The effect of an ageing and less fit population on the ability of people to egress buildings

The functional capability of building occupants to egress from buildings is likely to change as populations age and become less fit. A review of the current health literature suggests obesity can be used to determine the likely reduction in walking speed and also as a marker for other egress related factors such as the risk of falls. This paper examines the possible effects of gender, age and obesity and uses a Monte Carlo network evacuation model to examine whether these changes will significantly increase the total evacuation time from an exemplar high-rise building. Modelling results suggest that total evacuation times may increase by up to 20% when comparing historical data from Canada in 1971 with a future New Zealand scenario for 2031.     

Road traffic deaths in Brazil: rising trends in pedestrian and motorcycle occupant deaths

Objective: According to the World Health Organization, the global burden of road traffic mortality exceeds 1.27 million people annually; over 90 percent occur in low- and middle-income countries. Brazil's road traffic mortality rate of ～20 per 100,000 is significantly higher than nearby Chile or Argentina. To date, there has been very little information published on road traffic fatalities among vulnerable road users (VRUs) in Brazil. Methods: Road traffic fatality data from 2000 to 2008 were extracted from Brazil's Mortality Information System (SIM). Road traffic deaths were extracted using the International Classification of Diseases (ICD-10) V-codes (V01-V89) and then subcategorized by VRU categories. Information was then disaggregated by gender, age, and region. Results: In 2008, 39,211 deaths due to road traffic injuries were recorded in Brazil, resulting in a crude mortality rate of 20.7 per 100,000 inhabitants. Pedestrian mortality averaged 5.46 deaths per 100,000 between 2000 and 2008. The mortality rate for elderly pedestrians (80+ years) is 20.1 per 100,000, over 10 times that of 0- to 9-year-olds. In the past decade, motorcycle occupant mortality has dramatically increased by over 300 percent from 1.5 per 100,000 in 2000 to 4.7 per 100,000 in 2008. The 20- to 29-year age group remains most affected by motorcycle deaths, with a peak fatality rate of 10.76 per 100,000 in 2008. The north and northeast regions, with the lower per capita gross domestic product (GDP), have higher proportions of VRU deaths compared with other regions. Conclusions: Vulnerable road users are contributing an increasing proportion of the road traffic fatalities in Brazil. Nationally, elderly pedestrians are at particularly high risk and motorcycle fatalities are increasing at a rapid rate. Less prosperous regions have higher proportions of VRU deaths. Understanding the epidemiology of road traffic mortality in vulnerable road user categories will better allow for targeted interventions to reduce these preventable deaths.     

Gender aspects of work-related injuries in a Swedish municipality

The purpose of this study was to investigate gender aspects of work-related injuries in a Swedish municipality (population 41,000). All unintentional injuries treated at in- and out-patient facilities were recorded during a period of 1 year. The work-related injuries were mapped out in more detail with the help of standardized and structured surveys via telephone interviews and hospital records. The rate of work-related injuries among the gainfully employed was 33 per 1000. Males were observed to suffer more work-related injuries than females (46 compared to 12 per 1000 gainfully employed persons), and there were gender differences with regard to work-related injuries and injury event patterns. Young men showed the highest rate of injuries. Injuries caused during machine operation were the most common for both males and females, amounting to almost one quarter of all injuries. Injuries caused by falls were most common amongst females in the age groups 15–24 (25%) and 45–64 (28%). More attention should be given to gender aspects of work-related injuries and their prevention.     

Older adult falls at a metropolitan airport: 2009-2010

IntroductionWe investigated falls at a metropolitan airport to determine fall incidence, identify potential causes of these falls, and suggest opportunities for mitigation.MethodsWe used deidentified incident reports of all falls requiring EMS response that occurred at the airport during 2009 and 2010.ResultsOn average, one fall occurred every 2.3 days. Ninety-six percent (96%) of falls occurred in terminals. Of all falls, 44% occurred on escalators, making escalators the most common location. Seventy-two percent (72%) of fallers were females; 43% were ≥ 65 years; 92% of all falls resulted in a documented injury; 37% of falls resulted in transport to hospital emergency departments. Escalator fall risks include carrying bags (due to changes in baggage fees), using cells phones, not using handrails, and compromised strength and balance.Conclusions and ImpactDiverting at-risk passengers to elevators could significantly reduce the overall falls. Interventions targeting escalator falls have the greatest promise for reducing falls at this airport.     

