Systematic review of cognitive and behavioral strategies used in effective harm reduction interventions for people who use cocaine

OBJECTIVE

The aim of this systematic review is to identify cognitive and behavioral strategies that have been used in effective harm reduction interventions for people who use cocaine.

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the search was performed on February 26, 2023 across databases including PsycInfo, PubMed, Scopus, and Web of Science. Studies were included if they (1) report the use of one cognitive or behavioral strategy, (2) have harm reduction as the objective, (3) involve participants who used cocaine as at least one of their substances, (4) be published within the last 10 years, and (5) have a randomized controlled trial design. The Cochrane RoB 2.0 Tool was used to assess risk of bias. The cognitive and behavioral strategies were extracted and organized based on their frequency of use in the studies and their corresponding outcomes.

RESULTS

The final synthesis included k = 10 studies with N = 3,567 participants. Psychoeducation strategies, influence on social norms, personalized feedback, increased self-efficacy and motivational interviewing were the most frequently used promising strategies across studies.

CONCLUSIONS

This review underscores the significance of incorporating cognitive and behavioral strategies within harm reduction interventions, as they represent a promising domain that could enhance the effectiveness of addressing cocaine use.

Describing the impact of psychological safety on risk prevention: A threshold model construction

BACKGROUND

Like other things, psychological safety has a too-much-of-a-good-thing effect on the risk prevention process. There are warranted systematic and theoretical discussions on both positive and negative influences of psychological safety, which provide useful guides to handling potential risks for workers.

OBJECTIVE

This study focuses on the psychological safety analysis of work safety for workers in high-risk industries through the construction of a theoretical model, illustrating that a higher level of psychological safety is not better.

METHOD

This study explores the impact of workers' psychological safety on the potential risk of work safety by conducting a comprehensive analysis of relevant literature and employing inductive reasoning and analogy methodology.

RESULTS

We systematically reviewed the research background and several hypotheses of psychological safety, described the relationship between psychological safety and risk prevention from three levels, and constructed the threshold initial, special, and extended model of psychological safety to reveal the importance of workers' psychological safety when handling potential risks.

CONCLUSION

This research effectively describes the influence of high, moderate, and low levels of psychological safety on the risk prevention of work safety, which provides a psychological model guide to developing measures for the improvement of work safety management.

The challenge of risk prevention in home healthcare-An interview study with nurses in municipal care

BACKGROUND

Safety in home healthcare has garnered increased attention as more people are receiving care for complex conditions at home. The prerequisites for providing safe care at home differ from those in hospitals. Malnutrition, falls, pressure ulcers and inappropriate medication commonly follow poor risk assessments, causing unnecessary suffering and costs. Therefore, risk prevention in home healthcare needs to be prioritised and studied more closely.

AIM

To describe nurses' experiences of performing risk prevention in municipal home healthcare.

METHODS

Qualitative inductive approach, using semi-structured interviews with 10 registered nurses in a municipality in southern Sweden. Data underwent qualitative content analysis.

FINDINGS

The analysis resulted in three main categories and one overarching theme describing nurses' experiences of risk prevention in home healthcare. Getting everyone onboard comprises the categories: Managing safety while respecting the patient's self-determination, which covers patient participation, the strategic importance of respecting different views of risks and information and the fact that healthcare workers are guests in the patient's home. Finding ways to make it work touches upon the relational aspect, including next-of-kin and promoting a common understanding to prevent risks. Being squeezed between resources and requirements refers to ethical dilemmas, teamwork, leadership and organisational prerequisites.

CONCLUSION

Patient habits, living conditions and limited awareness of risks is a challenge in risk prevention in home healthcare, where patient participation plays a pivotal role. Risk prevention in home healthcare needs to be initiated at an early stage of disease and ageing and should be seen as a process where early health-promoting interventions can prevent the development and accumulation of risks over time. Long-term cross-organisational collaborations and patients' physical, mental and psychosocial conditions also need to be taken into account.

