Type 2 diabetes:assessing the relative risks and benefits of glucose-lowering medications

The selection of appropriate pharmacologic therapy for any disease requires a careful assessment of benefit and risk. In the case of type 2 diabetes, this decision typically balances the benefits accrued from improved glycemic control with the risks inherent in glucose-lowering medications. This review is intended to assist therapeutic decision-making by carefully assessing the potential benefit from improved metabolic control relative to the potential risks of a wide array of currently prescribed glucose-lowering agents. Wherever possible, risks and benefits have been expressed in terms of absolute rates (events per 1000 patient-years) to facilitate cross-study comparisons. The review incorporates data from new studies (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation, Action to Control Cardiovascular Risk in Diabetes, and the Veterans Affairs Diabetes Trial), as well as safety issues associated with newer glucose-lowering medications. © 2010 Elsevier Inc. All rights reserved.

Workers' understanding of chemical risks: electroplating case study

BACKGROUND: There is limited research concerning how small companies in particular, respond to health and safety messages. AIMS: To understand individuals' knowledge and beliefs about chemical risks and to compare these with those of experts. METHODS: The use of chromic acid in particular, and also other chemicals associated with chrome plating were studied. All chromium plating firms were based in the West Midlands. The methodology involved initial face to face interviews (n = 21) with chromium platers, structured questionnaires (n = 84) to test the prevalence of beliefs identified in the interviews, an expert questionnaire, and a workshop to discuss findings. The responses of platers were compared with those of occupational health and safety experts. RESULTS: Although chromium platers appeared to understand the short term adverse effects of the chemicals to which they are exposed, their understanding of long term, or chronic effects appeared to be incomplete. They had good knowledge of acute effects based primarily on experience. Platers were aware of the hazardous nature of the chemicals with which they work, but did not draw distinction between the terms "hazards" and "risks". They had difficulties articulating the effects of the chemicals and how exposure might occur; although it is inappropriate to equate this with lack of knowledge. A significant minority of platers displayed deficiencies in understanding key technical terms used in Safety Data Sheets. CONCLUSIONS: This study provides a method which can be used to gain some understanding of workers' knowledge and beliefs about risks that they are exposed to in the workplace. The study also identifies gaps between the platers' knowledge and beliefs and those of experts. New risk information needs to be designed which addresses the information needs of platers using language that they understand.

Social and scientific issues in the acceptibility of radiation risks

Ionising radiation hazards are perhaps the most documented and regulated occupational and environmental hazard. In the radiological protection field a single expert advisory organisation has had an unusually large influence on the international standard setting process. This is the International Commission on Radiological Protection (ICRP). Two common, and opposing views, exist over the formulation of protection recommendations by the ICRP. The first, and most widely accepted, is that its recommendations are scientifically determined. The second view, is that its recommendations are politically or socially determined. Neither of these analyses adequately accounts for the complex process in which protection recommendations are formulated. A third view, provided by studies of the origins of scientific controversy, suggests that both science and social factors are important in the assessment and limitation of risk. The aim of this thesis is not simply to examine the origin of controversy. Issues of equal, if not more, importance are the resolution of controversy, the formation of consensus and the maintenance of expert authority and influence. These issues form the central focus of this thesis. The aim is to assess the process through which the ICRP formulates its radiological protection recommendations and comment on the extent that these are influenced by the affiliations of its members. This thesis concludes that the ICRP's recommendations have been shaped by a complex relationship of scientific and social considerations, in which a socio-technical commitment to nuclear energy has played a key role. The Commission has responded to new scientific data by making complex changes to its philosophy and methods of describing risk. Where reductions in numerical limits have been applied they have been accompanied by practical measures designed to limit the impact of the change and provide continuity with the old limits and flexibility in the application of the new recommendations.

Mathematical modelling of patient risks in a hospital environment, using multiple regression analysis

The aim of this research work was primarily to examine the relevance of patient parameters, ward structures, procedures and practices, in respect of the potential hazards of wound cross-infection and nasal colonisation with multiple resistant strains of Staphylococcus aureus, which it is thought might provide a useful indication of a patient's general susceptibility to wound infection. Information from a large cross-sectional survey involving 12,000 patients from some 41 hospitals and 375 wards was collected over a five-year period from 1967-72, and its validity checked before any subsequent analysis was carried out. Many environmental factors and procedures which had previously been thought (but never conclusively proved) to have an influence on wound infection or nasal colonisation rates, were assessed, and subsequently dismissed as not being significant, provided that the standard of the current range of practices and procedures is maintained and not allowed to deteriorate. Retrospective analysis revealed that the probability of wound infection was influenced by the patient's age, duration of pre-operative hospitalisation, sex, type of wound, presence and type of drain, number of patients in ward, and other special risk factors, whilst nasal colonisation was found to be influenced by the patient's age, total duration of hospitalisation, sex, antibiotics, proportion of occupied beds in the ward, average distance between bed centres and special risk factors. A multi-variate regression analysis technique was used to develop statistical models, consisting of variable patient and environmental factors which were found to have a significant influence on the risks pertaining to wound infection and nasal colonisation. A relationship between wound infection and nasal colonisation was then established and this led to the development of a more advanced model for predicting wound infections, taking advantage of the additional knowledge of the patient's state of nasal colonisation prior to operation.