Search results for: health risk
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 13440

Search results for: health risk

12690 Public Participation for an Effective Flood Risk Management: Building Social Capacities in Ribera Alta Del Ebro, Spain

Authors: Alba Ballester Ciuró, Marc Pares Franzi

Abstract:

While coming decades are likely to see a higher flood risk in Europe and greater socio-economic damages, traditional flood risk management has become inefficient. In response to that, new approaches such as capacity building and public participation have recently been incorporated in natural hazards mitigation policy (i.e. Sendai Framework for Action, Intergovernmental Panel on Climate Change reports and EU Floods Directive). By integrating capacity building and public participation, we present a research concerning the promotion of participatory social capacity building actions for flood risk mitigation at the local level. Social capacities have been defined as the resources and abilities available at individual and collective level that can be used to anticipate, respond to, cope with, recover from and adapt to external stressors. Social capacity building is understood as a process of identifying communities’ social capacities and of applying collaborative strategies to improve them. This paper presents a proposal of systematization of participatory social capacity building process for flood risk mitigation, and its implementation in a high risk of flooding area in the Ebro river basin: Ribera Alta del Ebro. To develop this process, we designed and tested a tool that allows measuring and building five types of social capacities: knowledge, motivation, networks, participation and finance. The tool implementation has allowed us to assess social capacities in the area. Upon the results of the assessment we have developed a co-decision process with stakeholders and flood risk management authorities on which participatory activities could be employed to improve social capacities for flood risk mitigation. Based on the results of this process, and focused on the weaker social capacities, we developed a set of participatory actions in the area oriented to general public and stakeholders: informative sessions on flood risk management plan and flood insurances, interpretative river descents on flood risk management (with journalists, teachers, and general public), interpretative visit to the floodplain, workshop on agricultural insurance, deliberative workshop on project funding, deliberative workshops in schools on flood risk management (playing with a flood risk model). The combination of obtaining data through a mixed-methods approach of qualitative inquiry and quantitative surveys, as well as action research through co-decision processes and pilot participatory activities, show us the significant impact of public participation on social capacity building for flood risk mitigation and contributes to the understanding of which main factors intervene in this process.

Keywords: flood risk management, public participation, risk reduction, social capacities, vulnerability assessment

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12689 Assessment-Assisted and Relationship-Based Financial Advising: Using an Empirical Assessment to Understand Personal Investor Risk Tolerance in Professional Advising Relationships

Authors: Jerry Szatko, Edan L. Jorgensen, Stacia Jorgensen

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A crucial component to the success of any financial advising relationship is for the financial professional to understand the perceptions, preferences and thought-processes carried by the financial clients they serve. Armed with this information, financial professionals are more quickly able to understand how they can tailor their approach to best match the individual preferences and needs of each personal investor. Our research explores the use of a quantitative assessment tool in the financial services industry to assist in the identification of the personal investor’s consumer behaviors, especially in terms of financial risk tolerance, as it relates to their financial decision making. Through this process, the Unitifi Consumer Insight Tool (UCIT) was created and refined to capture and categorize personal investor financial behavioral categories and the financial personality tendencies of individuals prior to the initiation of a financial advisement relationship. This paper discusses the use of this tool to place individuals in one of four behavior-based financial risk tolerance categories. Our discoveries and research were aided through administration of a web-based survey to a group of over 1,000 individuals. Our findings indicate that it is possible to use a quantitative assessment tool to assist in predicting the behavioral tendencies of personal consumers when faced with consumer financial risk and decisions.

Keywords: behavior-based advising, financial relationship building, risk capacity based on behavior, risk tolerance, systematic way to assist in financial relationship building

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12688 Building Climate Resilience in the Health Sector in Developing Countries: Experience from Tanzania

Authors: Hussein Lujuo Mohamed

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Introduction: Public health has always been influenced by climate and weather. Changes in climate and climate variability, particularly changes in weather extremes affect the environment that provides people with clean air, food, water, shelter, and security. Tanzania is not an exception to the threats of climate change. The health sector is mostly affected due to emergence and proliferation of infectious diseases, thereby affecting health of the population and thus impacting achievement of sustainable development goals. Methodology: A desk review on documented issues pertaining to climate change and health in Tanzania was done using Google search engine. Keywords included climate change, link, health, climate initiatives. In cases where information was not available, documents from Ministry of Health, Vice Presidents Office-Environment, Local Government Authority, Ministry of Water, WHO, research, and training institutions were reviewed. Some of the reviewed documents from these institutions include policy brief papers, fieldwork activity reports, training manuals, and guidelines. Results: Six main climate resilience activities were identified in Tanzania. These were development and implementation of climate resilient water safety plans guidelines both for rural and urban water authorities, capacity building of rural and urban water authorities on implementation of climate-resilient water safety plans, and capacity strengthening of local environmental health practitioners on mainstreaming climate change and health into comprehensive council health plans. Others were vulnerability and adaptation assessment for the health sector, mainstreaming climate change in the National Health Policy, and development of risk communication strategy on climate. In addition information, education, and communication materials on climate change and to create awareness were developed aiming to sensitize and create awareness among communities on climate change issues and its effect on public health. Conclusion: Proper implementation of these interventions will help the country become resilient to many impacts of climate change in the health sector and become a good example for other least developed countries.

Keywords: climate, change, Tanzania, health

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12687 Management of Blood Exposure Risk: Knowledge and Attitudes of Caregivers in Pediatric Dapartments

Authors: Hela Ghali, Oumayma Ben Amor, Salwa Khefacha, Mohamed Ben Rejeb, Sirine Frigui, Meriam Tourki Dhidah, Lamine Dhidah, Houyem Said Laatiri

