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The Swedish risk management case of Baltic fatty fishes, in which dioxin levels may be too high, is a typical multidimensional food safety decision problem involving public health, economic, environmental and socio-cultural aspects. To effectively address the dioxin food safety problem, the multiple dimensions and conflicting interests of stakeholders have to be considered systematically when evaluating competing risk management options. The objectives of this study were to illustrate the applicability of the Multi-Criteria Decision Analysis (MCDA) method for multidimensional food safety risk management problems, and to evaluate the Swedish dioxin risk management using MCDA. The results show that the MCDA method is indeed a relevant tool for modelling the multifactorial Swedish dioxin problem and for initiating discussions amongst stakeholders to increase the acceptance of chosen strategies. Abolishing the derogation from the European Commission's maximum limits for the presence of dioxins in Swedish fish is the dominant strategy for risk assessors, whereas the preferences provided by the other stakeholders would suggest a continuation of the derogation without providing consumer information. However, the preferences of female consumers match with the 2011 decision of the Swedish government to ask for a derogation in combination with consumer information. The conclusion drawn from our MCDA analysis is comparable to the government's decision that—given the gradual reduction in dioxin concentrations in Baltic fish—the decision to continue providing consumer information or not mainly depends on how risk managers balance the preferences of the different stakeholders. [ABSTRACT FROM AUTHOR]

Risk analysis consists of risk assessment (RA), risk management (RM), and risk communication (RC). In most countries, RA and RM of food safety are separated to achieve a high scientific integrity, and typically occur in sequential order. However, in case of a food safety incident, even though being separate processes, RA and RM are performed simultaneously due to great time pressure and expected high impacts. The aim of this study was to analyze and evaluate the observed interactions between RA and RM processes, during three major food incidents in Europe, and to provide suggestions for possible improvement. Based on the differences observed between the three cases, strengths and weaknesses of each system have been identified. The enterohemorrhagic Escherichia coli (EHEC) crisis in 2011 in Germany, the horsemeat scandal in 2013 in Ireland, and the fipronil incident in 2017 in the Netherlands were used as case studies. Timelines of these incidents and crisis management procedures in place in each of the three countries provided the basis for further analysis. First, results showed that details of the communication processes between RA and RM bodies were frequently lacking in crisis management protocols. Second, RA, RM, and RC processes differed for each incident, due to differences in estimated risk for public health, but also due to differences in the organization within a country. Based on our results, we recommend that crisis management protocols should contain a section on communication between RA, RM, and on communication between member states in the EU. [ABSTRACT FROM AUTHOR]

This study aims to assess how clinical outcomes of immunotherapy in real-world (effectiveness) correspond to outcomes in clinical trials (efficacy) and to look into factors that might explain an efficacy-effectiveness (EE) gap. All patients diagnosed with stage IV non-small cell lung cancer (NSCLC) in 2015–2018 in six Dutch large teaching hospitals (Santeon network) were identified and followed-up from date of diagnosis until death or end of data collection. Progression-free survival (PFS) and overall survival (OS) from first-line (1L) pembrolizumab and second-line (2L) nivolumab were compared with clinical trial data by calculating hazard ratios (HRs). From 1950 diagnosed patients, 1005 (52%) started with any 1L treatment, of which 83 received pembrolizumab. Nivolumab was started as 2L treatment in 141 patients. For both settings, PFS times were comparable between real-world and trials (HR 1.08 (95% CI 0.75–1.55), and HR 0.91 (95% CI 0.74–1.14), respectively). OS was significantly shorter in real-world for 1L pembrolizumab (HR 1.55; 95% CI 1.07–2.25). Receiving subsequent lines of treatment was less frequent in real-world compared to trials. There is no EE gap for PFS from immunotherapy in patients with stage IV NSCLC. However, there is a gap in OS for 1L pembrolizumab. Fewer patients proceeding to a subsequent line of treatment in real-world could partly explain this. [ABSTRACT FROM AUTHOR]

