STEADI: CDC's approach to make older adult fall prevention part of every primary care practice

IntroductionPrimary care providers play a critical role in protecting older adult patients from one of the biggest threats to their health and independence—falls. A fall among an older adult patient cannot only be fatal or cause a devastating injury, but can also lead to problems that can effect a patient's overall quality of life.MethodsIn response, the Centers for Disease Control and Prevention (CDC) developed the STEADI initiative to give health care providers the tools they need to help reduce their older adult patient's risk of a fall.ResultsCDC's STEADI resources have been distributed widely and include practical materials and tools for health care providers and their patients that are designed to be integrated into every primary care practice.ConclusionAs the population ages, the need for fall prevention efforts, such as CDC's STEADI, will become increasingly critical to safeguard the health of Americans.Practical applicationsSTEADI's electronic health records (EHRs), online trainings, assessment tools, and patient education materials are available at no-cost and can be downloaded online at www.cdc.gov/STEADI. Health care providers should look for opportunities to integrate STEADI materials into their practice, using a team-based approach, to help protect their older patients.     

Measuring safety climate in elderly homes

IntroductionProvision of a valid and reliable safety climate dimension brings enormous benefits to the elderly home sector. The aim of the present study was to make use of the safety climate instrument developed by OSHC to measure the safety perceptions of employees in elderly homes such that the factor structure of the safety climate dimensions of elderly homes could be explored.MethodIn 2010, surveys by mustering on site method were administered in 27 elderly homes that had participated in the "Hong Kong Safe and Healthy Residential Care Home Accreditation Scheme" organized by the Occupational Safety and Health Council.ResultsSix hundred and fifty-one surveys were returned with a response rate of 54.3%. To examine the factor structure of safety climate dimensions in our study, an exploratory factor analysis (EFA) using principal components analysis method was conducted to identify the underlying factors. The results of the modified seven-factor's safety climate structure extracted from 35 items better reflected the safety climate dimensions of elderly homes. The Cronbach alpha range for this study (0.655 to 0.851) indicated good internal consistency among the seven-factor structure. Responses from managerial level, supervisory and professional level, and front-line staff were analyzed to come up with the suggestion on effective ways of improving the safety culture of elderly homes. The overall results showed that managers generally gave positive responses in the factors evaluated, such as "management commitment and concern to safety," "perception of work risks and some contributory influences," "safety communication and awareness," and "safe working attitude and participation." Supervisors / professionals, and frontline level staff on the other hand, have less positive responses. The result of the lowest score in the factors - "perception of safety rules and procedures" underlined the importance of the relevance and practicability of safety rules and procedures.ConclusionThe modified OSHC safety climate tool provided better evidence of structural validity and reliability for use by elderly homes' decision makers as an indicator of employee perception of safety in their institution.Impact on industryThe findings and suggestions in the study provide useful information for the management, supervisors/professionals and frontline level staff to cultivate the safety culture in the elderly home sector. Most important, elderly homes can use the modified safety climate scale to identify problem areas in their safety culture and safety management practices and then target these for intervention.     

Small female rib cage fracture in frontal sled tests

Objectives: The 2 objectives of this study are to (1) examine the rib and sternal fractures sustained by small stature elderly females in simulated frontal crashes and (2) determine how the findings are characterized by prior knowledge and field data.

Methods: A test series was conducted to evaluate the response of 5 elderly (average age 76 years) female postmortem human subjects (PMHS), similar in mass and size to a 5th percentile female, in 30 km/h frontal sled tests. The subjects were restrained on a rigid planar seat by bilateral rigid knee bolsters, pelvic blocks, and a custom force-limited 3-point shoulder and lap belt. Posttest subject injury assessment included identifying rib cage fractures by means of a radiologist read of a posttest computed tomography (CT) and an autopsy. The data from a motion capture camera system were processed to provide chest deflection, defined as the movement of the sternum relative to the spine at the level of T8.

?A complementary field data investigation involved querying the NASS-CDS database over the years 1997–2012. The targeted cases involved belted front seat small female passenger vehicle occupants over 40 years old who were injured in 25 to 35 km/h delta-V frontal crashes (11 to 1 o'clock).

Results: Peak upper shoulder belt tension averaged 1,970 N (SD = 140 N) in the sled tests. For all subjects, the peak x-axis deflection was recorded at the sternum with an average of ?44.5 mm or 25% of chest depth. The thoracic injury severity based on the number and distribution of rib fractures yielded 4 subjects coded as Abbreviated Injury Scale (AIS) 3 (serious) and one as AIS 5 (critical). The NASS-CDS field data investigation of small females identified 205 occupants who met the search criteria. Rib fractures were reported for 2.7% of the female occupants.