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Background: Blood exposure accidents are the most common problem in hospitals that threaten healthcare professionals with a high risk of infectious complications which weighs heavily on health systems worldwide. Paramedics are the highest risk group due to the nature of their daily activities. We aimed to determine knowledge and attitudes about the management of blood-exposure accidents among nurses and technicians in two pediatric departments. Materials/Methods: This is a cross-sectional descriptive study conducted on March 2017, carried out with the care staff of the pediatric ward of the Farhat Hached Teaching Hospital of Sousse and pediatric surgery of the Fattouma Bourguiba University Hospital in Monastir, using a pre- tested and self-administered questionnaire. Data entry and analysis were performed using Excel software. Results: The response rate was 85.1%. A female predominance (82.5%) was reported among respondents with a sex ratio of 0.21. 80% of the participants were under 35 years old. Seniority of less than 10 years was found in 77.5% of respondents. Only 22.5% knew the definition of a blood- exposure accident. 100% and 95% of participants reported the relative risk, respectively, to hepatitis and AIDS viruses. However, only 15% recognized the severity factors of a blood-exposure accident. Hygiene compliance was the most important dimension for almost the entire population for the prevention. On the other hand, only 12.5% knew the meaning of 'standard precautions' and ¼ considered them necessary for at-risk patients only. 40% reported being exposed at least once, among them, 87.5% used betadine, and 77.5% said that anti-infectious chemoprophylaxis is necessary regardless of the patient's serological status. However, 52.5% did not know the official reporting circuit of management of blood-exposure accident in their institutions. Conclusion: For better management of risks in hospitals and an improvement of the safety of the care, a reinforcement of the sensibilization of the caregivers with regard to the risks of blood exposure accident is necessary, while developing their knowledge to act in security.

Keywords: attitudes, blood-exposure accident, knowledge, pediatric department

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12686 Fall Prevention: Evidence-Based Intervention in Exercise Program Implementation for Keeping Older Adults Safe and Active

Authors: Jennifer Holbein, Maritza Wiedel

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Background: Aging is associated with an increased risk of falls in older adults, and as a result, falls have become public health crises. However, the incidence of falls can be reduced through healthy aging and the implementation of a regular exercise and strengthening program. Public health and healthcare professionals authorize the use of evidence‐based, exercise‐focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practices. The purpose of this study was to assess the feasibility of an intervention, A Matter of Balance, in terms of demand, acceptability, and implementation into current exercise programs. Subjects: Seventy-five participants from rural communities, above the age of sixty, were randomized to an intervention or attention-control of the standardized senior fitness test. Methods: Subject completes the intervention, which combines two components: (1) motivation and (2) fall-reducing physical activities with protocols derived from baseline strength and balanced assessments. Participants (n=75) took part in the program after completing baseline functional assessments as well as evaluations of their personal knowledge, health outcomes, demand, and implementation interventions. After 8-weeks of the program, participants were invited to complete follow-up assessments with results that were compared to their baseline functional analyses. Out of all the participants in the study who complete the initial assessment, approximately 80% are expected to maintain enrollment in the implemented prescription. Furthermore, those who commit to the program should show mitigation of fall risk upon completion of their final assessment.

Keywords: aging population, exercise, falls, functional assessment, healthy aging

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12685 Street-Connected Youth: A Priority for Global HIV Prevention

Authors: Shorena Sadzaglishvili, Teona Gotsiridze, Ketevan Lekishvili, Darejan Javakhishvili, Alida Bouris

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Globally, adolescents and young people experience high levels of HIV vulnerability and risk. Estimates suggest that AIDS-related deaths among young people are increasing, suggesting poor prioritization of adolescents in national plans for HIV testing and treatment services. HIV/AIDS is currently the sixth leading cause of death in people aged 10-24 years. Among young people, street connected youth are clearly distinguished as being among the most at risk for HIV infection. The present study recognizes the urgent need to scale up effective HIV responses that are tailored to the unique needs of street connected youth for the global HIV agenda and especially, the former Soviet country - Georgia, where 'street kids' are a new phenomenon and estimated to be about 2,500. During two months trained interviewers conducted individual semi-structured qualitative interviews with 22 key informants from the local governmental and nongovernmental service organizations, including psychologists, social workers, peer educators, mobile health workers, and managers. Informants discussed social network characteristics influencing street connected youth’s sexual risk behaviors. Data were analyzed using Dedoose. It was revealed that there are three types of homogeneous networks of street-connected youth aged 10-19 based on ethnical background: (1) Georgians; (2) migrant kids of Azeri-Kurdish origin, and (3) local Roma-Moldavian kids. These networks are distinguished with various HIV risk through both risky sexual and drug-related behaviors. In addition, there are several cases of HIV infection identified through reactive social services. Street connected youth do not have basic information about the HIV related sexual, alcohol and drug behaviors nor there are any systematic programs providing HIV testing and consultation for reducing the vulnerability of HIV infection. There is a need to systematically examine street-connected youth risk-taking behaviors by applying an integrated, multilevel framework to a population at great risk of HIV. Acknowledgment: This work was supported by Shota Rustaveli National Science Foundation of Georgia (SRNSFG) [#FR 17_31], Ilia State University.

Keywords: street connected youth, social networks, HIV/AIDS, HIV testing

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12684 Long Term Survival after a First Transient Ischemic Attack in England: A Case-Control Study

Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski

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Transient ischaemic attacks (TIAs) are warning signs for future strokes. TIA patients are at increased risk of stroke and cardio-vascular events after a first episode. A majority of studies on TIA focused on the occurrence of these ancillary events after a TIA. Long-term mortality after TIA received only limited attention. We undertook this study to determine the long-term hazards of all-cause mortality following a first episode of a TIA using anonymised electronic health records (EHRs). We used a retrospective case-control study using electronic primary health care records from The Health Improvement Network (THIN) database. Patients born prior to or in year 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general medical practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Weibull-Cox survival model which included both scale and shape effects and a random frailty effect of GP practice. 20,633 cases and 58,634 controls were included. Cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to matched controls (HR = 3.04, 95% CI (2.91 - 3.18)). The HRs for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to matched controls. Aspirin provided long-term survival benefits to cases. Cases aged 39-60 years on aspirin had HR of 0.93 (0.84 - 1.00), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5 years, 10 years and 15 years, respectively, compared to cases in the same age group who were not on antiplatelets. Similar beneficial effects of aspirin were observed in other age groups. There were no significant survival benefits with other antiplatelet options. No survival benefits of antiplatelet drugs were observed in controls. Our study highlights the excess long-term risk of death of TIA patients and cautions that TIA should not be treated as a benign condition. The study further recommends aspirin as the better option for secondary prevention for TIA patients compared to clopidogrel recommended by NICE guidelines. Management of risk factors and treatment strategies should be important challenges to reduce the burden of disease.

