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Cohen JS, Howard MB, McDonald EM, Ryan LM. A Call to Action: Addressing Socioeconomic Disparities in Childhood Unintentional Injury Risk. Pediatrics 2024; 153:e2023063445. [PMID: 38439733 DOI: 10.1542/peds.2023-063445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 03/06/2024] Open
Affiliation(s)
- Joanna S Cohen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Beth Howard
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eileen M McDonald
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leticia Manning Ryan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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2
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Omaki E, Shields W, Buhs S, Curtis M, Kulak D, Luna J, Frattaroli S. Working with fire departments to adapt and implement evidence-based programs that increase uptake of smoke alarms: a case-series report. J Burn Care Res 2022; 43:1271-1276. [DOI: 10.1093/jbcr/irac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
We describe a partnership between an academic injury center and three US fire departments to adapt and implement strategies for promoting smoke alarm programs. Each fire department identified the aims and parameters for a new promotion campaign for their smoke alarm programs. Promotion was directed towards residents in each department’s catchment area who were eligible for the smoke alarm program. All three departments independently elected to use an automated telephone message to promote their smoke alarm programs. Uptake of smoke alarm installation services ranged between .02% and 2% of the calls placed. In Rochester, automated calls were sent to all residential landlines via the city’s non-emergency call center; requests for smoke alarms increased by a factor of 7.5 in the month following the campaign. In Grand Rapids, automated calls were sent to 6% of the households served due to the telecommunications infrastructure; because of the limited reach, the overall number of requests remained unchanged, and the number of callers citing the automated calls was less than the number of requests callers reported were motivated by Grand Rapids’ existing promotion strategies. In Cloquet, the automated calls were broadcast on a rolling basis to geographic clusters of households; although the number of requests remained unchanged, fire district officials were pleased to reduce driving time between appointments which allowed volunteers to offer more home visit appointments. Automated telephone calls can be a valuable tool for promoting smoke alarm programs, but fire departments should carefully identify how dissemination strategies can best complement existing program efforts.
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Affiliation(s)
- Elise Omaki
- Johns Hopkins Center for Injury Research & Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health
| | - Wendy Shields
- Johns Hopkins Center for Injury Research & Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health
| | | | - Michael Curtis
- Residential Safety Program, Grand Rapids Fire Department
| | - Dawn Kulak
- Residential Safety Program, Grand Rapids Fire Department
| | | | - Shannon Frattaroli
- Johns Hopkins Center for Injury Research & Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health
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Huang XM, Yuan FZ, Chen YR, Huang Y, Yang ZX, Lin L, Yu JK. Physical therapy and orthopaedic equipment-induced reduction in the biomechanical risk factors related to knee osteoarthritis: a systematic review and Bayesian network meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e051608. [PMID: 35140149 PMCID: PMC8830256 DOI: 10.1136/bmjopen-2021-051608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/14/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Are physical therapy or orthopaedic equipment efficacious in reducing the biomechanical risk factors in people with tibiofemoral osteoarthritis (OA)? Is there a better therapeutic intervention than others to improve these outcomes? DESIGN Systematic review with network meta-analysis (NMA) of randomised trials. DATA SOURCES PubMed, Web of Science, Cochrane Library, Embase and MEDLINE were searched through January 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trials exploring the benefits of using physical therapy or orthopaedic equipment in reducing the biomechanical risk factors which included knee adduction moment (KAM) and knee adduction angular impulse (KAAI) in individuals with tibiofemoral OA. DATA EXTRACTION AND SYNTHESIS Two authors extracted data independently and assessed risk of bias. We conducted an NMA to compare multiple interventions, including both direct and indirect evidences. Heterogeneity was assessed (sensitivity analysis) and quantified (I2 statistic). Grading of Recommendations Assessment, Development and Evaluation assessed the certainty of the evidence. RESULTS Eighteen randomised controlled trials, including 944 participants, met the inclusion criteria, of which 14 trials could be included in the NMA. Based on the collective probability of being the overall best therapy for reducing the first peak KAM, lateral wedge insoles (LWI) plus knee brace was closely followed by gait retraining, and knee brace only. Although no significant difference was observed among the eight interventions, variable-stiffness shoes and neuromuscular exercise exhibited an increase in the first peak KAM compared with the control condition group. And based on the collective probability of being the overall best therapy for reducing KAAI, gait retraining was followed by LWI only, and lower limb exercise. CONCLUSION The results of our study support the use of LWI plus knee brace for reducing the first peak KAM. Gait retraining did not rank highest but it influenced both KAM and KAAI and therefore it was the most recommended therapy for reducing the biomechanical risk factors.
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Affiliation(s)
- Xi-Meng Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Fu-Zhen Yuan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - You-Rong Chen
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ying Huang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ze-Xi Yang
- Department of Orthopedic, Peking University Third Hospital, Beijing, China
| | - Lin Lin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jia-Kuo Yu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Shields W, Omaki E, Villalba J, Gielen A. It Is Not the Batteries! Smoke Alarm Presence and Functionality 5 to 7 Years Postinstallation of Sealed Lithium Battery Alarms. J Burn Care Res 2022; 43:1135-1139. [PMID: 35021233 PMCID: PMC9435477 DOI: 10.1093/jbcr/irab249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Smoke alarms with lithium batteries have been marketed as long life or "10-Year Alarms." Previous work has drawn into question the actual term of functionality for lithium battery alarms. This article reports on observed smoke alarm presence and functionality in a sample of 158 homes that had participated in a fire department smoke alarm installation program 5 to 7 years prior to the observations. A total of 391 alarms were originally installed in the 158 homes that completed the revisit. At the time of the revisit, 217 of those alarms were working (54%), 28 were nonworking (7%), and 146 were missing (39%). Of the 158 homes that completed the revisit, n = 62 (39%) had all their originally installed project alarms up and working at the revisit. Respondents who reported owning their homes or who reported living in their home for 6 or more years were significantly more likely to maintain all of their project alarms than renters or those living in their homes for 5 or fewer years. Smoke alarm installation programs should consider revisiting homes within 5 to 7 years postinstallation to inspect and replace any missing or nonfunctioning alarms. We recommend programs conducting community risk reduction programs track and plan installations and revisits to improve smoke alarm coverage.
