Effect of cold conditions on manual performance while wearing petroleum industry protective clothing

The purpose of this study was to investigate manual performance and thermal responses during low work intensity in persons wearing standard protective clothing in the petroleum industry when they were exposed to a range of temperatures (5, -5, -15 and -25℃) that are relevant to environmental conditions for petroleum industry personnel in northern regions. Twelve men participated in the study. Protective clothing was adjusted for the given cold exposure according to current practices. The subjects performed manual tests five times under each environmental condition. The manual performance test battery consisted of four different tests: tactile sensation (Semmes-Weinstein monofilaments), finger dexterity (Purdue Pegboard), hand dexterity (Complete Minnesota dexterity test) and grip strength (grip dynamometer). We found that exposure to -5℃ or colder lowered skin and body temperatures and reduced manual performance during low work intensity. In conclusion the current protective clothing at a given cold exposure is not adequate to maintain manual performance and thermal balance for petroleum workers in the high north.     

How top managers in health organizations set directions that guide decision making

Cases describing strategic decisions made in health care organizations were analyzed to determine how top managers set directions that guide decision making. Four tactics were identified--issue, idea, objective, and reframing. Decision-adoption rates, decision merit, and duration of the decision-making process were used to determine the effectiveness of each tactic. The effects that stem from using each tactic were qualified by factors describing urgency, importance, and differences between the tactics used by CEOs and middle managers (leverage). Tactics were found to have more influence on decision effectiveness than the intervening variables of urgency, importance, and leverage. Reframing was found to be the most effective tactic under all conditions but was the least frequently used by decision makers. Issue and idea tactics were the least effective, but idea tactics were used more often than any other tactic. Issue tactics were even less effective when applied to urgent and important decisions. Objectives were surprisingly effective in a crisis and for the more important decision.     

Cognitive Development and the Dynamics of Decision-making among Adolescents

Cognitive development was examined in relation to the amount of time students would deliberate before making a decision, the effect of perceived emotional stress on decision making, and identification of all possible decisions that would have to be made. Subjects were 94 eighth-11th grade students in New Mexico and Montana. Results indicated abstract thinkers had a better decision-making process than concrete thinkers and made more health promoting decisions. Health educators are challenged to create educational strategies that enhance abstract development and teach classic steps of decision-making, thus improving the decision-making ability of youth.     

Shared decision making and decision aids - a literature review

Shared decision making (SDM) is a process within a patient centred consultation that involves both the patient and doctor discussing management options and agreeing on management decisions in partnership. Decision aids are designed to help patients understand the options relating to management for certain conditions and their possible benefits and potential adverse effects. We discuss the evolution and rationale behind SDM and the evidence relating to outcomes, the types of decision aids available, and research relating to their use.     

The impact of age on cost-effectiveness ratios and its control in decision making

Throughout Europe and in a number of other industrialized countries, the coming decades have been predicted to feature an increase in the proportion of patients who are elderly. This has led to considerable concern with respect to financing the health care system and has also increased the concerns about the efficiency of health care. Integrating ageing and efficiency issues, this paper examines the effects of age on the cost-effectiveness of medical interventions and its impact on decision making. First, at the clinical level, the relation between age and the cost-effectiveness of medical interventions is analysed. Second, at the population level, a framework is presented which allows researchers and decision makers to assess the impact of these effects on the decision-making process. It is shown that the allocation of health care resources at the macro-level is seriously impaired when age is ignored as a variable in cost-effectiveness analysis. Because clinical trials typically employ ‘young’ populations, when the data are extrapolated to the whole population the attractiveness of medical interventions in terms of cost-effectiveness may be considerably overestimated. Furthermore, the cost-effectiveness ratio may vary across countries or over time as a result of demographic or epidemiological variation. Economic evaluators should describe the impact of age, which should then be considered by decision makers to control for age effects.     

Verma,Ravi K., Pelto,Pretti J., Schensul,Stephen L., Joshi,Archana. (Eds.). (2004). Sexuality in the time of AIDS: Contemporary perspectives from communities in India

There is an ever-growing trend toward more patient involvement in making health care decisions. This trend has been accompanied by the development of “informed decision-making” interventions to help patients become more engaged and comfortable with making these decisions. We describe the effects of a prostate cancer screening decision aid on knowledge, beliefs about screening, risk perception, control preferences, decisional conflict, and decisional anxiety. Data were collected from 200 males aged 50–70 years in the general population who randomly were assigned to exposure to the decision aid or no exposure as a control condition. A Solomon four-group design was used to test for possible pretest sensitization effects and to assess the effects of exposure to the decision aid. No significant pretest sensitization effects were found. Analysis of the exposure effects found that knowledge increased significantly for those exposed to the decision aid compared with those unexposed. Exposure to the decision aid also had some influence on decreasing both decisional conflict and decisional anxiety. Decision aids can play an important role in increasing patients' knowledge and decreasing anxiety when asked to make health care decisions.     