Background Social integration of people with intellectual disability (ID) moving into regular neighbourhoods tends to be studied and evaluated without detailed knowledge about the social psychological aspects of everyday interaction between neighbours with and without ID. The goal of the present paper is to show how the authors' social psychological research programme may contribute to this field of inquiry. Methods The different ways in which societies respond to features and behaviours that may be perceived as deviant are theoretically analysed. Results of empirical studies are reported to clarify how social responses to people with ID are special in terms of perceptions, emotions and interaction desires of people with and without ID during a pre-contact and contact phase. Results On the basis of the theoretical analysis, it is concluded that regular neighbouring in modern Western society often takes the form of benevolent tolerance, rather than stigmatisation and prejudice. However, empirical studies reveal that, prior to getting people with ID as new neighbours, prospective neighbours without ID experience a specific pattern of emotions that are associated with specific desires (e.g. with respect to information supply or a caring relationship). These anticipatory reactions are dependent on the expected size of the group moving in and on the severity of ID. Furthermore, while actually engaging in neighbouring, neighbours with and without ID appear to have experiences related to behaviour of residents, staff and features of housing facilities that are perceived as (in)congruent with regular neighbouring. Conclusions It is concluded that interpersonal relationships between neighbours with and without ID should not be simplified in terms of attitudes that would be primarily prejudiced/stigmatising versus entirely accepting. Rather, our studies paint a more complex picture of sometimes ambivalent thoughts, feelings and interaction needs that all should be taken into account to make social integration a success. [ABSTRACT FROM AUTHOR]

This exploratory quantitative study examines past risky sexual behaviors among young men who were circumcised as part of a rite of passage to adulthood embedded within a cultural and traditional belief system in the Eastern Cape Province in South Africa. Following permission from the Eastern Cape House of Traditional Leaders (ECHOTL), individual face-to-face interviews using a structured questionnaire were conducted among 114 initiates. The mean age of the participants was 18.9 years, ranging from 15 to 32 years old. About 79.8% reported already having had sex with a woman prior to initiation. Of those, 89% reported that they ever used condoms when having sex, and 61% reported consistent use. Logistic regression analysis showed that consistent condom use increased with higher educational levels. Those involved in other risky health behaviors (specifically, smoking) were also more likely to report inconsistent condom use. Most participants had positive beliefs about male circumcision and STI/HIV transmission. This study provides a first look at the sexual behaviors of young men at the time of their initiation in adulthood, a process that is intended to make it socially acceptable to initiate sexual relations and highlights a major public health challenge in integrating the protective health benefits of circumcision with indigenous cultural practices. [ABSTRACT FROM AUTHOR]

Background: We compared the effect of a 12-week group-based multidisciplinary self-management rehabilitation program, combining physical training (twice weekly) and cognitive-behavioral therapy (once weekly) with the effect of 12-week group-based physical training (twice weekly) on cancer survivors' quality of life over a 1-year period.Materials and Methods: One hundred forty-seven survivors [48.8 +/- 10.9 years (mean +/- SD), all cancer types, medical treatment > or = 3 months ago] were randomly assigned to either physical training (PT, n = 71) or to physical training plus cognitive-behavioral therapy (PT + CBT, n = 76). Quality of life and physical activity levels were measured before and immediately after the intervention and at 3- and 9-month post-intervention using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 questionnaire and the Physical Activity Scale for the Elderly, respectively.Results: Multilevel linear mixed-effects models revealed no differential pattern in change of quality of life and physical activity between PT and PT + CBT. In both PT and PT + CBT, quality of life and physical activity were significantly and clinically relevantly improved immediately following the intervention and also at 3- and 9-month post-intervention compared to pre-intervention (p < 0.001).Conclusion: Self-management physical training had substantial and durable positive effects on cancer survivors' quality of life. Participants maintained physical activity levels once the program was completed. Combining physical training with our cognitive-behavioral intervention did not add to these beneficial effects of physical training neither in the short-term nor in the long-term. Physical training should be implemented within the framework of standard care for cancer survivors. [ABSTRACT FROM AUTHOR]

