Incidence and costs of unintentional falls in older people in the United Kingdom

STUDY OBJECTIVE: To estimate the number of accident and emergency (A&E) attendances, admissions to hospital, and the associated costs as a result of unintentional falls in older people. DESIGN: Analysis of national databases for cost of illness. SETTING: United Kingdom, 1999, cost to the National Health Service (NHS) and Personal Social Services (PSS). PARTICIPANTS: Four age groups of people 60 years and over (60–64, 65–69, 70–74, and 75) attending an A&E department or admitted to hospital after an unintentional fall. Databases analysed were the Home Accident Surveillance System (HASS) and Leisure Accident Surveillance System (LASS), and Hospital Episode Statistics (HES). MAIN RESULTS: There were 647 721 A&E attendances and 204 424 admissions to hospital for fall related injuries in people aged 60 years and over. For the four age groups A&E attendance rates per 10 000 population were 273.5, 287.3, 367.9, and 945.3, and hospital admission rates per 10 000 population were 34.5, 52.0, 91.9, and 368.6. The cost per 10 000 population was £300 000 in the 60–64 age group, increasing to £1 500 000 in the 75 age group. These falls cost the UK government £981 million, of which the NHS incurred 59.2%. Most of the costs (66%) were attributable to falls in those aged 75 years. The major cost driver was inpatient admissions, accounting for 49.4% of total cost of falls. Long term care costs were the second highest, accounting for 41%, primarily in those aged 75 years. CONCLUSIONS: Unintentional falls impose a substantial burden on health and social services

Trust in leader-follower relationships:how and when trust building enhances dyadic and organisational outcomes

Guided by theory in both the trust and leadership domains, the overarching aim of this thesis was to answer a fundamental question. Namely, how and when does trust-building between leaders and followers enhance leader-member exchange (LMX) development and organisational trust? Although trust is considered to be at the crux of the leader-follower relationship, surprisingly little theoretical or empirical attention has been devoted to understanding the precise nature of this relationship. By integrating both a typology of trustworthy behaviour and a process model of trust development with LMX theory, study one developed and tested a new model of LMX development with leader-follower trust-building as the primary mechanism. In a three wave cross-lagged design, 294 student dyads in a business simulation completed measures of trust perceptions and LMX across the first 6 months of the LMX relationship. Trust-building was found to account for unexplained variance in the LMX construct over time, while controlling for initial relationship quality, thus confirming the critical role of the trust-building process in LMX development. The strongest evidence was found for the role of integrity-based trust-building behaviour, albeit only when such behaviour was not attributed to insincere motives. The results for ability and benevolence-based trustworthy behaviour revealed valued insights into the developmental nature of trustworthiness perceptions within LMX relationships. Thus, the pattern of results in study one provided a more comprehensive and nuanced understanding of the dynamic interplay between trust and LMX. In study two, leader trust-building was investigated cross-sectionally within an organisational sample of 201 employees. The central aim of this study was to investigate whether leader trust-building within leader-follower relationships could be leveraged for organisational trust. As expected, the trust-building process instigated by members in study one was replicated for leaders in study two. In addition, the results were most consistent for benevolence-based trust building, whereas both integrity- and ability-based trust-building were moderated by the position of the leader within the organisation’s hierarchy. Overall, the findings of this thesis shed considerable light on the richness of trusting perceptions in organisations, and the critical role of trust-building in LMX development and organisational trust

The cost-utility of telemedicine to screen for diabetic retinopathy in India.

PURPOSE: To assess the cost-effectiveness of a telemedicine diabetic retinopathy (DR) screening program in rural Southern India that conducts 1-off screening camps (i.e., screening offered once) in villages and to assess the incremental cost-effectiveness ratios of different screening intervals. DESIGN: A cost-utility analysis using a Markov model. PARTICIPANTS: A hypothetical cohort of 1000 rural diabetic patients aged 40 years who had not been previously screened for DR and who were followed over a 25-year period in Chennai, India. METHODS: We interviewed 249 people with diabetes using the time trade-off method to estimate utility values associated with DR. Patient and provider costs of telemedicine screening and hospital-based DR treatment were estimated through interviews with 100 diabetic patients, sampled when attending screening in rural camps (n = 50) or treatment at the base hospital in Chennai (n = 50), and with program and hospital managers. The sensitivity and specificity of the DR screening test were assessed in comparison with diagnosis using a gold standard method for 346 diabetic patients. Other model parameters were derived from the literature. A Markov model was developed in TreeAge Pro 2009 (TreeAge Software Inc, Williamstown, MA) using these data. MAIN OUTCOME MEASURES: Cost per quality-adjusted life-year (QALY) gained from the current teleophthalmology program of 1-off screening in comparison with no screening program and the cost-utility of this program at different screening intervals. RESULTS: By using the World Health Organization threshold of cost-effectiveness, the current rural teleophthalmology program was cost-effective ($1320 per QALY) compared with no screening from a health provider perspective. Screening intervals of up to a frequency of screening every 2 years also were cost-effective, but annual screening was not (>$3183 per QALY). From a societal perspective, telescreening up to a frequency of once every 5 years was cost-effective, but not more frequently. CONCLUSIONS: From a health provider perspective, a 1-off DR telescreening program is cost-effective compared with no screening in this rural Indian setting. Increasing the frequency of screening up to 2 years also is cost-effective. The results are dependent on the administrative costs of establishing and maintaining screening at regular intervals and on achieving sufficient coverage