Neuropsychological Learning Deficits as Predictors of Treatment Outcome in Patients with Eating Disorders

Eating disorders (EDs) are severe psychiatric illnesses that require individualized treatments. Decision-making deficits have been associated with EDs. Decision-making learning deficits denote a lack of strategies to elaborate better decisions that can have an impact on recovery and response to treatment. This study used the Iowa Gambling Task (IGT) to investigate learning differences related to treatment outcome in EDs, comparing between patients with a good and bad treatment outcome and healthy controls. Likewise, the predictive role of impaired learning performance on therapy outcome was explored. Four hundred twenty-four participants (233 ED patients and 191 healthy controls) participated in this study. Decision making was assessed using the Iowa Gambling Task before any psychological treatment. All patients received psychological therapy, and treatment outcome was evaluated at discharge. Patients with bad outcome did not show progression in the decision-making task as opposed to those with good outcome and the healthy control sample. Additionally, learning performance in the decision-making task was predictive of their future outcome. The severity of learning deficits in decision making may serve as a predictor of the treatment. These results may provide a starting point of how decision-making learning deficits are operating as dispositional and motivational factors on responsiveness to treatment in EDs.     

Heat strain in cold

In spite of increased environmental cold stress, heat strain is possible also in a cold environment. The body heat balance depends on three factors: environmental thermal conditions, metabolic heat production and thermal insulation of clothing and other protective garments. As physical exercise may increase metabolic heat production from rest values by ten times or even more, the required thermal insulation of clothing may vary accordingly. However, in most outdoor work, and often in indoor cold work, too, the thermal insulation of clothing is impractical, difficult or impossible to adjust according to the changes in physical activity. This is especially true with whole body covering garments like chemical protective clothing. As a result of this imbalance, heat strain may develop. In cold all the signs of heat strain (core temperature above 38 degrees C, warm or hot thermal sensations, increased cutaneous circulation and sweating) may not be present at the same time. Heat strain in cold may be whole body heat strain or related only to torso or core temperature. Together with heat strain in torso or body core, there can be at the same time even cold strain in peripheral parts and/or superficial layers of the body. In cold environment both the preservation of insulation and facilitation of heat loss are important. Development of clothing design is still needed to allow easy adjustments of thermal insulation.     

U.S. EPA authority to use cumulative risk assessments in environmental decision-making

Conventionally, in its decision-making, the U.S. EPA has evaluated the effects and risks associated with a single pollutant in a single exposure medium. In reality, people are exposed to mixtures of pollutants or to the same pollutant through a variety of media, including the air, water, and food. It is now more recognized than before that environmental exposure to pollutants occurs via multiple exposure routes and pathways, including inhalation, ingestion, and dermal absorption. Moreover, chemical, biologic, radiologic, physical, and psychologic stressors are all acknowledged as affecting human health. Although many EPA offices attempt to consider cumulative risk assessment and cumulative effects in various ways, there is no Agency-wide policy for considering these risks and the effects of exposure to these risks when making environmental decisions. This article examines how U.S. courts might assess EPA's general authority and discretion to use cumulative risk assessment as the basis for developing data in support of environmental decision-making, and how courts might assess the validity of a cumulative risk assessment methodology itself.     

Neurobiology of physical environmental stress]

Although effects of physical environmental stress, including noise and whole-body vibration, on human psychological activities and emotion are not negligible for environmental and occupational hygiene, attempts to elucidate their physiological and biomedical mechanisms have been not made until recently. Neurobiological researches on the effects of the physical environment, e.g., noise and whole-body vibration on organisms were reviewed. It has been well accepted that such effects can be classified into specific and nonspecific reactions to the stressor. Activations of the mesofrontal and the meso-accumbens dopaminergic (DA) systems and changes of frontal substance P (SP) have been reported to play a part in emotional changes and to be induced by acute physical environmental stressors as a nonspecific reaction. On the basis of data demonstrating that these three systems do not show the same changes with the chronic exposure, it is assumed that emotional changes may account for the differences among the systems. Specific responses of amygdaline DA and SP to noise suggest that the psychopharmacological mechanisms by which actions of DA and SP in the cortical association areas for the sensory systems of hearing, as well as in the amygdala and the mesencephalon together, cause the specific sensation of noise, and furthermore lead to psychological and physical nonspecific reactions. In these mechanisms, descending amygdalofugal neural systems of SP, neurotensin (NT) and somatostatin are activated as a common pathway, and subsequently relayed to the hypothalamus-pituitary system responsible for several endocrinological hormones. The involvements of the hippocampal VIP in whole-body vibration and of the DA and NT in cold exposure have been pointed out. Further researches to elucidate the roles of central neurotransmitters in physical environmental stress will be important in the study of human high-level mental activity.     