Keywords: dual antiplatelet therapy (DAPT), General Practice, Multiple Imputation, The Health Improvement Network(THIN), hazard ratio (HR), Weibull-Cox model

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12683 The Relationship between Incidental Emotions, Risk Perceptions and Type of Army Service

Authors: Sharon Garyn-Tal, Shoshana Shahrabani

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Military service in general, and in combat units in particular, can be physically and psychologically stressful. Therefore, type of service may have significant implications for soldiers during and after their military service including emotions, judgments and risk perceptions. Previous studies have focused on risk propensity and risky behavior among soldiers, however there is still lack of knowledge on the impact of type of army service on risk perceptions. The current study examines the effect of type of army service (combat versus non-combat service) and negative incidental emotions on risk perceptions. In 2014 a survey was conducted among 153 combat and non-combat Israeli soldiers. The survey was distributed in train stations and central bus stations in various places in Israel among soldiers waiting for the train/bus. Participants answered questions related to the levels of incidental negative emotions they felt, to their risk perceptions (chances to be hurt by terror attack, by violent crime and by car accident), and personal details including type of army service. The data in this research is unique because military service in Israel is compulsory, so that the Israeli population serving in the army is wide and diversified. The results indicate that currently serving combat participants were more pessimistic in their risk perceptions (for all type of risks) compared to the currently serving non-combat participants. Since combat participants probably experienced severe and distressing situations during their service, they became more pessimistic regarding their probabilities of being hurt in different situations in life. This result supports the availability heuristic theory and the findings of previous studies indicating that those who directly experience distressing events tend to overestimate danger. The findings also indicate that soldiers who feel higher levels of incidental fear and anger have pessimistic risk perceptions. In addition, respondents who experienced combat army service also have pessimistic risk perceptions if they feel higher levels of fear. In addition, the findings suggest that higher levels of the incidental emotions of fear and anger are related to more pessimistic risk perceptions. These results can be explained by the compulsory army service in Israel that constitutes a focused threat to soldiers' safety during their period of service. Thus, in this stressful environment, negative incidental emotions even during routine times correlate with higher risk perceptions. In conclusion, the current study results suggest that combat army service shapes risk perceptions and the way young people control their negative incidental emotions in everyday life. Recognizing the factors affecting risk perceptions among soldiers is important for better understanding the impact of army service on young people.

Keywords: army service, combat soldiers, incidental emotions, risk perceptions

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12682 An Integrated HCV Testing Model as a Method to Improve Identification and Linkage to Care in a Network of Community Health Centers in Philadelphia, PA

Authors: Catelyn Coyle, Helena Kwakwa

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Objective: As novel and better tolerated therapies become available, effective HCV testing and care models become increasingly necessary to not only identify individuals with active infection but also link them to HCV providers for medical evaluation and treatment. Our aim is to describe an effective HCV testing and linkage to care model piloted in a network of five community health centers located in Philadelphia, PA. Methods: In October 2012, National Nursing Centers Consortium piloted a routine opt-out HCV testing model in a network of community health centers, one of which treats HCV, HIV, and co-infected patients. Key aspects of the model were medical assistant initiated testing, the use of laboratory-based reflex test technology, and electronic medical record modifications to prompt, track, report and facilitate payment of test costs. Universal testing on all adult patients was implemented at health centers serving patients at high-risk for HCV. The other sites integrated high-risk based testing, where patients meeting one or more of the CDC testing recommendation risk factors or had a history of homelessness were eligible for HCV testing. Mid-course adjustments included the integration of dual HIV testing, development of a linkage to care coordinator position to facilitate the transition of HIV and/or HCV-positive patients from primary to specialist care, and the transition to universal HCV testing across all testing sites. Results: From October 2012 to June 2015, the health centers performed 7,730 HCV tests and identified 886 (11.5%) patients with a positive HCV-antibody test. Of those with positive HCV-antibody tests, 838 (94.6%) had an HCV-RNA confirmatory test and 590 (70.4%) progressed to current HCV infection (overall prevalence=7.6%); 524 (88.8%) received their RNA-positive test result; 429 (72.7%) were referred to an HCV care specialist and 271 (45.9%) were seen by the HCV care specialist. The best linkage to care results were seen at the test and treat the site, where of the 333 patients were current HCV infection, 175 (52.6%) were seen by an HCV care specialist. Of the patients with active HCV infection, 349 (59.2%) were unaware of their HCV-positive status at the time of diagnosis. Since the integration of dual HCV/HIV testing in September 2013, 9,506 HIV tests were performed, 85 (0.9%) patients had positive HIV tests, 81 (95.3%) received their confirmed HIV test result and 77 (90.6%) were linked to HIV care. Dual HCV/HIV testing increased the number of HCV tests performed by 362 between the 9 months preceding dual testing and first 9 months after dual testing integration, representing a 23.7% increment. Conclusion: Our HCV testing model shows that integrated routine testing and linkage to care is feasible and improved detection and linkage to care in a primary care setting. We found that prevalence of current HCV infection was higher than that seen in locally in Philadelphia and nationwide. Intensive linkage services can increase the number of patients who successfully navigate the HCV treatment cascade. The linkage to care coordinator position is an important position that acts as a trusted intermediary for patients being linked to care.

Keywords: HCV, routine testing, linkage to care, community health centers

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12681 Survey on Prevalence of Endo and Ecto-Parasites of Rattus rattus in Mazandaran Province, North of Iran

Authors: Fatemeh Rezaei, Afsaneh Amouei, Iman Bakouei, Mahdi Sharif, Shahabeddin Sarvi, Mohammad Taghi Rahimi, Ahmad Daryani

Abstract:

Background: Rodents act as reservoir host and important potential source for many zoonotic pathogens which pose a public health risk to humans. Therefore, it is necessary to investigate the prevalence of gastrointestinal and ectoparasites among rodents. Materials and Methods: 118 Rattus rattus were captured using snap live traps. Each rat was combed with a fine tooth comb to dislodge ectoparasite and studied. Various samples were collected from feces, examined wet smear, formalin-ether method and stained with modified acid-fast staining and trichrome. Result: The overall prevalence of gastrointestinal parasites of examined rats was 75.4%. Cryptosporidium 30.5%, was the most prevalent protozoan which was followed by Giardia 20.3% and Entamoeba muris 13.5%, Trichomonas muris 10.1% and Spironucleus muris 3.3%. The prevalence of helminth egg was as following Syphacia obvelata 24.5%, Hymenolepis diminuta 10.1% and Trichuris muris 9.3%. 86.4% rodents were found to be infested with ectoparasites including mite 35.6%, flea 28.4%, and lice 42.7%. A significant statistical difference was observed between prevalence and gender of infected individuals. Conclusions: The prevalence of gastrointestinal and ectoparasites of collected rats in studied area is remarkably high. In addition, Rattus rattus can be considered as potential risk for human health.

