This title will help the multiplicity of clinicians who treat increasing numbers of patients with established cardiometabolic disease. It reflects the experiences and challenges that the authors have ...seen in leading lipid and prevention clinics in primary and secondary care over the last two decades. It will aid in providing answers for those seeking strategies to manage this complex range of symptoms.
To Your Health Kraemer, Helena Chmura; Lowe, Karen Kraemer; Kupfer, David J.
03/2005
eBook
The public is bombarded daily with reports about risk factors, many conflicting with each other, other accepted as “scientific truth” for awhile, then scientifically disproved, yet others ...questionable that later prove to be true. Physicians are faced with trying to make sense of those conflicting or questionable results in the scientific literature in order to guide their patients to the best possible decisions. The situation is not much easier for scientists whom ay waste yers of their productive life, and considerable resources, basing their research efforts on what prove to be misleading earlier research findings. What this book does is to present, in non “academese” and with many examples from the general media and scientific journals, a guide to a critical reading of research reports, which, in turn, serves as a guide to researchers as to which approaches are likely to be regarded with raised eyebrows, and what they need to do to generate results that will be take seriously. This stimulating and helpful book was written for informed consumers and physicians as well as for scientists evaluating the risk research literature or contemplating projects on risk research.
The Politics of Precautionexamines the politics of consumer and environmental risk regulation in the United States and Europe over the last five decades, explaining why America and Europe have often ...regulated a wide range of similar risks differently. It finds that between 1960 and 1990, American health, safety, and environmental regulations were more stringent, risk averse, comprehensive, and innovative than those adopted in Europe. But since around 1990, the book shows, global regulatory leadership has shifted to Europe. What explains this striking reversal?
David Vogel takes an in-depth, comparative look at European and American policies toward a range of consumer and environmental risks, including vehicle air pollution, ozone depletion, climate change, beef and milk hormones, genetically modified agriculture, antibiotics in animal feed, pesticides, cosmetic safety, and hazardous substances in electronic products. He traces how concerns over such risks--and pressure on political leaders to do something about them--have risen among the European public but declined among Americans. Vogel explores how policymakers in Europe have grown supportive of more stringent regulations while those in the United States have become sharply polarized along partisan lines. And as European policymakers have grown more willing to regulate risks on precautionary grounds, increasingly skeptical American policymakers have called for higher levels of scientific certainty before imposing additional regulatory controls on business.
Real-world experience underscores the complexity of interactions among multiple drivers of climate change risk and of how multiple risks compound or cascade. However, a holistic framework for ...assessing such complex climate change risks has not yet been achieved. Clarity is needed regarding the interactions that generate risk, including the role of adaptation and mitigation responses. In this perspective, we present a framework for three categories of increasingly complex climate change risk that focus on interactions among the multiple drivers of risk, as well as among multiple risks. A significant innovation is recognizing that risks can arise both from potential impacts due to climate change and from responses to climate change. This approach encourages thinking that traverses sectoral and regional boundaries and links physical and socio-economic drivers of risk. Advancing climate change risk assessment in these ways is essential for more informed decision making that reduces negative climate change impacts.
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Climate change risk is complex. Multiple drivers of risk and multiple risks interact. We present a framework for climate change risk assessment that includes interactions among multiple risk drivers and among multiple risks. A significant innovation is integrating mitigation and adaptation responses as a determinant of climate change risk. This framework illustrates how risk drivers (hazards, exposures, vulnerabilities, and responses), as well as multiple risks, can aggregate, compound, and cascade to increase or decrease risk severity.
An Axiomatic Approach to Systemic Risk Chen, Chen; Iyengar, Garud; Moallemi, Ciamac C.
Management science,
06/2013, Letnik:
59, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Systemic risk refers to the risk of collapse of an entire complex system as a result of the actions taken by the individual component entities or agents that comprise the system. Systemic risk is an ...issue of great concern in modern financial markets as well as, more broadly, in the management of complex business and engineering systems. We propose an axiomatic framework for the measurement and management of systemic risk based on the simultaneous analysis of outcomes across agents in the system and over scenarios of nature. Our framework defines a broad class of systemic risk measures that accomodate a rich set of regulatory preferences. This general class of systemic risk measures captures many specific measures of systemic risk that have recently been proposed as special cases and highlights their implicit assumptions. Moreover, the systemic risk measures that satisfy our conditions yield decentralized decompositions; i.e., the systemic risk can be decomposed into risk due to individual agents. Furthermore, one can associate a shadow price for systemic risk to each agent that correctly accounts for the externalities of the agent's individual decision making on the entire system.