Supervision of students may protect academic physicians from cognitive bias: a study of decision making and multiple treatment alternatives in medicine.

OBJECTIVE: To determine how professional characteristics and practices of physicians alter the selection of medical treatments involving multiple alternatives. Situations involving multiple alternatives can increase the difficulty of making a decision, resulting in more choice deferral than when fewer alternatives are available. DESIGN, SETTING, PARTICIPANTS: A survey and scenario were mailed to a random sample of 314 primary and emergency care physicians affiliated with the Indiana University Medical Center. Using a scenario involving treatment decisions for a patient with osteoarthritis, the effects of multiple treatment alternatives on decision making were explored. Other physician factors included experience, workload, fatigue, continuing education, and supervision. MAIN OUTCOME MEASURES: Physicians' treatment decisions. RESULTS: Physician response was 61% (n = 192). In contrast to previous studies, physicians in the present study were equally likely to prescribe a new medication, regardless of whether they were deciding about 1 medication or between 2 similar medications (54.5% v. 56.0%, P = 0.841). However, physicians who supervise medical students were far less influenced by the cognitive bias associated with multiple choices than those who did not supervise medical students. Supervising physicians were more likely to defer making a decision when there was only 1 treatment option than when there were 2 (49.3% v. 37%, P = 0.143), whereas the opposite was true for nonsupervising physicians (33.3% v. 63%, P = 0.040). The number of hours spent supervising medical students and the number of years as a physician were also important factors in the decision-making process. CONCLUSIONS: Multiple treatment alternatives may result in a deferral of choice. However, this cognitive bias is attenuated by experience and supervision, thus enhancing decision making. Implicit and explicit learning gained through experience and the supervisory process appears to be a central mechanism by which the physicians are protected from this cognitive bias.     

Values Education: Extending the View

A number of values education strategies have recently been developed for use in the classroom. The Shaver model described here incorporates a rational decision-making process based on basic moral values. That process involves identifying and clarifying values, value labeling and generalization, examining the possible consequences of value decision, recognizing and resolving value conflict, and forming qualified decisions. It is not, however, necessary to proceed through that exact sequence of steps. For example, values discussion may begin with the teacher helping a students to recognize a value conflict. From that point, the discussion may move the identification and labeling of values. Consequently, there is flexibility in how this model may be used in the classroom. This model is developed on the premise that people who use such a process in making decisions relating to social-ethnical issues enhance their functioning within a democratic society. It is suggested that people who utilize this process in relation to health issues can likewise enhance the effectiveness of their health-related decisions. Hopefully, there will be a yield of postive health behaviors.     

糖尿病增强环境物理因素致健康损伤效应的研究现状

糖尿病可改变极端气温条件下的体温调节能力,患者在极端低温和高温下生活,遭受冷损伤或热损伤的风险将比健康人群更大;糖尿病可能会延迟暂时性噪声性听力损失的修复能力和加重永久性噪声性听力损失;糖尿病大鼠对电磁场致血脑屏障功能的损伤也比健康大鼠的更严重。因而提示,糖尿病可增强环境物理因素的健康损伤,其机制可能涉及氧化应激、出汗障碍和血流收缩功能异常,因而糖尿病患者这一特殊易感人群需要相应的防护措施。     

Decision making in acquiring medical technologies in Israeli medical centers: a preliminary study

OBJECTIVE: This preliminary study had two objectives: a) charting the considerations relevant to decisions about acquisition of new medical technology at the hospital level; and b) creating a basis for the development of a research tool that will examine the function of the Israeli health system in assessment of new medical technologies. METHODS: A comprehensive literature review and in-depth interviews with decision makers at different levels allowed formulation of criteria considered by decision makers when they decide to purchase and use (or disallow the use) of new medical technology. The resulting questionnaire was sent to medical center directors, along with a letter explaining the goals of the study. The questionnaire included 31 possible considerations for decision making concerning the acquisition of new medical technology by medical centers. The interviewees were asked to indicate the relevance of each consideration in the decision-making process. REULTS: The most relevant criteria for the adoption of new technologies related to the need for a large capital investment, clinical efficacy of the technology as well as its influence on side effects and complication rates, and a formal approval by the Ministry of Health. Most interviewees stated that pressures exerted by the industry, by patients, or by senior physicians in the hospital are less relevant to decision making. Very small and usually not statistically significant differences in the ranking of hospital directors were found according to the hospitals' ownership, size, or location. CONCLUSIONS: The present study is a basis for a future study that will map and describe the function of hospital decision makers within the area of new technology assessment and the decision-making process in the adoption of new healthcare technologies.     

