Pripravnost javnog zdravstva Europskih zemalja za kemijske nesreće

In response to the attack of 11 September 2001 on the USA, World Health Organization (WHO), Regional Office for Europe took immediate steps in order to be able to assist countries in case of a terrorist attack. Among other things, WHO organised a series of different consultations with international organisations, government representatives and experts in order to assess the state of preparedness at the national and international levels, to identify the main problems and to make recommendations. The problems were addressed in the context of possible public health consequences, regardless of whether such an incident derived from a deliberate act or a naturally occurring event. This overview gives a brief account of presentation made at the European Union “First Civil Protection Forum”, which was held in Brussels in November 2002, and which served as a basis for defining the EU priorities and actions to make Europe a safer place to live.Kao odgovor na napad na Sjedinjene Američke Države 11. rujna 2001, Regionalni ured za Europu Svjetske zdravstvene organizacije (SZO) odmah je poduzeo nekoliko koraka kako bi bio spreman da pomogne državama u slučaju terorističkog napada. Među ostalim, SZO je organizirao niz različitih konzultacija s međunarodnim organizacijama, predstavnicima država i ekspertima s ciljem da se procijeni stupanj pripreme na nacionalnoj i međunarodnoj razini, da se identificiraju glavni problemi, te da se donesu preporuke. Tim problemima pristupilo se u kontekstu mogućih posljedica na javno zdravstvo, neovisno o tome da li se radi o namjernom aktu ili prirodno nastalom slučaju. Ovaj pregled predstavlja kratki sadržaj uvodnog predavanja pripremljenog za “Prvi forum civilne zaštite” Europske unije, koji je održan u Bruxellesu u studenome 2002, a koji je poslužio kao osnova za definiranje prioriteta i akcija Europske unije, kako bi Europa postala sigurnije mjesto za život

Risk factors for delay in symptomatic presentation: a survey of cancer patients

Background: Delay in symptomatic presentation leading to advanced stage at diagnosis may contribute to poor cancer survival. To inform public health approaches to promoting early symptomatic presentation, we aimed to identify risk factors for delay in presentation across several cancers. Methods: We surveyed 2371 patients with 15 cancers about nature and duration of symptoms using a postal questionnaire. We calculated relative risks for delay in presentation (time from symptom onset to first presentation >3 months) by cancer, symptoms leading to diagnosis and reasons for putting off going to the doctor, controlling for age, sex and deprivation group. Results: Among 1999 cancer patients reporting symptoms, 21% delayed presentation for >3 months. Delay was associated with greater socioeconomic deprivation but not age or sex. Patients with prostate (44%) and rectal cancer (37%) were most likely to delay and patients with breast cancer least likely to delay (8%). Urinary difficulties, change of bowel habit, systemic symptoms (fatigue, weight loss and loss of appetite) and skin symptoms were all common and associated with delay. Overall, patients with bleeding symptoms were no more likely to delay presentation than patients who did not have bleeding symptoms. However, within the group of patients with bleeding symptoms, there were significant differences in risk of delay by source of bleeding: 35% of patients with rectal bleeding delayed presentation, but only 9% of patients with urinary bleeding. A lump was a common symptom but not associated with delay in presentation. Twenty-eight percent had not recognised their symptoms as serious and this was associated with a doubling in risk of delay. Embarrassment, worry about what the doctor might find, being too busy to go to the doctor and worry about wasting the doctor’s time were also strong risk factors for delay, but were much less commonly reported (<6%). Interpretation: Approaches to promote early presentation should aim to increase awareness of the significance of cancer symptoms and should be designed to work for people of the lowest socioeconomic status. In particular, awareness that rectal bleeding is a possible symptom of cancer should be raised

Risk factors for delayed presentation and referral of symptomatic cancer: Evidence for common cancers

Background:It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.Methods:We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these.Results:Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, ‘misdiagnosis’ occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results.Conclusion:Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately. © 2009 Cancer Research UK All rights reserved

Quid pro quo:reflections on the value of problem structuring workshops

Attracting clients who are willing to invest in using a problem structuring method (PSM) can be particularly difficult for the emerging generation of modellers. There are many reasons for this, not least that the benefits of a problem structuring intervention are vague and evidence of benefits are often anecdotal for example, claims of constructing a deeper understanding of the problem or building the commitment of a group to implementing an outcome. This paper contributes to the evaluation of problem structuring methods by reflecting on the quid pro quo that a client and problem structuring modeller can enjoy from collaboration. The paper reflects on 21 cases, where Journey Making (a problem structuring method) was used with 16 organizations to help managers agree a suite of actions to tackle a complex strategic issue. The reflections are clustered around those benefits that pertain to: PSMs in general; PSMs that use computer-supported workshops; the Journey Making methodology

Consumer acceptance of dairy products with a saturated fatty acid-reduced, monounsaturated fatty acid-enriched content

Agriculture-based reformulation initiatives, including oleic acid-rich lipid supplementation of the dairy cow diet, provide a novel means for reducing intake of saturated fatty acids (SFA) at a population level. In a blinded manner, this study evaluated the consumer acceptance of SFA-reduced, monounsaturated fatty acid-enriched (modified) milk, Cheddar cheese, and butter when compared with control and commercially available comparative samples. The effect of providing nutritional information about the modified cheese was also evaluated. Consumers (n = 115) rated samples for overall liking (appearance, flavor, and texture) using 9-point hedonic scales. Although no significant differences were found between the milk samples, the modified cheese was liked significantly less than a regular-fat commercial alternative for overall liking and liking of specific modalities and had a lower liking of texture score compared with the control cheese. The provision of health information significantly increased the overall liking of the modified cheese compared with tasting the same sample in a blinded manner. Significant differences were evident between the butter samples for overall liking and modalities of liking; all of the samples were significantly more liked than the commercial butter and sunflower oil spread. In conclusion, this study illustrated that consumer acceptance of SFA-reduced, monounsaturated fatty acid-enriched dairy products was dependent on product type. Future research should consider how optimization of the textural properties of fatty acid-modified (and fat-reduced) cheese might enhance consumer acceptance of this product

Can information affect sensory perceptions? Evidence from a survey on Italian organic food consumers

This paper aims to investigate the influence of information on consumers’ preferences and sensory perceptions of organic food using a sample of 301 Italian organic food consumers. Consumers stated their preferences for “core organic” attributes, labels and information on food products and performed blind and informed tests on strawberry yoghurts and cookies. Data were analysed using descriptive analysis, Mann-Whitney U tests and Wilcoxon signed-rank test. Results revealed that consumers appreciate “core organic” attributes, like artisanal production and variability of sensory attributes. Comparing blind and informed tests, results showed that information affects the overall liking of products and consumers’ perception of product-specific sensory attributes. However, the influence of information on sensory perceptions depends on the product category, sensory attributes and the type of information provided

The effects of health value on healthful food selection intention at restaurants: Considering the role of attitudes toward taste and healthfulness of healthful foods

This study investigated restaurant customers’ intent to choose healthful (e.g., low-fat or low-calorie) menu items using the value–attitude–behavior model. The sample was comprised of customers who had previously consumed these types of healthful items at a casual dining restaurant. Structural equation modeling was used to analyze data. Results revealed that customers’ health values had a positive effect on attitudes and behavioral intentions and that customers’ attitudes toward low-fat or low-calorie menu items positively influenced behavioral intentions. However, attitudes toward taste of healthful menu items exerted a greater impact on behavioral intentions to choose, recommend, and spread a positive word-of-mouth about those menu items. To meet customers’ desire, restaurants should continue to focus on great-tasting healthful foods