Experiencing resilience through the eyes of early career social workers

This is the author accepted manuscript. The final version is available from Oxford University Press via the DOI in this record.Within the social work profession, resilience is integrated into educational programmes, professional development courses and frameworks. Such prevalence reflects the importance of resiliency for the profession. This may be the case in particular for those newer to the profession, where the challenges of managing the adversity synonymous with the social work role are still new, despite an increasing level of responsibility. This study focuses on early career social workers, an important but underexplored career stage within this occupation. The aim of which was to enhance understanding of how resilience is experienced by those who are in a unique transitional period in their careers; no longer students, whilst also not yet experienced social workers. The experiences of resilience for this group was explored through semi-structured interviews with fourteen social workers, all employed within Local Authorities in England. Through thematic analysis, three themes were identified: support, team dynamics, and maintaining professionalism. The findings offer important insights, which can inform and contribute to the supportive environments organisations can foster. As such, the practical implications of the research focus on fostering an environment of positivity, through more guided group supervision and the physical positioning of early career workers within office spaces

Leader trustworthy behavior and organizational trust: the role of the immediate manager for cultivating trust

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Drawing from both trust-building theory and interpersonal trust literature, we investigate how trust between a leader and follower may be leveraged to influence organizational trust. We also explore the mediating mechanisms of this link and test a potential moderator. A cross-sectional, multifoci design was adopted and participants were 201 employees within a public sector organization. Leader trustworthy behavior was found to predict organizational trust, mediated by trustworthiness perceptions and trust in the leader. Support for the boundary condition was found; namely, when leaders were more senior, the relationship between trustworthy behavior and organizational trust was stronger. The findings suggest that leaders can meaningfully influence organizational trust perceptions through the enactment of trustworthy behavior, although the strength of this effect varied as a function of their position

Investigating when and why psychological entitlement predicts unethical pro-organizational behavior

In this research, we examine the relationship between employee psychological entitlement (PE) and employee willingness to engage in unethical pro-organizational behavior (UPB). We hypothesize that a high level of PE–the belief that one should receive desirable treatment irrespective of whether it is deserved–will increase the prevalence of this particular type of unethical behavior. We argue that, driven by self-interest and the desire to look good in the eyes of others, highly entitled employees may be more willing to engage in UPB when their personal goals are aligned with those of their organizations. Support for this proposition was found in Study 1, which demonstrates that organizational identification accentuates the link between PE and the willingness to engage in UPB. Study 2 builds on these findings by examining a number of mediating variables that shed light on why PE leads to a greater willingness among employees to engage in UPB. Furthermore, we explored the differential effects of PE on UPB compared to counterproductive work behavior (CWB). We found support for our moderated mediation model, which shows that status striving and moral disengagement fully mediate the link between PE and UPB. PE was also linked to CWB, and was fully mediated by perceptions of organizational justice and moral disengagement

Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women.

OBJECTIVE: To define risk thresholds for cost-effectiveness of risk-reducing salpingo-oophorectomy (RRSO) for ovarian cancer (OC) prevention in low/intermediate risk postmenopausal women. METHODS: A decision-analytic model compares lifetime costs-&-effects of offering 'RRSO' with 'no RRSO' to postmenopausal women ≥50years for different lifetime OC-risk thresholds: 2%, 4%, 5%, 6%, 8% and 10%. Well established data from the literature are used to estimate total costs, effects in terms of Quality-Adjusted-Life-Years(QALYs), cancer incidence, incremental cost-effectiveness ratio(ICER) and impact. Costs are reported at 2012 prices; costs/outcomes discounted at 3.5%. Deterministic/probabilistic sensitivity analysis (PSA) evaluate model uncertainty. RESULTS: RRSO does not save QALYs and is not cost-effective at the 2% general population lifetime OC-risk. At 4% OC-risk RRSO saves QALYs but is not cost-effective. At risk thresholds ≥5%, RRSO saves more life-years and QALYs and is highly cost-effective. The ICERs for OC-risk levels 5%, 6%, 8% and 10% are £15,247, £9958, £4584, and £1864 respectively. The gain in life-years from RRSO equates to 29.2, 40.1, 62.1 and 80.3days at risk thresholds of 5%, 6%, 8% and 10% respectively. The results are not sensitive to treatment costs of RRSO/OC/cardiovascular events but are sensitive to utility-scores for RRSO. On PSA, 67%, 80%, 84%, 91% and 94% of simulations at risk thresholds of 4%, 5%, 6%, 8% and 10% respectively are cost-effective for RRSO. CONCLUSION: RRSO is highly cost-effective in postmenopausal women aged >50 with ≥5% lifetime OC-risk and increases life-expectancy by ≥29.2days. The results could have significant clinical implications given the improvements in risk prediction and falling costs of genotyping.The study is not funded by any charity or grant