Falls are a common hospital occurrence complicating the care of patients. From an economic perspective, the impact of in-hospital falls and related injuries is substantial. However, few studies have examined the economic implications of falls prevention interventions in an acute care setting. The 6-PACK programme is a targeted nurse delivered falls prevention programme designed specifically for acute hospital wards. It includes a risk assessment tool and six simple strategies that nurses apply to patients classified as high-risk by the tool.
To examine the incremental cost-effectiveness of the 6-PACK programme for the prevention of falls and fall-related injuries, compared with usual care practice, from an acute hospital perspective.
The 6-PACK project is a multicentre cluster randomised controlled trial (RCT) that includes 24 acute medical and surgical wards from six hospitals in Australia to investigate the efficacy of the 6-PACK programme. This economic evaluation will be conducted alongside the 6-PACK cluster RCT. Outcome and hospitalisation cost data will be prospectively collected on approximately 16 000 patients admitted to the participating wards during the 12-month trial period. The results of the economic evaluation will be expressed as ‘cost or saving per fall prevented’ and ‘cost or saving per fall-related injury prevented’ calculated from differences in mean costs and effects in the intervention and control groups, to generate an incremental cost-effectiveness ratio (ICER).
This economic evaluation will provide an opportunity to explore the cost-effectiveness of a targeted nurse delivered falls prevention programme for reducing in-hospital falls and fall-related injuries. This protocol provides a detailed statement of a planned economic evaluation conducted alongside a cluster RCT to investigate the efficacy of the 6-PACK programme to prevent falls and fall-related injuries.
The protocol for the cluster RCT is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000332921).
We agree with their view that the dominant paradigm in injury control is that all childhood injuries, irrespective of their origins, are unacceptable. We would argue this paradigm extends to all age groups. Taken to its extreme, this position does not, however, stand up to scrutiny. Are the proponents seriously suggesting we seek to prevent even the mildest of injuries? For example, a child tripping over and sustaining a barely visible abrasion to her arm but nevertheless is crying as a result. We believe most parents would probably briefly console the child and once the crying had abated encourage them to continue playing and then completely forget about the incident.
...]]>To perform a cost–benefit analysis of the installation of speed cameras on the beltways of Barcelona.
The analysis was performed from the society perspective over a 2-year period using a controlled before-and-after study design. The net benefit was calculated using, as benefits, the willingness to pay for the estimated number of people who avoided injury as a consequence of the intervention, subtracting costs and savings. Sensitivity analyses were performed using the maximum and minimum estimated number of people who avoided injury, assuming that there was a minimum of one death avoided, using the maximum value of a statistical life, assigning all implementation costs to the first year and assuming there was no time lost due to speed reduction.
Base case results showed a net benefit of 6.8 million. Sensitivity analyses suggested that net benefits could range from 5.6 to 23.1 million over 2 years.
The use of speed cameras in urban areas has a favourable economic impact even when assessed using conservative assumptions.
The influence of the built environment on health is of contemporary societal interest. The design of streets in neighbourhood settings may contribute positively to the health of populations through increased physical activity, but it may also have injury consequences.
We conducted a national cross-sectional study to describe the injury experiences of 9021 students from 180 Canadian schools that participated in the 2006 Health Behaviour in School-Aged Children survey. Street designs surrounding each school (5 km circular buffer) were estimated via geographic information systems for three established measures of connectivity (intersection density, average block length and connected node ratio). A composite scale of connectivity was derived using factor analysis. Multilevel logistic regression analyses were used to examine the associations between the composite connectivity measure and students' reports of physical activity injuries occurring in the street (street injuries).
Students living in neighbourhoods with low versus high street connectivity reported possible increases in the occurrence of street injuries (OR, 1.38; 95% CI, 0.84 to 2.26). This relationship was mainly attributable to the occurrence of bicycle injuries (52% of all street injuries; OR, 2.33; 95% CI, 1.28 to 4.25). The population attributable risk was 20% for street injuries potentially caused by living in an area with low connectivity.
The design of streets, as a measure of the built environment, is related to the occurrence of youth injury. Positive effects of poorly connected street designs that are likely in terms of physical activity were offset by negative injury outcomes, although the injuries observed were mostly minor in nature.
The international classification of diseases version 10 (ICD-10) uses alphanumeric expanded codes and external cause of injury codes (E-codes).
To examine the reliability and validity of emergency department (ED) coders in applying E-codes in ICD-9 and -10.