Conclusions: The small elderly test subjects sustained a higher number of rib cage fractures than expected in what was intended to be a minimally injurious frontal crash test condition. Neither field studies nor prior laboratory frontal sled tests conducted with 50th percentile male PMHS predicted the injury severity observed. Although this was a limited study, the results justify further exploration of the risk of rib cage injury for small elderly female occupants.     

Talking with teens about traffic safety: Initial feasibility,acceptability, and efficacy of a parent-targeted intervention for primary care settings

IntroductionThe aims of the current pilot study were to evaluate the feasibility, acceptability, and preliminary efficacy of the Talking with Teens about Traffic Safety Program. The program consists of a clinic-based health coaching session with parents of adolescents at their annual well-child visit to promote parent-teen communication about teen driver safety including: a Parent Handbook that is designed to serve as a primer on teen driver safety and facilitate parent-teen communication on a variety of teen driver topics; an interactive practice driving toolset; and an endorsement of the materials by the primary care provider.MethodFifty-four parent-teen dyads (n = 108 total) were recruited from a primary care practice. Dyads were randomized (1:1) into a treatment group or a usual care group. Implementation fidelity was assessed using checklists completed by health coaches and parent interviews. After 6 months, parents reported how often they talked with their teen about 12 safe driving topics (e.g., state graduated driver licensing laws).ResultsParents in the treatment group reported more frequent discussions than parents in the control group on 7 out of the 12 topics. Fidelity data indicate that 100% of sessions were implemented as designed and were acceptable to parents.ConclusionsThe program was feasible to administer and there was evidence for preliminary efficacy. Generally, effects were larger for more infrequently discussed topics, which is to be expected due to the potential for ceiling effects on more commonly discussed topics (e.g., distracted driving). A larger multi-site study is warranted.Practical applicationsThe results from this pilot study provide support for implementation fidelity and establish a proof-of-concept for the Talking with Teens about Traffic Safety Program. The results provide guidance for developing partnerships with pediatricians and parents to develop parent-teen communication interventions on injury prevention topics.     

Age-Dependent Factors Affecting Thoracic Response: A Finite Element Study Focused on Japanese Elderly Occupants

Objectives: The ultimate goal of this research is to reduce thoracic injuries due to traffic crashes, especially in the elderly. The specific objective is to develop and validate a full-body finite element model under 2 distinct settings that account for factors relevant for thoracic fragility of elderly: one setting representative of an average size male and one representative of an average size Japanese elderly male.

Methods: A new thorax finite element model was developed from medical images of a 71-year-old average Japanese male elderly size (161cm, 60 kg) postmortem human subject (PMHS). The model was validated at component and assembled levels against original series of published test data obtained from the same elderly specimen. The model was completed with extremities and head of a model previously developed. The rib cage and the thoracic flesh materials were assigned age-dependent properties and the model geometry was scaled up to simulate a 50th percentile male. Thereafter, the model was validated against existing biomechanical data for younger and elderly subjects, including hub-to-thorax impacts and frontal impact sled PMHS test data. Finally, a parametric study was conducted with the new models to understand the effect of size and aging factors on thoracic response and risk of rib fractures.

Results: The model behaved in agreement with tabletop test experiments in intact, denuded, and eviscerated tissue conditions. In frontal impact sled conditions, the model showed good 3-dimensional head and spine kinematics, as well as rib cage multipoint deflections. When properties representative of an aging person were simulated, both the rib cage deformation and the predicted number of rib fractures increased. The effects of age factors such as rib cortical thickness, mechanical properties, and failure thresholds on the model responses were consistent with the literature. Aged and thereby softened flesh reduced load transfer between ribs; the coupling of the rib cage was reduced. Aged costal cartilage increased the severity of the diagonal belt loading sustained by the lower loaded rib cage.

Conclusions: When age-specific parameters were implemented in a finite element (FE) model of the thorax, the rib cage kinematics and thorax injury risk increased. When the effect of size was isolated, 2 factors, in addition to rib material properties, were found to be important: flesh and costal cartilage properties. These 2 were identified to affect rib cage deformation mechanisms and may potentially increase the risk of rib fractures.     

