Suchergebnisse

Inappropriate administration of radiation for cancer treatment can result in severe consequences such as premature death or appreciably impaired quality of life. There has been little study of vulnerable treatment process components and their contribution to the risk of radiation treatment (RT). In this article, we describe the application of probabilistic fault tree methods to assess the probability of radiation misadministration to patients at a large cancer treatment center. We conducted a systematic analysis of the RT process that identified four process domains: Assessment, Preparation, Treatment, and Follow‐up. For the Preparation domain, we analyzed possible incident scenarios via fault trees. For each task, we also identified existing quality control measures. To populate the fault trees we used subjective probabilities from experts and compared results with incident report data. Both the fault tree and the incident report analysis revealed simulation tasks to be most prone to incidents, and the treatment prescription task to be least prone to incidents. The probability of a Preparation domain incident was estimated to be in the range of 0.1–0.7% based on incident reports, which is comparable to the mean value of 0.4% from the fault tree analysis using probabilities from the expert elicitation exercise. In conclusion, an analysis of part of the RT system using a fault tree populated with subjective probabilities from experts was useful in identifying vulnerable components of the system, and provided quantitative data for risk management.

Families experience multiple stressors as a result of military service. The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction as assessed by the Family Adaptability and Cohesion Evaluation Scale-IV, parental social functioning assessed via the Short Form Health Survey-36, and child mental health and behavioral functioning (parental reports of clinician-diagnosed mental health conditions such as depression) and an adapted version of the Strengths and Difficulties Questionnaire. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the "whole child" within the broader ecological and military family context to understand factors associated with children's mental and behavioral health. The results from the present study highlight the complex relationships that may be at play, which, in turn, have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent's military service.

Risks associated with toxicants in food are often controlled by exposure reduction. When exposure recommendations are developed for foods with both harmful and beneficial qualities, however, they must balance the associated risks and benefits to maximize public health. Although quantitative methods are commonly used to evaluate health risks, such methods have not been generally applied to evaluating the health benefits associated with environmental exposures. A quantitative method for risk‐benefit analysis is presented that allows for consideration of diverse health endpoints that differ in their impact (i.e., duration and severity) using dose‐response modeling weighted by quality‐adjusted life years saved. To demonstrate the usefulness of this method, the risks and benefits of fish consumption are evaluated using a single health risk and health benefit endpoint. Benefits are defined as the decrease in myocardial infarction mortality resulting from fish consumption, and risks are defined as the increase in neurodevelopmental delay (i.e., talking) resulting from prenatal methylmercury exposure. Fish consumption rates are based on information from Washington State. Using the proposed framework, the net health impact of eating fish is estimated in either a whole population or a population consisting of women of childbearing age and their children. It is demonstrated that across a range of fish methylmercury concentrations (0–1 ppm) and intake levels (0–25 g/day), individuals would have to weight the neurodevelopmental effects 6 times more (in the whole population) or 250 times less (among women of child‐bearing age and their children) than the myocardial infarction benefits in order to be ambivalent about whether or not to consume fish. These methods can be generalized to evaluate the merits of other public health and risk management programs that involve trade‐offs between risks and benefits.