Genebanks at Risk: Hazard Assessment and Risk Management of National and International Genebanks

Genebanks are crucial for safeguarding global crop diversity but are themselves exposed to several risks. However, a scientific basis for identifying, assessing, and managing risks is still lacking. Addressing these research gaps, this study provides risk analysis for three key risk groups: natural hazards, political risks, and financial risks, carried out on a sample of 80 important national and international genebanks, comprising at least 4.78 million accessions or roughly 65% of the reported total of ex situ conserved accessions worldwide. The assessment tool of Munich Re "Natural Hazards Edition" allowed a location-specific comparison of the natural hazard exposure. Results showed that genebanks in the Asia-Pacific region are most exposed to natural hazards, while institutions in African and some Asian countries are rather vulnerable to political risks. Financing is a major problem for national genebanks in developing countries, whereas the Global Crop Diversity Trust achieved considerable financial security for international genebanks. Large differences in the risk exposure of genebanks exist, making a location- and institution-specific risk assessment indispensable. Moreover, there is significant room for improvement with respect to quality and risk management at genebanks. Transferring risks of genebanks to third parties is underdeveloped and should be used more widely.

[New outlook on safety of traditional Chinese medicine: concept and practice]

Profound changes have taken place in human disease spectrum, constitution spectrum, and drug use behavior, and the safety of traditional Chinese medicine(TCM) faces new trends and problems. In particular, serious adverse reactions/events such as liver injury and kidney injury caused by non-toxic TCM have been frequently reported, overturning people's understanding of TCM safety, and even shaking the public's confidence in the development of TCM. In the new era of globalization, correctly understanding the situation and problems of TCM safety and addressing the dilemmas in safety evaluation and risk prevention of TCM are the key missions to be undertaken by TCM practitioners. This paper suggests that the situation and problems of TCM safety should be viewed objectively and dialectically, and the use standard of TCM should be advanced with the times. Furthermore, this paper puts forward the new conception and methodology of TCM safety(including one innovative understanding, two types of evaluation modes, tri-elements injury hypothesis; four-quadrant risk decision processes, and five-grade safety evidence body) for the first time, hoping to provide new theories, new strategies, new methods and successful examples for solving the safety problems of TCM.

CEOs' early-life disaster experience and corporate earnings quality: Focusing on the Great Chinese Famine

This paper aims to examine the impact of CEOs' early-life disaster experiences on corporate earnings quality. We proxy the disaster experience with whether CEOs lived through the Great Chinese Famine and the famine intensity they experienced. The results indicate that CEOs' early-life famine experience is significantly positively associated with corporate earnings quality, and the famine effects are more obvious for CEOs who experienced the famine at adolescent ages. Further tests show that the famine experience effects are more pronounced in companies with high investor protection and cross-listing and with CEOs who have a relatively high level of education or background in economic management. The findings suggest CEOs would bear the imprint of an adverse early-life experience, which has risk aversion and learning effects on their decision making in corporate earnings information disclosure.

Safe patient handling education: analysis from European higher education institutions

OBJECTIVES

According to current research, patient handling is not universally taught in academic nursing programs in Europe. Miscellaneous patient handling education may expose students and novice health care workers to occupational hazards, especially if the evidence-based contents of safe patient handling are not recognized. Health care workers deal with high physical workloads daily, which points out the importance of evidence-based curricula contents from the early phases of education. The aim of this study was to describe the patient handling education and to analyse the differences in curricula among higher education institutions (HEIs) in Europe.

MATERIAL AND METHODS

The study used a cross-sectional design and was conducted in HEIs educating health care professionals in Europe. The data was collected through a Webropol questionnaire consisting of structured and open-ended questions.

RESULTS

Only 68.4% of the respondents stated that they have a framework that guides the patient handling education. Additionally, some answers referred to guidelines that are not adequate to be referred to as evidence-based guidelines on patient handling. There is variation in emphasizing workplace safety and risk assessment issues in the curricula, and variation in teaching of assistive aids.

CONCLUSIONS

Currently the patient handling education in the studied HEIs does not meet the requirements of evidence-based practice. The establishment of a European-wide framework, including both theoretical and practical training for safe patient handling is needed. The inclusion of risk assessment and workplace safety issues is essential to improve the risk management knowledge and skills and further avoid work-related musculoskeletal disorders. Int J Occup Med Environ Health. 2022;35(5):615-23.

Trial Assay for Safe First-Aid Protocol for the Stinging Sea Anemone Anemonia viridis (Cnidaria: Anthozoa) and a Severe Toxic Reaction

Anemonia viridis is an abundant and widely distributed temperate sea anemone that can form dense congregations of individuals. Despite the potential severity of its sting, few detailed cases have been reported. We report a case of a severe toxic reaction following an A. viridis sting in a 35-year-old oceanographer. She developed severe pain, itching, redness, and burning sensation, which worsened one week after treatment with anti-inflammatories, antihistamines and corticosteroids. Prompted by this event, and due to the insufficient risk prevention, lack of training for marine-environment users, and lack of research into sting-specific first-aid protocols, we evaluated the cnidocyst response to five different compounds commonly recommended as rinse solutions in first-aid protocols (seawater, vinegar, ammonia, baking soda, and freshwater) by means of the Tentacle Solution Assay. Vinegar and ammonia triggered an immediate and massive cnidocyst discharge after their application and were classified as activator solutions. Baking soda and freshwater were also classified as activator solutions, although with a lower intensity of discharge. Only seawater was classified as a neutral solution and therefore recommended as a rinse solution after A. viridis sting, at least until an inhibitory solution is discovered.

