A randomized trial to assess the effectiveness of an infant home safety programme

The aim of this study was to test an intervention aimed at addressing the risk of injury in infants 2 - 12 months of age. A non-blinded, randomized controlled trial was conducted, whereby parents were randomly assigned to either a control or one of two intervention groups. Parents completed questionnaires regarding safety behaviours and injuries at the 2 (baseline), 6 and 12 month immunization visit at the community health unit. During the 2 month visit to the health unit, the two intervention groups received a home safety kit containing nine items, an instructional brochure and a risk assessment checklist. Subjects randomized to the safety kit plus home visit group also received a standardized home visit from a community health nurse. Two of the 14 parental safety behaviours showed a significant increase in use among parents in the intervention groups. Neither of the interventions was associated with a reduction in parent-reported injuries among children. It was concluded that home visitation may provide a beneficial adjunct to the provision of safety devices and may increase use by parents.     

Accidental injuries among the elderly within the Vienna community: Epidemiology,risk factors and preventive measures

Abstract

Unintentional injuries ('accidents’) among elderly people are a significant burden in public health because such accidents happen frequently and because the proportion of older age groups in the population will continue to rise during the coming decades. One aim of this study, which was done in Vienna, the capital of Austria, was to broaden the preventive concept, adding lifestyle and living conditions to already well-known risk factors following the health promotion approach. Furthermore, characteristics that predispose older residents to accidents should be identified in order to design preventive measures for reducing injuries in this age group.

809 interviews with people 60 years of age and over were conducted, concerning accidents, outcomes of accidents, physical fitness, drug intake, type of house or dwelling, equipment in the household incorporating safety features, psychological well-being and social relations. The information collected was used to draw cross-sectional comparisons between participants who reported having experienced at least one accident in the previous 12 months and those who did not. Furthermore, the accident incidents were classified into 2 groups: incidents without injuries and injurious accidents. The latter served as a base for the epidemiology of injuries for people 60 years of age and over within the Vienna community.

20% of all senior citizens suffer at least one unintentional injury every year, in addition to which 8% experience critical incidents (mostly falls) without injury. Most accidents occur at home or involve pedestrians in public traffic areas. Over 90% of all accidents are falls, and 20% result in fractures. The most important risk factors for accidents in the elderly are gender, increasing age, poor physical fitness and low physical activity, the type of household and household equipment, poor psychological well-being, low income and loneliness.

The findings regarding falls suggest some possible opportunities for reducing the risk of falls by improving buildings and dwellings of the elderly. A promising attempt at practical implementation of these findings is being conducted by the Vienna-based Austrian Institute for Home and Leisure Safety in cooperation with the Vienna City Council. These two organizations are implementing a long-term program that aims at mobilizing institutions and organizations involved in working with the elderly.     

Characteristics of non-fatal injuries in Leon, Nicaragua - 2004

This article describes the epidemiology of injuries collected in the Injury Surveillance System in Leon Hospital in Nicaragua. A total of 6659 persons were treated for injuries in 2004. It was discovered that 88% of all injuries were unintentional, 9% involved interpersonal violence, 2% were self-inflicted and 0.2% was undetermined. Men accounted for 64.7% of the cases, with the highest rate among 20 - 24 year olds (5625.8 per 100,000 inhabitants). Among women, the highest rate was in those aged 64 years and older (5324.2 per 100 000 inhabitants). The most common mechanisms were falls (33.9%), blunt force (26.8%), cut/pierce/stab (15.1%) and transportation-related (12.8%). These results indicate the need to identify prevention strategies for those injuries that were most commonly treated in emergency, such as unintentional falls among older women, self-inflicted poisoning among young women and blunt force and transportation-related injuries among young men.     

