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

Re‐evaluation of phosphoric acid–phosphates – di‐, tri‐ and polyphosphates (E 338–341, E 343, E 450–452) as food additives and the safety of proposed extension of use

The Panel on Food Additives and Flavourings added to Food (FAF) provided a scientific opinion re‐evaluating the safety of phosphates (E 338–341, E 343, E 450–452) as food additives. The Panel considered that adequate exposure and toxicity data were available. Phosphates are authorised food additives in the EU in accordance with Annex II and III to Regulation (EC) No 1333/2008. Exposure to phosphates from the whole diet was estimated using mainly analytical data. The values ranged from 251 mg P/person per day in infants to 1,625 mg P/person per day for adults, and the high exposure (95th percentile) from 331 mg P/person per day in infants to 2,728 mg P/person per day for adults. Phosphate is essential for all living organisms, is absorbed at 80–90% as free orthophosphate excreted via the kidney. The Panel considered phosphates to be of low acute oral toxicity and there is no concern with respect to genotoxicity and carcinogenicity. No effects were reported in developmental toxicity studies. The Panel derived a group acceptable daily intake (ADI) for phosphates expressed as phosphorus of 40 mg/kg body weight (bw) per day and concluded that this ADI is protective for the human population. The Panel noted that in the estimated exposure scenario based on analytical data exposure estimates exceeded the proposed ADI for infants, toddlers and other children at the mean level, and for infants, toddlers, children and adolescents at the 95th percentile. The Panel also noted that phosphates exposure by food supplements exceeds the proposed ADI. The Panel concluded that the available data did not give rise to safety concerns in infants below 16 weeks of age consuming formula and food for medical purposes

A formative evaluation of the Triple Zero Kids Challenge teacher&#039;s Guide

The Triple Zero Kids&#039; Challenge is an online, interactive safety game and a mobile application. It provides young children in Australia with essential information on how to identify and report legitimate emergencies by calling Triple Zero (000). As a companion resource, the Triple Kids&#039; Challenge Teacher&#039;s Guide provides educators of lower primary school students with a series of structured learning activities to consolidate and extend the key messages of the online game. To ensure that the learning activities in the guide are both feasible and appropriate for the target age group, a formative evaluation was conducted with lower-primary students and their teachers. This paper reports on the results of the evaluation and highlights the importance of formative evaluation to the development of safety education programs for children. While the evaluation indicated that the learning activities were feasible and appropriate for lower-primary school students, it also identified the need for numerous modifications and improvements that have been incorporated into a revised 2017 version of the guide

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

Economic value of home fire safety checks in New South Wales

In 2014, Fire Rescue New South Wales piloted a Home Fire Safety Checks program aimed at high risk individuals. This entailed the visiting of 228 homes in eight suburbs to provide safety checks; smoke alarms; changing of batteries; fire blankets and fire safety information. Economic valuation was conducted of the program at pilot and at a full roll-out

Home Fire Safety Checks in New South Wales : an economic evaluation of the pilot program

Traumatic events such as fire can result in fatality, injury, and loss of property; even a minor fire can interrupt the normal flow of people’s lives. During the years 2009–2013, urban and regional New South Wales (NSW) experienced an annual average of 4329 residential structural fires with 593 injuries and 22 fatalities at an annual cost of $656 million dollars. In 2014, Fire and Rescue NSW piloted a program called Home Fire Safety Checks (HFSC), aimed at high-risk households. In total, 228 homes in 8 suburbs received safety checks, including having smoke alarms installed, having batteries changed in smoke alarms, and being provided with fire blankets and fire safety information. The pilot study design enabled detailed economic evaluation of the program, including both development costs and ongoing costs for a full roll-out. Analysis of the cost of fire within NSW, combined with measurements of the success of similar programs internationally, demonstrates the program’s cost effectiveness. Savings per dollar spent exceed$12 if the program includes 1% of high-risk homes and obtains a 0.75% reduction in number of fires. These results demonstrate that a full roll-out of the HFSC program warrants ongoing funding. External factors affecting program delivery include community acceptance and willingness to participate in the program, particularly very high-risk individuals, and ongoing behavioral change. In addition, HFSC faces the same ongoing funding challenges other preventative community programs face in a period of tightening state budgets

Using a cluster randomized controlled trial to determine the effects of intervention of battery and hardwired smoke alarms in New South Wales, Australia : home fire safety checks pilot program

Introduction: In 2014, Fire & Rescue New South Wales piloted the delivery of its home fire safety checks program aimed at engaging and educating targeted top “at risk” groups to prevent and prepare for fire. This pilot study aimed to assess the effectiveness of smoke alarms using a cluster randomized controlled trial. Methods: Survey questionnaires were distributed to the households that had participated in the home fire safety checks program (intervention group). A separate survey questionnaire was distributed to the control group that was identified with similar characteristics to the intervention group in the same suburb. To adjust for potential clustering effects, generalized estimation equations with a log link were used. Results: Multivariable analyses revealed that battery and hardwired smoking alarm usage increased by 9% and 3% respectively among the intervention group compared to the control group. Females were more likely to install battery smoke alarms than males. Respondents who possessed a certificate or diploma (AOR = 1.31, 95% CI 1.00–1.70, P = 0.047) and those who were educated up to years 8–12 (AOR = 1.32, 95% CI 1.06–1.64, P = 0.012) were significantly more likely to install battery smoke alarms than those who completed bachelor degrees. Conversely, holders of a certificate or diploma and people who were educated up to years 8–12 were 31% (AOR = 0.69, 95% CI 0.52–0.93, P = 0.014) and 24% (AOR = 0.76, 95% CI 0.60–0.95, P = 0.015) significantly less likely to install a hardwired smoke alarm compared to those who completed bachelor degrees. Conclusions: This pilot study provided evidence of the benefit of the home fire safety checks program in New South Wales. Future interventional research on home fire safety checks on preventing and preparing for fire should engage, educate and assess the complacency of male respondents when implementing the safety procedures, even when they are aware of their risks