Anneliese Spinks

Determinants of household water conservation: The role of demographic, infrastructure, behavior, and psychosocial variables

Securing water supplies in urban areas is a major challenge for policy makers, both now and into the future. This study aimed to identify the key determinants of household water use, with a view to identifying those factors that could be targeted in water demand management campaigns. Objective water use data and surveys were collected from 1008 households in four local government areas of southeast Queensland, Australia. Results showed that demographic, psychosocial, behavioral, and infrastructure variables all have a role to play in determining household water use. Consistent with past research, household occupancy was the most important predictor of water use. Households in regions recently exposed to drought conditions and higher-level restrictions also used less water than those who had less experience with drought. The effect of water efficient technology was mixed: some water efficient appliances were associated with less water use, while others were associated with more water use. Results also demonstrated the importance of considering water use as a collective behavior that is influenced by household dynamics. Households who reported a stronger culture of water conservation used less water. These findings, along with evidence that good water-saving habits are linked to water conservation, highlight the value of policies that support long-term cultural shifts in the way people think about and use water.

An experimental test of voluntary strategies to promote urban water demand management

In light of the current and future threats to global water security the current research focuses on trialing interventions to promote urban water conservation. We report an experimental study designed to test the long-term impact of three different interventions on household water consumption in South East Queensland. Participants from 221 households were recruited and completed an initial survey, and their houses were fitted with smart water meters which measured total water usage at 5 s intervals. Households were allocated into one of four conditions: a control group and three interventions groups (water saving information alone, information plus a descriptive norm manipulation, and information plus tailored end-user feedback). The study is the first to use smart water metering technology as a tool for behaviour change as well as a way to test the effectiveness of demand management interventions. Growth curve modelling revealed that compared to the control, the three intervention groups all showed reduced levels of household consumption (an average reduction of 11.3 L per person per day) over the course of the interventions, and for some months afterwards. All interventions led to significant water savings, but long-term household usage data showed that in all cases, the reduction in water use resulting from the interventions eventually dissipated, with water consumption returning to pre-intervention levels after approximately 12 months. Implications for water demand management programs are discussed.

A systematic review of the quality of burn scar rating scales for clinical and research use

INTRODUCTION Scar rating scales have the potential to contribute to better evaluation of scar properties in both research and clinical settings. Despite a large number of scars assessment scales being available, there is limited information regarding the clinimetric properties of many of these scales. The purpose of the review was to inform clinical and research practice by determining the quality and appropriateness of existing scales. This review summarises the available evidence for the clinimetric properties of reliability, validity (including responsiveness), interpretability and feasibility of existing scales. METHODS Electronic searches of MEDLINE, CINAHL, EMBASE and The Cochrane Library databases from 1990 onwards were used to identify English articles related to burn scar assessment scales. Scales were critically reviewed for clinimetric properties that were reported in, but not necessarily the focus of studies. RESULTS A total of 29 studies provided data for 18 different scar rating scales. Most scar rating scales assessed vascularity, pliability, height and thickness. Some scales contained additional items such as itch. Only the Patient and Observer Scar Assessment Scale (POSAS) received a high quality rating but only in the area of reliability for total scores and the subscale vascularity. The Vancouver Scar Scale (VSS) received indeterminate ratings for construct validity, reliability and responsiveness. Where evidence was available, all other criteria for the POSAS, VSS and the remaining 17 scales received an indeterminate rating due to methodological issues, or a low quality rating. Poorly defined hypotheses limited the ability to give a high quality rating to data pertaining to construct validity, responsiveness and interpretability. No scale had empirical testing of content validity and no scale was of sufficient quality to consider criterion validity. CONCLUSIONS The POSAS, with high quality reliability but indeterminate validity, was considered to be superior in performance based on existing evidence. The VSS had the most thorough review of clnimetrics although available data received indeterminate quality ratings. On the basis of the evidence, the use of total scores has not been supported, nor has the measurement of pigmentation using a categorical scale.

The epidemiology of burn injuries in an Australian setting, 2000-2006.

OBJECTIVES To describe presentation characteristics of burn leading to death or hospital treatment (i.e. inpatient admissions and emergency department [ED] presentations) across the state of Victoria, Australia, for the years 2000-2006 inclusive. METHODS Data were provided by the Victorian Injury Surveillance Unit (VISU) from three different datasets pertaining to burn deaths, hospital inpatient admissions and non-admitted ED presentations. Population estimates were derived from census data provided by Australian Bureau of Statistics. RESULTS During the 7-year period, 178 people died and 36,430 were treated for non-fatal burn injury, comprising 7543 hospital admissions and 28,887 non-admitted ED presentations. Males, children aged less than 5 years of age, and the elderly (> or =65 years of age) were at the highest risk of injury. Contact with heat and hot substances represented the major aetiological factor contributing to thermal injuries accounting for 64% of all hospital admissions and 90% of ED presentations. Temporal trends indicate no change in the population rate of burn deaths or hospital admissions during the study period. CONCLUSIONS ED presentations and hospital admissions and deaths have remained the same over this study period, but rates of burn remain high in males, children and the elderly. This could be due to variations in the implementation of government prevention and control programs and the divergence in efficient treatments and clinical practices amongst hospital care providers. Therefore, educational efforts for prevention should be the keystone to minimise the incidence of burns.