Keywords: prevalence, rodent, intestinal parasites, ecto-parasites, zoonose

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12680 The Effect of the Organization of Mental Health Care on General Practitioners’ Prescription Behavior of Psychotropics for Adolescents in Belgium

Authors: Ellen Lagast, Melissa Ceuterick, Mark Leys

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Although adolescence is a stressful period with an increased risk for mental illnesses such as anxiety and depression, little in-depth knowledge is available on the determinants of the use of psychotropic drugs (BZD/SSRIs) and the effects. A qualitative research with adolescents in Flanders was performed. Based on indepth interviews, the interviewees indicate feelings of ambiguity towards their medication use because on the one hand the medication helps to manage their mental vulnerability and disrupted lives, but on the other hand they experience a loss of control of their self and their environment. Undesired side-effects and stigma led to a negative pharmaceutical self. The interviewed youngsters also express dissatisfaction about the prescription behavior with regard to psychotropic drugs of their general practitioner (GP). They wished to have received more information about alternative non-pharmaceutical treatment options. Notwithstanding these comments, the majority of the interviewees maintained trust in their GP to act in their best interest. This paper will relate the prescription behavior in primary care to the organization of mental health care to better understand the “phamaceuticalization” and medicalization of mental health problems in Belgium. Belgium implemented fundamental mental health care reforms to collaborate, to integrate care and to optimize continuity of care. Children and adolescents still are confronted with long waiting lists to access (non-medicalized) mental health services. This access to mental health care partly explains general practitioners’ prescription behavior of psychotropics. Moreover, multidisciplinary practices have not pervaded primary health care yet. Medicalization and pharmaceuticalization of mental health vulnerabilities of youth are both a structural and cultural problem.

Keywords: adolescents, antidepressants, benzodiazepines, mental health system, psychotropic drugs

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12679 Alteration of Placental Development and Vascular Dysfunction in Gestational Diabetes Mellitus Has Impact on Maternal and Infant Health

Authors: Sadia Munir

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The aim of this study is to investigate changes in placental development and vascular dysfunction which subsequently affect feto-maternal health in pregnancies complicated by gestational diabetes mellitus (GDM). Fetal and postnatal adverse health outcomes of GDM are shown to be associated with disturbances in placental structure and function. Children of women with GDM are more likely to be obese and diabetic in childhood and adulthood. GDM also increases the risk of adverse pregnancy outcomes, including preeclampsia, birth injuries, macrosomia and neonatal hypoglycemia, respiratory distress syndrome, neonatal cardiac dysfunction and stillbirth. Incidences of type 2 diabetes in the MENA region are growing at an alarming rate which is estimated to become more than double by 2030. Five of the top 10 countries for diabetes prevalence in 2010 were in the Gulf region. GDM also increases the risk of development of type 2 diabetes. Interestingly, more than half of the women with GDM develop diabetes later in their life. The human placenta is a temporary organ located at the interface between mother and fetal blood circulation. Placenta has a central role as both a producer as well as a target of several molecules that are involved in placental development and function. We have investigated performed a Pubmed search with key words placenta, GDM, placental villi, vascularization, cytokines, growth factors, inflammation, hypoxia, oxidative stress and pathophysiology. We have investigated differences in the development and vascularization of placenta, their underlying causes and impact on feto-maternal health through literature review. We have also identified gaps in the literature and research questions that need to be answered to completely understand the central role of placenta in the GDM. This study is important in understanding the pathophysiology of placenta due to changes in the vascularization of villi, surface area and diameter of villous capillaries in pregnancies complicated by GDM. It is necessary to understand these mechanisms in order to develop treatments to reverse their effects on placental malfunctioning, which in turn, will result in improved mother and child health.

Keywords: gestational diabetes mellitus, placenta, vasculature, villi

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12678 Survival Analysis of Identifying the Risk Factors of Affecting the First Recurrence Time of Breast Cancer: The Case of Tigray, Ethiopia

Authors: Segen Asayehegn

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Introduction: In Tigray, Ethiopia, next to cervical cancer, breast cancer is one of the most common cancer health problems for women. Objectives: This article is proposed to identify the prospective and potential risk factors affecting the time-to-first-recurrence of breast cancer patients in Tigray, Ethiopia. Methods: The data were taken from the patient’s medical record that registered from January 2010 to January 2020. The study considered a sample size of 1842 breast cancer patients. Powerful non-parametric and parametric shared frailty survival regression models (FSRM) were applied, and model comparisons were performed. Results: Out of 1842 breast cancer patients, about 1290 (70.02%) recovered/cured the disease. The median cure time from breast cancer is found at 12.8 months. The model comparison suggested that the lognormal parametric shared a frailty survival regression model predicted that treatment, stage of breast cancer, smoking habit, and marital status significantly affects the first recurrence of breast cancer. Conclusion: Factors like treatment, stages of cancer, and marital status were improved while smoking habits worsened the time to cure breast cancer. Recommendation: Thus, the authors recommend reducing breast cancer health problems, the regional health sector facilities need to be improved. More importantly, concerned bodies and medical doctors should emphasize the identified factors during treatment. Furthermore, general awareness programs should be given to the community on the identified factors.

Keywords: acceleration factor, breast cancer, Ethiopia, shared frailty survival models, Tigray

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12677 Annoyance Caused by Air Pollution: A Comparative Study of Two Industrialized Regions

Authors: Milena M. Melo, Jane M. Santos, Severine Frere, Valderio A. Reisen, Neyval C. Reis Jr., Mariade Fátima S. Leite

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Although there had been a many studies that shows the impact of air pollution on physical health, comparatively less was known of human behavioral responses and annoyance impacts. Annoyance caused by air pollution is a public health problem because it can be an ambient stressor causing stress and disease and can affect quality of life. The objective of this work is to evaluate the annoyance caused by air pollution in two different industrialized urban areas, Dunkirk (France) and Vitoria (Brazil). The populations of these cities often report feeling annoyed by dust. Surveys were conducted, and the collected data were analyzed using statistical analyses. The results show that sociodemographic variables, importance of air quality, perceived industrial risk, perceived air pollution and occurrence of health problems play important roles in the perceived annoyance. These results show the existence of a common problem in geographically distant areas and allow stakeholders to develop prevention strategies.