含阶梯结构的高层楼梯井内烟气湍流及输运特征量的全局敏感性分析

高层建筑竖井火灾中影响因素众多,并且各因素对高层楼梯井火灾中重要现象、关键数值等的影响大小不一,使得此类火灾中的实验或理论研究成本较高。通过建立全局敏感性分析平台,定量考察了高层楼梯井结构所涉及因素的影响大小,并能够方便地筛选掉对所考察量影响较小的因素,以降低实验或计算成本。使用数值模拟方法,通过CFD软件对包含阶梯几何框架的高层楼梯井结构火灾进行了共计60次工况计算。并且根据计算结果,使用全局参数敏感性分析方法,得出建筑尺寸、热释放速率、环境参数对高层楼梯井内烟气湍流特性及输运特性的敏感性排序。结果表明,火源热释放速率对各输出参数的影响均占38%以上。     

Society's aggression level as a predictor of traffic fatality rate

This research investigated the relationship of violence/aggression and other societal variables to traffic accidents. In the first of two studies, multiple regression was applied to 1977 data from each of the 50 states and the District of Columbia. Traffic fatalities per registered vehicle was the dependent variable. The independent variables were homicide rate, suicide rate, fatality rate from other causes, unemployment rate, personal income, density of physicians, alcohol consumption, motor vehicles per capita, road mileage per vehicle, sex and age distribution of drivers, and attained education. The main finding was that the homicide rate (but not the suicide rate) predicted the traffic fatality rate; additional significant predictors were the proportion of young drivers and the fatality rate from non-motor-vehicle accidents. The two primary predictors (homicides and young drivers) accounted for 64 % of the variance of traffic fatalities. In the second study, validation was performed by using the 1977 regression coefficients to estimate 1978 traffic fatalities. The results indicate that when the 1977 regression coefficients were applied to the 1978 values for homicides and young drivers, they accounted for 49 % of the variance of the 1978 traffic fatalities. The findings are discussed in terms of how society's violence/aggression may contribute to traffic accidents.     

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older,United States, 2006–2011

IntroductionWith the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern.MethodsWe analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups.ResultsFrom 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion.ConclusionIncreasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare.Practical applicationsWith the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.     

Falls and fall prevention programmes in developing countries: environmental scan for the adaptation of the Canadian Falls prevention curriculum for developing countries

Problem

Falls in older persons in developing countries are poorly understood, and falls prevention and health promotion programmes for this population are largely lacking.

Methods

A systematic review was carried out of relevant literature on falls and prevention programmes, and falls prevention education, and a scan undertaken of health promotion programmes for older persons in a representative country - South Africa.

Results

Studies on the risk and prevalence of falls are largely retrospective and hospital-based, with varied methodology, including study period, sampling method and sample size. Falls prevalence is based largely on self-reports in studies on general trauma in all age groups. Falls incidence varies from 10.1% to 54%. No reports could be traced on sustained falls prevention or health promotion programmes.

Conclusion

Scant research has been conducted and little preventive education offered on falls in older persons. Adaptation of the Canadian Falls Prevention Curriculum for developing countries will help to fill gaps in knowledge and practice.

Impact on industry

With rapid increase in the populations of older persons in developing countries, research on age related disorders such as falls is required to guide policy and management of falls.     

Occupational accidents with ladders in Spain: Risk factors

Introduction

Occupational accidents suffered by workers in Spain when using ladders were analyzed over a six year period from 2003-2008, during which the total of notified ladder-related accidents amounted to 21,725. Method: Different accident-related factors were identified for the purpose of developing a pattern of those factors that had the greatest influence on the seriousness and the fatality of such accidents. Thus, a series of variables were examined such as age and length of service of the injured worker, firm size, the work sector, the injury suffered, and the part of the body that was injured. Since falls is the most frequent and most serious of ladder related occupational accidents, a special analysis of falls was performed. Results: The findings showed that the seriousness of ladder-related accidents increased with the age of the injured worker. Likewise, accidents at places other than the usual workplace were more serious and registered higher fatalities than those that occurred at the usual place of work. Conclusions: The analysis of falls from ladders established that accidents in smaller-sized firms were of greater seriousness and involved more fatalities than those in larger-sized firms. The investigation also underlined the need for stricter compliance with preliminary safety assessments when working with ladders.     