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Affiliation(s)
- Wendy Shields
- Address correspondence to Wendy Shields, PhD, MPH, Johns Hopkins Center for Injury Research and Policy, Baltimore, MD 21205, USA.
| | - Elise Omaki
- Johns Hopkins Center for Injury Research and Policy, Baltimore, Maryland, USA
| | - Joel Villalba
- Johns Hopkins Center for Injury Research and Policy, Baltimore, Maryland, USA
| | - Andrea Gielen
- Johns Hopkins Center for Injury Research and Policy, Baltimore, Maryland, USA
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Glauberman G, Qureshi K. Community/Public Health Nurses' Awareness of Residential High-Rise Fire Safety issues. SAGE Open Nurs 2021; 7:23779608211040597. [PMID: 34869858 PMCID: PMC8642064 DOI: 10.1177/23779608211040597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/07/2021] [Accepted: 07/31/2021] [Indexed: 11/16/2022] Open
Abstract
High-rise (HR) building fires remain a tragic cause of preventable injury and death in the United States. Recent incidences of HR building fires have served as high-profile reminders of the persistent threat that HR fires pose to public health. Fire safety is an important aspect of household emergency preparedness addressed by community/public health nurses (C/PHNs). This study aimed to address a gap in the literature regarding C/PHNs' awareness of fire safety for people and families who reside in HR buildings. A descriptive qualitative study using key-informant and focus group interviews was conducted involving C/PHNs (n = 19) in Honolulu, Hawaii. Qualitative data analysis revealed three main themes related to this issue: (1) C/PHN awareness of HR fire safety issues, (2) C/PHN perceived barriers for HR building occupant fire safety, and (3) C/PHN suggested strategies to address HR fire safety for occupants. Findings highlight how more needs to be done to assure that C/PHNs are adequately prepared to work with occupants of residential HR buildings on matters related to fire safety.
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Affiliation(s)
- Gary Glauberman
- School of Nursing and Dental Hygiene, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Kristine Qureshi
- School of Nursing and Dental Hygiene, University of Hawaii at Mānoa, Honolulu, HI, USA
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Casteel C, Bruening R, Carson M, Berard-Reed K, Ashida S. Evaluation of a Falls and Fire Safety Program for Community-Dwelling Older Adults. J Community Health 2020; 45:717-727. [PMID: 31974806 DOI: 10.1007/s10900-019-00786-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Remembering When™ (RW) is a falls and fire prevention program delivered by fire service personnel and homecare organizations to help older adults live safely at home for as long as possible. This study evaluated changes in falls prevention and fire safety behaviors and perceptions and social support associated with falls and residential fires among older adults following delivery of the RW program by fire service personnel. In a convenience sample of adults 65 + years residing in five Iowa communities, 70 received the RW program during a home visit and 75 received the RW program in a group presentation followed by a home visit. Baseline and follow-up telephone interviews were conducted to assess changes in falls and fire safety behaviors, perceptions and social support. Changes were assessed using McNemar's exact test and paired sample t-tests. To control for dependence of 26 households with two participants, one participant was randomly selected and included in the analysis (n = 119). The RW program improved falls and residential fire prevention behaviors among older adults. Perceived efficacy to prevent falls increased from baseline (p = 0.047). Perceived susceptibility (p = 0.021) and control of fires (p = 0.000) increased while perceived severity (p = 0.025) and fear of residential fires (p = 0.019) decreased when compared to baseline. The proportion of participants reporting discussing falls with friends and family increased (p < 0.001), and more participants reported discussing fire prevention with healthcare professionals (p = 0.039). Fire service personnel can be effective deliverers of falls prevention information to older adults.
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Affiliation(s)
- Carri Casteel
- Department of Occupational and Environmental Health, University of Iowa, 145 N. Riverside Drive CPHB S314, Iowa City, IA, 52242, USA.
| | - Rebecca Bruening
- Department of Occupational and Environmental Health, University of Iowa, 145 N. Riverside Drive CPHB S314, Iowa City, IA, 52242, USA
| | - McKyla Carson
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, USA
| | | | - Sato Ashida
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, USA
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Chen J, Dignam T, Yip F, García BR, Blanton C, Brown MJ, Sircar K. Smoke Alarms and Carbon Monoxide Alarms in Households With Children, Puerto Rico, 2010. J Prim Prev 2020; 41:279-295. [PMID: 32410066 PMCID: PMC7936878 DOI: 10.1007/s10935-020-00590-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In 2017, Puerto Rico sustained extensive damage from Hurricane Maria, increasing the risk of fires and carbon monoxide (CO) poisonings. Using a population-based, in-person survey of households with children less than 6 years old in Puerto Rico, we collected data in 2010 concerning the presence of smoke alarms and CO alarms in these households. We generated national estimates by extrapolating the number of households in each stratum using data from the 2010 Census. We determined which household characteristics predicted the presence of these alarms. Of 355 households analyzed, 31% had functional smoke alarms, or an estimated 109,773 households territory wide. The presence of smoke alarms was associated with living in multifamily housing and no child in the household receiving government medical insurance. Public housing or publicly subsidized housing, as compared to owner-occupied housing and unsubsidized rental housing, was associated with having a functional smoke alarm in households with children aged less than 6 years. Based on only six houses having CO alarms, we estimated only 7685 (2%) households had CO alarms. The low prevalence of functional smoke or CO alarms 7 years before Hurricane Maria is unfortunate and should be remedied by ensuring that such alarms are widely installed in current rebuilding activities.
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Affiliation(s)
- Jessica Chen
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Timothy Dignam
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, 30341, USA.
| | - Fuyuen Yip
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, 30341, USA
| | - Brenda Rivera García
- Office of Epidemiology and Research, Puerto Rico Department of Health, San Juan, PR, USA
| | - Curtis Blanton
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Jean Brown
- Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kanta Sircar
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, 30341, USA
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Zhang K, Arora P, Sati N, Béliveau A, Troke N, Veroniki AA, Rodrigues M, Rios P, Zarin W, Tricco AC. Characteristics and methods of incorporating randomized and nonrandomized evidence in network meta-analyses: a scoping review. J Clin Epidemiol 2019; 113:1-10. [DOI: 10.1016/j.jclinepi.2019.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 03/04/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
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López-López JA, Davies SR, Caldwell DM, Churchill R, Peters TJ, Tallon D, Dawson S, Wu Q, Li J, Taylor A, Lewis G, Kessler DS, Wiles N, Welton NJ. The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis. Psychol Med 2019; 49:1937-1947. [PMID: 31179960 PMCID: PMC6712954 DOI: 10.1017/s003329171900120x] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 11/05/2022]
Abstract
Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of -1.11 (95% credible interval -1.62 to -0.60) for face-to-face CBT, -1.06 (-2.05 to -0.08) for hybrid CBT, and -0.59 (-1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.
