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THE CONTINUUM OF HEALTH RISK ASSESSMENTS Edited by Michael G. Tyshenko The Continuum of Health Risk Assessments Edited by Michael G. Tyshenko Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Vana Persen Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com The Continuum of Health Risk Assessments, Edited by Michael G. Tyshenko p. cm. ISBN 978-953-51-0212-0 Contents Preface IX Part 1 Typical Health Risk Assessment Case Studies for Novel Risks 1 Chapter 1 The Risk of Blood-Borne Viral Infection due to Syringe Re-Use 3 Tamer Oraby, Susie Elsaadany, Robert Gervais, Mustafa Al-Zoughool, Michael G. Tyshenko, Lynn Johnston, Mel Krajden, Dick Zoutman, Jun Wu and Daniel Krewski Chapter 2 Professional Drivers and Psychoactive Substances Consumption: First Results from Medical Surveillance at the Workplace in Italy 21 Gian Luca Rosso, Mauro Feola, Maria Paola Rubinetto, Nicola Petti and Lorenzo Rubinetto Part 2 Health Risk Assessment Case Studies for Emerging Risks 29 Chapter 3 Xenotropic Murine Leukemia Virus-Related Virus as a Case Study: Using a Precautionary Risk Management Approach for Emerging Blood-Borne Pathogens in Canada 31 Michael G. Tyshenko, Susie ElSaadany, Tamer Oraby, Marian Laderoute, Jun Wu, Willy Aspinall, Daniel Krewski and Peter R. Ganz Chapter 4 Ultrafine and Fine Aerosol Deposition in the Nasal Airways of a 9-Month-Old Girl, a 5-Year-Old Boy and a 53-Year-Old Male 47 Jinxiang Xi, JongWon Kim and Xiuhua A. Si Chapter 5 Safety, Security and Quality: Lessons from GMO Risk Assessments Alice Benessia and Giuseppe Barbiero 73 VI Contents Part 3 Improving Future Risk Assessment Analyses 109 Chapter 6 Breast Cancer Prognostication and Risk Prediction in the Post-Genomic Era 111 Xi Zhao, Ole Christian Lingjærde and Anne-Lise Børresen-Dale Chapter 7 Physics of Open Systems: A New Approach to Use Genomics Data in Risk Assessment 135 Viacheslav Ageev, Boric Fomin, Oleg Fomin, Tamara Kachanova, Chao Chen, Maria Spassova and Leonid Kopylev Chapter 8 New Models for the In Vitro Study of Liver Toxicity: 3D Culture Systems and the Role of Bioreactors 161 Giovanna Mazzoleni and Nathalie Steimberg Preface There are a myriad number of different types of risks that, as individuals, we face every day that impact human health. Exposure to hazards can result from the natural and build environments with modulation of this exposure due to other factors such as our biology (eg. genetics, age, gender and comorbid conditions) and social interactions (eg. lifestyle choices and our level of risk acceptance). A broad population health approach includes determinants of health, this is the collective label given to factors and conditions that are thought to have an influence on health. Using such an extended understanding of the risk issue and its determinants of health context are very important to the scope of risk assessment efforts. Many risks that we face on a daily basis may be unavoidable, so there is an expectation by individuals that the level of risk is being managed and reduced to safe levels through evidence-based risk assessments and public health interventions. There has been a growing recognition that risks need to be viewed in their public health context to ensure that the most important risks are prioritized and addressed. Under a broader public health imperative, risk assessments are used as an important process to quantify the probability of harmful effects to individuals, sub-populations (eg. vulnerable patient groups) or entire populations. Thus, both quantitative and qualitative risk assessments help to evaluate the risks associated with hazards, help to prioritize the risks, and allow for cost-effective option generation to eliminate or control the hazards. The completion of risk assessments, appropriate in scope, can help decision-makers to select the most efficient and effective evidence based strategies. With limited government health budgets challenged by an aging population demographic such an understanding can improve resource allocation. Risk assessment must be sufficiently broad to ensure adequate understanding of the risk and to identify effective risk management options. This book presents an interesting and diverse collection of health risk assessments and health risk management research for known, and emerging risks that span a continuum towards future developments that aim to improve risk assessment analyses. Two case studies for existing health risks are presented in the first section and utilize surveys and look-back modeling methods. The second section deals with X Preface emerging health risk and provides three case studies and demonstrates the difficulties of assessing new risks when the scientific evidence base is limited. The third section provides case studies that challenge traditional assessments to improve future risk assessment methods. Case studies for existing risks in the first section include drug use in Italian professional delivery truck drivers and using look-back risk assessment for syringe reuse in Canada. The first chapter by Oraby et al. describes the occurrence of syringe reuse reported in a Canadian health care setting on approximately 1,400 patients in the province of Alberta. Multiple syringe re-use events may act as a vector to transmit both RNA and DNA viruses. This look-back study analyzed the risks for Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) using a probabilistic model with sensitivity analyses. The second chapter case study by Rosso et al. presents a medical survey that tests professional drivers for the presence of various psychoactive substances. Positives were identified by using a commercially available immunoassay rapid kit test which indicates consumption of psychoactive drugs. This is of interest and important since the dependence on drugs may pose a risk to drivers in their profession affecting their reaction time and driving judgment. This is one of the first and important contributions to the literature in this area. The study is of high importance as drivers under the influence of psychoactive drugs may endanger themselves or others if impaired at the jobsite. Case studies for emerging risks in the second section include evidence-based precautionary interventions to safeguard blood supplies, the evaluation of nanoparticle deposition in the lung and nasal airways and the discourse surrounding emerging potential health risks of genetically modified animals consumed as food. The third chapter by Tyshenko et al. reviews a case study concerning xenotropic murine leukemia virus-related virus (XMRV) and its emergence as a potential new blood pathogen that occurred in 2009; a lack of information for decision-making confounded risk assessment and early management decision-making. The chapter provides insight into the early assessment process and the application of precaution, an often poorly described management action rarely captured in peer review literature. The situation surrounding this potential new threat to blood safety was largely resolved in mid-2011 when it was determined that the virus was an artifact from contaminated patient samples and from contamination stemming from a diagnostic test kit widely used by researchers. The case study provides good assessment and management insight into the application of early precautionary action and the use of expert opinion for proactive risk management of emerging blood-borne pathogens. The fourth chapter by Jinxiang et al. assesses the airflow and aerosol dynamic characteristics within the nasal cavity for three different individuals. The study assesses and models the physical dimensions of the nasal airway and lungs for an