Consensus guidelines for improving patients' understanding of invasive fungal disease and related risk prevention in the haematology/oncology setting, 2021

Patients with invasive fungal disease (IFD) are at significant risk of morbidity and mortality. A productive partnership between patients, their carers/families, and the multidisciplinary team managing the infection and any underlying conditions, is essential. Sharing information and addressing knowledge gaps are required to ensure those at risk of IFD avoid infection, while those with suspected or confirmed infection optimise their therapy and avoid toxicities. This new addition to the Australian and New Zealand consensus guidelines for the management of IFD and antifungal use in the haematology/oncology setting outlines the key information needs of patients and their carers/families. It specifically addresses risk factor reduction, antifungal agents and adherence, and the risks and benefits of complementary and alternative therapies. Knowledge gaps are also identified to help inform the future research agenda.

Factors Associated with SARS-CoV-2 Infection Risk among Healthcare Workers of an Italian University Hospital

We report the results of a study on the cumulative incidence of SARS-CoV-2 infections in about 6000 workers of the University Hospital of Modena, Northern Italy, in the period March 2020–January 2021, and the relations with some individual and occupational factors. Overall, in healthcare workers (HCW) the cumulative incidence of COVID-19 during the period was 13.8%. Results confirm the role of overweight and obesity as significant risk factors for SARS-CoV-2 infection. Chronic respiratory diseases, including asthma, also proved to be significantly associated with the infection rate. Considering occupational factors, the COVID-19 risk was about threefold (OR: 2.7; 95% CI 1.7–4.5) greater in nurses and nurse aides than in non-HCW, and about double (OR: 1.9; 95% CI 1.2–3.2) in physicians. Interestingly, an association was also observed between infection risk and nightshifts at work (OR: 1.8; 95% CI 1.4–2.3), significantly related to the total number of shifts in the whole eleven-month period. Even if the vaccination campaign has now greatly modified the scenario of SARS-CoV-2 infections among HCW, the results of this study can be useful for further development of health and policy strategies to mitigate the occupational risk related to the new variants of coronavirus, and therefore the evolution of the pandemic.

Translating Co-Design from Face-to-Face to Online: An Australian Primary Producer Project Conducted during COVID-19

Primary producers face considerable risks for poor mental health. While this population can be difficult to engage in programs to prevent poor mental health, approaches tailored to reflect the context of primary producers’ life and work have been successful. This paper reports on the co-design phase of a project designed to prevent poor mental health for primary producers—specifically, the advantages, challenges and considerations of translating face-to-face co-design methods to an online environment in response to COVID-19 restrictions. The co-design phase drew upon the existing seven-step co-design framework developed by Trischler and colleagues. Online methods were adopted for all steps of the process. This paper models how this co-design approach can work in an online, primary producer context and details key considerations for future initiatives of this type. The development of online co-design methods is an important additional research method for use not only during a pandemic but also when operating with limited resources or geographic constraints. Results demonstrate the following: (i) co-designing online is possible given adequate preparation, training and resource allocation; (ii) “hard to reach” populations can be engaged using online methods providing there is adequate early-stage relationship building; (iii) co-design quality need not be compromised and may be improved when translating to online; and (iv) saved costs and resources associated with online methods can be realigned towards intervention/service creation, promotion and user engagement. Suggestions for extending Trischler and colleagues’ model are incorporated.

