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.     

Implementing falls prevention research into policy and practice in Australia: past, present and future

Introduction

Falls in older Australians are a significant public health issue with one in three older people falling one or more times each year.

Method

Many fall prevention randomized controlled trials have been conducted in Australia as well as across the world.

Results

The findings of these studies now constitute a substantial evidence base that can provide direction for health and lifestyle interventions for preventing falls in older people. This research evidence has contributed to health policy in Australia to some extent, but is yet to be widely implemented into practice. This opinion piece overviews previous policy initiatives and describes a new Partnership research program funded by the Australian National Health and Medical Research Council (NHMRC), which seeks to further influence health policy and address the ongoing research-practice gap.     

Using the RE-AIM framework to translate a research-based falls prevention intervention into a community-based program: lessons learned

Problem

Exercise-based research interventions demonstrate reduced risk and rates of falls for community dwelling older adults; however, little is known about effective mechanisms for the translation, implementation, and maintenance of these interventions in community settings.

Method

The RE-AIM framework was used to assess the translatability of an effective exercise-based research intervention in a community setting. Questions included: Reach — Would the target population attend? Effectiveness — What was the adherence and compliance to the program? Were there individual improvements in falls risk factors? Adoption: Would staff at the center adopt the program and offer it past the funding period? Implementation — What adaptations, including optimal frequency and duration, should be made to meet the community needs, still adhere to core elements and achieve similar outcomes? Maintenance — Would the program be sustained by our community partners?

Discussion

The process of translating a controlled research intervention targeting older adults at risk of falls into a community setting was challenging. Licensed professionals developed the infrastructure to safely and effectively deliver the program. The end product was highly appealing program to our target audience, resulted in improved outcomes and was successfully adopted and maintained by the community partner.

Summary

Partnerships between community and healthcare providers are key to successful implementation of falls prevention interventions. Lessons learned from this experience can be applied to the translation of future exercise-based falls prevention interventions.     

Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults

Background

Falls are a common, serious, and often unrecognized problem facing older adults. The objective of this study was to provide an initial clinical and statistical validation for a public health strategy of fall risk self-assessment by older adults using a Fall Risk Questionnaire (FRQ).

Methods

Adults age 65 + (n = 40) were recruited at a Los Angeles Veterans Affairs (VA) medical facility and at a local assisted living facility. Participants completed the FRQ self-assessment and results were compared to a “gold standard” of a clinical evaluation of risks using the American/British Geriatrics Society guidelines to assess independent predictors of falls: history of previous falls, fear of falling, gait/balance, muscle weakness, incontinence, sensation and proprioception, depression, vision, and medications. For the comparison, we used an iterative statistical approach, weighing items based on relative risk.

Results

There was strong agreement between the FRQ and clinical evaluation (kappa = .875, p < .0001). Individual item kappa values ranged from .305-.832. After dropping one FRQ item (vision risk) because of inadequate agreement with the clinical evaluation (kappa = .139, p = .321), the final FRQ had good concurrent validity.

Conclusions

The FRQ goes beyond existing screening tools in that it is based on both evidence and clinical acceptability and has been initially validated with clinical examination data. A larger validation with longitudinal follow-up should determine the actual strength of the FRQ in predicting future falls.     

我国尘肺防治的研究进展与展望

生产性粉尘是我国作业场所最普遍且严重威胁劳动者健康的职业有害因素,接触生产性粉尘引发的尘肺病是我国发病最高的职业病。为控制尘肺病的发生,以《中华人民共和国职业病防治法》为依据,我国已经进行了大量配套职业卫生标准的研制工作,同时,在生产粉尘健康危害评价、接尘人群的健康监护和呼吸防护用品研制方面开展了大量科研工作。要达到国际劳工组织和世界卫生组织提出的2030年消除矽肺病目标,我们的尘肺防治工作任重道远。     

新疆天山公路泥石流风险评价研究

结合泥石流危险度和公路受泥石流损毁度两个指标,构建了天山公路泥石流风险评价模型,实现了对天山公路全线主要泥石流沟的风险值量化:风险值大于0.80的为极度危险,应以防为主,治为辅;风险值在0.50～0.80之间的为高度危险,应防、治并重;风险值在0.25～0.60之间的为中度危险,应以治为主,防为辅;风险值小于0.25的为轻度危险,应以防为主,治为辅。     

粤港澳大湾区污染场地土壤风险管控制度体系建设与思考

防范污染场地环境风险和保障人居环境安全是粤港澳大湾区建设世界级城市群面临的重要挑战和工作内容之一.由于粤港澳在政治制度和土地管理等方面的差异,以及珠三角9市内部城市化水平、产业结构以及环境管理能力的差别,大湾区各地污染场地风险管控模式有明显的差异,分析粤港澳大湾区典型城市污染场地风险管控特点,对加强污染场地风险管控技术交流与合作,优化大湾区污染场地风险管控制度具有重要意义.本文在简述我国污染场地风险管控制度体系的基础上,重点介绍了广州、深圳、东莞、香港和澳门的污染场地风险管控制度体系、监管对象、污染评估与整治程序等的特点,对其风险管控制度体系进行了分析与对比,并针对土地规划、政策反馈、信息公开及联盟机制探索等提出了思考与建议.总体来看,香港及珠三角部分地市构建了行之有效的污染场地风险管控制度体系,且体现了一定的地方特点,但随着污染场地的进一步开发再利用,打造粤港澳大湾区世界级城市群的建设目标将对污染场地风险管控策略的安全性、精细化和时效性等提出更高的要求,互相借鉴和充分学习,加强大湾区2区9市污染场地风险管控上的技术交流与合作,是实现大湾区污染场地安全再利用与高效开发的有效路径.     

《大气污染防治行动计划》实施的环境健康效果评估

为了定量评估《大气十条》实施带来的环境健康效益,本文首先依据PM_(2.5)浓度和人口数据,分析2013～2017年全国人口加权浓度的变化,其次利用Ben MAP模型对全国338个地级及以上城市2013年PM_(2.5)基准情景和2017年PM_(2.5)控制情景进行分析,定量分析全国31个省(市)及338个地级及以上城市减少过早死亡人数.结果表明,由于PM_(2.5)浓度大幅下降,2013～2017年全国PM_(2.5)人口加权浓度呈逐年下降趋势;北京、天津、河北等京津冀及周边地区减少过早死亡人数最多. 2017年全国280个城市避免过早死亡人数有所增加,58个城市避免过早死亡人数有所下降.以WHO过渡期第1阶段目标值(PM_(2.5)年均浓度为35μg·m-3)作为控制情景,估算2013年全国过早死亡人数约为101 293人,2017年约为41 080人,《大气十条》的实施大约避免60 213人过早死亡.依据支付意愿法调查结果,估算增加的健康效益约为549. 7亿元.     

炼化常减压装置挥发性有机物无组织源谱分析

以典型常减压装置中工艺管线无组织逸散VOCs为切入点,选取不同地域的多套常减压装置,参照美国EPA包袋法采样标准,并按照HJ 644-2013标准将气态样品转移到组合三吸附管内,利用气相色谱-质谱仪进行分析检测.结果表明,常减压装置无组织排放的VOCs共含116种物质,以烷烃类、烯烃类和醛酮类物质占主导,其中烷烃类物质占总排放的65%以上.在此基础上,对检出物质占比量进行量化分析,明确了常减压装置VOCs无组织排放因子以2-甲基丁烷、丁烯和苯等物质为主,并检出了微量的萘.相关结论可为炼化企业构建VOCs排放清单提供有力支撑,对于后续精细化管理炼化行业的VOCs排放具有指导意义.