Aim. To identify the psychosocial needs of breast-cancer patients and their relatives along with factors affecting these needs and to develop a tentative model to guide further research and need assessments in clinical practice. Background. Women experiencing breast cancer must deal with the diagnosis of a life-threatening illness. Treatment and the recovery process can be demanding for patients and their relatives. Need assessment may help clinicians focus on providing appropriate help. Design. Literature review. Method. Undertaken using electronic databases and specific research terms; 20 articles were identified and analysed. Results. The needs identified by patients involve (1) treatment-related physical and social impairment like fatigue, menopausal symptoms and a changed body image and (2) emotional distress like fear of recurrence, anxiety and depression. Partners need help to protect themselves and the patient from different threats. Women need information to maintain control and manage their illness. Partners want information concerning the patient's condition and both of them about the prognosis and perspectives. There is a lack of knowledge of relatives' needs. Mutual familial support, women's and partners' health and emotional distress may affect the interaction between the patients and their partners. Conclusions. A tentative family-based model to guide further research and clinical support is proposed. Further research is needed to determine precisely which psychosocial factors may influence fulfilment of the patients' and relatives' needs. Relevance to clinical practice. The proposed model may provide a framework for healthcare professionals to evaluate the patients' and relatives' met and unmet needs and the real demand for help, to guide care planning, counselling and education. [ABSTRACT FROM AUTHOR]

An existing 12-week cancer rehabilitation group programme, combining physical training and psychosocial sessions, was recently tested in a quantitative longitudinal cohort study ( n = 658) among adult patients who have problems coping with cancer. Results showed improvements in all quality of life domains. The objective of the present study was to explore patients' perspectives on how and to what extent the rehabilitation programme had met their needs in order to optimize the programme. Patients who participated in the programme no longer than 5 years ago were interviewed in three focus groups ( n = 23). Participants saw rehabilitation as provided by the programme as an important steppingstone in their ongoing recovery process and identified the integrated physical training, psychosocial sessions and patient-to-patient contacts as a powerful and supportive combination. Recommendations for improvements to the programme mainly concerned the psychosocial module. Information needs varied strongly among participants and, in this respect, it was hard to satisfy all of them. Participants suggested that the programme should focus more on developing skills to cope with cancer, its consequences and emerging problems after rehabilitation. In conclusion, participants valued the group-based multi-modal cancer rehabilitation programme and recommended to focus more on developing coping skills. [ABSTRACT FROM AUTHOR]

Objective: Nasal use of snuff is the predominant form of tobacco use among black South African women. This study examines the association between snuff use and chronic bronchitis (CB) among black South African women. Design: The study investigated a nationally representative sample of 4464 black South African women ≥125 years old who participated in the 1998 South African Demographic and Health Survey. Data on participants' tobacco use patterns, medical history and other relevant factors were obtained through an interviewer-administered questionnaire. Peak expiratory flow rates (PEFR) were also measured. Data analysis included χ² statistics, Student t tests and multiple logistic regression analysis. Outcome measure: CB, defined as reporting a productive cough for ≥3 months/year for at least 2 successive years. Results: The prevalence of current snuff use was 16.1% (n = 719). Compared to non-users of snuff, snuff users were not only more likely to present with a history of tuberculosis (TB)(23.3% vs 15.9%; p = 0.06), but they were also more likely to present with CB (5.3% vs 2.8%; p<0.01) and a lower PEFR (275 litres/min vs 293 litres/ min; p<0.01). Significant determinants of CB included snuff use >8 times/day (odds ratio (OR) 2.86, 95% CI 1.17 to 7.02) a history of TB (OR 7.23, 95% CI 4.02 to 13.03), current smoking (OR 2.84, 95% CI 1.60 to 5.04) and exposure to smoky cooking fuels (OR 1.98, 95% CI 1.32 to 2.96). Conclusions: These data suggest that snuff use, in the form predominantly used in South Africa, increases the risk of CB. This challenges the idea that snuff may be a much less harmful alternative to smoking in South Africa. [ABSTRACT FROM AUTHOR]

