A UK scheme to help small firms control health risks from chemicals: toxicological considerations

The UK has developed a simple scheme to provide practical control advice to small and medium-sized enterprises (SMEs), to assist them in their risk assessments and risk management decisions. This scheme makes use of toxicological hazard information indicated by R-phrases assigned under the European Union (EU) classification system, to assign substances to hazard bands. In the UK scheme, the allocation of substances to hazard bands according to R-phrases has taken into account three key factors: whether or not the toxicological endpoint has an identifiable dose threshold; the seriousness of the resultant health effect; and the relative exposure levels at which toxic effects occur. Based on all these considerations, R-phrases have been allocated to hazard bands within the scheme. An evaluation exercise has been undertaken, to compare the output of the scheme with established health-based occupational exposure limits, for more than 100 substances. The results of this exercise demonstrate that as far as possible, the scheme recommends control strategies which should provide adequate control. This scheme is potentially a very powerful means of helping SMEs adequately control chemical health risks in the workplace. Since it utilises the EU-agreed classification system, the scheme can be applied to any substance supplied and used in the workplace and it may also be used internationally.     

Probabilities and health risks: a qualitative approach

Health risks, defined in terms of the probability that an individual will suffer a particular type of adverse health event within a given time period, can be understood as referencing either natural entities or complex patterns of belief which incorporate the observer's values and knowledge, the position adopted in the present paper. The subjectivity inherent in judgements about adversity and time frames can be easily recognised, but social scientists have tended to accept uncritically the objectivity of probability. Most commonly in health risk analysis, the term probability refers to rates established by induction, and so requires the definition of a numerator and denominator. Depending upon their specification, many probabilities may be reasonably postulated for the same event, and individuals may change their risks by deciding to seek or avoid information. These apparent absurdities can be understood if probability is conceptualised as the projection of expectation onto the external world. Probabilities based on induction from observed frequencies provide glimpses of the future at the price of acceptance of the simplifying heuristic that statistics derived from aggregate groups can be validly attributed to individuals within them. The paper illustrates four implications of this conceptualisation of probability with qualitative data from a variety of sources, particularly a study of genetic counselling for pregnant women in a U.K. hospital. Firstly, the official selection of a specific probability heuristic reflects organisational constraints and values as well as predictive optimisation. Secondly, professionals and service users must work to maintain the facticity of an established heuristic in the face of alternatives. Thirdly, individuals, both lay and professional, manage probabilistic information in ways which support their strategic objectives. Fourthly, predictively sub-optimum schema, for example the idea of AIDS as a gay plague, may be selected because they match prevailing social value systems.     

A general family practitioner approach for Asian-American mental health services.

A psychologist in general family practice functions as a primary care provider, who is similar to the traditional family doctor who provides treatment for clients and their families. The psychologist has an ongoing interaction with the family and serves as a resource for the family to consult when in difficulty; he or she uses knowledge of the client, as well as knowledge of the client's family, community, and social environment. This approach seems particularly suitable for Asian Americans whose culture emphasizes the role of the family. It helps to minimize the client's inhibition against seeking mental health services and provides the psychologist with certain clinical advantages. Two cases are presented to illustrate the application of this approach to Asian American clients. Situations in which family members should not be seen by the same psychologist and the issues of transference, countertransference, and confidentiality are also considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comments on "An approach for modeling noncancer dose responses with an emphasis on uncertainty" and "A probabilistic framework for the Reference Dose (probabilistic RfD)"

Common bile duct (CBD) surgery sometimes demands performing 'a la Roux' hepaticojejunal anastomosis. This kind of stoma is technically easy to perform on a biliary stump of sufficient width (> 8 mm), sufficient length (> 0.5 cm) and with a resilient wall so that stitches will not cut off. In some cases, however, the anatomical conditions are poor: short or thin biliary stump. This situation is especially encountered in iatrogenic lesions of the main biliary channel, but it can infrequently be found in some malignant lesions of the CBD. The authors present their procedure of hepaticojejunal anastomosis without suture, which is adequate for the treatment of benign or even malignant stenosis of the CBD. The method realizes anastomosis of the segments without using sutures by simply keeping them in apposition with continuous traction exerted via a Foley-type balloon catheter which stents the anastomosis in an axial manner. The balloon is then inflated and traction is exerted on the catheter, enabling the two segments of the anastomosis to remain in place until complete healing (10 days average). We performed the procedure in 7 cases: 4 for neoplastic stenosis, and 3 for an accidental lesion of the CBD. There was no perioperative morbidity and 1 fatal outcome. The results prompt further evaluation of the method.     