某铅锌矿爆破有害效应分析及安全评估

以某铅锌矿爆破施工为背景,在现场试验的基础上,对测得的振动速度进行回归分析,得到场地爆破振动衰减规律,并结合爆破主频率,确定了周围民房的容许振动速度为2cm/s。同时,对爆破冲击波和噪声进行研究,结果表明:爆破振动、冲击波和噪声均与爆心距、炸药量有关。当爆心距相同时,噪声对建筑物和人员的影响最大,空气冲击波次之,爆破振动较小。主要从控制最大段药量和爆源距安全原则考虑,提出了防爆破振动、噪声和冲击波及飞石的安全距离。另外,还提出了硐口悬挂3层麻袋、堵塞炮泥和控制起爆网络中段间微差等安全措施,并对有害效应进行评估,其结果对后续爆破设计和施工具有实用价值和指导意义。     

Characterization of fall patients: Does age matter?

IntroductionEvaluating age-specific fall characteristics is important for prevention programs. The aim was to characterize fallers who presented to our trauma center. We hypothesized that fall characteristics and outcomes would vary with age.MethodsData were retrospectively collected from the trauma registry and electronic medical records during January 1st, 2014-December 31st, 2015. Data were analyzed by Chi-square test with Yates’ continuity correction and one-way ANOVA with Bonferroni’s multiple comparisons test.ResultsThere were 1541 fallers, 814 (52.8%) were male. Ages ranged from 11 months to 100 years. The admission rate was high at 86%, with an average hospital stay of 5.7 days. Patients in the 0-18 and 19-45 age groups spent significantly less time in the hospital (p < 0.0001). Elderly patients had the highest average injury severity score (p < 0.0001). However, the youngest patients required surgery more often (p = 0.0004). The overall mortality rate was 3.6% and 52.8% were male. The mortality rate increased with age, from 0% for the 0-18 age group to 6.9% for patients ≥ 65 years of age. Remarkably, fallers in the 19-45 and 46-64 age groups predominantly died from ground level falls even though the average fall height in these groups was the highest (p < 0.0001). More fallers in the 19-45 and 46-64 age groups tested positive for alcohol/drug use (p < 0.0001). Middle-aged and elderly patients were more likely to be discharged to a skilled nursing or rehabilitation facility compared to younger patients who were discharged home.Conclusions and practical applicationsFall characteristics and outcomes varied with age. Data on age-specific characteristics, outcomes, and risk factors of falls will help in developing targeted interventions and may lead to better approaches to treat patients.     

A cost–benefit analysis of three older adult fall prevention interventions

IntroductionOne out of three persons aged 65 and older falls annually and 20% to 30% of falls result in injury. The purpose of this cost–benefit analysis was to identify community-based fall interventions that were feasible, effective, and provided a positive return on investment (ROI).MethodsA third-party payer perspective was used to determine the costs and benefits of three effective fall interventions. Intervention effectiveness was based on randomized controlled trial results. National data were used to estimate the average annual benefits from averting the direct medical costs of a fall. The net benefit and ROI were estimated for each of the interventions.ResultsFor the Otago Exercise Program delivered to persons aged 65 and older, the net benefit was $121.85 per participant and the ROI was 36% for each dollar invested. For Otago delivered to persons aged 80 and older, the net benefit was $429.18 and the ROI was 127%. Tai chi: Moving for Better Balance had a net benefit of $529.86 and an ROI of 509% and Stepping On had a net benefit of $134.37 and an ROI of 64%.ConclusionsAll three fall interventions provided positive net benefits. The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs. These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment.     

