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Concept: Hazard

351

Social and political tensions keep on fueling armed conflicts around the world. Although each conflict is the result of an individual context-specific mixture of interconnected factors, ethnicity appears to play a prominent and almost ubiquitous role in many of them. This overall state of affairs is likely to be exacerbated by anthropogenic climate change and in particular climate-related natural disasters. Ethnic divides might serve as predetermined conflict lines in case of rapidly emerging societal tensions arising from disruptive events like natural disasters. Here, we hypothesize that climate-related disaster occurrence enhances armed-conflict outbreak risk in ethnically fractionalized countries. Using event coincidence analysis, we test this hypothesis based on data on armed-conflict outbreaks and climate-related natural disasters for the period 1980-2010. Globally, we find a coincidence rate of 9% regarding armed-conflict outbreak and disaster occurrence such as heat waves or droughts. Our analysis also reveals that, during the period in question, about 23% of conflict outbreaks in ethnically highly fractionalized countries robustly coincide with climatic calamities. Although we do not report evidence that climate-related disasters act as direct triggers of armed conflicts, the disruptive nature of these events seems to play out in ethnically fractionalized societies in a particularly tragic way. This observation has important implications for future security policies as several of the world’s most conflict-prone regions, including North and Central Africa as well as Central Asia, are both exceptionally vulnerable to anthropogenic climate change and characterized by deep ethnic divides.

Concepts: Scientific method, Greek loanwords, Observation, Climate change, Ethnic group, Disaster, Hazard, Global warming

183

Safety of evacuation is of paramount importance in disaster planning for elderly people; however, little effort has been made to investigate evacuation-related mortality risks. After the Fukushima Daiichi Nuclear Plant accident we conducted a retrospective cohort survival survey of elderly evacuees.

Concepts: Cohort study, Chernobyl disaster, Actuarial science, Nuclear fission, Geriatrics, Hazard, Emergency evacuation, Three Mile Island accident

164

Prospective Hazard Analysis techniques such as Healthcare Failure Modes and Effects Analysis (HFMEA) and Structured What If Technique (SWIFT) have the potential to increase safety by identifying risks before an adverse event occurs. Published accounts of their application in healthcare have identified benefits, but the reliability of some methods has been found to be low. The aim of this study was to examine the validity of SWIFT and HFMEA by comparing their outputs in the process of risk assessment, and comparing the results with risks identified by retrospective methods.

Concepts: Risk, Psychometrics, Risk management, Probability, Hazard, Risk assessment, Failure mode and effects analysis, Safety engineering

56

PURPOSE: Running and other strenuous sports activities are purported to increase osteoarthritis (OA) risk, more so than walking and less-strenuous activities. Analyses were therefore performed to test whether running, walking, and other exercise affect OA and hip replacement risk, and to assess BMI’s role in mediating these relationships. METHODS: Proportional hazards analyses of patients' report of having physician-diagnosed OA and hip replacement vs. exercise energy expenditure (metabolic equivalents, METs). RESULTS: 74,752 runners reported 2004 OA and 259 hip replacements during 7.1-year follow-up, while the 14,625 walkers reported 696 OA and 114 hip replacements over 5.7 years. Compared to running <1.8 METhr/d, the risks for OA and hip replacement decreased: 1) 18.1% (P=0.01) and 35.1% (P=0.03), respectively, for 1.8 to 3.6 METhr/d run; 2) 16.1% (P=0.03) and 50.4% (P=0.002), respectively, for 3.6 to 5.4 METhr/d run; and 3) 15.6% (P=0.02) and 38.5% (P=0.01), respectively, for ≥5.4 METhr/d run, suggesting that the risk reduction mostly occurred by 1.8 METhr/d. Baseline BMI was strongly associated with both OA (5.0% increase per kg/m, P=2x10) and hip replacement risks (9.8% increase per kg/m, P=4.8x10), and adjustment for BMI substantially diminished the risk reduction from running ≥1.8 METhr/d for OA (from 16.5%, P=0.01 to 8.6%, P=0.21) and hip replacement (from 40.4%, P=0.005 to 28.5%, P=0.07). The reductions in OA and hip replacement risk by exceeding 1.8 METhr/d did not differ significantly between runners and walkers. Other (non-running) exercise increased the risk of OA by 2.4% (P=0.009) and hip replacement by 5.0% per METhr/d (P=0.02), independent of BMI. CONCLUSIONS: Whereas other exercise increased OA and hip replacement risk, running significantly reduced their risk due, in part, to running's association with lower BMI.

Concepts: Risk, Hip replacement, Running, Walking, Hazard, Indian Reductions, Replacements

40

Background The distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care. Methods Using data from the National Practitioner Data Bank, we analyzed 66,426 claims paid against 54,099 physicians from 2005 through 2014. We calculated concentrations of claims among physicians. We used multivariable recurrent-event survival analysis to identify characteristics of physicians at high risk for recurrent claims and to quantify risk levels over time. Results Approximately 1% of all physicians accounted for 32% of paid claims. Among physicians with paid claims, 84% incurred only one during the study period (accounting for 68% of all paid claims), 16% had at least two paid claims (accounting for 32% of the claims), and 4% had at least three paid claims (accounting for 12% of the claims). In adjusted analyses, the risk of recurrence increased with the number of previous paid claims. For example, as compared with physicians who had one previous paid claim, the 2160 physicians who had three paid claims had three times the risk of incurring another (hazard ratio, 3.11; 95% confidence interval [CI], 2.84 to 3.41); this corresponded in absolute terms to a 24% chance (95% CI, 22 to 26) of another paid claim within 2 years. Risks of recurrence also varied widely according to specialty - for example, the risk among neurosurgeons was four times as great as the risk among psychiatrists. Conclusions Over a recent 10-year period, a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims.