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Affiliation(s)
- José A. López-López
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Basic Psychology & Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Sarah R. Davies
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah M. Caldwell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Tim J. Peters
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah Tallon
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Qi Wu
- Faculty of Health Sciences, University of York, York, UK
| | - Jinshuo Li
- Faculty of Health Sciences, University of York, York, UK
| | - Abigail Taylor
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - David S. Kessler
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Wiles
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J. Welton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Shields WC, Gielen AC, Frattaroli S, Musci RJ, McDonald EM, Van Beeck EF, Bishai DM. Child Housing Assessment for a Safe Environment (CHASE): a new tool for injury prevention inside the home. Inj Prev 2019; 26:215-220. [PMID: 31160373 DOI: 10.1136/injuryprev-2018-043054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop a tool to assess the safety of the home environment that could produce valid measures of a child's risk of suffering an injury. METHODS Tool development: A four-step process was used to develop the CHASE (Child Housing Assessment for a Safe Environment) tool, including (1) a literature scan, (2) reviewing of existing housing inspection tools, (3) key informants interviews, and (4) reviewing the National Electronic Injury Surveillance System to determine the leading housing elements associated with paediatric injury. Retrospective case-control study to validate the CHASE tool: Recruitment included case (injured) and control (sick but not injured) children and their families from a large, urban paediatric emergency department in Baltimore, Maryland in 2012. Trained inspectors applied both the well-known Home Quality Standard (HQS) and the CHASE tool to each enrollee's home, and we compared scores on individual and summary items between cases and controls. RESULTS Twenty-five items organised around 12 subdomains were included on the CHASE tool. 71 matched pairs were enrolled and included in the analytic sample. Comparisons between cases and controls revealed statistically significant differences in scores on individual items of the CHASE tool as well as on the overall score, with the cases systematically having worse scores. No differences were found between groups on the HQS measures. CONCLUSION Programmes conducting housing inspections in the homes of children should consider including the CHASE tool as part of their inspection measures. Future study of the CHASE inspection tool in a prospective trial would help assess its efficacy in preventing injuries and reducing medical costs.
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Affiliation(s)
- Wendy C Shields
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA .,Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrea C Gielen
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon Frattaroli
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eileen M McDonald
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - E F Van Beeck
- Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David M Bishai
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Health Economics, Johns Hopkins Center for Injury Research and Policy, Baltimore, Maryland, USA
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Saramago P, Espinoza MA, Sutton AJ, Manca A, Claxton K. The Value of Further Research: The Added Value of Individual-Participant Level Data. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:273-284. [PMID: 30671918 DOI: 10.1007/s40258-019-00462-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Judgements based on average cost-effectiveness estimates may disguise significant heterogeneity in net health outcomes. Decisions about coverage of new interventions are often more efficient when they consider between-patient heterogeneity, which is usually operationalized as different selections for different subgroups. While most model-based cost-effectiveness studies are populated with aggregated-level sub-group estimates, individual-level data are recognized as the best source of evidence to produce unbiased and efficient estimates to explore this heterogeneity. This paper extends a previously published framework to assesses the added value of having access to individual-level data, compared to using aggregate-level data only, in the absence/presence of mutually exclusive population subgroups. Supported by a case study on the cost-effectiveness of interventions to increase uptake of smoke-alarms, the extended framework provided a quantification of the benefits foregone of not using individual-level data, pointed to the optimal number of subgroups and where further research should be undertaken. Although not indicating changes in reimbursement decisions, results showed that irrespective of using aggregate or individual-level data, no substantial additional gains are obtained if more than two subgroups are taken into account. However, depending on the evidence type used, different subgroups are revealed as warranting larger research funds. The use of individual-level data, rather than aggregate, may however influence not only the extent to which an appropriate understanding of existing heterogeneity is attained, but, more importantly, it may shape approval decisions for particular population subgroups and judgements of future research.
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Affiliation(s)
- Pedro Saramago
- Centre for Health Economics, The University of York, York, UK.
| | - Manuel A Espinoza
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Andrea Manca
- Centre for Health Economics, The University of York, York, UK
| | - Karl Claxton
- Centre for Health Economics, The University of York, York, UK
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Effectiveness of home fire safety interventions. A systematic review and meta-analysis. PLoS One 2019; 14:e0215724. [PMID: 31107902 PMCID: PMC6527231 DOI: 10.1371/journal.pone.0215724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/09/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To assess the effectiveness of Home Fire Safety (HFS) interventions versus other interventions/no interventions/controls on HFS knowledge and behaviour at short-, intermediate- and long-term follow ups. DESIGN Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES MEDLINE, EMBASE and PubMed databases were searched from January 1998 to July 2018, and studies retrieved. PARTICIPANTS Toddlers, children (primary or secondary school), teenagers or adults. INTERVENTIONS/COMPARISON HFS interventions compared to other interventions / no interventions / controls. OUTCOMES HFS knowledge and behaviour. RESULTS 10 studies were identified (8 RCTs and 2 prospective cohort). Two studies assessed the effects of HFS interventions vs no interventions on HFS knowledge at up to 4 months follow up in school children and demonstrated significant difference between groups (very low quality, 2 RCTs, 535 participants, SMD 0.38, 95% CI: 0.21 to 0.55, p < 0.001). One study examined the effects of different modes of HFS interventions (computer-based vs instructor-led) on HFS knowledge and behaviour immediately post-intervention in adults and displayed no significant difference between groups (HFS knowledge; very low quality, 1 RCT, 68 participants, SMD -0.02, 95% CI: -0.50 to 0.45, p = 0.92) and (HFS behaviour; very low quality, 1 RCT, 68 participants, SMD 0.06, 95% CI: -0.41 to 0.54, p = 0.79) respectively. CONCLUSION The limited evidence supports the use of HFS interventions to improve HFS knowledge and behaviour in children, families with children and adults.