A modified framework for rural general practice: the importance of recruitment and retention

Whilst definitions of what constitutes general practice vary according to purpose, the pivotal role of general practitioners as key providers of health and medical services is acknowledged. Recent concerns to address both what general practitioners and their patients want and get from general practice stem from a recognized need to include stakeholder concerns about the adequacy of general practice alongside workforce issues such as recruitment and retention. Nowhere is this need so crucial as in rural areas where the range of health services is limited and major inequities exist in the availability of general practitioners. An extended framework for evaluating what general practitioners and their patients expect and receive from general practice, with particular reference to rural general practice in Australia is presented. Three inter-related dimensions of recruitment, retention and a whole patient/whole family approach to health care are suggested as underpinning this framework. The significance of each dimension to ensuring the provision of quality general practice care in rural communities, and the links between them, are outlined in the proposed framework.     

Sexual assault history and health perceptions: Seven general population studies.

This article uses data from 7 population surveys to evaluate the association of sexual assault history with health perceptions. It estimates the extent of generalizability across gender, ethnic groups, and studies; the extent to which depression accounts for or mediates the association; and whether some circumstances of assault are more strongly related to poor subjective health. Data from each of 18 subsamples of the surveys were analyzed (pooled?N?=?10,001; 7,550 women and 2,451 men), and results were combined by using meta-analysis. Assault was associated with poor subjective health (odds ratio [OR]?=?1.63, 95% confidence interval [CI]?=?1.36, 1.95) and this result was consistent regardless of gender, ethnicity, or sample. Controlling depression did not markedly change this result (OR?=?1.46, 95% CI?=?1.21, 1.77), indicating that depression did not account for or mediate the assault-health perceptions association. Multiple assault and assaults by strangers or spouse were most strongly associated with poor subjective health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A conceptual framework for mental health services: the matrix model

We cloned two novel cytochrome P450 cDNAs (CYP2D23 and CYP2D24) from a rabbit liver cDNA library. The open-reading frames of these cDNAs encode proteins that are each composed of 500 amino acids. The amino acid sequence identity of CYP2D23 with CYP2D24 is 91.6%, and the homology of these two isozymes with other known mammalian CYPs in the CYP2D subfamily range from 64.9 to 79.8%. Using RT-PCR, we determined the distribution of these two isozymes in 9 major organs, including brain tissue sections. CYP2D23 mRNA was abundantly expressed in the liver and small intestine, but only slightly in the brain sections, whereas CYP2D24 mRNA was expressed in the liver, small intestine, and stomach. CYP2D23 and CYP2D24 were heterogeneously expressed in 293T cells. CYP2D24 effectively catalyzed the oxidation of bufuralol and bunitrolol, the archetypal substrates of the CYP2D subfamily, while CYP2D23 exhibited catalytic activity only toward bufuralol. The results of this first study on rabbit CYP2D isozymes indicate that CYP2D23 and CYP2D24 are functionally expressed in rabbits, and have different organ distributions and metabolic properties.     

Dioxins: is it time for a scientifically based assessment of risks for human health?

This paper highlights the effect of dioxin exposure on human health, as was discussed at the BgVV Symposium, held June 17, 1996, at the Auditorium of the Institute of Pharmacology at the Free University (H?rsaal des Instituts für Pharmakologie an der Freien Universit?t Berlin), Thielallee 67, 14195 Berlin.     

