, four weeks and six months post intervention. Discussion This study addresses the current lack of evidence for behaviour change interventions focussing on osteoporosis prevention. It addresses missed opportunities of using workplaces as a platform to target high-risk individuals with sedentary occupations. The intervention was designed to modify behaviour levels to bring about risk reduction. It is the first to address dietary and physical activity components each with unique intervention strategies in the context of osteoporosis prevention. The intervention used locally relevant behavioural strategies previously shown to support good outcomes in other countries. The combination of these elements have not been incorporated in similar studies in the past, supporting the study hypothesis that the intervention will be more efficacious than standard practice in osteoporosis prevention through improvements in calcium intake and physical activity.

Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial

Depression is common after a cardiac event; however it often remains untreated. Previously, we reported the efficacy and feasibility of a 6-month tele-health programme (MoodCare), which integrates depression management into a cardiovascular disease (CVD) risk reduction programme for Acute Coronary Syndrome (ACS) patients with low mood. Here, we evaluate the long-term efficacy of the programme at 12-month follow-up.

Assessing and managing breast cancer risk: Clinicians' current practice and future needs

Decision support tools for the assessment and management of breast cancer risk may improve uptake of prevention strategies. End-user input in the design of such tools is critical to increase clinical use. Before developing such a computerized tool, we examined clinicians' practice and future needs. Twelve breast surgeons, 12 primary care physicians and 5 practice nurses participated in 4 focus groups. These were recorded, coded, and analyzed to identify key themes. Participants identified difficulties assessing risk, including a lack of available tools to standardize practice. Most expressed confidence identifying women at potentially high risk, but not moderate risk. Participants felt a tool could especially reassure young women at average risk. Desirable features included: evidence-based, accessible (e.g. web-based), and displaying absolute (not relative) risks in multiple formats. The potential to create anxiety was a concern. Development of future tools should address these issues to optimize translation of knowledge into clinical practice.

'High' risk? A systematic review of the acute outcomes of mixing alcohol with energy drinks

Alcohol mixed with energy drinks (AmED) is a relatively new consumption trend generating increasing concern regarding potential adverse effects. Despite the political and health imperative, there has been no systematic and independent synthesis of the literature to determine whether or not AmED offers additional harms relative to alcohol. The aim of this study was to review the evidence about whether co-consumption of energy drinks and alcohol, relative to alcohol alone, alters: (i) physiological, psychological, cognitive and psychomotor outcomes; (ii) hazardous drinking practices; and (iii) risk-taking behaviour.

Evaluating a school-based alcohol program: the WARP experience

The Western Alcohol Reduction Program (WARP) is a community designed and lead, secondary school-based, program that seeks to address issues related to alcohol use by young people in the Melbourne western metropolitan region. Taking a whole-of community approach, the program consisted of six programs for a class of 20 students from schools in western Melbourne. The program sought to highlight negative influences of alcohol on life outcomes, and addresses the issues of alcohol-related behaviour in assaults, injuries and preventable consequences of risk-taking behaviour. The findings of this evaluation suggest that students have modified some of their drinking behaviours over the program, have modified some of their risky behaviours and have increased their knowledge in some areas. This program, designed specifically to meet the needs of the local school and students, has the potential to increase the alcohol- and drug-related knowledge of students, while also having a positive impact on alcohol-related behaviours.

The influence of sex, temperament, risk-taking and mental health on the emergence of gambling: a longitudinal study of young people

There are a host of complex and interlinked psychological, social and biological factors involved in the development of problem gambling (PG). While existing research, which is predominantly cross-sectional, shows that emerging adulthood is a critical period for PG, the early risk factors for PG are currently unknown. Here, we recruited a sample of 156 early adolescents with no history of PG (mean age 12.6 years) and longitudinally followed them up into late adolescence (mean age 18.9 years) to investigate the role of sex, risk-taking behaviour and changes in temperament and psychiatric symptoms in the evolution of risky gambling behaviour. There were sex-independent effects of temperament and risk-taking behaviour, with greater developmental increases in temperamental frustration (i.e. negative affectivity), greater developmental decreases in temperamental attention (i.e. effortful control) and greater involvement in risky behaviours, such as alcohol use, predicting greater likelihood of being in the risky gambling group. In addition, there were sex-dependent effects whereby higher levels of baseline aggression in females and lower levels of the same in males were more predictive of risky gambling. These findings highlight how sex-dependent and independent factors across the early- to mid-adolescent period influence the occurrence of gambling later in life.

Improving coronary heart disease self-management using mobile technologies (Text4Heart): a randomised controlled trial protocol

BACKGROUND: Cardiac rehabilitation (CR) is a secondary prevention program that offers education and support to assist patients with coronary heart disease (CHD) make lifestyle changes. Despite the benefits of CR, attendance at centre-based sessions remains low. Mobile technology (mHealth) has potential to reach more patients by delivering CR directly to mobile phones, thus providing an alternative to centre-based CR. The aim of this trial is to evaluate if a mHealth comprehensive CR program can improve adherence to healthy lifestyle behaviours (for example, physically active, fruit and vegetable intake, not smoking, low alcohol consumption) over and above usual CR services in New Zealand adults diagnosed with CHD.

METHODS/DESIGN: A two-arm, parallel, randomised controlled trial will be conducted at two Auckland hospitals in New Zealand. One hundred twenty participants will be randomised to receive a 24-week evidence- and theory-based personalised text message program and access to a supporting website in addition to usual CR care or usual CR care alone (control). The primary outcome is the proportion of participants adhering to healthy behaviours at 6 months, measured using a composite health behaviour score. Secondary outcomes include overall cardiovascular disease risk, body composition, illness perceptions, self-efficacy, hospital anxiety/depression and medication adherence.

DISCUSSION: This study is one of the first to examine an mHealth-delivered comprehensive CR program. Strengths of the trial include quality research design and in-depth description of the intervention to aid replication. If effective, the trial has potential to augment standard CR practices and to be used as a model for other disease prevention or self-management programs.

Family-based interventions for reducing sedentary time in youth: a systematic review of randomized controlled trials

Family involvement in interventions to reduce sedentary time may help foster appropriate long-term screen-based habits in children. This review systematically synthesized evidence from randomized controlled trials of interventions with a family component that targeted reduction of sedentary time, including TV viewing, video games and computer use, in children. MEDLINE, PubMed, PsycInfo, CINAHL and Embase were searched from inception through March 2012. Seventeen articles were considered eligible and included in the review. Studies were judged to be at low-to-moderate risk of bias. Despite inconsistent study results, level of parental involvement, rather than the setting itself, appeared an important determinant of intervention success. Studies including a parental component of medium-to-high intensity were consistently associated with statistically significant changes in sedentary behaviours. Participant age was also identified as a determinant of intervention outcomes; all three studies conducted in pre-school children demonstrated significant decreases in sedentary time. Finally, TV exposure appeared to be related to changes in energy intake rather than physical activity. Future studies should assess the effects of greater parental involvement and child age on success of sedentary behaviour interventions. More research is required to better understand the relationship between screen time and health behaviours, particularly energy intake.