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Al Said S, Alabed S, Kaier K, Bode C, Meerpohl JJ, Duerschmied D. Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis. Hippokratia 2019. [DOI: 10.1002/14651858.cd013252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Samer Al Said
- University of Freiburg; Department of Cardiology and Angiology I, Heart Center; Freiburg Germany
| | - Samer Alabed
- University of Sheffield; Academic Unit of Radiology; Sheffield UK
| | - Klaus Kaier
- Faculty of Medicine and Medical Center, University of Freiburg; Institute for Medical Biometry and Statistics; Freiburg Germany
| | - Christoph Bode
- University of Freiburg; Department of Cardiology and Angiology I, Heart Center; Freiburg Germany
| | - Joerg J Meerpohl
- Medical Center - University of Freiburg; Institute for Evidence in Medicine (for Cochrane Germany Foundation); Breisacher Straße 153 Freiburg Germany 79110
| | - Daniel Duerschmied
- University of Freiburg; Department of Cardiology and Angiology I, Heart Center; Freiburg Germany
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Dias S, Caldwell DM. Network meta-analysis explained. Arch Dis Child Fetal Neonatal Ed 2019; 104:F8-F12. [PMID: 30425115 PMCID: PMC6761999 DOI: 10.1136/archdischild-2018-315224] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
- Bristol Medical School, University of Bristol, Bristol, UK
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15
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Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Goodenough T, Hawkins A, Hayes M, Hindmarch P, Hubbard S, Kay B, Kumar A, Majsak-Newman G, McColl E, McDaid L, Miller P, Mulvaney C, Peel I, Pitchforth E, Reading R, Saramago P, Stewart J, Sutton A, Timblin C, Towner E, Watson MC, Wynn P, Young B, Zou K. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penny Benford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Trudy Goodenough
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Adrian Hawkins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Paul Hindmarch
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bryony Kay
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa McDaid
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phil Miller
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Isabel Peel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Richard Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael C Watson
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
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16
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Omaki E, Shields WC, Frattaroli S, McDonald E, Jones V, Gielen A. Six-month follow-up of lithium-battery smoke alarms and self-reported reasons for disabling. Inj Prev 2016; 23:67-69. [PMID: 26781637 DOI: 10.1136/injuryprev-2015-041870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/10/2015] [Accepted: 12/22/2015] [Indexed: 11/04/2022]
Abstract
Although smoke alarms with lithium batteries are often marketed as '10-year alarms', on average, these alarms do not remain functional for 10 years. This paper describes self-reported reasons for non-working lithium-battery alarms 6-9 months following a smoke alarm installation programme. Data presented are for a cohort of 754 homes that participated in the installation programme and subsequently completed follow-up. A total of 1487 smoke alarms were installed. At follow-up, 126 alarms (8%) were missing and 37 (3%) were observed to be non-working. Of the non-working alarms, residents reported that they had been disabled 57% of the time. Reasons for disabling the alarms most often included that the battery was chirping (38%) or that it sounded while someone was cooking (24%). Smoke alarm installation programmes using lithium-battery alarms should consider highlighting education about smoke alarm maintenance, the hush feature and resources to replace alarms that malfunction soon after installation.
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Affiliation(s)
- Elise Omaki
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wendy C Shields
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon Frattaroli
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eileen McDonald
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vanya Jones
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea Gielen
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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17
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Omaki E, Rizzutti N, Shields W, Zhu J, McDonald E, Stevens MW, Gielen A. A systematic review of technology-based interventions for unintentional injury prevention education and behaviour change. Inj Prev 2016; 23:138-146. [PMID: 26787740 DOI: 10.1136/injuryprev-2015-041740] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/10/2015] [Accepted: 12/22/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aims of this literature review are to (1) summarise how computer and mobile technology-based health behaviour change applications have been evaluated in unintentional injury prevention, (2) describe how these successes can be applied to injury-prevention programmes in the future and (3) identify research gaps. METHODS Studies included in this systematic review were education and behaviour change intervention trials and programme evaluations in which the intervention was delivered by either a computer or mobile technology and addressed an unintentional injury prevention topic. Articles were limited to those published in English and after 1990. RESULTS Among the 44 technology-based injury-prevention studies included in this review, 16 studies evaluated locally hosted software programmes, 4 studies offered kiosk-based programmes, 11 evaluated remotely hosted internet programmes, 2 studies used mobile technology or portable devices and 11 studies evaluated virtual-reality interventions. Locally hosted software programmes and remotely hosted internet programmes consistently increased knowledge and behaviours. Kiosk programmes showed evidence of modest knowledge and behaviour gains. Both programmes using mobile technology improved behaviours. Virtual-reality programmes consistently improved behaviours, but there were little gains in knowledge. No studies evaluated text-messaging programmes dedicated to injury prevention. CONCLUSIONS There is much potential for computer-based programmes to be used for injury-prevention behaviour change. The reviewed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours.