Bicycle and pedestrian injuries were identified from the ED information system from one period before and two periods after transition from ICD-9 to -10 coding. Overall, 180 randomly selected bicycle and pedestrian injury charts were reviewed as the reference standard (RS). Original E-codes assigned by ED coders (ICD-9 in 2001 and ICD-10 in 2004 and 2007) were compared with charts (validity) and also to ICD-9 and -10 codes assigned from RS chart review, to each case by an independent (IND) coder (reliability). Sensitivity, specificity, simple, and chance-corrected agreements ( statistics) were calculated.
Sensitivity of E-coding bicycle injuries by the IND coder in comparison with the RS ranged from 95.1% (95% CI 86.3 to 99.0) to 100% (95% CI 94.0 to 100.0) for both ICD-9 and -10. Sensitivity of ED coders in E-coding bicycle injuries ranged from 90.2% (95% CI 79.8 to 96.3) to 96.7% (95% CI 88.5 to 99.6). The sensitivity estimates for the IND coder ranged from 25.0% (95% CI 14.7 to 37.9) to 45.0% (95% CI 32.1 to 58.4) for pedestrian injuries for both ICD-9 and -10.
Bicycle injuries are coded in a reliable and valid manner; however, pedestrian injuries are often miscoded as falls. These results have important implications for injury surveillance research.
Legislation in the province of Ontario, Canada, mandates users under the age of 18 to wear a helmet when they ride a bicycle, and legislation has been shown to significantly increase rates of bicycle helmet use. Legislation does not exist in Ontario for older bicyclists or for users of other non-motorised modes of transportation, and there are no current data available regarding rates of helmet use in these categories. This study was designed to determine the prevalence of helmet use among users of bicycles, skateboards, push scooters and inline skates in Toronto, Ontario, and the surrounding area. Further analysis was performed to examine factors associated with helmet use.
We performed a cross-sectional, observational study. Three trained, stationary observers captured 6038 users of bicycles (5783), skateboards (77), inline skates (165) and push scooters (13) in the summer of 2009. Observations were separated into three time periods capturing commuters, midday users and recreational users. A general linear model was used to assess the factors associated with helmet use among bicyclists.
Helmets were worn by 48.9% of all users observed and 50.0% of all bicyclists. Among bicyclists, females were more likely to wear helmets than males (prevalence ratio 1.27, 95% CI 1.17 to 1.36), while children were significantly more likely to wear helmets than adults (prevalence ratio 1.17, 95% CI 1.37 to 2.15). Significant behavioural variation was observed among users during the three observation periods (p<0.001), with commuters being the most likely to wear a helmet.
In the absence of comprehensive legislation encompassing all ages of users, only half of users of non-motorised, wheeled transportation devices are choosing to wear a helmet to protect against traumatic brain injury. Implementation of evidence-based strategies to increase helmet use, such as the introduction of legislation encompassing all ages and all equipment, is required.
Fires and burns are a leading cause of unintentional injury death in the USA. Although it has been anecdotally reported that vacant dwellings are at a higher risk for fire, the association between vacancy and fire risk at the individual household level has not been empirically measured.
In this cross-sectional study, geocoded residential vacant properties (VP) and fire events are analysed in Baltimore City at the census tract level and the individual household level.
On average, a 10% increase in the proportion of vacancies in a census tract was associated with a 9.9% increase in fires (95% CI: 5% to 15%). Random-effects Poisson models, controlling for housing and neighbourhood conditions, found contagion effects. The risk of fire in an occupied dwelling increased by 8% (95% CI: 1% to 10%) for every vacant structure within 10 m, and the risk of fire decreased by half (95% CI: 45% to 62%) for every km between an occupied dwelling and vacant building. Close proximity to VP was associated with trash fires within dwellings (p=0.039) and structure fires (p=0.012).
We believe that this is the first study to demonstrate increased risk posed by nearby VP at the household level, confirming earlier ecological analyses of the role of VP as strong correlates of home fires. Measurement of this risk can motivate property owners, policy makers and insurers to invest in risk reduction measures that include building maintenance and trash removal.
To quantify the relationship between imitative behaviour and poisonings in children.
USA.
This study is based on the evaluation of a large national database of unintentional oral ingestion poisonings involving children aged <5 years treated in US hospital emergency departments during 2004 and 2005. It begins with the premise that, among other factors, oral drug poisonings can result from children observing and imitating adult behaviour, but that non-oral drug and non-drug poisonings (to be referred to as non-drug poisonings) generally do not, because children do not see adults ingesting non-drug products. The study then compares and contrasts the child poisonings between the two poisoning categories. Differences in the poisoning rate between the oral drug and non-drug categories are estimated by the age and sex of the children. A binary logistic regression analysis is also conducted using non-drug poisonings as a control group to compare against oral drug poisonings.