Ten-Year Epidemiological Study of Pediatric Burns in Canada

The aim of this study was to report on the temporal trends, incidence rates, demographic, and external-cause data for all burn injury related deaths and hospital admissions among children Canadian aged 0 to 19 years for the years 1994 to 2003. Statistics Canada and Canadian Institute of Health Information data were used to describe burn injury related deaths and hospital admission trends in children aged 0 to 19 years who were residents of Canada (1994–2003). Population estimates were derived from census data provided by Statistics Canada. During the 10-year period, 494 children died and 10,229 were admitted to a Canadian hospital because of a burn-related injury. Males and children aged less than 5 years of age were at the highest risk of injury, with children aged 1 to 5 years at the highest risk of death. Scalds represented the major etiological factor contributing to thermal injuries accounting for 50% of all hospital admissions. Temporal trends indicate a significant a significant decline in burn injuries across all age groups during the period 1994 to 2003. There has been a clear reduction in the number of patients with burn injury requiring hospital admission. This trend indicates success in safety initiative to prevent burn injuries as well as in improvements in the treatments of burn and hospital admission procedures. Nonetheless, burn injury remains a serious threat to the well-being of the Canadian pediatric population.

Quantifying the risk of sports injury: a systematic review of activity-specific rates for children under 16 years of age

Injuries caused by sports and other forms of physical activity in young children constitute a significant public health burden. It is important to quantify this risk to ensure that the benefits of sport participation are not outweighed by the potential harms. This review summarises the literature reporting exposure-based injury rates for various forms of physical activity in children aged 15 years and younger. Forty eight studies were found, of which 27 reported injury rates per hourly based exposure measured and 21 reported injury rates according to some other measure. Fourteen different sports and activities were covered, mostly team ball sports, with soccer being the most widely studied. Injury definition and the method of ascertaining and measuring injuries differed between studies, which created a large variation in reported injury rates that did not necessarily represent actual differences in injury risk between activities. The highest hourly based injury rates were reported for ice hockey, and the lowest were for soccer, although the range of injury rates for both of these activities was wide. Very few studies have investigated sports-related injuries in children younger than 8 years or in unorganised sports situations.

Determinants of sufficient daily activity in Australian primary school children

Aims:  Australian guidelines recommend that children participate in at least one hour of physical activity every day. We aimed to measure physical activity participation in a random sample of Australian primary school children and to determine the biological, behavioural, environmental and social influences associated with insufficient daily activity.

Community-based programmes to prevent pedestrian injuries in children 0–14 years: a systematic review

Background. Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing pedestrian injury in children 0–14 years of age. Methods. A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study; target population was children under 14 years; outcome measure is either pedestrian injury rates or observed child pedestrian or vehicle driver behaviour; and use of a community control or an historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results. The review found four studies that met all the inclusion criteria. The three studies using injury as their outcome measure found a 12%, 45% and 54% reduction for all childhood injuries with the fourth showing improved traffic control at child pedestrian sites (9% reduction in traffic flow) and sustainable community safety promotion activity. Conclusion. There is a paucity of research studies in the literature from which evidence regarding the effectiveness of community-based programmes for the prevention of pedestrian injury in children can be drawn. However, the hypothesis that community-based interventions are effective in reducing the incidence of childhood pedestrian injury would appear to be supported, with the degree of success being cumulative depending on the complexity of individual strategies employed.

Community based prevention programs targeting all injuries for children

Objective: Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing all-cause injury in children 0–14 years of age. Methods: A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; children under 14 years; outcome measure was injury rates; and either a community control or an historical control was used in the design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results: Thorough electronic and library search techniques yielded only nine formally evaluated community based all-cause child injury prevention programs that have reported actual injury outcomes. Of these nine studies, seven provided high level evidence where contemporary control communities were used for comparison; the remaining two used a pre and post-design or time trend analysis where historical data from the community were used as the comparison. Only three of the seven studies with contemporary control communities found significant effect of the intervention; the two studies without controls noted significant reductions in injury rates after the intervention period. Conclusion: There is a paucity of research from which evidence regarding the effectiveness of community based childhood injury prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

A systematic review of the management and outcome of toxic epidermal necrolysis treated in burns centres

INTRODUCTION Toxic epidermal necrolysis (TEN) is a rare condition characterised by mucocutaneous exfoliation of greater than 30% total body surface area (%TBSA), increasingly being treated in burns centres. The rate of mortality varies significantly in the literature, with recent prospective studies in non-burns centres reporting percentage mortality of approximately 45%. We undertook a systematic review of published studies that included TEN patients treated specifically in burns centres to determine a cumulative mortality rate. METHODS Electronic searches of MEDLINE, EMBASE and The Cochrane Library (Issue 4, 2010) databases from 1966 onwards were used to identify English articles related to the treatment of TEN in burns centres. RESULTS The systematic literature search identified 20 studies which specifically described patients with TEN grater than 30% %TBSA. Treatment regimens varied amongst studies, as did mortality. The overall percentage mortality of the combined populations was 30%. Risk factors commonly described as associated with mortality included age, %TBSA and delay to definitive treatment. CONCLUSION The review highlights the variation between principles of treatment and mortality amongst burns centres. It offers a standard that burns centre can use to internationally compare their mortality rates. The review supports the ongoing reporting of outcomes in TEN patients with epidermal detachment greater than 30%.