To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The concluding chapter provides a synthesis and reflection on insights from this book. It first summarizes the main findings regarding how disaster risk today is a legacy of urban history, drawing on salient examples from the six case study cities and cautioning that risk becomes very “path dependent” as future options are constrained by past decisions. After discussing limitations of the study and further research needs, the chapter suggests that the Urban Risk Dynamics framework and findings from the six cases are relevant to any city, demonstrating this for Vancouver (Canada). It then reflects on the practical significance of the book. It argues that the findings demonstrate why disaster risk and risk reduction should be viewed dynamically; why understanding risk should start with the city, not the hazard or disaster; and why interdisciplinary approaches are critical for reducing risk. Recognizing this can help analysts, planners, and policy-makers, for example, to not only identify current risk hotspots but anticipate future ones, to consider risk from a multihazard standpoint, and to develop strategies and solutions that are effective in the long term.
HMG-CoA reductase inhibitors, also known as statin medications, are used to reduce cholesterol levels in efforts to prevent heart attacks and strokes. Extensive evidence justifies the use of statins. As an exercise, we take a skeptical look at the evidence and raise concerns about the consistency, patient-centeredness, and potency of benefit. Much of the justification for statins focuses on LDL cholesterol as a surrogate for heart disease. Only one major clinical trial has demonstrated that statins (versus placebos) result in longer life expectancy. Subject populations evaluated in statin trials tend to be highly selected. Older adults, a group that almost universally uses the medications, have been studied only rarely. Assuming that lower LDL levels reflect better health, a recent campaign promotes lowering LDL cholesterol values to below 50 mg/dl. The campaign is based on the assumption that the relationship between LDL cholesterol and mortality is linear. Inspection of the data reveals that the relationship is log linear; there is more benefit for initiating treatment among people who are initially at high LDL levels in comparison with those who are initially at lower risk.
This final chapter demonstrates how the catastrophe (CAT) models described in previous chapters can be used as inputs for CAT risk management. CAT model outputs, which can translate into actionable strategies, are risk metrics such as the average annual loss, exceedance probability curves, and values at risk (as defined in Chapter 3). Practical applications include risk transfer via insurance and CAT bonds, as well as risk reduction, consisting of reducing exposure, hazard, or vulnerability. The forecasting of perils (such as tropical cyclones and earthquakes) is explored, as well as strategies of decision-making under uncertainty. The overarching concept of risk governance, which includes risk assessment, management, and communication between various stakeholders, is illustrated with the case study of seismic risk at geothermal plants. This scenario exemplifies how CAT modelling is central in the trade-off between energy security and public safety and how large uncertainties impact risk perceptions and decisions.
Different aspects of social relationships (e.g., social network size or loneliness) have been associated with dementia risk, while their overlap and potentially underlying pathways remain largely unexplored. This study therefore aimed to (1) discriminate between different facets of social relationships by means of factor analysis, (2) examine their associations with dementia risk, and (3) assess mediation by depressive symptoms.
Methods
Thirty-six items from questionnaires on social relationships administered in Wave 2 (2004/2005) of the English Longitudinal Study of Ageing (n = 7536) were used for exploratory and confirmatory factor analysis. Factors were then used as predictors in Cox proportional hazard models with dementia until Wave 9 as outcome, adjusted for demographics and cardiovascular risk factors. Structural equation modeling tested mediation by depressive symptoms through effect decomposition.
Results
Factor analyses identified six social factors. Across a median follow-up time of 11.8 years (IQR = 5.9–13.9 years), 501 people developed dementia. Higher factor scores for frequency and quality of contact with children (HR = 0.88; p = 0.021) and more frequent social activity engagement (HR = 0.84; p < 0.001) were associated with lower dementia risk. Likewise, higher factor scores for loneliness (HR = 1.13; p = 0.011) and negative experiences of social support (HR = 1.10; p = 0.047) were associated with higher dementia risk. Mediation analyses showed a significant partial effect mediation by depressive symptoms for all four factors. Additional analyses provided little evidence for reverse causation.