The effects of co-presence on risk perception and intention to engage in risky behaviors

IntroductionThis study investigated the relation between co-presence and bicyclists' riding behavior. We assumed that the presence of peer riders would either facilitate or inhibit risky behaviors depending on bicyclists' perceptions of three traffic contexts conducive to risk taking (i.e., red-light, go straight, and turn to left).MethodYoung bicyclists (N = 207) were randomly assigned to two experimental conditions (alone vs. with peers). They filled in a scenario-based questionnaire about their intentions to adopt risky behaviors in three specific traffic situations as well as their risk perception of these situations and their general self-perceived efficacy as a bicyclist. We hypothesized that the presence of peer riders engaged in a risky behavior will facilitate the intention to adopt risky behaviors in situations where group risk is evaluated as lower than individual risk. In opposition, the presence of peer riders engaged in a risky behavior will inhibit the intention to adopt risky behaviors in situations where group risk is evaluated as higher than individual risk.ResultsThe results confirmed the hypotheses.Practical ApplicationsThe findings offer insights for developing new effective education and intervention programs in order to reduce the frequency of dangerous behavior among bicyclists.     

Risk for household safety hazards: Socioeconomic and sociodemographic factors

IntroductionMany unintentional injuries to young children occur in the home. The current study examines the relation between family socioeconomic and sociodemographic factors and risk factors for home injury.MethodsPresence of household hazards was examined in 80 families with toddler-aged children. Parental ability to identify household hazards in pictures was also assessed. ANOVAs and Pearson product–moment correlations examined the relationship between presence of household hazards, knowledge to identify hazards, and factors of yearly family income, parental age, parental education, parental marital status, child ethnicity, and the number of children living in the home.ResultsA greater number of hazards were found in the homes of both the lowest and highest income families, but poorer knowledge to identify household hazards was found only among parents of the lowest income families and younger parents. Across family socioeconomic status, parent knowledge of hazards was related to observed household hazards.ConclusionsThe relationship between family income and risk for injury is complex, and children of both lower and higher SES families may be at risk for injury.Practical applicationsWhile historically particular focus has been placed on risk for injury among children in low income families, injury prevention efforts should target reducing presence of household hazards in both high and low SES families.     

The state of the residential fire fatality problem in Sweden: Epidemiology,risk factors,and event typologies

IntroductionResidential fires represent the largest category of fatal fires in Sweden. The purpose of this study was to describe the epidemiology of fatal residential fires in Sweden and to identify clusters of events.MethodData was collected from a database that combines information on fatal fires with data from forensic examinations and the Swedish Cause of Death-register. Mortality rates were calculated for different strata using population statistics and rescue service turnout reports. Cluster analysis was performed using multiple correspondence analysis with agglomerative hierarchical clustering.ResultsMale sex, old age, smoking, and alcohol were identified as risk factors, and the most common primary injury diagnosis was exposure to toxic gases. Compared to non-fatal fires, fatal residential fires more often originated in the bedroom, were more often caused by smoking, and were more likely to occur at night. Six clusters were identified. The first two clusters were both smoking-related, but were separated into (1) fatalities that often involved elderly people, usually female, whose clothes were ignited (17% of the sample), (2) middle-aged (45–64 years old), (often) intoxicated men, where the fire usually originated in furniture (30%). Other clusters that were identified in the analysis were related to (3) fires caused by technical fault, started in electrical installations in single houses (13%), (4) cooking appliances left on (8%), (5) events with unknown cause, room and object of origin (25%), and (6) deliberately set fires (7%).ConclusionsFatal residential fires were unevenly distributed in the Swedish population. To further reduce the incidence of fire mortality, specialized prevention efforts that focus on the different needs of each cluster are required.Practical applicationsCooperation between various societal functions, e.g. rescue services, elderly care, psychiatric clinics and other social services, with an application of both human and technological interventions, should reduce residential fire mortality in Sweden.     

A framework for definition of logical scenarios for safety assurance of automated driving

Abstract

Objective: In order to introduce automated vehicles on public roads, it is necessary to ensure that these vehicles are safe to operate in traffic. One challenge is to prove that all physically possible variations of situations can be handled safely within the operational design domain of the vehicle. A promising approach to handling the set of possible situations is to identify a manageable number of logical scenarios, which provide an abstraction for object properties and behavior within the situations. These can then be transferred into concrete scenarios defining all parameters necessary to reproduce the situation in different test environments.