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Affiliation(s)
- Elise Omaki
- Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, Maryland, USA
| | - Nicholas Rizzutti
- Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, Maryland, USA
| | - Wendy Shields
- Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, Maryland, USA
| | - Jeffrey Zhu
- Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, Maryland, USA
| | - Eileen McDonald
- Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, Maryland, USA
| | - Martha W Stevens
- Johns Hopkins School of Medicine, Division of Pediatric Emergency Medicine, Baltimore Maryland, USA
| | - Andrea Gielen
- Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, Maryland, USA
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18
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Wynn PM, Zou K, Young B, Majsak-Newman G, Hawkins A, Kay B, Mhizha-Murira J, Kendrick D. Prevention of childhood poisoning in the home: overview of systematic reviews and a systematic review of primary studies. Int J Inj Contr Saf Promot 2015; 23:3-28. [DOI: 10.1080/17457300.2015.1032978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Gosia Majsak-Newman
- NHS Clinical Research and Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Adrian Hawkins
- Great North Children's Hospital, New Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Bryony Kay
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | | | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
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19
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Zou K, Wynn PM, Miller P, Hindmarch P, Majsak-Newman G, Young B, Hayes M, Kendrick D. Preventing childhood scalds within the home: Overview of systematic reviews and a systematic review of primary studies. Burns 2015; 41:907-24. [PMID: 25841997 PMCID: PMC4504085 DOI: 10.1016/j.burns.2014.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/14/2014] [Accepted: 11/04/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To synthesise and evaluate the evidence of the effectiveness of interventions to prevent scalds in children. METHODS An overview of systematic reviews (SR) and a SR of primary studies were performed evaluating interventions to prevent scalds in children. A comprehensive literature search was conducted covering various resources up to October 2012. Experimental and controlled observational studies reporting scald injuries, safety practices and safety equipment use were included. RESULTS Fourteen systematic reviews and 39 primary studies were included. There is little evidence that interventions are effective in reducing the incidence of scalds in children. More evidence was found that inventions are effective in promoting safe hot tap water temperature, especially when home safety education, home safety checks and discounted or free safety equipment including thermometers and thermostatic mixing valves were provided. No consistent evidence was found for the effectiveness of interventions on the safe handling of hot food or drinks nor improving kitchen safety practices. CONCLUSION Education, home safety checks along with thermometers or thermostatic mixing valves should be promoted to reduce tap water scalds. Further research is needed to evaluate the effectiveness of interventions on scald injuries and to disentangle the effects of multifaceted interventions on scald injuries and safety practices.
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Affiliation(s)
- Kun Zou
- Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Persephone M Wynn
- Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Philip Miller
- Acute Medicine, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK.
| | - Paul Hindmarch
- Great North Children's Hospital, Research Unit Level 2, New Victoria Wing, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
| | - Gosia Majsak-Newman
- NHS Clinical Research & Trials Unit, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Ben Young
- Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Mike Hayes
- Child Accident Prevention Trust, Canterbury Court (1.09), 1-3 Brixton Road, London SW9 6DE, UK.
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
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20
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Melendez-Torres GJ, Bonell C, Thomas J. Emergent approaches to the meta-analysis of multiple heterogeneous complex interventions. BMC Med Res Methodol 2015; 15:47. [PMID: 26032785 PMCID: PMC4455278 DOI: 10.1186/s12874-015-0040-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 05/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple interventions meta-analysis has been recommended in the methodological literature as a tool for evidence synthesis when a heterogeneous set of interventions is included in the same review—and, more recently, when a heterogeneous set of complex interventions is included. However, there is little guidance on the use of this method with complex interventions. This article suggests two approaches to model complexity and heterogeneity through this method. DISCUSSION 'Clinically meaningful units' groups interventions by modality or similar theory of change, whereas 'components and dismantling' separates out interventions into combinations of components and either groups interventions by the combination of components they demonstrate or extracts effects for each identified component and, possibly, interactions between components. Future work in systematic review methodology should aim to understand how to develop taxonomies of components or theories of change that are internally relevant to the studies in these multiple interventions meta-analyses. SUMMARY Despite little meaningful prior guidance to its use in this context, multiple interventions meta-analysis has the potential to be a useful tool for synthesising heterogeneous sets of complex interventions. Researchers should choose an approach in accordance with their specific aims in their systematic review.
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Affiliation(s)
- G J Melendez-Torres
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Chris Bonell
- Social Science Research Unit, UCL Institute of Education, University College London, University of London, London, UK.
| | - James Thomas
- Social Science Research Unit, UCL Institute of Education, University College London, University of London, London, UK.
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21
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Zeng C, Li H, Yang T, Deng ZH, Yang Y, Zhang Y, Lei GH. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis Cartilage 2015; 23:189-202. [PMID: 25497083 DOI: 10.1016/j.joca.2014.11.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/15/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the efficacy of different electrical stimulation (ES) therapies in pain relief of patients with knee osteoarthritis (OA). METHOD Electronic databases including MEDLINE, Embase and Cochrane Library were searched through for randomized controlled trials (RCTs) comparing any ES therapies with control interventions (sham or blank) or with each other. Bayesian network meta-analysis was used to combine both the direct and indirect evidence on treatment effectiveness. RESULTS 27 trials and six kinds of ES therapies, including high-frequency transcutaneous electrical nerve stimulation (h-TENS), low-frequency transcutaneous electrical nerve stimulation (l-TENS), neuromuscular electrical stimulation (NMES), interferential current (IFC), pulsed electrical stimulation (PES), and noninvasive interactive neurostimulation (NIN), were included. IFC is the only significantly effective treatment in terms of both pain intensity and change pain score at last follow-up time point when compared with the control group. Meanwhile, IFC showed the greatest probability of being the best option among the six treatment methods in pain relief. These estimates barely changed in sensitivity analysis. However, the evidence of heterogeneity and the limitation in sample size of some studies could be a potential threat to the validity of results. CONCLUSION IFC seems to be the most promising pain relief treatment for the management of knee OA. However, evidence was limited due to the heterogeneity and small number of included trials. Although the recommendation level of the other ES therapies is either uncertain (h-TENS) or not appropriate (l-TENS, NMES, PES and NIN) for pain relief, it is likely that none of the interventions is dangerous. LEVEL OF EVIDENCE LevelⅡ, systematic review and network meta-analysis of RCTs.
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Affiliation(s)
- C Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - H Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - T Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Z-h Deng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Y Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Y Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - G-h Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
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22
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Gielen AC, Perry EC, Shields WC, McDonald E, Frattaroli S, Jones V. Changes in smoke alarm coverage following two fire department home visiting programs: what predicts success? Inj Epidemiol 2014; 1:30. [PMID: 27747662 PMCID: PMC5005669 DOI: 10.1186/s40621-014-0030-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Door-to-door canvassing and installation of smoke alarms have been found to be effective at increasing the number of homes protected. This analysis reports on how smoke alarm coverage changes six months after a home visiting program in a large urban sample, and how this change varies by characteristics of the residents and characteristics of the services delivered during the home visit. Methods Fire department Standard and Enhanced home visiting programs were compared. During the home visit, fire fighters installed lithium battery smoke alarms. Residents in the Enhanced program received tailored education about fire safety. Six months after the home visit, participating residences were visited to complete a follow-up survey and to have the installed alarms checked. Results 81% of the 672 homes that had a working smoke alarm on every level of the home at the end of the home visit remained safe at follow-up, and 87% of the residents found the home visit was very useful, and these rates did not differ between the Enhanced and Standard programs. The degree to which firefighters delivered their services varied, although households in which the resident’s engagement with the fire department team was rated as excellent were 3.96 times as likely to be safe at follow-up compared to those with poor or fair resident engagement (p=0.03). Conclusions There is a need to better understand how to maximize the time spent with residents during smoke alarm home visiting programs. This study helps with the development of methods needed for implementing and evaluating such programs in real-world settings. Electronic supplementary material The online version of this article (doi:10.1186/s40621-014-0030-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea C Gielen
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, 624 N. Broadway, Baltimore, 21205, MD, USA.