Cultural sensitivity is increasingly recognized as a means to enhance the effectiveness of health promotion programmes all over the world. Sociocultural meanings and terminology of diseases are important in understanding how different groups perceive and interpret illness. This study was conducted as part of the process of developing and adapting a sexually transmitted infection (STI)/HIV peer led health education intervention for soon-to-be-released inmates who were predominantly Nguni speakers in South Africa. Two focus group discussions (FGDs) were conducted with prison inmates in each of four facilities. Additionally, one FGD was conducted in each prison with non-health trained (custodial) personnel who were Nguni speakers from the same community (n = 27). The data revealed unique terminology and meanings attached to several biomedically defined STIs. These sociocultural constructions were not limited to inmates as findings from warders' discussions showed a similar pattern. Moreover, we found the existence of a number of traditional 'folk' STIs and culture-specific prevention methods. These conceptualizations influence reported health-care-seeking behaviour, where dual consultation of traditional healers and biomedical remedies is widely practiced. The research has biopsychological as well as cultural implications for the development and adaptation of contextually relevant health promotion interventions. [ABSTRACT FROM AUTHOR]

Aim: To analyse the cost effectiveness of foldable monofocal intraocular lenses (IOLs) compared to foldable multifocal IOLs in cataract surgery alongside a prospective, multicentre randomised clinical trial (RCT). Methods: Patients underwent cataract surgery with bilateral monofocal (n = 97) or multifocal (n =93)IOL implantation. Cost data and patient preferences, using the visual analogue scale (VAS), the time trade-off (TTO), and the standard gamble (SG) technique were obtained preoperatively and postoperatively by structured interviews. The incremental costs (multifocal minus monofocal), mean costs per patient, and differences in preferences were computed. Results: Mean costs for glasses per patient in the monofocal group were € 41.67 and in the multifocal group € 149.58. The difference in costs between the multifocal and monofocal group was € -92.09 and was statistically significant (p =0.008). No significant differences were found in total costs or in effectiveness between the monofocal and multifocal IOL group. Conclusion: The cost effectiveness of multifocal IOLs is reduced to a cost minimisation analysis, because of the inabilily to demonstrate significant differences in effects. The use of multifocal IOLs in cataract surgery resulted in a significant reduction in costs for patient's postoperative spectacles. [ABSTRACT FROM AUTHOR]

Background/aims: To assess reliability and validity of the QUOTE-cataract, a questionnaire that measures the quality of care from the perspective of cataract patients. Methods: The QUOTE-cataract was tested in a multicentre study among 540 cataract patients in three different hospitals. Reliability was represented by internal consistency (Cronbach's α), and repeatability (intraclass correlation coefficient (ICC)). Validity was evaluated qualitatively and by factor analyses. Results: A strong internal consistency coefficient (0.89), and high repeatability (ICC = 0.76) demonstrated good reliability. Content validity was assured by involvement of patients in the development of the questionnaire. Factor analysis confirmed an underlying taxonomy of generic and disease specific items. Conclusion: The QUOTE-cataract has good reliability and provides a valid assessment of quality of care in cataract surgery. [ABSTRACT FROM AUTHOR]

During the last decade, pelvic floor muscle exercise (PFME) therapy has proved its short-term efficacy among women with urinary incontinence. Long-term success with PFME therapy is hampered by non-adherence. So far, specific knowledge on determinants of adherence behavior has been scarce. A cross-sectional study was conducted to elucidate the relative importance of determinants of the intention to adhere to PFME therapy in women with urinary incontinence. Based on behavioral theories, literature research and interviews, a questionnaire measuring determinants of the intention to adhere to PFME therapy was developed. In total, 129 women, aged 17 years or over, with symptoms of urinary incontinence, completed this questionnaire. Multiple regression analysis with backward elimination was carried out to identify determinants that predict intention. Significant predictors of the intention to adhere to PFME therapy were the amount of urinary loss per wet episode and women's perception of their ability to do the exercises as recommended under various circumstances. Building self-efficacy might be a good starting point for health education interventions aiming to promote adherence to PFME therapy, which can be used by physiotherapists and general practitioners. [ABSTRACT FROM AUTHOR]