Methods: This article proposes a framework for defining safety-relevant scenarios based on the potential collision between the subject vehicle and a challenging object, which forces the subject vehicle to depart from its planned course of action to avoid a collision. This allows defining only safety-relevant scenarios, which can directly be related to accident classification. The first criterion for defining a scenario is the area of the subject vehicle with which the object would collide. As a second criterion, 8 different positions around the subject vehicle are considered. To account for other relevant objects in the scenario, factors that influence the challenge for the subject vehicle can be added to the scenario. These are grouped as action constraints, dynamic occlusions, and causal chains.

Results: By applying the proposed systematics, a catalog of base scenarios for a vehicle traveling on controlled-access highways has been generated, which can directly be linked to parameters in accident classification. The catalog serves as a basis for scenario classification within the PEGASUS project.

Conclusions: Defining a limited number of safety-relevant scenarios helps to realize a systematic safety assurance process for automated vehicles. Scenarios are defined based on the point of the potential collision of a challenging object with the subject vehicle and its initial position. This approach allows defining scenarios for different environments and different driving states of the subject vehicle using the same mechanisms. A next step is the generation of logical scenarios for other driving states of the subject vehicle and for other traffic environments.     

Chest injuries of elderly postmortem human surrogates (PMHSs) under seat belt and airbag loading in frontal sled impacts: Comparison to matching THOR tests

Abstract

Objective: The goal of the study was to develop experimental chest loading conditions that would cause up to Abbreviated Injury Scale (AIS) 2 chest injuries in elderly occupants in moderate-speed frontal crashes. The new set of experimental data was also intended to be used in the benchmark of existing thoracic injury criteria in lower-speed collision conditions.

Methods: Six male elderly (age >63) postmortem human subjects (PMHS) were exposed to a 35?km/h (nominal) frontal sled impact. The test fixture consisted of a rigid seat, rigid footrest, and cable seat back. Two restraint conditions (A and B) were compared. Occupants were restrained by a force-limited (2.5?kN [A] and 2?kN [B]) seat belt and a preinflated (16?kPa [A] and 11?kPa [B]; airbag). Condition B also incorporated increased seat friction. Matching sled tests were carried out with the THOR-M dummy. Infra-red telescoping rod for the assessment of chest compression (IRTRACC) readings were used to compute chest injury risk. PMHSs were exposed to a posttest injury assessment. Tests were carried out in 2 stages, using the outcome of the first one combined with a parametric study using the THUMS model to adjust the test conditions in the second. All procedures were approved by the relevant ethics board.

Results: Restraint condition A resulted in an unexpected high number of rib fractures (fx; 10, 14, 15 fx). Under condition B, the adjustment of the relative airbag/occupant position combined with a lower airbag pressure and lower seat belt load limit resulted in a reduced pelvic excursion (85 vs. 110?mm), increased torso pitch and a substantially lower number of rib fractures (1, 0, 4 fx) as intended.

Conclusions: The predicted risk of rib fractures provided by the THOR dummy using the C_max and PC Score injury criteria were lower than the actual injuries observed in the PMHS tests (especially in restraint condition A). However, the THOR dummy was capable of discriminating between the 2 restraint scenarios. Similar results were obtained in the parametric study with the THUMS model.     

An ethnography of low-income mothers' safeguarding efforts

Problem

Children living in lower-income environments are at greater risk for unintentional injuries. However, little is known about the safety practices of mothers living in low-income situations.

Method

This ethnographic study explored the child safeguarding experiences of low-income mothers using in-home interviews and observations.

Results

Mothers' safeguarding efforts included cognitive and emotional work, child directed work, and work directed at the physical and social environments. Factors that influenced the women's safeguarding included the quality of the indoor space, availability of safe play space, traffic hazards, sibling interactions, child care supports, relationships with neighbors, and trust in community services.

Discussion

These findings have implications for the conceptualization of safeguarding practices and provide insight about the experiences of mothers living on low-incomes.

Impact on Industry

When developing safety interventions, program planners should consider the views and practices of mothers as well as contextual factors in the physical and social environments.     

Disparities in the prevalence of smoke alarms in U.S. households: Conclusions drawn from published case studies

Introduction

Deaths from fires and burns are a leading cause of fatal home injury in the United States. Smoke alarms are one of the most effective interventions to prevent residential fire deaths. Nationwide, more than 95% of homes are estimated to have at least one smoke alarm. There is evidence that homes at highest risk of fire deaths lag behind national averages in smoke alarm use and maintenance.