Keywords: air pollution, annoyance, industrial risks, public health, perception of pollution, settled dust

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12676 Knowledge regarding Sexual and Reproductive Health among Adolescents in Higher Secondary School

Authors: Kopila Shrestha

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Adolescent sexual reproductive health is one of the most important issues in the world. Reproductive ability is taking place at an earlier age and adolescents are indulging in risk taking behaviors day by day. A descriptive cross-sectional study was conducted in Kathmandu valley to assess the knowledge regarding sexual and reproductive health among adolescent. Total of 200 respondents were selected through non-probability convenient sampling technique. Self-administered written questionnaires using semi-structured questions were used. The collected data were analyzed by using descriptive statistics such as frequency, percentage, mean, standard deviation and inferential statistics such as Chi-square test. The findings revealed that most of the respondents had adequate knowledge regarding transmission and protection of HIV/AIDs and STIs but still some respondents had a misconception regarding it. Few respondents had knowledge regarding legal age for marriage and the minimum age for first child bearing. The statistical analysis revealed that the total mean knowledge score with standard deviation was 45.02±8.674. Nearly half of the respondents (49.5%) had a moderate level of knowledge, followed by an inadequate level of knowledge 29.5% and adequate level of knowledge 21.0% regarding sexual and reproductive health. There was significant association of level of knowledge with area of residence (p-value .002) but no association with age (p-value .067), sex (p-value .999), religion (p-value .082) and ethnicity (p-value .114). Nearly half of the participants possess some knowledge about sexual and reproductive health but still effective educational intervention is required in higher secondary school to encourage more sensible and healthy behaviour.

Keywords: adolescents, higher secondary school, knowledge, sexual and reproductive health

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12675 Re-identification Risk and Mitigation in Federated Learning: Human Activity Recognition Use Case

Authors: Besma Khalfoun

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In many current Human Activity Recognition (HAR) applications, users' data is frequently shared and centrally stored by third parties, posing a significant privacy risk. This practice makes these entities attractive targets for extracting sensitive information about users, including their identity, health status, and location, thereby directly violating users' privacy. To tackle the issue of centralized data storage, a relatively recent paradigm known as federated learning has emerged. In this approach, users' raw data remains on their smartphones, where they train the HAR model locally. However, users still share updates of their local models originating from raw data. These updates are vulnerable to several attacks designed to extract sensitive information, such as determining whether a data sample is used in the training process, recovering the training data with inversion attacks, or inferring a specific attribute or property from the training data. In this paper, we first introduce PUR-Attack, a parameter-based user re-identification attack developed for HAR applications within a federated learning setting. It involves associating anonymous model updates (i.e., local models' weights or parameters) with the originating user's identity using background knowledge. PUR-Attack relies on a simple yet effective machine learning classifier and produces promising results. Specifically, we have found that by considering the weights of a given layer in a HAR model, we can uniquely re-identify users with an attack success rate of almost 100%. This result holds when considering a small attack training set and various data splitting strategies in the HAR model training. Thus, it is crucial to investigate protection methods to mitigate this privacy threat. Along this path, we propose SAFER, a privacy-preserving mechanism based on adaptive local differential privacy. Before sharing the model updates with the FL server, SAFER adds the optimal noise based on the re-identification risk assessment. Our approach can achieve a promising tradeoff between privacy, in terms of reducing re-identification risk, and utility, in terms of maintaining acceptable accuracy for the HAR model.

Keywords: federated learning, privacy risk assessment, re-identification risk, privacy preserving mechanisms, local differential privacy, human activity recognition

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12674 Magnitude and Determinants of Overweight and Obesity among High School Adolescents in Addis Ababa, Ethiopia

Authors: Mulugeta Shegaze, Mekitie Wondafrash, Alemayehu A. Alemayehu, Shikur Mohammed, Zewdu Shewangezaw, Mukerem Abdo, Gebresilasea Gendisha

Abstract:

Background: The 2004 World Health Assembly called for specific actions to halt the overweight and obesity epidemic that is currently penetrating urban populations in the developing world. Adolescents require particular attention due to their vulnerability to develop obesity and the fact that adolescent weight tracks strongly into adulthood. However, there is scarcity of information on the modifiable risk factors to be targeted for primary intervention among urban adolescents in Ethiopia. This study was aimed at determining the magnitude and risk factors of overweight and obesity among high school adolescents in Addis Ababa. Methods: An institution-based cross-sectional study was conducted in February and March 2014 on 456 randomly selected adolescents from 20 high schools in Addis Ababa city.  Demographic data and other risk factors of overweight and obesity were collected using self-administered structured questionnaire, whereas anthropometric measurements of weight and height were taken using calibrated equipment and standardized techniques. The WHO STEPS instrument for chronic disease risk was applied to assess dietary habit and physical activity. Overweight and obesity status was determined based on BMI-for-age percentiles of WHO 2007 reference population. Results: The prevalence rates of overweight, obesity, and overall overweight/ obesity among high school adolescents in Addis Ababa were 9.7% (95%CI = 6.9-12.4%), 4.2% (95%CI = 2.3-6.0%), and 13.9% (95%CI = 10.6-17.1%), respectively. Overweight/obesity prevalence was highest among female adolescents, in private schools, and in the higher wealth category. In multivariable regression model, being female [AOR(95%CI) = 5.4(2.5,12.1)], being from private school [AOR(95%CI) = 3.0(1.4,6.2)], having >3 regular meals [AOR(95%CI) = 4.0(1.3,13.0)], consumption of sweet foods [AOR(95%CI) = 5.0(2.4,10.3)] and spending >3 hours/day sitting [AOR(95%CI) = 3.5(1.7,7.2)] were found to increase overweight/ obesity risk, whereas high Total Physical Activity level [AOR(95%CI) = 0.21(0.08,0.57)] and better nutrition knowledge [AOR(95%CI) = 0.160.07,0.37)] were found protective. Conclusions: More than one in ten of the high school adolescents were affected by overweight/obesity with dietary habit and physical activity are important modifiable risk factors. Well-tailored nutrition education program targeting lifestyle change should be initiated with more emphasis to female adolescents and students in private schools.