Characteristics of non-fatal injuries in Leon,Nicaragua – 2004

This article describes the epidemiology of injuries collected in the Injury Surveillance System in Leon Hospital in Nicaragua. A total of 6659 persons were treated for injuries in 2004. It was discovered that 88% of all injuries were unintentional, 9% involved interpersonal violence, 2% were self-inflicted and 0.2% was undetermined. Men accounted for 64.7% of the cases, with the highest rate among 20 – 24 year olds (5625.8 per 100 000 inhabitants). Among women, the highest rate was in those aged 64 years and older (5324.2 per 100 000 inhabitants). The most common mechanisms were falls (33.9%), blunt force (26.8%), cut/pierce/stab (15.1%) and transportation-related (12.8%). These results indicate the need to identify prevention strategies for those injuries that were most commonly treated in emergency, such as unintentional falls among older women, self-inflicted poisoning among young women and blunt force and transportation-related injuries among young men.     

Nudging using the ‘dish of the day’ strategy does not work for plant‐based meals in a Danish sample of adolescent and older people

Adequate nutrition is an important factor for health and well‐being in adolescents and later years. Fruits and vegetables are part of a healthy diet as important source of nutrients, but their intakes are lower than the recommendations in European countries. This study aimed to compare the choices made by adolescents and older people between three similar dishes, one based on meat, one on fish and one on vegetables, in two different conditions: a neutral (control) situation and an intervention situation in which the vegetable‐based meal was designated ‘dish of the day’. The comparisons of choices will be made within the same age group (adolescents in the control group vs. adolescents in the intervention group; older people in the control group vs. older people in the intervention group). A quasi‐randomised field trial design was used with a sample of 94 adolescents (aged 10–19 years) and 97 older people (aged ≥65 years), who were randomly allocated to intervention or control groups. In the control situation participants were asked to choose between three similar meals, one meat, one fish and one the VeggiEat dish. In the intervention, the VeggiEat dish was labelled the ‘Dish of the day’. All dishes were provided free of charge, displayed side by side in the same order and served in same portions. The dish choices showed no differences between the control and intervention groups in both age groups, and no differences were found among the other variables analysed. This nudging strategy, ‘dish of the day’, seems not to work for the Danish sample of adolescents and older people. Future nudging studies with these populations are needed in order to find the best strategy to move adolescents' and older people's food habits toward a healthier pattern.     

Evaluation of a home injury prevention program in a WHO Safe Community

The objective of this study was to evaluate the effect of a community-based injury prevention program on home injuries. Unintentional injuries occurring in private homes and during leisure time account for 70-80% of injuries treated in public health care. A quasiexperimental design was used for the study, with cross-sectional preand post-implementation measurements in the program area and in a neighboring control community. Children and the elderly were two main target groups of the intervention program, which was based on a participative strategy for community involvement. The study was based on defined total populations. The total relative risk for home injury occurrence decreased in the study area, whereas it increased in the control area. Regarding age and gender, there was a decrease for females and males in the study area and a slight increase in the control area. For males, the youngest and oldest age groups showed no decrease, whereas females showed a decrease among the youngest and those aged 60-79. No decrease was observed in the control area. The study showed that the Safe Community approach had a general effect on the incidence of home injuries.     

The food pyramid challenge

Pyramid Power is a 1‐hour programme designed to teach food choices, serving sizes and nutrition. Participants (19 women and 8 men) were challenged to follow the recommendation in a step‐by‐step manner. Evaluation, two months after the programme, resulted in two major areas of change. Participants improved their scoring of three food groups (bread‐cereal‐rice‐pasta, vegetable and fruit) and decreased the number of fat–sweet mentions. The programme and challenge provides a way for nutritionists to identify what participants are eating, to track progress and to identify future programme needs.     

Short‐term impact of a voluntary health intervention on overall vs. preventive healthcare consumption

Healthtrac Rewards is a US‐based, workplace wellness intervention promoting healthy behaviour through voluntary self‐reporting of participants' dietary habits, physical activity and medical concerns. Monthly financial incentives encourage either primary participation or secondary participation requiring additional interaction with Healthtrac personnel. Using data from 17 533 eligible employees, the purpose of the study was to determine whether Healthtrac participants consumed fewer healthcare services, as measured by 2004 medical claim costs or numbers of procedures, relative to non‐participants. High‐cost individuals tended to self‐select into the programme. Costs were 22–27% greater among participants after controlling for other factors. Participants consumed more preventive care, however, which was correlated with reduced future procedures. The secondary intervention was more effective than the primary intervention, suggesting a priority on increasing intensity of involvement vs. basic enrolment.     