Identifying the Non-Traditional Safety Risk Paths of Employees from Chinese International Construction Companies in Africa

In recent years, more and more construction enterprises are expanding into overseas markets, especially in underdeveloped regions such as Africa. Compared to domestic construction projects, international construction projects have been faced with more uncertainties and increased levels of safety risks to the employees in the context of political turmoil, racism, and religious conflict in the host country. This study aims to answer what risk factors contribute to the threat to the safety of overseas employees and how safety risk factors interact, using employees from Chinese international construction companies (CICCs) in Africa as an example. A total of 39 safety risk factors were selected by literature review and case study based on Heinrich's Domino Theory of Accident Causation. To identify the critical safety risk sources and significant risk paths, a questionnaire survey was conducted among 208 professionals who have participated in construction projects in Africa. Using structural equation modeling (SEM), a total of twelve critical risk paths and five controllable risk sources were identified. The improper behaviors of the CICCs and their employees were shown to have the largest impact on the safety of Chinese employees, through the mediating effect of the criminal offense. This study provides some insights into safety risk management in international construction projects. Meanwhile, the quantitative approach proposed can also be used by other international companies or governments in identifying the safety risk paths of their overseas workers involved in international construction projects.

Analysis of the Impact of Human-Cobot Collaborative Manufacturing Implementation on the Occupational Health and Safety and the Quality Requirements

Implementing Industry 4.0 and interconnected robotization in industrial enterprises drifts towards occupational changes. Nowadays, the task is to create cooperation and collaboration between a robot and a human in a common robotized workplace so that it is safe and effective. The type of robot, the robotic device that works in collaboration with a human operator, is called a cobot. In the case of a closer interaction of the robot or cobot with humans, it is necessary to consider where it is possible to replace human work entirely or where it is possible to merely supplement it. The most socially acceptable option is the implementation of robots only for the performance of supplementary tasks, since the traditional work positions of people in manufacturing processes would remain largely preserved. On the other hand, workplace robotization is particularly suitable for work environments with hazardous chemical substances that are carcinogenic and toxic to humans. Similarly, robotization helps to improve workplace ergonomics and also to avoid, for humans, very laborious and often repetitive work. The SWOT analysis (analysis of Strengths, Weaknesses, Opportunities, and Threats) was used as a relevant tool to assess various aspects of the impact of increasing robotization on working positions in industrial enterprises. SWOT analysis is an indicative assessment of the suitability of implementation of robots in a given workplace, which helps to create an optimal solution and indicate new areas of needed analysis and research directions.

Knowledge and Perceptions Towards Cardiovascular Disease Prevention Among Patients with Type 2 Diabetes Mellitus: A Review of Current Assessments and Recommendations

INTRODUCTION

Patients with type 2 diabetes mellitus (T2DM) are at significantly higher risk of developing cardiovascular diseases (CVD). There is a scarcity of literature reviews that describe and summarize T2DM patients' knowledge and perception about CVD prevention.

OBJECTIVES

To describe and summarize the assessment of knowledge and perceptions about CVD risk and preventive approaches among patients with T2DM.

METHODS

A scoping review methodology was adopted, and three scientific databases, Google Scholar, Science Direct, and PubMed were searched using predefined search terms. A multistage screening process that considered relevancy, publication year (2009-2019), English language, and article type (original research) was followed. We formulated research questions focused on the assessment of levels of knowledge and perceptions of the illness relevant to CVD prevention and the identification of associated patients' characteristics.

RESULTS

A total of 16 studies were included. Patients were not confident to identify CVD risk and other clinical consequences that may occur in the prognostic pathway of T2DM. Furthermore, patients were less likely to identify all CV risk factors indicating a lack of understanding of the multi-- factorial contribution of CVD risk. Patients' beliefs about medications were correlated with their level of adherence to medications for CVD prevention. Many knowledge gaps were identified, including the basic disease expectations at the time of diagnosis, identification of individuals' CVD risk factors, and management aspects. Knowledge and perceptions were affected by patients' demographic characteristics, e.g., educational level, race, age, and area of residence.

CONCLUSION

There are knowledge gaps concerning the understanding of CVD risk among patients with T2DM. The findings necessitate educational initiatives to boost CVD prevention among patients with T2DM. Furthermore, these should be individualized based on patients' characteristics, knowledge gaps, disease duration, and estimated CVD risk.

Health students' knowledge and infectious disease exposure: findings from a cross-sectional study in Namibia

BACKGROUND

Namibia has recently introduced a number of health training programmes that expose students to infectious disease risks such as human immunodeficiency virus (HIV) and tuberculosis (TB). We explored the knowledge of students in relation to HIV and TB and whether or not there was evidence of exposure.

METHODS

We conducted two cross-sectional surveys of Namibian health students (medicine and pharmacy) in 2018.

RESULTS

There was a strong association between knowledge and exposure to HIV, but not TB (i.e. explicit exposure versus latent). Regression analysis suggested the time-related risk (age/year of study) to be predictive of knowledge in both studies. The training rotation in the respiratory unit predicted TB knowledge and post-exposure prophylaxis predicted HIV knowledge.