| | - Elise C Perry
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Wendy C Shields
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Eileen McDonald
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Shannon Frattaroli
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Vanya Jones
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, 624 N. Broadway, Baltimore, 21205, MD, USA
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23
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Rohde D, Corcoran J. The evidence for smoke alarm type: photoelectric vs ionisation. Aust N Z J Public Health 2014; 38:494. [PMID: 25269981 DOI: 10.1111/1753-6405.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- David Rohde
- School of Geography, Planning and Environmental Management, University of Queensland
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24
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Hubbard S, Cooper N, Kendrick D, Young B, Wynn PM, He Z, Miller P, Achana F, Sutton A. Network meta-analysis to evaluate the effectiveness of interventions to prevent falls in children under age 5 years. Inj Prev 2014; 21:98-108. [PMID: 25062752 DOI: 10.1136/injuryprev-2013-041135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to simultaneously evaluate the effectiveness of a range of interventions to increase the possession of safety equipment or behaviours to prevent falls in children under 5 years of age in the home. METHODS A recently published systematic review identified studies to be included in a network meta-analysis; an extension of pairwise meta-analysis that enables comparison of all evaluated interventions simultaneously, including comparisons not directly compared in individual studies. RESULTS 29 primary studies were identified, of which 16 were included in at least 1 of 4 network meta-analyses. For increasing possession of a fitted stair gate, the most intensive intervention (including education, low cost/free home safety equipment, home safety inspection and fitting) was the most likely to be the most effective, with an OR versus usual care of 7.80 (95% CrI 3.08 to 21.3). For reducing possession or use of a baby walker: education only was most likely to be most effective, with an OR versus usual care of 0.48 (95% CrI 0.31 to 0.84). Little difference was found between interventions for possession of window locks (most intensive intervention versus usual care OR=1.56 (95% CrI 0.02 to 89.8)) and for not leaving a child alone on a high surface (education vs usual care OR=0.89 (95% CrI 0.10 to 9.67)). There was insufficient evidence for network meta-analysis for possession and use of bath mats. CONCLUSIONS These results will inform healthcare providers of the most effective components of interventions and can be used in cost-effectiveness analyses.
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Affiliation(s)
- Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Zhimin He
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Philip Miller
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
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25
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Saramago P, Cooper NJ, Sutton AJ, Hayes M, Dunn K, Manca A, Kendrick D. Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study. BMC Public Health 2014; 14:459. [PMID: 24886450 PMCID: PMC4046996 DOI: 10.1186/1471-2458-14-459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 04/24/2014] [Indexed: 12/02/2022] Open
Abstract
Background The UK has one of the highest rates for deaths from fire and flames in children aged 0–14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of ‘functioning’ smoke alarms and consequently for the prevention of fire-related injuries in children in the UK. Methods We carried out a decision model-based probabilistic cost-effectiveness analysis. We used a hypothetical population of newborns and evaluated the impact of living in a household with or without a functioning smoke alarm during the first 5 years of their life on overall lifetime costs and quality of life from a public health perspective. We compared seven interventions, ranging from usual care to more complex interventions comprising of education, free/low cost equipment giveaway, equipment fitting and/or home safety inspection. Results Education and free/low cost equipment was the most cost-effective intervention with an estimated incremental cost-effectiveness ratio of £34,200 per QALY gained compared to usual care. This was reduced to approximately £4,500 per QALY gained when 1.8 children under the age of 5 were assumed per household. Conclusions Assessing cost-effectiveness, as well as effectiveness, is important in a public sector system operating under a fixed budget restraint. As highlighted in this study, the more effective interventions (in this case the more complex interventions) may not necessarily be the ones considered the most cost-effective.
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Affiliation(s)
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, 2nd Floor Adrian Building, University Road, Leicester LE1 7RH, UK.
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Deave T, Towner E, McColl E, Reading R, Sutton A, Coupland C, Cooper N, Stewart J, Hayes M, Pitchforth E, Watson M, Kendrick D. Multicentre cluster randomised controlled trial evaluating implementation of a fire prevention Injury Prevention Briefing in children's centres: study protocol. BMC Public Health 2014; 14:69. [PMID: 24450931 PMCID: PMC3913957 DOI: 10.1186/1471-2458-14-69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK has one of the highest fatality rates for deaths from fire-related injuries in children aged 0-14 years; these injuries have the steepest social gradient of all injuries in the UK. Children's centres provide children under five years old and their families with a range of services and information, including home safety, but their effectiveness in promoting injury prevention has yet to be evaluated. We developed a fire prevention intervention for use in children's centres comprising an Injury Prevention Briefing (IPB) which provides evidence on what works and best practice from those running injury prevention programmes, and a facilitation package to support implementation of the IPB. This protocol describes the design and methods of a trial evaluating the effectiveness and cost-effectiveness of the IPB and facilitation package in promoting fire prevention. METHODS/DESIGN Pragmatic, multicentre cluster randomised controlled trial, with a nested qualitative study, in four study centres in England. Children's centres in the most disadvantaged areas will be eligible to participate and will be randomised to one of three treatment arms comprising: IPB with facilitation package; IPB with no facilitation package; usual care (control). The primary outcome measure will be the proportion of families who have a fire escape plan at follow-up. Eleven children's centres per arm are required to detect an absolute difference in the percentage of families with a fire escape plan of 20% in either of the two intervention arms compared with the control arm, with 80% power and a 5% significance level (2-sided), an intraclass correlation coefficient of 0.05 and assuming outcomes are assessed on 20 families per children's centre. Secondary outcomes include the assessment of the cost-effectiveness of the intervention, other fire safety behaviours and factors associated with degree of implementation of the IPB. DISCUSSION This will be the first trial to develop and evaluate a fire prevention intervention for use in children's centres in the UK. Its findings will be generalisable to children's centres in the most disadvantaged areas of the UK and may also be generalisable to similar interventions to prevent other types of injury. TRIAL REGISTRATION http://NCT01452191 (date of registration: 13/10/2011).
