Bridget Kool

The contribution of alcohol to falls at home among working-aged adults

The role of alcohol in the occurrence and burden of fall related injury at home is unclear. We examined the contribution of alcohol to fatal and hospitalized injuries due to unintentional falls at home among working-aged adults. We conducted a population-based case-control study in Auckland, New Zealand between July 2005 and July 2006. Cases were 335 people aged 25-60 years who were admitted to hospital or died as a result of unintentional falls at home. Control subjects were 352 people randomly selected from the electoral roll from the same age band as the cases. The participants or next-of-kin completed a structured interview that ascertained data on sociodemographic, personal, and lifestyle factors including alcohol consumption. After controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding 6h relative to none was associated with a significantly increased risk of fall related injury (for two standard drinks: odds ratio: 3.7, 95% confidence interval: 1.2-10.9; for three or more drinks: odds ratio: 12.9, 95% confidence interval: 5.2-31.9). Approximately 20% of unintentional falls at home in this population may be attributable to the consumption of two or more alcoholic drinks in the preceding 6h. Drinking is strongly associated with unintentional falls at home that result in admission to hospital or death. Moreover, a substantial proportion of falls at home among working-age people can be attributed to alcohol consumption. This largely unrecognized problem should be addressed in falls prevention programs.

The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies

Objective: To appraise the published epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption among young and middle-aged adults. Design: Systematic review. Methods: Data sources: searches of electronic databases (eg, Medline, EMBASE, CINAHL, PsycINFO, Scopus), websites of relevant organisations, major injury journals, reference lists of relevant articles, and contact with experts in the field. Inclusion criteria: epidemiological studies with an English language abstract investigating alcohol use as a risk factor (exposure) for unintentional falls or related injuries among individuals aged 25–60 years. Studies were critically appraised using the GATE LITE tool. Meta-analysis was not attempted because of the heterogeneity of the eligible studies. Results: Four case–control, three cohort and one case–crossover study fulfilled the inclusion criteria. The studies showed an increased risk of unintentional falls among young and middle-aged adults with increasing exposure to alcohol use. However, the magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. Modest evidence of a dose–response relationship with acute alcohol use was observed. The association between usual alcohol use and fall risk was inconclusive, and evidence of a gender difference was inconsistent. Conclusions: Alcohol use appears to be an important risk factor for falls among young and middle-aged adults. Controlled studies with sufficient power that adjust effect estimates for potential confounders (eg, fatigue, recreational drug use) are required to determine the population-based burden of fall-related injuries attributable to alcohol. This can help inform and prioritise falls prevention strategies for this age group.

Hospitalised and Fatal Head Injuries in Viti Levu, Fiji: Findings from an Island-Wide Trauma Registry (TRIP 4)

Background: Globally, head injury is a substantial cause of mortality and morbidity. A disproportionately greater burden is borne by low- and middle-income countries. The incidence and characteristics of fatal and hospitalised head injuries in Fiji are unknown. Methods: Using prospective data from the Fiji Injury Surveillance in Hospital system, the epidemiology of fatal and hospitalised head injuries was investigated (2004–2005). Results: In total, 226 hospital admissions and 50 fatalities (66% died prior to admission) with a principal diagnosis of head injury were identified (crude annual rates of 34.7 and 7.7/100,000, respectively). Males were more likely to die and be hospitalised as a result of head injury than females. The highest fatality rate was among those in the 30–44-year age group. Road traffic crashes were the leading causes of injuries resulting in death (70%), followed by ‘hit by person or object’ and falls (14% each). Among people admitted to hospital, road traffic crashes (34.5%) and falls (33.2%) were the leading causes of injury. The leading cause of head injuries in children was falls, in 15–29-year-olds road traffic crashes, and in adults aged 30–44 years or 45 years and older ‘hit by person or object’. Among the two major ethnic groups, Fijians had higher rates of falls and ‘hit by person or object’ and Indians higher rates for road traffic crashes. There were no statistically significant differences between the overall rates of head injuries or the fatal and non-fatal rates among Fijians or Indians by gender following age standardisation to the total Fijian national population. Conclusion: Despite underestimating the overall burden, this study identified head injury to be a major cause of death and hospitalisation in Fiji. The predominance of males and road traffic-related injuries is consistent with studies on head injuries conducted in other low- and middle-income countries. The high fatality rate among those aged 30–44 years in this study has not been noted previously. The high case fatality rate prior to admission to the hospital requires urgent attention.

Association between prescription medications and falls at home among young and middle-aged adults

Using data from a population-based case–control study of people aged 25–60 years in Auckland, New Zealand, the authors investigated the association between medications and fall-related injuries at home. The 335 cases comprised people who died or were admitted to hospital as a result of unintentional falls at home, and the 352 controls were randomly selected from the electoral roll. After controlling for confounding by demographic, personal and lifestyle factors, the use of two or more prescription medications relative to one or no medications was associated with an increased risk of fall injury (OR 2.5, 95% CI 1.3 to 4.8). Antihypertensives and lipid lowering drugs were the most common groups involved. The findings suggest that, as in the case of older people, younger working aged adults who use multiple prescription medications are at increased risk of falls, an aspect that should be considered in falls prevention programmes.