This paper was accepted by Gérard P. Cachon, stochastic models and simulation.
The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates ...over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.
We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.
Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs 95% UI 111·2 million to 137·0 million), high systolic blood pressure (122·2 million DALYs 110·3 million to 133·3 million, and low birthweight and short gestation (83·0 million DALYs 78·3 million to 87·7 million), and for women, were high systolic blood pressure (89·9 million DALYs 80·9 million to 98·2 million), high body-mass index (64·8 million DALYs 44·4 million to 87·6 million), and high fasting plasma glucose (63·8 million DALYs 53·2 million to 76·3 million). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9–11·6) decline in deaths and a 10·8% (8·3–13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7–17·5) of deaths and 6·2% (3·9–8·7) of DALYs, and population growth for 12·4% (10·1–14·9) of deaths and 12·4% (10·1–14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9–29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.
Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.
The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
► We consider the results of 15 different studies on risk-taking in investment, each of which gathered data by gender. ► Each study used the same very simple and easy-to-comprehend mechanism for ...eliciting risk preferences. ► We find the extremely robust result that women are more risk averse than men. ► Most of the data were not collected in order to study gender differences, but rather to study other hypotheses regarding investment behavior, ameliorating the issue of publication bias with respect to gender results.
Are men more willing to take financial risks than women? The answer to this question has immediate relevance for many economic issues. We assemble the data from 15 sets of experiments with one simple underlying investment game. Most of these experiments were not designed to investigate gender differences and were conducted by different researchers in different countries, with different instructions, durations, payments, subject pools, etc. The fact that all data come from the same basic investment game allows us to test the robustness of the findings. We find a very consistent result that women invest less, and thus appear to be more financially risk averse than men.
Summary Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease ...analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. Methods We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability YLD and years of life lost YLL) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. Findings In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% 95% uncertainty interval 6·2–7·7 of global DALYs), tobacco smoking including second-hand smoke (6·3% 5·5–7·0), and household air pollution from solid fuels (4·3% 3·4–5·3). In 1990, the leading risks were childhood underweight (7·9% 6·8–9·4), household air pollution from solid fuels (HAP; 6·8% 5·5–8·0), and tobacco smoking including second-hand smoke (6·1% 5·4–6·8). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2–10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4–1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, Andean Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, most of Latin America, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. Interpretation Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. Funding Bill & Melinda Gates Foundation.
Cultural theory (CT) developed from grid/group analysis, which posits that different patterns of social relations—hierarchist, individualist, egalitarian, and fatalist—produce compatible cultural ...biases influencing assessment of which hazards pose high or low risk and how to manage them. Introduced to risk analysis (RA) in 1982 by Douglas and Wildavsky's Risk and Culture, this institutional approach to social construction of risk surprised a field hitherto focused on psychological influences on risk perceptions and behavior. We explain what CT is and how it developed; describe and evaluate its contributions to the study of risk perception and management, and its prescriptions for risk assessment and management; and identify opportunities and resources to develop its contributions to RA. We suggest how the diverse, fruitful, but scattered efforts to develop CT both inside and outside the formal discipline of RA (as exemplified by the Society for Risk Analysis) might be leveraged for greater theoretical, methodological, and applied progress in the field.
While flooding is the costliest natural disaster risk, public‐sector investments provide incomplete protection. Moreover, individuals are in general reluctant to voluntarily invest in measures which ...limit damage costs from natural disasters. The moral hazard hypothesis argues that insured individuals take fewer other preparedness measures based on their assumption that their losses will be covered anyway. Conversely, the advantageous selection hypothesis argues that individuals view insurance and other risk reduction measures as complements. This study offers a comprehensive assessment of factors related to the separate uptake of natural disaster insurance and the flood‐proofing of homes as well as why people may take both of these measures together. We use data from a survey conducted in Paris, France, in 2018, after several flood events, for a representative sample of 2976 residents facing different levels of flood risk. We perform both main effects regressions and interaction analyses to reveal that home adaptation to flooding is positively associated with comprehensive insurance coverage, which includes financial protection against natural disasters. Furthermore, actual and perceived risks, as well as awareness of official information on flood risk, are found to explain some of the relationship between home adaptation and comprehensive insurance purchase. We suggest several recommendations to policymakers based on these insights which aim to address insurance coverage gaps and the failure to take disaster risk reduction measures. In particular, groups in socially vulnerable situations may benefit from subsidized insurance, low interest loans, and decision aids to implement costly adaptation measures.
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