Keywords: adolescents, NCDs, overweight, obesity

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12673 Oral Hygiene Behaviors among Pregnant Women with Diabetes Who Attend Primary Health Care Centers at Baghdad City

Authors: Zena F. Mushtaq, Iqbal M. Abbas

Abstract:

Background: Diabetes mellitus during pregnancy is one of the major medical and social problems with increasing prevalence in last decades and may lead to more vulnerable to dental problems and increased risk for periodontal diseases. Objectives: To assess oral hygiene behaviors among pregnant women with diabetes who attended primary health care centers and find out the relationship between oral hygiene behaviors and studied variables. Methodology: A cross sectional design was conducted from 7 July to 30 September 2014 on non probability (convenient sample) of 150 pregnant women with diabetes was selected from twelve Primary Health Care Centers at Baghdad city. Questionnaire format is tool for data collection which had designed and consisted of three main parts including: socio demographic, reproductive characteristics and items of oral hygiene behaviors among pregnant women with diabetes. Reliability of the questionnaire was determined through internal consistency of correlation coefficient (R= 0.940) and validity of content was determined through reviewing it by (12) experts in different specialties and was determined through pilot study. Descriptive and inferential statistics were used to analyze collected data. Result: Result of study revealed that (35.3%) of study sample was (35-39) years old with mean and SD is (X & SD = 33.57 ± 5.54) years, and (34.7%) of the study sample was graduated from primary school and less, half of the study sample was government employment and self employed, (42.7%) of the study sample had moderate socioeconomic status, the highest percentage (70.0%) of the study sample was nonsmokers, The result indicates that oral hygiene behaviors have moderate mean score in all items. There are no statistical significant association between oral hygiene domain and studied variables. Conclusions: All items related to health behavior concerning oral hygiene is in moderate mean of score, which may expose pregnant women with diabetes to high risk of periodontal diseases. Recommendations: Dental care provider should perform a dental examination at least every three months for each pregnant woman with diabetes, explanation of the effect of DM on periodontal health, oral hygiene instruction, oral prophylaxis, professional cleaning and treatment of periodontal diseases(scaling and root planing) when needed.

Keywords: diabetes, health behavior, pregnant women, oral hygiene

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12672 A Model of Human Security: A Comparison of Vulnerabilities and Timespace

Authors: Anders Troedsson

Abstract:

For us humans, risks are intimately linked to human vulnerabilities - where there is vulnerability, there is potentially insecurity, and risk. Reducing vulnerability through compensatory measures means increasing security and decreasing risk. The paper suggests that a meaningful way to approach the study of risks (including threats, assaults, crisis etc.), is to understand the vulnerabilities these external phenomena evoke in humans. As is argued, the basis of risk evaluation, as well as responses, is the more or less subjective perception by the individual person, or a group of persons, exposed to the external event or phenomena in question. This will be determined primarily by the vulnerability or vulnerabilities that the external factor are perceived to evoke. In this way, risk perception is primarily an inward dynamic, rather than an outward one. Therefore, a route towards an understanding of the perception of risks, is a closer scrutiny of the vulnerabilities which they can evoke, thereby approaching an understanding of what in the paper is called the essence of risk (including threat, assault etc.), or that which a certain perceived risk means to an individual or group of individuals. As a necessary basis for gauging the wide spectrum of potential risks and their meaning, the paper proposes a model of human vulnerabilities, drawing from i.a. a long tradition of needs theory. In order to account for the subjectivity factor, which mediates between the innate vulnerabilities on the one hand, and the event or phenomenon out there on the other hand, an ensuing ontological discussion about the timespace characteristics of risk/threat/assault as perceived by humans leads to the positing of two dimensions. These two dimensions are applied on the vulnerabilities, resulting in a modelling effort featuring four realms of vulnerabilities which are related to each other and together represent a dynamic whole. In approaching the problem of risk perception, the paper thus defines the relevant realms of vulnerabilities, depicting them as a dynamic whole. With reference to a substantial body of literature and a growing international policy trend since the 1990s, this model is put in the language of human security - a concept relevant not only for international security studies and policy, but also for other academic disciplines and spheres of human endeavor.

Keywords: human security, timespace, vulnerabilities, risk perception

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12671 Evaluating the Effects of Weather and Climate Change to Risks in Crop Production

Authors: Marcus Bellett-Travers

Abstract:

Different modelling approaches have been used to determine or predict yield of crops in different geographies. Central to the methodologies are the presumption that it is the absolute yield of the crop in a given location that is of the highest priority to those requiring information on crop productivity. Most individuals, companies and organisations within the agri-food sector need to be able to balance the supply of crops with the demand for them. Different modelling approaches have been used to determine and predict crop yield. The growing need to ensure certainty of supply and stability of prices requires an approach that describes the risk in producing a crop. A review of current methodologies to evaluate the risk to food production from changes in the weather and climate is presented.

Keywords: crop production, risk, climate, modelling

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12670 Capacities of Early Childhood Education Professionals for the Prevention of Social Exclusion of Children

Authors: Dejana Bouillet, Vlatka Domović

Abstract:

Both policymakers and researchers recognize that participating in early childhood education and care (ECEC) is useful for all children, especially for those who are exposed to the high risk of social exclusion. Social exclusion of children is understood as a multidimensional construct including economic, social, cultural, health, and other aspects of disadvantage and deprivation, which individually or combined can have an unfavorable effect on the current life and development of a child, as well as on the child’s development and on disadvantaged life chances in adult life. ECEC institutions should be able to promote educational approaches that portray developmental, cultural, language, and other diversity amongst children. However, little is known about the ways in which Croatian ECEC institutions recognize and respect the diversity of children and their families and how they respond to their educational needs. That is why this paper is dedicated to the analysis of the capacities of ECEC professionals to respond to the demands of educational needs of this very diverse group of children and their families. The results obtained in the frame of the project “Models of response to educational needs of children at risk of social exclusion in ECEC institutions,” funded by the Croatian Science Foundation, will be presented. The research methodology arises from explanations of educational processes and risks of social exclusion as a complex and heterogeneous phenomenon. The preliminary results of the qualitative data analysis of educational practices regarding capacities to identify and appropriately respond to the requirements of children at risk of social exclusion will be presented. The data have been collected by interviewing educational staff in 10 Croatian ECEC institutions (n = 10). The questions in the interviews were related to various aspects of inclusive institutional policy, culture, and practices. According to the analysis, it is possible to conclude that Croatian ECEC professionals are still faced with great challenges in the process of implementation of inclusive policies, culture, and practices. There are several baselines of this conclusion. The interviewed educational professionals are not familiar enough with the whole complexity and diversity of needs of children at risk of social exclusion, and the ECEC institutions do not have enough resources to provide all interventions that these children and their families need.