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Affiliation(s)
- Toity Deave
- Centre for Child & Adolescent Health, Health & Life Sciences, University of the West of England Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Elizabeth Towner
- Centre for Child & Adolescent Health, Health & Life Sciences, University of the West of England Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, 4th Floor, William Leech Building, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Richard Reading
- Jenny Lind Paediatric Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Jane Stewart
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
| | - Mike Hayes
- Child Accident Prevention Trust, Canterbury Court (1.09), 1 - 3 Brixton Road, London SW9 6DE, UK
| | - Emma Pitchforth
- London School of Economics Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Michael Watson
- School of Health Sciences, D86, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2HA, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
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Achana F, Hubbard S, Sutton A, Kendrick D, Cooper N. An exploration of synthesis methods in public health evaluations of interventions concludes that the use of modern statistical methods would be beneficial. J Clin Epidemiol 2013; 67:376-90. [PMID: 24388291 DOI: 10.1016/j.jclinepi.2013.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 09/19/2013] [Accepted: 09/25/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To review the methods currently used to synthesize evidence in public health evaluations and demonstrate the availability of more sophisticated approaches. STUDY DESIGN AND SETTING A systematic review of National Institute for Health and Care Excellence (NICE) public health appraisals published between 2006 and 2012 was performed to assess the methods used for the synthesis of effectiveness evidence. The ability of new developments in evidence synthesis methodology to address the challenges and opportunities present in a public health context is demonstrated. RESULTS Nine (23%) of the 39 NICE appraisals included in the review performed pairwise meta-analyses as part of the effectiveness review with one of these also including a network meta-analysis. Of the remainder, 29 (74.4%) presented narrative summaries of the evidence only, and 1 (2.6%) appraisal did not present any review of effectiveness and/or cost-effectiveness evidence. Heterogeneity of outcomes, methods, and interventions were the main reasons given for not pooling the data. Exploration of quantitative synthesis methods shows that pairwise meta-analyses can be extended to incorporate individual participant data (when it is available), extend the number of interventions being compared using a network meta-analysis, and adjust for both subject- and summary-level covariates. All these can contribute to ensuring the analysis answers directly the policy-relevant questions. CONCLUSION More sophisticated methods in evidence synthesis should be considered to make evaluations in public health more useful for decision makers.
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Affiliation(s)
- Felix Achana
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Denise Kendrick
- Division of Primary Care, Community Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK.
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Young B, Wynn PM, He Z, Kendrick D. Preventing childhood falls within the home: overview of systematic reviews and a systematic review of primary studies. ACCIDENT; ANALYSIS AND PREVENTION 2013; 60:158-171. [PMID: 24080473 DOI: 10.1016/j.aap.2013.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 06/05/2013] [Accepted: 08/06/2013] [Indexed: 06/02/2023]
Abstract
In most countries falls are the most common medically attended childhood injury and the majority of injuries in pre-school children occur at home. Numerous systematic reviews have reviewed evidence of the effectiveness of falls prevention interventions, but this evidence has not been synthesised into an overview, making it difficult for policy makers and practitioners to easily access the evidence. To synthesise all available evidence, we conducted an overview of reviews of home safety interventions targeting childhood falls, extracted data from primary studies included in the reviews and supplemented this with a systematic review of primary studies published subsequent to the reviews. Bibliographic databases, websites, conference proceedings, journals and bibliographies of included studies were searched for systematic reviews of studies with experimental or controlled observational designs. Thirteen reviews were identified containing 24 primary studies. Searches for additional primary studies identified five further studies not included in reviews. Evidence of the effect of interventions on falls or fall injuries was sparse, with only one of three primary studies reporting this outcome finding a reduction in falls. Interventions were effective in promoting the use of safety gates and furniture corner covers. There was some evidence of a reduction in baby walker use. The effect on the use of window safety devices, non-slip bath mats/decals and the reduction of tripping hazards was mixed. There was limited evidence that interventions were effective in improving lighting in corridors, altering furniture layout and restricting access to roofs. Most interventions to prevent childhood falls at home have not been evaluated in terms of their effect on reducing falls. Policy makers and practitioners should promote use of safety gates and furniture covers and restriction of baby walker use. Further research evaluating the effect of interventions to reduce falls and falls-related injuries is urgently required.
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Affiliation(s)
- Ben Young
- University of Nottingham, Division of Primary Care, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
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Uthman OA, van der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, Foster NE. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ 2013; 347:f5555. [PMID: 24055922 PMCID: PMC3779121 DOI: 10.1136/bmj.f5555] [Citation(s) in RCA: 214] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether there is sufficient evidence to conclude that exercise interventions are more effective than no exercise control and to compare the effectiveness of different exercise interventions in relieving pain and improving function in patients with lower limb osteoarthritis. DATA SOURCES Nine electronic databases searched from inception to March 2012. STUDY SELECTION Randomised controlled trials comparing exercise interventions with each other or with no exercise control for adults with knee or hip osteoarthritis. DATA EXTRACTION Two reviewers evaluated eligibility and methodological quality. Main outcomes extracted were pain intensity and limitation of function. Trial sequential analysis was used to investigate reliability and conclusiveness of available evidence for exercise interventions. Bayesian network meta-analysis was used to combine both direct (within trial) and indirect (between trial) evidence on treatment effectiveness. RESULTS 60 trials (44 knee, two hip, 14 mixed) covering 12 exercise interventions and with 8218 patients met inclusion criteria. Sequential analysis showed that as of 2002 sufficient evidence had been accrued to show significant benefit of exercise interventions over no exercise control. For pain relief, strengthening, flexibility plus strengthening, flexibility plus strengthening plus aerobic, aquatic strengthening, and aquatic strengthening plus flexibility, exercises were significantly more effective than no exercise control. A combined intervention of strengthening, flexibility, and aerobic exercise was also significantly more effective than no exercise control for improving limitation in function (standardised mean difference -0.63, 95% credible interval -1.16 to -0.10). CONCLUSIONS As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis. PROTOCOL REGISTRATION PROSPERO (www.crd.york.ac.uk/prospero/) No CRD42012002267.