Conclusions
Frequency and quality of social contacts, social activity engagement, and feelings of loneliness are associated with dementia risk and might be suitable targets for dementia prevention programs, partly by lowering depressive symptoms.
Through in-depth interviews, this study aimed to understand perspectives of key stakeholders regarding the decision to curtail academic operations in the setting of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak before the declaration of a pandemic on March 11, 2020, and how such processes may be optimized in the future to best protect public health and safety.
Methods:
Virtual interviews with key stakeholders from 4 academic institutions were conducted from September to December 2020 using a standardized interview question template. The interviews lasted approximately 30-45 minutes and each interview was recorded with permission. The interviews were then transcribed and reviewed for qualitative analysis.
Results:
The decision to curtail academic operations involved several common themes, such as discussing how institutions would control the outbreak and the process of transitioning to virtual learning and remote work. Universities were monitoring other universities’ responses as well as evaluating the prevalence of cases nationally and globally. Risks and challenges identified included housing for international students, financial implications, and loss of academic productivity.
Conclusions:
The decision-making process may be optimized in the future by focusing on communication within a smaller committee, prioritizing epidemiology over fiscal implications, and embracing an openness to consider new strategies. Further research regarding this topic should be pursued to best protect public health and safety.
In 2020, the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) published up-to-date recommendations for the clinical management of persons living with dementia (PLWD) and their caregivers. During the CCCDTD5 meetings, a list of recommendations for dementia care was compiled. With the aid of family physicians and the Canadian Consortium on Neurodegeneration in Aging, we selected the most relevant CCCDTD5 recommendations for primary care and tailored and summarized them in the present manuscript to facilitate their reference and use. These recommendations focus on (a) risk reduction, (b) screening and diagnosis, (c) deprescription of dementia medications, and (d) non-pharmacological interventions. The development of recommendations for the ongoing management of dementia is an iterative process as new evidence on interventions for dementia is published. These recommendations are important in the primary care setting as the entry point for PLWD into the health system.
Designers in the real world must adhere to cost and schedules, pay attention to the competition, and work in multidisciplinary teams. Their products are typically the result of incremental, rather than radical, innovation. A questionnaire on how design thinking influences organizational outcomes revealed that four beneficial practices were to form diverse teams, generate diverse ideas, emphasize active listening, and execute real-world experiments. Curiosity, interest, and a drive for sense-making drive motivation, which can be measured by the Motivation to Innovate Inventory. Innovation requires risks and thus a balance between taking and reducing risks. Both traditional and foresight forecasting reduce risks, although the foresight perspective is more uniquely suited to the current complexity of world events. Technical and scientific progress contributes to success, but the process of innovation must be analyzed within a complete system that depends not only on the product but on the market environment, production facilities, knowledge, and social support within the organization.
The United States and China are the primary nodes of the multinodal world order. Together they are the middle third of the global economy, with the world’s biggest military budgets. Their parity makes rivalry inevitable because they are one another’s greatest counterpart. But their parity is asymmetric. China’s power relies on its demographic scale and on its Pacific Asian integration, while the US remains the center of the familiar global system that it created and it is the avatar of the developed world. While a Cold War is unlikely, the dangers posed by global rivalry are profound, ranging from nuclear war to failure to cooperate on global problems. The primary nodes also face asymmetric challenges. The US faces the challenge of adjusting to a central but not hegemonic global role. China faces the challenge of domestic tolerance and a mutually beneficial integration of Greater China and, more generally, of Pacific Asia. Beyond the primary nodes, regional reduction of uncertainties can contribute to the stabilization of world order. Cooperation founded on mutual respect is the prerequisite of successful global governance in a post-hegemonic world.
It is crucial to communicate the hazards of climate change and our power to act on them, believing and acting with ‘constructive optimism’. The COVID-19 pandemic has taught us the significance of effective risk communication. Transparent and credible oversight of risk management strategies by reputable authorities is vital.
Primary health care (PHC) physicians’ perceptions are vital to understand as they are the first-line health care providers in cardiovascular diseases (CVD) risk assessment and management. This study aims to explore PHC physicians’ perceptions on their roles and their perceptions on management and risk reduction approaches on CVD risk reduction and management in Fiji.