Concepts: Statistics, Risk, Physician, Hazard, Large numbers, Recurrence relation, Specialty, Medical malpractice

29

Leading themes have guided tobacco control efforts, and these themes have changed over the decades. When questions arose about health risks of tobacco, they focused on two key themes: 1) how bad is the problem (i.e., absolute risk) and 2) what can be done to reduce the risk without cessation (i.e., prospects for harm reduction). Using the United States since 1964 as an example, we outline the leading themes that have arisen in response to these two questions. Initially, there was the recognition that “cigarettes are hazardous to health” and an acceptance of safer alternative tobacco products (cigars, pipes, light/lower-tar cigarettes). In the 1980s there was the creation of the seminal theme that “Cigarettes are lethal when used as intended and kill more people than heroin, cocaine, alcohol, AIDS, fires, homicide, suicide, and automobile crashes combined.” By around 2000, support for a less-dangerous light/lower tar cigarette was gone, and harm reduction claims were avoided for products like cigars and even for smokeless tobacco which were summarized as “unsafe” or “not a safe alternative to cigarettes.”

Concepts: Risk, Tobacco, Cigarette, Nicotine, Heroin, Cigar, World Health Organization, Hazard

28

Assess the national prevalence of current workplace exposure to potential skin hazards, secondhand smoke (SHS), and outdoor work among various industry and occupation groups. Also, assess the national prevalence of chronic workplace exposure to vapors, gas, dust, and fumes (VGDF) among these groups.

Concepts: Medicine, Asthma, Potential, Hazard

28

Agriculture poses varied dangers to hired farm workers in the U.S., but little information exists on occupational risks for chronic musculoskeletal pain. We examined common work positions, such as kneeling, carrying heavy loads, and repetitive motion that may increase the risk for chronic musculoskeletal pain.

Concepts: Agriculture, Risk, Decision theory, Risk management, Uncertainty, Tractor, Hazard

27

Novelty preference or sensation seeking is associated with disorders of addiction and predicts rodent compulsive drug use and adolescent binge drinking in humans. Novelty has also been shown to influence choice in the context of uncertainty and reward processing. Here we introduce a novel or familiar neutral face stimuli and investigate its influence on risk-taking choices in healthy volunteers. We focus on behavioural outcomes and imaging correlates to the prime that might predict risk seeking. We hypothesized that subjects would be more risk seeking following a novel relative to familiar stimulus. We adapted a risk-taking task involving acceptance or rejection of a 50:50 choice of gain or loss that was preceded by a familiar (pre-test familiarization) or novel face prime. Neutral expression faces of males and females were used as primes. Twenty-four subjects were first tested behaviourally and then 18 scanned using a different variant of the same task under functional MRI. We show enhanced risk taking to both gain and loss anticipation following novel relative to familiar images and particularly for the low gain condition. Greater risk taking behaviour and self-reported exploratory behaviours was predicted by greater right ventral putaminal activity to novel versus familiar contexts. Social novelty appears to have a contextually enhancing effect on augmenting risky choices possibly mediated via ventral putaminal dopaminergic activity. Our findings link the observation that novelty preference and sensation seeking are important traits predicting the initiation and maintenance of risky behaviours, including substance and behavioural addictions.

Concepts: Risk, Decision theory, Risk management, Drug addiction, Behavior, Motivation, Uncertainty, Hazard

27

OBJECTIVE: To evaluate the association of body adiposity index (BAI) with all-cause and cardiovascular disease (CVD) mortality risk. DESIGN AND METHODS: The current analysis comprised 19 756 adult men who enrolled in the Aerobics Centre Longitudinal Study and completed a baseline examination during 1988-2002. All-cause and CVD mortality was registered till December 31, 2003. RESULTS: During an average follow-up of 8.3 years (163 844 man-years), 353 deaths occurred (101 CVD deaths). Age- and examination year-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality risk were higher for men with high values of BMI (HR = 1.63, 95% CI = 1.19 - 2.23), waist circumference (1.55, 1.22-1.96) and percentage of body fat (%BF) (1.36, 1.04-1.31), but not for men with high values of BAI (1.28, 0.98-1.66). The HRs for CVD mortality risks were higher for men with high values in all adiposity measures (HRs ranged from 1.73 to 2.06). Most of these associations, however, became nonsignificant after adjusting for multiple confounders including cardiorespiratory fitness. CONCLUSION: BAI is not a better predictor of all-cause and CVD mortality risk than BMI, waist circumference or %BF.

Concepts: Epidemiology, Disease, Death, Risk, Fat, Sociology, Adipose tissue, Hazard