There was a significant increase in the relative likelihood of oral drug poisonings beginning at age 20–23 months that is consistent with the expected onset of complicated imitative behaviours in children. Based upon our analysis, imitative behaviour may have contributed to about 17 300 child poisonings treated annually in the emergency department, possibly accounting for about 20% of poisonings involving children aged <5 years and 30% of the poisoning injuries involving children aged 20–59 months.
Comprehensive efforts to prevent poisoning need to address the problem of imitative behaviour in children. Caregivers should never ingest medications in the presence of children.
Improvised explosive devices have become the characteristic weapon of conflicts in Iraq and Afghanistan. While little can be done to mitigate against the effects of blast in free-field explosions, scaled blast simulations have shown that the combat boot can attenuate the effects on the vehicle occupants of anti-vehicular mine blasts. Although the combat boot offers some protection to the lower limb, its behaviour at the energies seen in anti-vehicular mine blast has not been documented previously.
The sole of eight same-size combat boots from two brands currently used by UK troops deployed to Iraq and Afghanistan were impacted at energies of up to 518 J, using a spring-assisted drop rig.
The results showed that the Meindl Desert Fox combat boot consistently experienced a lower peak force at lower impact energies and a longer time-to-peak force at higher impact energies when compared with the Lowa Desert Fox combat boot.
This reduction in the peak force and extended rise time, resulting in a lower energy transfer rate, is a potentially positive mitigating effect in terms of the trauma experienced by the lower limb.
Currently, combat boots are tested under impact at the energies seen during heel strike in running. Through the identification of significantly different behaviours at high loading, this study has shown that there is rationale in adding the performance of combat boots under impact at energies above those set out in international standards to the list of criteria for the selection of a combat boot.
Unintentional injuries to children in the outdoors have a significant impact on child mortality, development and healthcare costs. This paper presents the findings of a systematic review about the effectiveness of programs that provided information, advice or education about the prevention of unintentional injuries to children under 15 years during outdoor play and leisure.
A structured search strategy was conducted in a range of databases. All report titles and abstracts were screened using pre-defined criteria. Included reports were quality appraised using a modified Graphical Appraisal Tool for Epidemiological studies (GATE) tool. All quality appraisals and data extraction were checked by a second reviewer. If not provided in the original reports, ORs and mean differences were calculated, where sufficient data were available.
Twenty-three studies met the inclusion criteria. There was a paucity of robust study designs. The majority of studies only reported a short-term follow-up of intermediate outcome measures. Only two studies measured injury rates; both reported a reduction, but both studies also had considerable methodological weaknesses. The five studies that measured the use of protective equipment reported mixed results, although there is some evidence that suggests that more extensive educational programs (such as health fairs and media campaigns) increase their use. The 20 studies that measured behaviour, attitude or knowledge outcomes reported highly mixed results.
Methodological weaknesses of the included studies limit support for a particular course of action. To better inform policy and practice, future research should (1) use robust study designs and (2) not rely on short-term proxy outcome measures.
11–13 May 2012, Tokyo, Japan.
5 June 2012, Falköping, Sweden.
10–13 June 2012, Banff, Alberta.
9–10 August 2012, Sydney, Australia.
1–4 October 2012, Wellington, New Zealand.
14–17 October 2012, Seattle, Washington.
6–9 November 2013, Montreal, Quebec.
Health inequalities were once incorrectly believed to result from genetic and biological differences between race groups. As health research evolved and evidence of meaningful genetic or biological race differences failed to materialise, scholars began to identify socioeconomic status (SES) as the primary reason for health inequalities. This notion too was incorrect. Today it is widely recognised that social determinants (eg, poverty, education and environment) substantially contribute to health risks and outcomes.
Intimate partner and sexual violence and child maltreatment are major public health problems and violations...]]>
Burn Prevention Week in the USA was held last February and as they have done for many years, the Shriners lent their support. This is welcome but I was disappointed that the campaign is essentially educational. Two new characters, Boots and Brewster—a caped, cuddly bear and a googly-eyed teapot—teach children to be ‘burn aware’ by taking them through a house, room by room, pointing out dangers, and how to avoid them. Entertaining no doubt, but effective? Based on the evidence, unlikely.
Instead, I had hoped Shriners would use their great influence to combat efforts to have the fire-safe cigarette law repealed. Long ago, paediatrician Jack Crawford, recruited Liz McLoughlin to be part of his Shriners Burn Prevention Center in Boston. In 1978, McLoughlin joined Andrew McGuire's Trauma Foundation in San Francisco and after working to decrease sleepwear flammability they targeted preventing...]]>