Methods:
This is a qualitative study conducted in the Suva Medical area among 7 health centers from 1 August to 31 September, 2021. Purposive sampling was used to recruit physicians who worked in the Suva medical area as PHC physicians with at least 6 months’ experience in the Special Outpatients Department clinics. In-depth interview were conducted using a semi-structured questionnaire over the telephone and recorded on a tablet device application. The interview content was then transcribed, and thematic analysis was done.
Results:
This study included 25 PHC physicians. From the thematic analysis, 2 major themes emerged with 6 subthemes. Theme 1 was CVD management skills with 3 subthemes including education, experience and trainings, beliefs and attitudes of physicians, self-confidence and effectiveness in CVD risk reduction and management. Theme 2 was roles and expectations with 3 subthemes including perceptions of effective treatment, perceptions of physicians’ roles and perceptions of patients’ expectations. Physicians generally see their role as central and imperative. They perceive to be important and leading toward combating CVDs.
Conclusions:
Physicians’ perceptions on their commitment to prevention and management of CVDs through their skills and knowledge, beliefs and motivation should be acknowledged. It is recommended that the physicians are updated on the current evidence-based medicine. Limitations include results that may not be the reflection of the entire physician and multidisciplinary community and the difficulties in face-to-face interviews due to the coronavirus diseases of 2019 pandemic.
Disaster impact databases are important resources for informing research, policy, and decision making. Therefore, understanding the underpinning methodology of data collection used by the databases, how they differ, and quality indicators of the data recorded is essential in ensuring that their use as reference points is valid.
Methods:
The Australian Disaster Resilience Knowledge Hub (AIDRKH) is an open-source platform supported by government to inform disaster management practice. A comparative descriptive review of the Disaster Mapper (hosted at AIDRKH) and the international Emergency Events Database (EM-DAT) was undertaken to identify differences in how Australian disasters are captured and measured.
Results:
The results show substantial variation in identification and classification of disasters across hazard impacts and hazard types and a lack of data structure for the systematic reporting of contextual and impact variables.
Conclusions:
These differences may have implications for reporting, academic analysis, and thus knowledge management informing disaster prevention and response policy or plans. Consistency in reporting methods based on international classification standards is recommended to improve the validity and usefulness of this Australian database.
This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts.
Methods:
This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis.
Results:
A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories.
Conclusions:
The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.
Many health care professionals undertake roles that require them to visit the home of the client or a range of other possible locations, rather than the client coming into the health care service setting. Primary health care nurses usually work alone and often have little control over the environment so their role requires a different approach to risk management. Assessment of risk is necessary to identify any potential harm or risk to safety. This should be considered from both personal and professional perspectives. Although risk is present in all activities of life, the management of risk is essential when providing services that meet the needs of clients while minimising the chance of undesirable incidents. This chapter identifies common safety concerns when providing health care in people’s homes and explains the purpose of risk assessment and the mechanisms through which risk is managed. It also describes measures for reducing risk and discusses proactive behaviour for self-protection.
Many health care professionals undertake roles that require them to visit the home of the client or a range of other possible locations, rather than the client coming into the health care service setting. Primary health care nurses usually work alone and often have little control over the environment so their role requires a different approach to risk management. Assessment of risk is necessary to identify any potential harm or risk to safety. This should be considered from both personal and professional perspectives. Although risk is present in all activities of life, the management of risk is essential when providing services that meet the needs of clients while minimising the chance of undesirable incidents. This chapter identifies common safety concerns when providing health care in people’s homes and explains the purpose of risk assessment and the mechanisms through which risk is managed. It also describes measures for reducing risk and discusses proactive behaviour for self-protection.
Political unrest in the Middle East heightens the possibility of catastrophe due to violent conflict and/or terrorist attacks. However, the disaster risk reduction strategy in the Saudi health care system appears to be a reactive approach focused more on flood hazards than other threats. Given the current unstable political situation in its neighboring countries and Saudi Arabia’s key role in providing humanitarian assistance and disaster relief to those affected by internal conflicts and wars, it is essential to develop a framework for training standards related to complex humanitarian disasters to provide the requisite skills and knowledge in a gradual manner, according to local context and international standards. This framework could also support the World Health Organization’s (WHO; Geneva, Switzerland) initiative for establishing a national disaster assistance team in Saudi Arabia.
