Health impacts and economic costs of residential fires (RESFIRES study) : protocol for a population-based cohort study using linked administrative data

Introduction: Residential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call the fire service, and international studies highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. The objectives of this study are to quantify the incidence, health impacts, risk factors and economic costs of residential fires in New South Wales (NSW), Australia. Methods and analysis: The RESFIRE cohort will include all persons living at an NSW residential address which experienced a fire over the period 2005–2014. Nine data sources will be linked to provide a comprehensive picture of individual trajectories from fire event to first responder use (fire and ambulance services), emergency department presentations, hospital admissions, burn out-patient clinic use and death. These data will be used to describe the circumstances and characteristics of residential fires, provide a profile of fire-related injuries, examine trends over time, and explore the relationship between fire circumstance, emergency and health services utilisation, and health outcomes. Regression modelling, including multilevel modelling techniques, will be used to explore factors that impact on these relationships. Costing models will be constructed. Ethics and dissemination: Ethical approval for this study has been obtained from the NSW Population and Health Service Research Ethics Committee and Western Sydney University Human Research Ethics Committee. The study reference group comprises key stakeholders including Fire and Rescue NSW, policy agencies, health service providers and burns clinicians ensuring wide dissemination of results and translation of data to inform practice and identify areas for targeted prevention. Summary reports in formats designed for policy audiences in parallel with scientific papers will be produced

Phosphate decreases urine calcium and increases calcium balance: A meta-analysis of the osteoporosis acid-ash diet hypothesis

<p>Abstract</p> <p>Background</p> <p>The acid-ash hypothesis posits that increased excretion of "acidic" ions derived from the diet, such as phosphate, contributes to net acidic ion excretion, urine calcium excretion, demineralization of bone, and osteoporosis. The public is advised by various media to follow an alkaline diet to lower their acidic ion intakes. The objectives of this meta-analysis were to quantify the contribution of phosphate to bone loss in healthy adult subjects; specifically, a) to assess the effect of supplemental dietary phosphate on urine calcium, calcium balance, and markers of bone metabolism; and to assess whether these affects are altered by the b) level of calcium intake, c) the degree of protonation of the phosphate.</p> <p>Methods</p> <p>Literature was identified through computerized searches regarding phosphate with surrogate and/or direct markers of bone health, and was assessed for methodological quality. Multiple linear regression analyses, weighted for sample size, were used to combine the study results. Tests of interaction included stratification by calcium intake and degree of protonation of the phosphate supplement.</p> <p>Results</p> <p>Twelve studies including 30 intervention arms manipulated 269 subjects' phosphate intakes. Three studies reported net acid excretion. All of the meta-analyses demonstrated significant decreases in urine calcium excretion in response to phosphate supplements whether the calcium intake was high or low, regardless of the degree of protonation of the phosphate supplement. None of the meta-analyses revealed lower calcium balance in response to increased phosphate intakes, whether the calcium intake was high or low, or the composition of the phosphate supplement.</p> <p>Conclusion</p> <p>All of the findings from this meta-analysis were contrary to the acid ash hypothesis. Higher phosphate intakes were associated with decreased urine calcium and increased calcium retention. This meta-analysis did not find evidence that phosphate intake contributes to demineralization of bone or to bone calcium excretion in the urine. Dietary advice that dairy products, meats, and grains are detrimental to bone health due to "acidic" phosphate content needs reassessment. There is no evidence that higher phosphate intakes are detrimental to bone health.</p

Health impacts and economic costs of residential fires (RESFIRES study): protocol for a population-based cohort study using linked administrative data

Introduction Residential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call the fire service, and international studies highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. The objectives of this study are to quantify the incidence, health impacts, risk factors and economic costs of residential fires in New South Wales (NSW), Australia.Methods and analysis The RESFIRE cohort will include all persons living at an NSW residential address which experienced a fire over the period 2005–2014. Nine data sources will be linked to provide a comprehensive picture of individual trajectories from fire event to first responder use (fire and ambulance services), emergency department presentations, hospital admissions, burn out-patient clinic use and death. These data will be used to describe the circumstances and characteristics of residential fires, provide a profile of fire-related injuries, examine trends over time, and explore the relationship between fire circumstance, emergency and health services utilisation, and health outcomes. Regression modelling, including multilevel modelling techniques, will be used to explore factors that impact on these relationships. Costing models will be constructed.Ethics and dissemination Ethical approval for this study has been obtained from the NSW Population and Health Service Research Ethics Committee and Western Sydney University Human Research Ethics Committee. The study reference group comprises key stakeholders including Fire and Rescue NSW, policy agencies, health service providers and burns clinicians ensuring wide dissemination of results and translation of data to inform practice and identify areas for targeted prevention. Summary reports in formats designed for policy audiences in parallel with scientific papers will be produced

Health impacts and economic costs of residential fires (RESFIRES study): protocol for a population-based cohort study using linked administrative data

IntroductionResidential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call the fire service, and international studies highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. The objectives of this study are to quantify the incidence, health impacts, risk factors and economic costs of residential fires in New South Wales (NSW), Australia.Methods and analysisThe RESFIRE cohort will include all persons living at an NSW residential address which experienced a fire over the period 2005–2014. Nine data sources will be linked to provide a comprehensive picture of individual trajectories from fire event to first responder use (fire and ambulance services), emergency department presentations, hospital admissions, burn out-patient clinic use and death. These data will be used to describe the circumstances and characteristics of residential fires, provide a profile of fire-related injuries, examine trends over time, and explore the relationship between fire circumstance, emergency and health services utilisation, and health outcomes. Regression modelling, including multilevel modelling techniques, will be used to explore factors that impact on these relationships. Costing models will be constructed.Ethics and disseminationEthical approval for this study has been obtained from the NSW Population and Health Service Research Ethics Committee and Western Sydney University Human Research Ethics Committee. The study reference group comprises key stakeholders including Fire and Rescue NSW, policy agencies, health service providers and burns clinicians ensuring wide dissemination of results and translation of data to inform practice and identify areas for targeted prevention. Summary reports in formats designed for policy audiences in parallel with scientific papers will be produced.</jats:sec

Randomized feasibility trial of replacing or discarding the nail plate after nail-bed repair in children

Abstract Background Nail-bed injuries are the most common hand injury in children. Surgical dogma is to replace the nail plate after repairing the nail bed. Recent evidence suggests this might increase infection rates and returns to clinic. The aim of this feasibility trial was to inform the design and conduct of a definitive trial comparing replacing or discarding the nail plate after nail-bed repair. Methods This study recruited participants from four hand units in the UK between April and July 2015. Participants were children under the age of 16 years with a nail-bed injury requiring surgery. They were randomized to either having the nail plate replaced or discarded after nail-bed repair. The follow-up method was also allocated randomly (postal versus clinic). Information was collected on complications at 2 weeks and 30 days, and on nail-plate appearance at 4 months using the Zook classification. Two possible approaches to follow-up were also piloted and compared. Results During the recruitment phase, there were 156 potentially eligible children. Sixty were randomized in just over 3 months using remote web-based allocation. By 2 weeks, there were two infections, both in children with replaced nail plates. The nail-replaced group also experienced more complications. There was no evidence of a difference in return rates between postal and clinic follow-up. Conclusion Recruitment was rapid and nail-bed repair appeared to have low complication and infection rates in this pilot trial. The findings have led to revision of the definitive trial protocol, including the mode and timing of follow-up, and modification of the Zook classification. </jats:sec