Benzodiazepines and falling injuries in the elderly

Abstract

Objective: To investigate the use of benzodiazepines (BD) in relation to the risk of falling injuries in an elderly population (65 yrs. or older)

Design: An unmatched case-control study. Setting: The town of Pori, Finland

Participants: 380 subjects aged 65 years or over, who presented for medical treatment due to a fall during the 12 months from Sept. 1987 to Aug. 1988, and 342 controls, 65 years or older, selected from the population register. The control subjects were examined according to a schedule that corresponded in time (time of day, day of the week and month) to the time-distribution of falls in an earlier study

Outcome measure: All falls leading to medical treatment. BD use was determined from the serum, and the type of BD was determined by interviews and controlled from patient records

Results: We found a tendency toward a dose-response relationship between the serum BD concentration and the occurrence of falling injury. The risk of faling injury related to short-acting BDs was increased 5-fold and that for other BDs 2-fold compared to the risk among those without any BD in the serum. Conclusion: The results indicate that BD use is associated with falls in the elderly, and that short-acting BDs seem to be associated with falls more often. The results suggest caution in the use of BDs in the elderly.     

Evaluation of commercial weight‐loss programmes in Greece

The objective was to evaluate the success of commercial weight‐loss programmes and define areas that need development in the Greek weight‐loss industry. A total of 973 people (217 men and 756 women), all customers of the same slimming company, participated in the study. Subjects were enrolled in a weight‐loss programme that lasted for a year. Body weight (BW) and height was measured at baseline and at the end of the treatment. For 470 participants, BW was also measured 1 year after the end of the programme (follow‐up). We evaluated alterations in initial and final BW, as well in body mass index (BMI) categorization. Sixty‐six women were allowed to start the programme, although underweight and 47.3% of the participants enrolled with a normal BMI. At the end of the treatment, 124 persons were underweight. Most subjects with a BMI >40 at baseline remained at the same BMI category after the implementation of the programme; however, this was a small group (n = 8). Most subjects (67.3%) remained at the same BMI category after treatment. One year after the completion of the programme, all participants presented significantly higher BW compared with that at the end of the programme. Results suggest that economic gaining is the priority for weight‐loss companies in Greece. The employed staff in its majority is neither nutritionists, nor dieticians, but employees well‐trained on marketing, who are being paid accordingly to their sales. Thus, many customers who are either underweight or of normal BW are enrolled in weight‐loss programmes for the company's financial benefit and are sold programmes with the use of appliances of questionable scientific validation.     

Profile of injury cases admitted to a tertiary level hospital in south India

Injuries now rank among the leading causes of morbidity and mortality the world over. Injuries are steadily increasing in developing countries like India. Systematic and scientific efforts in injury prevention and control are yet to begin in India. Data on injuries are very essential to plan preventive and control measures. The objective of this study is to know the profile of the injury cases admitted to M S Ramaiah hospital, Bangalore, India, using a cross-sectional study design for six months, i.e. from Oct 2008 to April 2009. The mean age of the study population was 35.3 years (SD = 15.38), 69.1% were injured in road traffic accidents (RTA), 28.7% due to falls and 2.2% due to burns. Nearly 14.4% were under the influence of alcohol. Nearly 73.6% of RTA cases were two-wheeler users, 48.5% had not followed sign boards and 56.5% had not obeyed the one-way rules, 63.5% of the two-wheeler users did not use helmets. Also, 38% of two wheelers had two pillion riders, whereas 57% of four-wheeler users had not used a seat belt. Among falls, 58% occurred at home, 49% occurred due to slippery surface. Road traffic accidents were the most common cause for injuries, in which two wheelers were most commonly involved. Strict enforcement of traffic rules and education on road safety are very essential to prevent injuries.     