Problem:
The main aim of this study is to provide Saudi health care providers with a competencies-based course in Basic Principles of Complex Humanitarian Emergency.
Methods:
The interactive, competencies-based course in Basic Principles of Complex Humanitarian Emergency was designed by five experts in disaster medicine and humanitarian relief in three stages, accordance to international standards and the local context. The course was piloted over five days at the Officers Club of the Ministry of Interior (MOI; Riyadh, Saudi Arabia). The 33 participants were from different health disciplines of the government sectors in-country. The participants completed the pre- and post-tests and attended three pilot workshops for disaster community awareness.
Results:
The overall knowledge scores were significantly higher in the post-test (62.9%) than the pre-test (44.2%). There were no significant differences in the pre- and post-knowledge scores for health care providers from the different government health disciplines. A 10-month, post-event survey demonstrated that participants were satisfied with their knowledge retention. Importantly, three of them (16.6%) had the opportunity to put this knowledge into practice in relation to humanitarian aid response.
Conclusion:
Delivering a competencies-based course in Basic Principles of Complex Humanitarian Emergency for health care providers can help improve their knowledge and skills for humanitarian assistance and disaster relief, which is crucial for disaster preparedness augmentation in Saudi Arabia.
Improving public awareness through education has been recognized widely as a basis for reducing the risk of disasters. Some of the first disaster just-in-time (JIT) education modules were built within 3–6 days after the south Asia tsunami, Hurricane Katrina, and the Bam, Pakistan, and Indonesia earthquakes through a Supercourse. Web monitoring showed that visitors represented a wide spectrum of disciplines and educational levels from 120 developed and developing countries. Building disaster networks using an educational strategy seizes the opportunity of increased public interest to teach and find national and global expertise in hazard and risk information. To be effective, an expert network and a template for the delivery of JIT education must be prepared before an event occurs, focusing on developing core materials that could be customized rapidly, and then be based on the information received from a recent disaster. The recyclable process of the materials would help to improve the quality of the teaching, and decrease the time required for preparation. The core materials can be prepared for disasters resulting from events such as earthquakes, hurricanes, tsunamis, floods, and bioterrorism.
There is a cascade of risks associated with a hazard evolving into a disaster that consists of the risk that: (1) a hazard will produce an event; (2) an event will cause structural damage; (3) structural damage will create functional damages and needs; (4) needs will create an emergency (require use of the local response capacity); and (5) the needs will overwhelm the local response capacity and result in a disaster (ie, the need for outside assistance). Each step along the continuum/cascade can be characterized by its probability of occurrence and the probability of possible consequences of its occurrence, and each risk is dependent upon the preceding occurrence in the progression from a hazard to a disaster. Risk-reduction measures are interventions (actions) that can be implemented to: (1) decrease the risk that a hazard will manifest as an event; (2) decrease the amounts of structural and functional damages that will result from the event; and/or (3) increase the ability to cope with the damage and respond to the needs that result from an event. Capacity building increases the level of resilience by augmenting the absorbing and/or buffering and/or response capacities of a community-at-risk. Risks for some hazards vary by the context in which they exist and by the Societal System(s) involved.
BirnbaumML, LorettiA, DailyEK, O’RourkeAP. Research and Evaluations of the Health Aspects of Disasters, Part VIII: Risk, Risk Reduction, Risk Management, and Capacity Building. Prehosp Disaster Med. 2016;31(3):300–308.
Microbial pathogens and pesticide residues in food pose a financial burden to society which can be reduced by incurring costs to reduce these food safety risks. We explore three valuation techniques that place a monetary value on food safety risk reductions, and we present a case study for each: a contingent valuation survey on pesticide residues, an experimental auction market for a chicken sandwich with reduced risk of Salmonella, and a cost-of-illness analysis for seven foodborne pathogens. Estimates from these techniques can be used in cost/benefit analyses for policies that reduce food safety risks.