CONCLUSIONS

Knowledge of TB and HIV appears mostly related to the duration of study in health students. Exposure or specific experience may enhance knowledge. Future training in infection control may be better focussed on improving knowledge in earlier years.

Feasibility and acceptability of a future-oriented empowerment program to prevent substance use and school dropout among school-disengaged youth

OBJECTIVE

To evaluate the feasibility and acceptability of a health promotion program to prevent school dropout and substance use among middle school-aged youth who display early warning signs of school disengagement.

INTERVENTION

Youth Empowerment Solutions for Positive Futures (YES-PF), an intensive, theoretically driven, 5-week summer enrichment program, aims to prevent school dropout and substance use by promoting youth empowerment, school engagement, and future orientation.

DESIGN AND SAMPLE

Using a pre-post-intervention design, we test feasibility and acceptability with 6th and 7th grade students (n = 43) who exhibited early warning signs for school disengagement (e.g., chronic absenteeism) in two school districts.

MEASURES

Program evaluation components included: (a) program session forms completed by facilitators; (b) post-program interviews with facilitators; (c) post-intervention program evaluation surveys with youth; (d) attendance; and (e) baseline and post-intervention surveys with youth to assess behavioral and psychosocial outcomes.

RESULTS

Facilitators routinely delivered core component lesson activities. Acceptability and program satisfaction were evidenced in strong program attendance by youth. Youth participants reported higher levels of leadership efficacy (p < .05) and a greater sense of control over their lives and potential problems (p < .01).

CONCLUSIONS

YES-PF was feasible and acceptable to school personnel and youth. Program refinement, based on implementation findings, is discussed.

Surgical Risk Assessment and Prevention in Elderly Spinal Deformity Patients

Introduction:

Prevalence of adult deformity surgery in the elderly individuals continues to increase. These patients have additional considerations for the spine surgeon during surgical planning. We perform an informative review of the spinal and geriatric literature to assess preoperative and intraoperative factors that impact surgical complication occurrences in this population.

Significance:

There is a need to understand surgical risk assessment and prevention in geriatric patients who undergo thoracolumbar adult deformity surgery in order to prevent complications.

Methods:

Searches of relevant biomedical databases were conducted by a medical librarian. Databases searched included MEDLINE, Web of Science, CINAHL, IPA, Cochrane, PQ Health and Medical, SocINDEX, and WHO’s Global Health Library. Search strategies utilized Medical Subject Headings plus text words for extensive coverage of scoliosis and surgical technique concepts.

Results:

Degenerative scoliosis affects 68% of the geriatric population, and the rate of surgical interventions for this pathology continues to increase. Complications following spinal deformity surgery in this patient population range from 37% to 62%. Factors that impact outcomes include age, comorbidities, blood loss, and bone quality. Using these data, we summarize multimodal risk prevention strategies that can be easily implemented by spine surgeons.

Conclusions:

After evaluation of the latest literature on the complications associated with adult deformity surgery in geriatric patients, comprehensive perioperative management is necessary for improved outcomes. Preoperative strategies include assessing physiological age via frailty score, nutritional status, bone quality, dementia/delirium risk, and social activity support. Intraoperative strategies include methods to reduce blood loss and procedural time. Postoperatively, development of a multidisciplinary team approach that encourages early ambulation, decreases opiate use, and ensures supportive discharge planning is imperative for better outcomes for this patient population.

Moving Beyond Role-Play: Evaluating the Use of Virtual Reality to Teach Emotion Regulation for the Prevention of Adolescent Risk Behavior Within a Randomized Pilot Trial

OBJECTIVE

The purpose of the current pilot study was to evaluate the acceptability and preliminary impact of using immersive virtual reality environments (IVREs) paired with a brief emotion regulation and risk reduction intervention (ER + IVRE) relative to this same intervention content paired with role-plays (ER + RP).

METHODS

Eighty-five adolescents attending middle school (grades 6th-8th; ages 12-15 years) in an urban northeast city were recruited and randomized to ER + IVRE (n = 44) or ER + RP (n = 41) and had complete data. Data examining acceptability, feasibility, sexual knowledge and attitudes, and ER were collected at baseline and 3 months after intervention completion. Analyses of covariance controlling for baseline scores were used to evaluate study outcomes. Within and between intervention effect sizes were calculated with effect sizes ≥.20 considered meaningful.