Prevention of falls to a lower level: evaluation of an occupational health and safety intervention via subsidies for the replacement of scaffolding

The objective of this study is to evaluate the impact of a subsidy policy for construction companies in Andalusia (Spain), which enables them to acquire new scaffolds. The rate of falls from scaffolds within the Andalusian construction sector in the period 2009–2011 was analysed. A randomised controlled trial was not possible as the subsidy was granted according to a public and competitive call. A quasi-experimental design based on an intervention group (subsidised companies) and a control group was chosen. Companies in the control group were selected from the social security census of companies in order to avoid selection bias. The subsidy policy has led to an overall 71% decrease in the rate of accident involving falls to a lower level in the companies that received grants in the period 2009–2011. The confidence interval for the comparison for the before–after difference in rates between the intervention group and the control group is found significant (confidence 95%, p = 0.05). The improvement of scaffolds was effective in reducing rates of accident with falls to a lower level. This intervention should be a priority in public policies. The process of standardisation of equipment with high accident risk should be developed further.     

The perception of fire risk by older people and its impact on relevant fire safety education

Accidents due to ‘fire and flames’ are second only to “falls” as the most important cause of accidental death in the homes of elderly individuals throughout the United Kingdom. This study aims to ascertain whether older people are receiving fire accident advice appropriate to their needs. A questionnaire addressing the issues of risk perception, fire preventative action and access to fire safety information was distributed to 1100 randomly selected members of the ‘Thousand Elders’ (a nation-wide consumer group established by the Centre for Applied Gerontology at The University of Birmingham, comprising people above the age of 50 years). Eight hundred and four questionnaires were returned and were analysed using the Statistical Package for Social Sciences. Fire risk was perceived as far less of an immediate threat than the danger of a personal attack by an intruder in the home. Recognition of fire risk and the effectiveness of fire safety measures did not result directly in safety appliances being fitted. The majority of ‘Elders’ had received no fire-fighting training, yet more than half felt confident in tackling a small fire. Neither did experience of a fire in the home necessarily increase action towards safety precautions. The majority had not been exposed to a fire safety campaign in the past 12 months. On exposure to a campaign, the impact towards fire safety was positive. The educational process should aim to close the gap between the recognition of the need for fire safety precautions and the implementation of fire safety measures. The key to effective fire prevention amongst older people depends upon: Information, Training and Support, i.e., relevant information supported by practical help and subsequent practical training in-situ by trusted community figures.     

Loosening the belt: on the effects of goal‐conflict situations on regular savings

This paper examines the effect of implementation intentions on consumers' success in pursuing conflicting saving–spending goals. Surveys of participants in a community‐based savings programme were conducted to test whether the forming of implementation intentions in specific action plans facilitate the pursuit of the focal savings goal. The intervention had no effect in facilitating the savings goal, suggesting that goal conflict undermines goal commitment above and beyond the influence of commitment mechanisms. Inquiring into the reasons for not saving within the implementation intention group, we found that conflict with spending goals emerged as a partial mediator explaining subjects' failure to enact their savings intentions. Implications for community‐based savings programmes are also discussed.     

How gender influences the effect of age on self‐efficacy and training success

Previous research has shown age and gender differences in training, but the results have been mixed and their combined influence is only rarely examined. We fill those gaps by analysing age and gender effects on self‐efficacy and training success. Study participants were trainees in an e‐learning time‐ and self‐management behaviour modelling training programme. We measured self‐efficacy before and after training and time‐ and self‐management behaviour before and 6 weeks after training. We expected the differences between pre‐ and post‐test results to indicate self‐efficacy development and we expected differences between pre‐ and follow‐up tests to indicate training success. A hierarchical regression analysis showed that age and gender interacted in both self‐efficacy development and training success. A structural equation model confirmed that men and women showed different relationships among age, self‐efficacy and training success. Older women showed more positive development compared with older men. We conclude that age and gender should both be considered in future design and training evaluations.     

Evaluation of the effectiveness of single-session school-based programmes to increase children's seat belt and pedestrian safety knowledge and self-reported behaviours

Young children experience many injuries as pedestrians and as passengers in vehicles. This study evaluated the effectiveness of two single-session school programmes, one to increase pedestrian safety knowledge and behaviour among Grade 1 children and the other to increase seat belt safety knowledge and usage among Grade 2 children. In the intervention groups, assessments were conducted on three occasions: before; soon after; and 2 months after the programmes; control groups did not receive the programme. The results revealed positive effects of these single-session safety programmes, as indicated by significant improvement and long-term retention of safety knowledge for both Grade 1 and Grade 2 children and self-reported increases in safety behaviours. Implications for future research and injury-prevention programming are discussed.     