Seasonal variation in fall-related emergency department visits by location of fall – United States, 2015

Introduction: In the United States, fall-related emergency department (ED) visits among older adults (age 65 and older) have increased over the past decade. Studies document seasonal variation in fall injuries in other countries, while research in the United States is inconclusive. The objectives of this study were to examine seasonal variation in older adult fall-related ED visits and explore if seasonal variation differs by the location of the fall (indoors vs. outdoors), age group, and sex of the faller. Methods: Fall-related ED visit data from the National Electronic Injury Surveillance System-All Injury Program were analyzed by season of the ED visit, location of the fall, and demographics for adults aged 65 years and older. Results: Total fall-related ED visits were higher during winter compared with other seasons. This seasonal variation was found only for falls occurring outdoors. Among outdoor falls, the variation was found among males and adults aged 65 to 74 years. The percentages of visits for weather-related outdoor falls were also higher among males and the 65–74 year age group. Conclusions: In 2015, there was a seasonal variation in fall-related ED visits in the United States. Weather-related slips and trips in winter may partially account for the seasonal variation. Practical Implications: These results can inform healthcare providers about the importance of screening all older adults for fall risk and help to identify specific patients at increased risk during winter. They may encourage community-based organizations serving older adults to increase fall prevention messaging during winter.     

Impact of the Graduated Driver Licensing Program in Nova Scotia

A comprehensive evaluation of the Nova Scotia graduated licensing program was conducted. This program was implemented on October 1, 1994 and applies to all novice drivers, regardless of age. It spans 2 1/2 years in two stages: a 6-month learner phase, followed by a 24-month newly licensed driver phase. During both phases several driving restrictions apply, most notably a requirement for adult supervision at all times in the learner phase and a night driving restriction from midnight to 5 a.m. in the newly licensed driver phase. The evaluation of this program used a series of increasingly refined analyses that controlled for the influence of other explanatory variables. All the analyses showed that the graduated licensing program in Nova Scotia was associated with a significant reduction in crashes. For drivers age 16, there was a 24 percent decrease in total crashes during the first full year of the program and a 37 percent reduction during the first 3 years of the program. Comparable decreases occurred in injury crashes. Improvements also were observed for all novice drivers, not just those who are young - there was a 19 percent decrease in the crash rate for all novice drivers. Comparisons with results from other graduated licensing programs indicate the Nova Scotia program has been more effective than others in reducing crashes.     

The relationship of beer consumption and state alcohol and motor vehicle policies to fatal accidents

Fatal accident data from 50 states and the District of Columbia were examined in order to determine the relationship between alcohol availability and fatal motor vehicle accidents. This relationship was analyzed for both fatal accidents and motor vehicle fatalities (potentially more than one per accident) using multiple regression. The independent variables were: (1) driving age (percent of drivers under 21); (2) beverage purchase age; (3) average beer consumption; (4) number of outlets per million population selling alcohol for on-premise consumption; (5) percentage of metropolitan residents; (6) percentage of male drivers; and (7) mileage per driver per year. It was found that the regression analyses for fatal accidents and for fatalities were highly similar. Driving age was the strongest predictor of highway mortality. On-premise availability of alcohol was significantly and inversely associated with motor vehicle fatalities. This suggests that when on-premise outlets are fewer and more geographically spread out, the chances of drinking and driving are greater. Finally, average beer consumption was significantly and positively associated with highway fatalities perhaps because many drivers consider it a “soft” alcoholic beverage that will not impair their ability to drive.     

The direct costs of fatal and non-fatal falls among older adults — United States

IntroductionThis study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars.MethodIncidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index.ResultsIn 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women.ConclusionMedically treated falls among older adults, especially among older women, are associated with substantial economic costs.Practical applicationWidely implementing evidence-based interventions for fall prevention is essential to decrease the incidence and healthcare costs associated with these injuries.     

Winter storm-related injuries in Oklahoma, January 2007

Introduction

A January 2007 ice storm occurred in Oklahoma, causing power outages and hazardous travel conditions. The objective of this investigation was to describe the nature of winter storm-related injuries among Oklahoma residents, to determine populations at risk, and to inform prevention-planning personnel.

Methods

Winter storm-related injuries were a temporarily reportable condition; all acute-care hospitals and the state medical examiner logged storm-related injuries and deaths during January 12 − 30, 2007. Medical records were retrospectively abstracted.Risk of injury was described by demographic group, injury type, and mechanism.

Results

Among 6,047 persons experiencing winter storm-related injuries, 74% were injured in falls, 13% in motor-vehicle collisions (MVCs), 8% while sledding, 1% by unintentional carbon monoxide poisoning, 1% in cleanup activities, and 3% by other mechanisms. Median age of injured persons was 39 years. Persons aged ≥ 40 years were 1.4 times more likely to experience falls as the cause of injury than those aged < 40 years, and falls were twice as likely as other mechanisms to cause fractures among persons aged ≥ 40 years. Injured persons aged < 40 years were 2.2 times more likely to experience MVC-related injuries, and 19 times more likely to experience sledding-related injuries than persons aged ≥ 40 years.