Method

We compiled a comprehensive list of published studies that focus on smoke alarm prevalence in high-risk homes. Our findings show that there are substantial gaps in both smoke alarm presence and functional status between high-risk homes and national average estimates.

Conclusions

To save more lives, improved efforts are needed to reduce the disparity in smoke alarm prevalence and functional use in the United States.     

Factors that influence the use of safe patient transfer technique in home care service

The aim of this pilot study was to explore whether home care service personnel used knowledge and skills in transfer technique in their daily work; knowledge and skills gained by participating in training programmes, and to identify factors that may hinder and support their use. Focus group interviews were held with 2 home care service groups in 2 Swedish towns. Individual interviews were conducted with the personnel's managers, unit leaders and safety representatives. Qualitative content analysis was used. The findings revealed that the personnel tried to use their knowledge and skills. However, there were both hindering and supporting factors for the use of safe work technique. The findings indicate that training programmes in transfer technique should not be implemented as isolated actions without considering the physical environment, the wishes of persons receiving care and their relatives, the work organisation, the safety culture and the role of managers.     

Fall-related injuries for three ages groups – Analysis of Swedish registry data 1999–2013

Introduction: The objective of this study was to analyze which factors (including factors pertaining to the individual, the household, and the local area) increase the risk of fall injuries for the three age groups with the highest risk for fall injuries in Sweden. Method: The study combined longitudinal data covering the period 1999–2013 from several different official registries from Statistics Sweden as well as from the Swedish health care system and fitted the models to data using mixed model regressions. Results: Three age groups had a markedly heightened risk for fall injuries: 1–3-year olds, 12–14 year olds, and the elderly (65+). The home was the most common location for fall injuries, as about 40% of all fall injuries occur in the home. Only for the elderly strong predictors for fall injuries were found, and these were: age, single household, and special housing. Conclusions: There is preventive potential in the special residences for the elderly and disabled. People living in these special residences make up a strongly selected group that needs extra safe environments. Our findings indicate that their needs are currently not meet. Practical applications: Design of special residences for the elderly and disabled should aim at reducing the consequences of falling.     

Potential of a Precrash Lateral Occupant Movement in Side Collisions of (Electric) Minicars

Objective: In minicars, the survival space between the side structure and occupant is smaller than in conventional cars. This is an issue in side collisions. Therefore, in this article a solution is studied in which a lateral seat movement is imposed in the precrash phase. It generates a pre-acceleration and an initial velocity of the occupant, thus reducing the loads due to the side impact.

Methods: The assessment of the potential is done by numerical simulations and a full-vehicle crash test. The optimal parameters of the restraint system including the precrash movement, time-to-fire of head and side airbag, etc., are found using metamodel-based optimization methods by minimizing occupant loads according to European New Car Assessment Programme (Euro NCAP).

Results: The metamodel-based optimization approach is able to tune the restraint system parameters. The numerical simulations show a significant averaged reduction of 22.3% in occupant loads.

Conclusion: The results show that the lateral precrash occupant movement offers better occupant protection in side collisions.     

Assessing fitness to drive—A validation study on patients with mild cognitive impairment

Objectives: There is no consensus yet on how to determine which patients with cognitive impairment are able to drive a car safely and which are not. Recently, a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment. A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia. The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid) for a closely related group of patients; that is, patients with mild cognitive impairment (MCI).

Methods: Eighteen patients with mild cognitive impairment completed the proposed approach to the measurement of fitness to drive, including clinical interviews, a neuropsychological assessment, and driving simulator rides. The criterion fitness to drive was again assessed by means of an on-road driving evaluation. The predictive validity of the fitness to drive assessment strategy was evaluated by receiver operating characteristic (ROC) analyses.

Results: Twelve patients with MCI (66.7%) passed and 6 patients (33.3%) failed the on-road driving assessment. The previously proposed approach to the measurement of fitness to drive achieved an overall predictive accuracy of 94.4% in these patients. The application of an optimal cutoff resulted in a diagnostic accuracy of 100% sensitivity toward unfit to drive and 83.3% specificity toward fit to drive. Further analyses revealed that the neuropsychological assessment and the driving simulator rides produced rather stable prediction rates, whereas clinical interviews were not significantly predictive for practical fitness to drive in the MCI patient sample.

Conclusions: The selected measures of the previously proposed approach revealed adequate accuracy in identifying fitness to drive in patients with MCI. Furthermore, a combination of neuropsychological test performance and simulated driving behavior proved to be the most valid predictor of practical fitness to drive.