Keywords: children at risk of social exclusion, ECEC professionals, inclusive policies, culture and practices, quallitative analysis

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12669 Telling the Truth to Patients Before Hip Fracture Surgery

Authors: Rawan Masarwa, Merav Ben Natan, Yaron Berkovich

Abstract:

Background: Hip fracture repair surgery carries a certain mortality risk, yet evidence suggests that orthopedic surgeons often refrain from discussing this issue with patients prior to surgery. Aim: This study aims to examine whether orthopedic surgeons address the issue of one-year post-surgery mortality before hip fracture repair surgery and to explore the factors influencing this decision. Method: The study uses a cross-sectional design, administering validated digital questionnaires to 150 orthopedic surgeons. Results: A minority of orthopedic surgeons reported consistently informing patients about the risk of mortality in the year following hip fracture surgery. The primary reasons for not discussing this risk were a desire to avoid frightening patients, time constraints, and concerns about undermining patient hope. Surgeons reported a medium-high level of perceived self-efficacy, with higher self-efficacy linked to a reduced likelihood of discussing one-year mortality risk. In contrast, older age and holding a specialist status in orthopedic surgery were associated with a higher likelihood of discussing this risk with patients. Conclusions: The findings suggest a need for interventions to address communication barriers and ensure consistent provision of essential information to patients undergoing hip fracture surgery. Additionally, they emphasize the importance of considering individual factors such as self-efficacy, age, and expertise in developing strategies to enhance patient-provider communication in orthopedic care settings.

Keywords: orthopedic surgeons, hip fracture surgery, mortality risk communication, patient information

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12668 Evaluating the Feasibility of Chemical Dermal Exposure Assessment Model

Authors: P. S. Hsi, Y. F. Wang, Y. F. Ho, P. C. Hung

Abstract:

The aim of the present study was to explore the dermal exposure assessment model of chemicals that have been developed abroad and to evaluate the feasibility of chemical dermal exposure assessment model for manufacturing industry in Taiwan. We conducted and analyzed six semi-quantitative risk management tools, including UK - Control of substances hazardous to health ( COSHH ) Europe – Risk assessment of occupational dermal exposure ( RISKOFDERM ), Netherlands - Dose related effect assessment model ( DREAM ), Netherlands – Stoffenmanager ( STOFFEN ), Nicaragua-Dermal exposure ranking method ( DERM ) and USA / Canada - Public Health Engineering Department ( PHED ). Five types of manufacturing industry were selected to evaluate. The Monte Carlo simulation was used to analyze the sensitivity of each factor, and the correlation between the assessment results of each semi-quantitative model and the exposure factors used in the model was analyzed to understand the important evaluation indicators of the dermal exposure assessment model. To assess the effectiveness of the semi-quantitative assessment models, this study also conduct quantitative dermal exposure results using prediction model and verify the correlation via Pearson's test. Results show that COSHH was unable to determine the strength of its decision factor because the results evaluated at all industries belong to the same risk level. In the DERM model, it can be found that the transmission process, the exposed area, and the clothing protection factor are all positively correlated. In the STOFFEN model, the fugitive, operation, near-field concentrations, the far-field concentration, and the operating time and frequency have a positive correlation. There is a positive correlation between skin exposure, work relative time, and working environment in the DREAM model. In the RISKOFDERM model, the actual exposure situation and exposure time have a positive correlation. We also found high correlation with the DERM and RISKOFDERM models, with coefficient coefficients of 0.92 and 0.93 (p<0.05), respectively. The STOFFEN and DREAM models have poor correlation, the coefficients are 0.24 and 0.29 (p>0.05), respectively. According to the results, both the DERM and RISKOFDERM models are suitable for performance in these selected manufacturing industries. However, considering the small sample size evaluated in this study, more categories of industries should be evaluated to reduce its uncertainty and enhance its applicability in the future.

Keywords: dermal exposure, risk management, quantitative estimation, feasibility evaluation

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12667 Clinical Risk Score for Mortality and Predictors of Severe Disease in Adult Patients with Dengue

Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

Abstract:

Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

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12666 Entropy Risk Factor Model of Exchange Rate Prediction

Authors: Darrol Stanley, Levan Efremidze, Jannie Rossouw

Abstract:

We investigate the predictability of the USD/ZAR (South African Rand) exchange rate with sample entropy analytics for the period of 2004-2015. We calculate sample entropy based on the daily data of the exchange rate and conduct empirical implementation of several market timing rules based on these entropy signals. The dynamic investment portfolio based on entropy signals produces better risk adjusted performance than a buy and hold strategy. The returns are estimated on the portfolio values in U.S. dollars. These results are preliminary and do not yet account for reasonable transactions costs, although these are very small in currency markets.

Keywords: currency trading, entropy, market timing, risk factor model

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12665 Hepatitis B Prevalence in Institutionalized Intellectually Disabled Children

Authors: Maryam Vaezjalali, Foad Davoodbeglou, Mehrnaz Mesdaghi, Hossein Goudarzi, Fariba Shojaei, Hourieh Aram

Abstract:

Introduction: Hepatitis B virus (HBV) infection causes chronic infection in human population, with high mortality. Some people are more susceptible to this infection. One of the high risk communities is mentally retarded children, who are institutionalized. Special conditions in these centers predispose children for HBV infection and transmission to healthy people. In this study our objective was to determine the prevalence of HBV infection among institutionalized mentally retarded children and study its associated risk factors. Materials and methods: In this study, 250 mentally retarded children (younger than 14 years old) were included. They were living in 5 nursing institutions, located in different parts of Tehran. HBsAg was measured in the sera of these patients by ELISA method. Results: Among 250 children, 20 children (8%) were HBsAg positive. HBV infection in girls was more than boys (11% to 5.6%). Among the types of mental retardation, children with cerebral palsy had the highest positive result for HBsAg. The most HBV infection (28.5%) was seen in children with longest duration of being institutionalized (10 to 11 years). Vaccinated children were more HBsAg positive (8.7%) than non-vaccinated children (5.3%). However, no significant relationship was observed between any of these factors and HBsAg positivity. Conclusion: Despite improvement of people’s health condition and implementation of HBV vaccination, the prevalence of HBV infection is high in institutionalized mentally retarded children, which highlights the need for active measures to reduce this infection among this high risk population.