Involving consumers in peer‐facilitated home‐based food hygiene training

A community‐based food hygiene initiative was piloted in the Toxteth–Granby area of Liverpool between December 2001 and March 2002. The project aimed to increase awareness and behaviour, related to poor food purchase, storage and handling practices, by actively involving members of the local community in home‐based peer‐facilitated training. Facilitators (23) were actively recruited from within the Toxteth–Granby community, and undertook a 4‐day induction and training programme, which included successful completion of the CIEH Basic Food Hygiene course. Facilitators subsequently recruited and visited nearly 1000 households (992) within the Toxteth–Granby electoral ward, undertook an observation sheet, a detailed questionnaire, and spent approximately 1 hour delivering food hygiene training. Facilitators returned to all households within an 8‐week period, and completed further observation sheets and questionnaires, for use in a comparative analysis. Facilitators and householders received incentives for their involvement in the project. Analysis of the data collected showed that general awareness of a range of food hygiene issues was high (such as hand washing before handling food), and most participants (73.8%) were able to recognise the main symptoms of food borne disease. As a result of the home‐based hygiene training there were significant changes in knowledge, attitudes, and food handling practices, including the use of refrigerators, purchase of chilled and frozen foods, washing or peeling of fruits and vegetables, and the cooking of meat‐based products. The project demonstrates that it is possible for communities to improve their food hygiene awareness and food handling behaviours through home‐based peer‐facilitated training programmes, with minimal input from professionals.     

Epidemiologic features and intervention effect of fall injury among rural school-aged children in southwest China: a short-term cohort study

ABSTRACT

Falls are the top one type in all unintentional injuries. In this study, we aim to explore the epidemiological characteristics of falls and assess the intervention effect. Our research had interviewed 2854 rural children in southwest China. Then, we used School–Family–Individual (SFI) comprehensive education model to conduct an intervention among 1506 children and follow up them for one year. The changes in injury knowledge and incidence rate before and after intervention were compared. We found the fall injury was 37.32% (178/477) and ranked top one in the total injuries. After intervention, the children's fall-injuries-related knowledge was significantly increased by 15.29 percent (P < 0.001). While falls incidence significantly decreased after- intervention (6.24% vs. 3.93%; P < 0.001). From the results we concluded that the falls rate was high and was the prior reason of all injuries. SFI intervention model can effectively reduce the incidence of the fall injury.     

Hospitalized fall-related injury trends in Sweden between 2001 and 2010

Previous studies have indicated increasing trends of hospitalized fall-related injuries amongst elderly. Whether this is true also in Sweden is unknown though it is important to study considering the potential societal impact. Data were obtained regarding hospitalized injuries with falls as external cause among those aged 65 years and above with information on injury type, gender and age, on a yearly basis, from 2001 to 2010. Age- and sex-specific incidence rates were calculated (per 100,000 population) for all fall-related injuries, and for each injury type and trend lines were drawn. Linear regression analyses and percentage change were calculated for the types of fall-related injuries. A decreasing incidence was observed in the younger age groups (65–79 years) with greater decreases amongst women (women: ?14.6%, men 65–79 years: ?10.5%). However, increasing rates were observed in the older age group (80 years and above), with greater increases amongst men (women: 4.3%, men: 11.4%). Superficial injuries showed greater increases than fractures amongst those aged 80 years and above. This study indicates that older elderly in Sweden are increasingly being hospitalized for less serious injuries. This changing injury panorama is important to include in the future planning of both health care and fall-related prevention.     

A Community Survey of Purchase Experiences of Older Consumers

A telephone survey was conducted which examined recent purchase experiences for 282 older consumers residing in a midwestern academic community. The types of purchases studied were eyeglasses, funeral services, hearing aids, home appliance repair services, home repair services, and nursing home care. Generally high satisfaction levels were reported for these purchases. A tendency on the part of the respondents to draw upon past knowledge and experience in making their purchase decisions was found. A procedural caution is noted in the interpretation of social survey data on local consumer services.