Conclusions

Younger persons were more likely injured in MVCs and sledding incidents, whereas older persons were more likely to experience falls and fractures.

Impact on industry

Prevention messages for winter storm-related injuries should target winter-driving safety tips to younger adults and precautions regarding falls to older adults.     

Injuries among electric power industry workers, 1995–2013

IntroductionWorkers in the electric power industry face many risks of injury due to the high diversity of work tasks performed in potentially hazardous and unpredictable work environments.MethodWe calculated injury rates by age, sex, occupational group, and injury type among workers in the Electric Power Research Institute’s (EPRI) Occupational Health and Safety Database (OHSD), which contains recordable injury, medical claims, and personnel data from 18 participating electric power companies from 1995 to 2013.ResultsThe OHSD includes a total of 63,193 injuries over 1,977,436 employee-years of follow-up, for an overall injury rate of 3.20 injuries per 100 employee-years. Annual injury rates steadily decreased from 1995 to 2000, increased sharply in 2001, and subsequently decreased to their lowest rate of 1.31 injuries per 100 employee-years in 2013. Occupations with the highest injury rates were welders (13.56 per 100 employee-years, 95% CI 12.74–14.37), meter readers (12.04 per 100 employee-years, 95% CI 11.77–12.31), and line workers (10.37 per 100 employee-years, 95% CI 10.19–10.56). Males had an overall higher injury rate compared to females (2.74 vs. 1.61 per 100 employee-years) although some occupations, such as meter reader, had higher injury rates for females. For all workers, injury rates were highest for those in the 21 to 30 age group (3.70 per 100 employee-years) and decreased with age. Welders and machinists did not follow this trend and had higher injury rates in the 65 + age group. There were 63 fatalities over the 1995 to 2013 period, with 21 fatalities (33.3%) occurring among line workers.ConclusionsAlthough injury rates have decreased over time, certain high-risk groups remain (i.e., line workers, mechanics, young males, older welders and machinists, and female meter readers).Practical applicationsProtective measures and targeted safety programs may be warranted to ensure the safety of electric power workers.     

Traumatic brain injury mortality among U.S. children and adolescents ages 0–19 years, 1999–2017

IntroductionTo examine recent traumatic brain injury (TBI) mortality changes among Americans aged 0–19 years by sex, age, urbanicity, state, and intent/causes of injury. Method: TBI mortality per 100,000 population and average annual percent changes (AAPCs), plus 95% confidence intervals (CIs) based on Joinpoint regression models. Results: Age-adjusted TBI mortality among Americans aged 0–19 years declined consistently, though at varying rates between 1999 and 2013 (AAPC = −4.8%, 95%CI: −6.3%, −3.2%), and then significantly increased from 4.42 per 100,000 population in 2013 to 5.17 per 100,000 population in 2017 (AAPC = 3.4%, 95% CI: 1.7%, 5.1%). During the study time period, boys, rural children, and youth aged 15–19 years had higher TBI mortality rates than girls, urban children, and younger children, respectively. TBI mortality from unintentional transport crashes decreased substantially in all age groups between 1999 and 2017, and especially from 1999 to 2010. TBI mortality from suicide increased significantly from 2008 to 2017 in the 10–14-year age group (AAPC = 14.6%, 95% CI: 12.6%, 16.6%) and from 2007 to 2017 in the 15–19-year age group (AAPC = 6.3%, 95% CI: 3.8%, 8.7%). Unintentional transport crashes were the leading cause of TBI-related mortality in 46 states in 1999, but by 2017, suicide became the first leading cause in 14 states. Conclusions: Pediatric TBI mortality declined consistently between 1999 and 2013 and increased significantly from 2013 to 2017, driven primarily by the mortality decrease from unintentional transport crashes and increase in suicide mortality. The spectrum of leading causes of pediatric TBI mortality changed across age groups and over time from 1999 to 2017. Practical Applications: TBI mortality increases in the United States since 2013 are driven primarily by increasing suicide rates, a trend that merits the attention of policy-makers and injury researchers. Action should be taken to curb growing TBI mortality rates among adolescents aged 10–19 years.