Moderate cold exposure in the Faroe fishing industry

Differences in female workers' finger temperatures, manual dexterity, ratings on thermal comfort, and local cooling exposure were studied in three factories in the Faroe Island fishing industry. Environmental temperatures in the factories varied from 5 to 19 degrees C with vertical gradients of 7 degrees C/m, and the mean temperatures of the flushing water varied from 2 to 15 degrees C. Finger temperature varied from 12 to 24 degrees C when measured 2 min after work was stopped, and about one-third of the women experienced thermal discomfort in the fingers during work. The fish temperature increased, on the average, less than 1 degrees C during passage through the production room, notwithstanding the thermal differences among the factories. These findings should be used in attempts to reduce the cold exposure of the workers; but also improved control should be recommended for both environmental and water temperatures in the factories.     

Determinants of received long-term care – Individual responses to regional nursing home provisions

Existing literature analyzing the choice of received long-term care by frail elderly (65+ years) predominantly focuses on physical and psychological conditions of elderly people as factors that influence the decision for a particular type of care. Until now, however, the regional in-patient long-term care supply has been neglected as influential factor in this decision-making process. In this study, we analyze the determinants of received long-term care in Germany by explicitly taking the regional supply of nursing homes into account. We estimate a multinomial probit model to illustrate this decision-making process. Therefore, within this discrete choice setting we distinguish between all available types of long-term care in Germany, i.e. four different types of formal and informal care provision. We find that the decision for long-term in-patient care is significantly correlated with the regional supply of nursing home beds, while controlling for physical and psychological conditions of the individual.     

Mothers' process of decision making for gastrostomy placement

In this article we present the findings of an exploration of mothers' discourses on decision making for gastrostomy placement for their child. Exploring in-depth interviews of a purposive sample, we analyzed the mothers' discourses of the decision-making process to understand how their experiences of the process influenced their subsequent constructions of decision making. Mothers negotiated decision making by reflecting on their personal experiences of feeding their child, either orally or via a tube, and interwove their background experiences with the communications from members of the health care team until a decision was reached. Decision making was often fraught with difficulty, resulting in anxiety and guilt. Experiences of decision making ranged from perceived coercion to true choice, which encompasses a truly child-centered decision. The resulting impact of the decision-making process on the mothers was profound. We conclude with an exploration of the implications for clinical practice and describe how health care professionals can support mothers to ensure that decision-making processes for gastrostomy placement in children are significantly improved.     

The contingency of patient preferences for involvement in health decision making

BACKGROUND: Studies indicate that better patient compliance and higher patient satisfaction result when agreement exists between the physician and the patient regarding the medical problem and its treatment. PURPOSES: This study will extend previous work by investigating (1) under what conditions patients prefer to be actively involved in their treatment decisions, (2) the underlying theoretical reasons that may account for patient decision-making preferences, and (3) what medical decision-making model can guide physicians and medical policy makers when adapting their medical decision-making styles. METHODOLOGY/APPROACH: A total of 2,765 individuals were surveyed by the National Opinion Research Center as part of the 2002 General Social Survey (GSS). This survey included a one-time topical module on "Doctors and Patients," which incorporated questions on patient preferences concerning the physician-patient relationship. Demographic information (e.g., age, education, and sex) was analyzed against patient preferences for medical decision making. FINDINGS: Results support patient preferences for participatory medical decision making, and this is especially true for younger, more educated, and female patients. PRACTICE IMPLICATIONS: Common prudence would suggest that the best way to determine a patient's preference for participating in medical decision making is to simply ask them. However, the very asking of this straightforward question is based on the assumption that patients do wish to be actively involved. Results of this study support such an assumption. In the absence of all other knowledge, the results of this national survey support the health care practitioner's belief that U.S. patients, in general, have a preference for being actively involved in medical decision making and that this preference is truer for younger, female, and more educated patients.     

Reimbursement of glitazones in treatment of type 2 diabetes patients in Denmark in the context of a voluntary system for submitting pharmacoeconomic studies

In 1998, guidelines for pharmacoeconomic evaluation were issued in Denmark. It was left to the discretion of the industry for which products to submit a pharmacoeconomic study. The impact of this voluntary system is illustrated by a case study on reimbursement of two types of glitazones. A review is presented of the evidence on safety, effectiveness and cost-effectiveness of glitazones that was available in the public domain at the time of reimbursement decision making, which was matched to the Danish criteria for general reimbursement of new pharmaceuticals. The study concludes that the voluntary system has not supported the inclusion of efficiency considerations in reimbursement decision making on glitazones. The decision-making process may be improved by mandatory pharmacoeconomic evaluations for selected products such as glitazones, which potentially represent a benefit to patients and potentially improve the cost-effectiveness of care, while at the same time having a considerable budget impact.