Ecologic studies of rodent reservoirs: their relevance for human health

To gain insight into the immunomodulatory effects of vitamin E (VE), immune cell population analyses were conducted using thymus and spleen from male broilers fed diets with various levels of VE supplementation (0, 17, 46, and 87 mg dl-alpha-tocopherol acetate/kg of feed). At 2 and 7 wk of age, the percentages of B cells, macrophages, and T cell subsets, delineated by the expression of CD4, CD8, and T cell receptor (TCR) isotype, in thymus and spleen were determined by flow cytometry. The percentages of thymic and splenic B cells and macrophages from 2- and 7-wk-old chickens, as well as the percentage of thymic T cells in 2-wk-old chickens, were unaffected by VE treatment. However, 7-wk-old broilers maintained on 87 mg VE/kg feed had a higher percentage of CD4+CD8- thymocytes, a higher CD4+CD8- to CD4-CD8+ thymocyte ratio, and a lower percentage of CD4+CD8+ thymocytes than chickens receiving no dietary VE supplementation. The VE-induced increase in the percentage of CD4+CD8- thymocytes was due to an increase in the TCR2+CD4+CD8- thymocyte subset, whereas the decrease in the percentage of CD4+CD8+ thymocytes involved all TCR defined T cell subsets. In the spleen, the percentage of CD4+CD8- T cells was lower in 2-wk-old chickens and higher in 7-wk-old chickens maintained on 87 mg/kg feed than in chickens receiving no dietary VE supplementation. The decrease in CD4+CD8- splenocytes at 2 wk of age was due to a decline in the percentage of TCR2+CD4+CD8- splenocytes, whereas the increase in CD4+CD8- splenocytes in 7-wk-old chicks was due to an increase in the percentages of all TCR defined CD4+CD8- T cell subsets. These data support an immunomodulatory effect of VE on CD4+CD8- T cells.     

A framework for health promotion and disease prevention programs.

There is a disquieting sense that many theoretically based health behavior change programs have been only minimally effective. Part of the problem may be that most current theories have considerable overlap, primarily focus on intraindividual and other individual-level variables, and tend to neglect the environment and issues related to program implementation. A framework is developed for health promotion and disease prevention programs that makes use of epidemiological and health indicator data and Healthy People 2000 goals to prioritize efforts, provides a schema to formulate programs on the basis of timing (prevention) and level of intervention, and addresses the marketing approach to target and implement programs. The framework integrates current theories to guide marketing and phases of research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pragmatic framework for smoking cessation: Implications for clinical and public health programs.

Smoking cessation research and programs are shifting toward reaching populations. A framework for intervention for tobacco and other addictive behaviors is presented that can accommodate this emerging paradigm as well as more traditional clinical approaches. Smoking cessation is seen to be determined by 3 sets of factors: (a) motivation, which includes both readiness to try to quit and persistence in the face of withdrawal and stress; (b) addiction level; and (c) environmental supports and barriers. Coping skills that provide ways of dealing with these factors are seen as the essential content of cessation programs. The implications of this framework for assessment and intervention are discussed, with particular attention to the different requirements of clinical (intensive, aimed at self-selected smokers) and population-based (brief, aimed at all smokers in a setting) programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methods for integrating moderation and mediation: A general analytical framework using moderated path analysis.

Studies that combine moderation and mediation are prevalent in basic and applied psychology research. Typically, these studies are framed in terms of moderated mediation or mediated moderation, both of which involve similar analytical approaches. Unfortunately, these approaches have important shortcomings that conceal the nature of the moderated and the mediated effects under investigation. This article presents a general analytical framework for combining moderation and mediation that integrates moderated regression analysis and path analysis. This framework clarifies how moderator variables influence the paths that constitute the direct, indirect, and total effects of mediated models. The authors empirically illustrate this framework and give step-by-step instructions for estimation and interpretation. They summarize the advantages of their framework over current approaches, explain how it subsumes moderated mediation and mediated moderation, and describe how it can accommodate additional moderator and mediator variables, curvilinear relationships, and structural equation models with latent variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health risks and health promotion for older women: utility of a health promotion diary

Elderly women require health screening and health promotion services from nurses and other health care providers. Nurses serving this population require knowledge of age-specific health screening and health promotion services. A case study from a geriatric nurse practitioner's practice demonstrates the complexity of these activities. A diary of such services can help nurses focus on elderly women's needs for health promotion interventions.     

Psychology and medicine: A new approach for community health development.

Notes that the problems of medical and mental health care delivery in developing countries are such that typical Western, urban-based approaches are inadequate. A programmatic solution in Costa Rica is described that relies on a cooperative team approach between physicians and psychologists in rural areas. A large-scale pilot program with a health team approach has shown great promise, and preliminary data indicate massive gains in the effectiveness with which community health development may be implemented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A process-oriented approach for averting confounds resulting from general performance deficiencies in schizophrenia.