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Affiliation(s)
- Olalekan A Uthman
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK
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Tricco AC, Cogo E, Holroyd-Leduc J, Sibley KM, Feldman F, Kerr G, Majumdar SR, Jaglal S, Straus SE. Efficacy of falls prevention interventions: protocol for a systematic review and network meta-analysis. Syst Rev 2013; 2:38. [PMID: 23738619 PMCID: PMC3683540 DOI: 10.1186/2046-4053-2-38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/28/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Falls are a leading cause of morbidity and mortality in older adults. Although numerous trials of falls prevention interventions have been completed, there is extensive variation in their intervention components and clinical context, such that the key elements of an effective falls prevention program remain unclear to patients, clinicians, and policy-makers. Our objective is to identify the most effective interventions and combinations of interventions that prevent falls though a systematic review and meta-analysis, including a network meta-analysis. METHODS/DESIGN We will search for published (e.g., MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ageline) and unpublished (e.g., trial registries, dissertations) randomised clinical trials (RCTs) in all languages examining interventions to prevent falls compared to usual care or other falls prevention interventions among adults aged ≥65 years from all settings (e.g., community, acute care, long-term care, and rehabilitation). The primary outcomes are number of injurious falls and number of hospitalizations due to falls. Secondary outcomes include falls rate, number of fallers, number of emergency room visits due to falls, number of physician visits due to falls, number of fractures, costs, and number of intervention-related harms (e.g., muscle soreness related to exercise).We will calibrate our eligibility criteria amongst the team and two independent team members will screen the literature search results in duplicate. Conflicts will be resolved through team discussion. A similar process will be used for data abstraction and quality appraisal with the Cochrane risk of bias tool.Our results will be synthesized descriptively and a random effects meta-analysis will be conducted if the studies are deemed methodologically, clinically, and statistically (e.g., I²<60%) similar. If appropriate, a network meta-analysis will be conducted, which will allow the comparison of interventions that have not been compared in head-to-head RCTs, as well as the effectiveness of interventions. DISCUSSION We will identify the most effective interventions and combinations of interventions that prevent falls in older people. Our results will be used to optimize falls prevention strategies, and our goal is to ultimately improve the health of seniors internationally. TRIAL REGISTRATION PROSPERO registry number: CRD42013004151.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada
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Achana FA, Cooper NJ, Dias S, Lu G, Rice SJC, Kendrick D, Sutton AJ. Extending methods for investigating the relationship between treatment effect and baseline risk from pairwise meta-analysis to network meta-analysis. Stat Med 2012; 32:752-71. [DOI: 10.1002/sim.5539] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/03/2012] [Accepted: 07/03/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Felix A. Achana
- Department of Health Sciences; University of Leicester; Leicester LE1 7RH U.K
| | - Nicola J. Cooper
- Department of Health Sciences; University of Leicester; Leicester LE1 7RH U.K
| | - Sofia Dias
- School of Social and Community Medicine; University of Bristol; Canynge Hall, 39 Whatley Road Bristol BS8 2PS U.K
| | - Guobing Lu
- School of Social and Community Medicine; University of Bristol; Canynge Hall, 39 Whatley Road Bristol BS8 2PS U.K
| | - Stephen J. C. Rice
- Centre for Reviews and Dissemination; University of York; York YO10 5DD U.K
| | - Denise Kendrick
- Division of Primary Care Research; Floor 13, Tower Building, University Park; Nottingham, NG7 2RD U.K
| | - Alex J. Sutton
- Department of Health Sciences; University of Leicester; Leicester LE1 7RH U.K
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Saramago P, Sutton AJ, Cooper NJ, Manca A. Mixed treatment comparisons using aggregate and individual participant level data. Stat Med 2012; 31:3516-36. [PMID: 22764016 DOI: 10.1002/sim.5442] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 04/23/2012] [Indexed: 11/06/2022]
Abstract
Mixed treatment comparisons (MTC) extend the traditional pair-wise meta-analytic framework to synthesize information on more than two interventions. Although most MTCs use aggregate data (AD), a proportion of the evidence base might be available at the individual level (IPD). We develop a series of novel Bayesian statistical MTC models to allow for the simultaneous synthesis of IPD and AD, potentially incorporating study and individual level covariates. The effectiveness of different interventions to increase the provision of functioning smoke alarms in households with children was used as a motivating dataset. This included 20 studies (11 AD and 9 IPD), including 11 500 participants. Incorporating the IPD into the network allowed the inclusion of information on subject level covariates, which produced markedly more accurate treatment-covariate interaction estimates than an analysis solely on the AD from all studies. Including evidence at the IPD level in the MTC is desirable when exploring participant level covariates; even when IPD is available only for a fraction of the studies. Such modelling may not only reduce inconsistencies within networks of trials but also assist the estimation of intervention subgroup effects to guide more individualised treatment decisions.
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Affiliation(s)
- Pedro Saramago
- Centre for Health Economics, University of York, York, UK.
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Leroy S. Revue systématique et méta-analyse : une simple synthèse de la connaissance ou un outil original de recherche ? Arch Pediatr 2012; 19:677-9. [DOI: 10.1016/j.arcped.2012.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/12/2012] [Indexed: 10/26/2022]
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Runyan CW. Editorial: introducing the 2012 volume of Epidemiologic Reviews on injury and violence. Am J Epidemiol 2012; 175:89-90. [PMID: 22180875 DOI: 10.1093/aje/kwr348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
This volume of Epidemiologic Reviews features 13 articles covering a variety of injury problems and research topics. In this commentary, the authors highlight the remarkable achievements in injury control and the important role the Haddon Matrix has played in understanding injury causation and developing preventive strategies; comment on the individual articles included in this volume in the broad categories of research methods, childhood injury, motor-vehicle-related injury, alcohol-related injury, intentional injury, and occupational injury; and outline research gaps and future directions in injury epidemiology and prevention.
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Affiliation(s)
- Susan P Baker
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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