This cross-sectional study analyses determinants of condom-use behaviour among patients attending dedicated STD clinics in South Africa. A structured interviewer-administered survey was conducted among 1473 patients. Patients' beliefs and attitudes towards condom use in general, as well as their personal condom-use behaviour were measured. Their perceptions, regarding the social influence of their partners and friends on their condom use, and of their self-efficacy in using condoms, while infected with an STD were also measured. Condom use, as a dependent variable, was examined and patients were placed in a pre-contemplation stage if they had never used a condom, contemplation if they had seriously thought of using a condom, some action stage if they sometimes used a condom and regular action stage if they used a condom every time. The relationships between the stages of change, as dependent variables, and the independent variables were investigated for both those patients with steady partners and those with outside partners. This was performed by stepwise multiple regression analyses. The variables that significantly explained stages of change were similar for patients with steady partners and those with outside partners. In both partner groups communication was the variable most strongly associated with the use of condoms. General self-efficacy in condom use, self-efficacy in condom use with a partner and attitudes towards the use of condoms played a role in determining patients' different stages of change. [ABSTRACT FROM AUTHOR]

If rheumatoid arthritis (RA) patients with a mild disease course could be identified early in the phase of the disease, therapy with less aggressive and probably less toxic antirheumatic drugs seems to be rational. The aim of this study was to investigate which factors at baseline could predict a clinical response (American College of Rheumatology preliminary response criteria) after treatment with chloroquine for 16 weeks. Two hundred and three early RA patients with active disease were treated with oral chloroquine sulphate (Nivaquine) at a daily dose of 300 mg during the first 4 weeks, 200 mg during the second 4 weeks and 100 mg thereafter. One hundred and eighty-three patients (90%) completed the study and 20 patients prematurely discontinued treatment. Of all the patients, 43 patients (21%) met the response criteria. A low level of C-reactive protein (CRP) was the only independent predictor for clinical response [relative risk: 0.97 (95% confidence interval: 0.95 –0.98)]. It was concluded that a clinical response to chloroquine therapy in early RA patients can be predicted by a low CRP level at baseline. [ABSTRACT FROM AUTHOR]

Evaluates a mushroom poisoning prevention program for young school children in the Krakow region of Poland in 1992. Examples of poisonous mushrooms; Details of the problem of mushroom poisoning; Symptoms of mushroom poisoning; Misconceptions on the toxicity of mushrooms common among parents.

Explores sexually transmitted diseases (STD) patients' illness representations within various socio-cultural contexts in South Africa. Patients' perceptions of the risk of contracting STDs in the context of gender relations, of formal and traditional medical treatment and ideas of prevention; Facilitation of healthy behaviors through multiple educational strategies.

Sexually transmitted diseases (STDS) are widespread in South Africa and contribute to the growing HIV epidemic. As an important step in curtailing the spread of STDs, this study explores STD patients' illness representations within its socio-cultural context, particularly gender relationships. In-depth interviews were conducted with Xhosa- and Zulu-speaking patients in clinics in Cape Town, Western Cape (N = 67) and in the rural areas of Kabokweni, Mpumalanga (N = 21) The findings suggest that STD patients' illness representations are reflections of their socio-cultural understanding of disease and of culturally defined gender relations. This, in turn, impacts on their general perceptions of the cause of STDs, their perceptions of the risk of contracting STDs, them entering and using formal and traditional medical treatment and on their ideas of prevention. Thus, healthy behaviours need to be facilitated through multiple educational strategies focusing on an improved understanding of the cause of the STD in its context of gender relations, the development of interpersonal and technical skills, as well as focusing on cues for action. [ABSTRACT FROM AUTHOR]