The most pervasive and least well-addressed problem in cognitive studies of schizophrenia is the propensity of schizophrenia patients to show inferior performance on a variety of cognitive tasks. Consequently, apparent specific cognitive abnormalities may actually reflect the interaction of task discriminating power with generalized deficit. L. J. Chapman and J. P. Chapman (1973) suggested psychometric approaches for eliminating such artifactual group differences. Unfortunately, their solution neglects important issues of process specification and does not provide a viable strategy for process-oriented investigators. Psychometric remediation of artifactual Group?×?Task interactions inevitably confounds the processes being measured, resulting in theoretically ambiguous findings. Moreover, evidence that changes in measurement reliability can both increase and decrease group discrimination challenges a basic underlying assumption of the Chapmans' matching solution. This article presents a process-oriented approach to solving this problem in schizophrenia research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alerting the general population to genetic risks: The value of health messages communicating the existence of genetic risk factors for public health promotion.

Background: Health messages alerting the public to previously unknown genetic risk factors for multifactorial diseases are a potentially useful strategy to create public awareness, and may be an important first step in promoting public health. However, there is a lack of evidence-based insight into its impact on individuals who were unaware of the existence of genetic risk factors at the moment of information exposure. Method: The authors conducted 3 experimental studies with health messages communicating information about genetic risk factors for salt sensitivity (Studies 1A and 1B) and heightened cholesterol (Study 2) compared with general information without reference to genetic risk factors as a between-subjects variable and risk perception and intention to engage in preventive behavior as dependent variables. Results: All 3 studies revealed lower perceived susceptibility among participants who received information on genetic risk factors, which was associated with lowered intentions to engage in preventive behavior. In Studies 1A and 1B, these effects were observed only for previously unaware individuals, whereas in Study 2, they were observed for the entire sample. Conclusion: Alerting the public to the existence of genetic risk factors may not necessarily be beneficial to public health. Public health promoters should be aware of the possible adverse effects of alerting the general population to genetic risk factors, and should simultaneously educate the public about the meaning and consequences of such factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Asymptotic confidence limits for the difference between two squared multiple correlations: A simplified approach.

This article develops equations for determining the asymptotic confidence limits for the difference between 2 squared multiple correlation coefficients. The present procedure uses the delta method described by I. Olkin and J. D. Finn (1995) but does not require the variance-covariance matrix and the partial derivatives for all the zero-order correlations that enter into the expression for the difference, as does their procedure. This simplified approach can lead to an extreme reduction in the calculations required, as well as a reduction in the mathematical complexity of the solution. This approach also demonstrates clearly that in some cases, it may be inappropriate to use the asymptotic confidence limits in tests of significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hardiness and health: A critique and alternative approach.

Recent research has suggested that individual differences in the personality variable of hardiness are related to health and illness. Despite some success at predicting health outcomes, there are several theoretical and empirical problems that must be addressed before research on this topic can proceed. Most critical are (a) how hardiness is to be measured; (b) whether hardiness should be treated as a unitary phenomenon or as three separate phenomena associated with commitment, control, and challenge; and (c) whether hardiness has direct effects on health or indirect effects by virtue of buffering the impact of stressful life events. After reviewing the literature and presenting our own study of the psychometric properties of the Hardiness Scale and its subcomponents, we draw the following conclusions: (a) Hardiness is not a unitary phenomenon, but should be treated as involving three separate phenomena; (b) of the three subcomponents of hardiness, only commitment and control have adequate psychometric properties and are systematically related to health outcomes; (c) lack of control and lack of commitment have direct effects on health because they are psychologically stressful; and (d) if there are buffering effects of commitment and control, they are in addition to these direct effects and are situation specific. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyzing data from experimental studies: A latent variable structural equation modeling approach.

This article illustrates the use of structural equation modeling (SEM) procedures with latent variables to analyze data from experimental studies. These procedures allow the researcher to remove the biasing effects of random and correlated measurement error on the outcomes of the experiment and to examine processes that may account for changes in the outcome variables that are observed. Analyses of data from a Project Family study, an experimental intervention project with rural families that strives to improve parenting skills, are presented to illustrate the use of these modeling procedures. Issues that arise in applying SEM procedures, such as sample size and distributional characteristics of the measures, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)