Keywords: hepatitis B virus, HBV vaccine, intellectually disabled children, mentally retarded

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12664 Spatial Analysis as a Tool to Assess Risk Management in Peru

Authors: Josué Alfredo Tomas Machaca Fajardo, Jhon Elvis Chahua Janampa, Pedro Rau Lavado

Abstract:

A flood vulnerability index was developed for the Piura River watershed in northern Peru using Principal Component Analysis (PCA) to assess flood risk. The official methodology to assess risk from natural hazards in Peru was introduced in 1980 and proved effective for aiding complex decision-making. This method relies in part on decision-makers defining subjective correlations between variables to identify high-risk areas. While risk identification and ensuing response activities benefit from a qualitative understanding of influences, this method does not take advantage of the advent of national and international data collection efforts, which can supplement our understanding of risk. Furthermore, this method does not take advantage of broadly applied statistical methods such as PCA, which highlight central indicators of vulnerability. Nowadays, information processing is much faster and allows for more objective decision-making tools, such as PCA. The approach presented here develops a tool to improve the current flood risk assessment in the Peruvian basin. Hence, the spatial analysis of the census and other datasets provides a better understanding of the current land occupation and a basin-wide distribution of services and human populations, a necessary step toward ultimately reducing flood risk in Peru. PCA allows the simplification of a large number of variables into a few factors regarding social, economic, physical and environmental dimensions of vulnerability. There is a correlation between the location of people and the water availability mainly found in rivers. For this reason, a comprehensive vision of the population location around the river basin is necessary to establish flood prevention policies. The grouping of 5x5 km gridded areas allows the spatial analysis of flood risk rather than assessing political divisions of the territory. The index was applied to the Peruvian region of Piura, where several flood events occurred in recent past years, being one of the most affected regions during the ENSO events in Peru. The analysis evidenced inequalities for the access to basic services, such as water, electricity, internet and sewage, between rural and urban areas.

Keywords: assess risk, flood risk, indicators of vulnerability, principal component analysis

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12663 Frailty Patterns in the US and Implications for Long-Term Care

Authors: Joelle Fong

Abstract:

Older persons are at greatest risk of becoming frail. As survival to the age of 80 and beyond continues to increase, the health and frailty of older Americans has garnered much recent attention among policy makers and healthcare administrators. This paper examines patterns in old-age frailty within a multistate actuarial model that characterizes the stochastic process of biological ageing. Using aggregate population-level U.S. mortality data, we implement a stochastic aging model to examine cohort trends and gender differences in frailty distributions for older Americans born 1865 – 1894. The stochastic ageing model, which draws from the fields of actuarial science and gerontology, is well-established in the literature. The implications for public health insurance programs are also discussed. Our results suggest that, on average, women tend to be frailer than men at older ages and reveal useful insights about the magnitude of the male-female differential at critical age points. Specifically, we note that the frailty statuses of males and females are actually quite comparable from ages 65 to 80. Beyond age 80, however, the frailty levels start to diverge considerably implying that women are moving quicker into worse states of health than men. Tracking average frailty by gender over 30 successive birth cohorts, we also find that frailty levels for both genders follow a distinct peak-and-trough pattern. For instance, frailty among 85-year old American survivors increased in years 1954-1963, decreased in years 1964-1971, and again started to increase in years 1972-1979. A number of factors may have accounted for these cohort differences including differences in cohort life histories, differences in disease prevalence, differences in lifestyle and behavior, differential access to medical advances, as well as changes in environmental risk factors over time. We conclude with a discussion on the implications of our findings on spending for long-term care programs within the broader health insurance system.

Keywords: actuarial modeling, cohort analysis, frail elderly, health

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12662 Competition between Regression Technique and Statistical Learning Models for Predicting Credit Risk Management

Authors: Chokri Slim

Abstract:

The objective of this research is attempting to respond to this question: Is there a significant difference between the regression model and statistical learning models in predicting credit risk management? A Multiple Linear Regression (MLR) model was compared with neural networks including Multi-Layer Perceptron (MLP), and a Support vector regression (SVR). The population of this study includes 50 listed Banks in Tunis Stock Exchange (TSE) market from 2000 to 2016. Firstly, we show the factors that have significant effect on the quality of loan portfolios of banks in Tunisia. Secondly, it attempts to establish that the systematic use of objective techniques and methods designed to apprehend and assess risk when considering applications for granting credit, has a positive effect on the quality of loan portfolios of banks and their future collectability. Finally, we will try to show that the bank governance has an impact on the choice of methods and techniques for analyzing and measuring the risks inherent in the banking business, including the risk of non-repayment. The results of empirical tests confirm our claims.

Keywords: credit risk management, multiple linear regression, principal components analysis, artificial neural networks, support vector machines

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12661 Effectiveness of Project Grit in Building Resilience among At-Risk Adolescents: A Case Study

Authors: Narash Narasimman, Calvin Leong Jia Jun, Raksha Karthik, Paul Englert

Abstract:

Background: Project Grit, a 12-week youth resilience program implemented by Impart and Spartans Boxing Club, aimed to help at-risk adolescents develop resilience through psychoeducation and mental health techniques for dealing with everyday stressors and adversity. The programme consists of two parts-1.5 hours of group therapy followed by 1 hour of boxing. Due to the novelty of the study, 6 male participants, aged 13 to 18, were recruited to participate in the study. Aim: This case study aims to examine the effectiveness of Project Grit in building resilience among at-risk adolescents. Methods: A case study design was employed to capture the complexity and uniqueness of the intervention, without oversimplifying or generalizing it. A 15-year-old male participant with a history of behavioural challenges, delinquency and gang involvement was selected for the study. Teacher, parent and child versions of the Strengths and Difficulties Questionnaire (SDQ) were administered to the facilitators, parents and participants respectively before and after the programme. Relevant themes from the qualitative interviews will be discussed. Results: Scores from all raters revealed improvements in most domains of the SDQ. Total difficulties scores across all raters improved from “very high” to “close to average”. High interrater reliability was observed (κ= .81). The participant reported learning methods to effectively deal with his everyday concerns using healthy coping strategies, developing a supportive social network, and building on his self efficacy. Themes from the subject’s report concurred with the improvement in SDQ scores. Conclusions: The findings suggest that Project Grit is a promising intervention for promoting resilience among at-risk adolescents. The teleological behaviourism framework and the combination of sports engagement and future orientation may be particularly effective in fostering resilience among this population. Further studies need to be conducted with a larger sample size to further validate the effectiveness of Project Grit.

Keywords: resilience, project grit, adolescents, at-risk, boxing, future orientation

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