RESULTS

At the 3-month follow-up assessment, several within intervention condition effect sizes were found to exceed d = 0.20 across the measured sexual attitudes and ER outcomes. Between intervention analyses found that adolescents randomized to ER + IVRE attended more intervention sessions, reported less difficulty accessing ER strategies (d = 0.46), and reported higher emotional self-efficacy (d = 0.20) at the 3-month follow-up relative to adolescents randomized to the ER + RP intervention.

CONCLUSIONS

This study provides preliminary evidence that using virtual reality environments to enhance ER skill building in risk situations was acceptable, feasible to deliver, and positively impacted ER abilities.

Ergonomic evaluation, with the RULA method, of greenhouse tasks of trellising crops

BACKGROUND

The present study uses the RULA method to define the most favourable working conditions to lower climbing greenhouse plants, the most problematic task involved in trellising crops.

OBJECTIVE

The aim is to prevent potential musculoskeletal disorders to the upper limbs in workers performing this task.

METHODS

The variety of scenarios involving this task was simulated in the laboratory to evaluate different working heights, crop weights, and types of guides handled.

RESULTS AND CONCLUSIONS

From the 2,544 tests made, only some ergonomically favourable conditions were found to be met when the work was done at a height of 1.4 m, although heights of between 1.2 and 1.6 m could prove acceptable. Furthermore, the study shows the importance of the type of hanger needed to perform the work correctly, of the group of hangers tested; ergonomically acceptable handling was possible only with the new-generation ones having the lock device. In the case of using other types of hangers, it is recommended not to support weights greater than 2 kg. In addition to the above recommendations, it is considered vital to guarantee the correct organization of the workday to include recovery times from the earliest working hours, given the repetitive nature of the work, as well as to promote training sessions to avoid incorrect postures, especially regarding the limbs, trunk, wrist, and neck.

Falls risk assessment in older patients in hospital

Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. All hospitals in NHS organisations develop risk prevention policies that include falls risk assessment. Falls risk assessment involves the use of risk screening tools, aimed at identifying patients at increased risk of falls, and risk assessment tools, which identify a patient's risk factors for falls. Various risk screening tools have been used in clinical practice, but no single tool is able to identify all patients at risk of falls or to accurately exclude all those who are not at risk of falls. Guidelines recommend that patients aged 65 years and over who are admitted to hospital should be considered at high risk of falls and that a multifactorial falls risk assessment should be performed. Therefore, falls risk assessment tools should be used to identify the risk factors for each inpatient aged 65 years or over, in order to determine the most appropriate care plan for falls prevention and to maximise patient mobility and independence.

A multi-agent safety response model in the construction industry

BACKGROUND

The construction industry is one of the sectors with the highest accident rates and the most serious accidents. A multi-agent safety response approach allows a useful diagnostic tool in order to understand factors affecting risk and accidents. The special features of the construction sector can influence the relationships among safety responses along the model of safety influences.

OBJECTIVE

The purpose of this paper is to test a model explaining risk and work-related accidents in the construction industry as a result of the safety responses of the organization, the supervisors, the co-workers and the worker.

METHODS

SAMPLE

374 construction employees belonging to 64 small Spanish construction companies working for two main companies participated in the study.

INSTRUMENTS

Safety responses were measured using a 45-item Likert-type questionnaire.

METHODOLOGY

The structure of the measure was analyzed using factor analysis and the model of effects was tested using a structural equation model.

RESULTS

Factor analysis clearly identifies the multi-agent safety dimensions hypothesized. The proposed safety response model of work-related accidents, involving construction specific results, showed a good fit.

CONCLUSIONS

The multi-agent safety response approach to safety climate is a useful framework for the assessment of organizational and behavioral risks in construction.

Timing effects in health valuations

This paper analyzes the impact of external sources of information, conveyed by the frequency of risky events that vary across time, on the individual willingness to pay (WTP) for a reduction of mortality risk. We collected data from a contingent valuation (CV) exercise conducted in two waves (fall and winter) to examine whether individual WTP varied across periods that differed in the predominance of fatal accidents. Risk valuations were based on fatal snow avalanche accidents, that is, a type of risk with seasonal differences in occurrence. We found slightly lower but statistically significant mean WTP figures in the winter than in the fall sample because of time-varying individual risk attitudes and, therefore, recommend controlling for these factors in risk assessment CV surveys.

Balancing risk prevention and health promotion: towards a harmonizing approach in care for older people in the community

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky's salutogenic framework, different perspectives between professionals and clients on the pathways that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others' perspective, and have a dialogue with each other, taking the life narrative of clients into account.