Development and piloting of the Fiji Injury Surveillance in Hospitals System (TRIP Project-1)

Introduction Whilst more than 90% of injury related deaths are estimated to occur in low-and-middle-income countries (LMICs), the epidemiology of fatal and hospitalised injuries in Pacific Island Countries has received scant attention. This study describes the development and piloting of a population-based trauma registry in Fiji to address this gap in knowledge. Methods The Fiji Injury Surveillance in Hospitals (FISH) system was an active surveillance system designed to identify injuries resulting in death or a hospital admission in Viti Levu, Fiji. During the pilot conducted over five months in 2005, Accident and Emergency registers, admission folders and morgue registers from 8 of Viti Levus 12 hospitals, and an additional 3 hospitals in other parts of the country were reviewed by hospital staff and medical students to identify cases and extract a minimum data set that included demographic factors; the mechanism, nature and context of injury; substance use; and discharge outcomes. The system was audited to identify and redress difficulties with data quality in a manner that also supported local capacity development and training in injury surveillance and data management. Results This pilot study demonstrated the potential to collect high quality data on injuries that can pose a significant threat to life in Fiji using a mechanism that also increased the capability of health professionals to recognise the significance of injury as a public health issue. Conclusion The injury surveillance system piloted provides the opportunity to inform national injury control strategies in Fiji and increase the capacity for injury prevention and more focused research addressing risk factors in the local context.

What helps and hinders indigenous student success in higher education health programmes: a qualitative study using the Critical Incident Technique

Tertiary institutions aim to provide high quality teaching and learning that meet the academic needs for an increasingly diverse student body including indigenous students. Tātou Tātou is a qualitative research project utilising Kaupapa Ma¯ori research methodology and the Critical Incident Technique interview method to investigate the teaching and learning practices that help or hinder Ma¯ori student success in non-lecture settings within undergraduate health programmes at the University of Auckland. Forty-one interviews were completed from medicine, health sciences, nursing and pharmacy. A total of 1346 critical incidents were identified with 67% helping and 33% hindering Ma¯ori student success. Thirteen sub-themes were grouped into three overarching themes representing potential areas of focus for tertiary institutional undergraduate health programme development: Māori student support services, undergraduate programme, and Ma¯ori student whanaungatanga. Academic success for indigenous students requires multi-faceted, inclusive, culturally responsive and engaging teaching and learning approaches delivered by educators and student support staff.

Innovation and effectiveness: changing the scope of school nurses in New Zealand secondary schools

Objective: To describe the changing role of school nurses in eight New Zealand (NZ) secondary schools from low socio‐economic areas with high Pacific Island and Māori rolls.

Longer term health of young and middle-aged adults following unintentional falls at home resulting in hospitalisation.

UNLABELLED Unintentional falls at home are a common cause of admissions to hospital amongst young and middle-aged adults. This population-based study investigated the longer-term health, physical and psychological outcomes following such injuries, and the predictors of these sequelae. METHOD Individuals aged 25-60 years admitted to hospital in the Auckland region between July 2005 and June 2006 following an unintentional fall at home were interviewed soon after the injury (baseline) and 15-months following the injury. Information collected at baseline on pre-injury status was analysed in relation to changes in general health and functioning, psychological outcomes, and role limitations at follow-up. RESULTS Of the 328 participants eligible for study, 251 (77%) completed the follow-up interview. Reductions in general health and overall functioning (compared with pre-injury status) were reported by 25% and 43% of participants, respectively. In multivariate analyses, predictors of specific adverse outcomes at follow-up included increasing age (reduction in functioning), lower limb injuries (reductions in general health and functioning); female gender (psychological sequelae); injury severity score ≥9 (anxiety and depression); and length of hospital stay (fear of falling and post-traumatic stress symptoms). CONCLUSIONS The significant longer-term reductions in health and levels of functioning reveal the importance of strengthening efforts to prevent falls amongst young and middle-aged adults, and identifying groups at increased risk of longer-term disability who could benefit from targeted interventions.

Development of a text message intervention aimed at reducing alcohol-related harm in patients admitted to hospital as a result of injury

BackgroundScreening for alcohol misuse and brief interventions (BIs) for harm in trauma care settings are known to reduce alcohol intake and injury recidivism, but are rarely implemented. We created the content for a mobile phone text message BI service to reduce harmful drinking among patients admitted to hospital following an injury who screen positive for hazardous alcohol use. The aim of this study was to pre-test and refine the text message content using a robust contextualisation process ahead of its formal evaluation in a randomised controlled trial.MethodsPre-testing was conducted in two phases. First, in-depth interviews were conducted with 14 trauma inpatients (16–60 years) at Auckland City Hospital and five key informants. Participants were interviewed face-to-face using a semi-structured interview guide. Topics explored included: opinions on text message ideas and wording, which messages did or did not work well and why, interactivity of the intervention, cultural relevance of messages, and tone of the content. In a second phase, consultation was undertaken with Māori (New Zealand’s indigenous population) and Pacific groups to explore the relevance and appropriateness of the text message content for Māori and Pacific audiences.ResultsFactors identified as important for ensuring the text message content was engaging, relevant, and useful for recipients were: reducing the complexity of message content and structure; increasing the interactive functionality of the text message programme; ensuring an empowering tone to text messages; and optimising the appropriateness and relevance of text messages for Māori and Pacific people. The final version of the intervention (named ‘YourCall™’) had three pathways for people to choose between: 1) text messages in English with Te Reo (Māori language) words of welcome and encouragement, 2) text messages in Te Reo Māori, and 3) text messages in English (with an option to receive a greeting in Samoan, Tongan, Cook Island Māori, Niuean, Tokelauan, Tuvaluan, or Fijian).ConclusionsWe have developed a text message intervention underpinned by established BI evidence and behaviour change theory and refined based on feedback and consultation. The next step is evaluation of the intervention in a randomised-controlled trial.

Fatalities and hospitalisations due to acute poisoning among New Zealand adults

Acute poisoning accounts for a significant proportion of the total burden of disease worldwide. While the rate of poisoning fatalities in New Zealand is comparable to other industrialised countries, demographic trends in incidence, particularly including socio‐economic indicators and substances involved, are less well known.