Evaluating the impact of caribou habitat restoration on predator and prey movement.

Fragmentation of the boreal forest by linear features, including seismic lines, has destabilized predator-prey dynamics, resulting in the decline of woodland caribou (Rangifer tarandus caribou) populations. Restoration of human-altered habitat has therefore been identified as a critical management tool for achieving self-sustaining woodland caribou populations. However, only recently has testing of the response of caribou and other wildlife to restoration activities been conducted. Early work has centered around assessing changes in wildlife use of restored seismic lines. We evaluated whether restoration reduces the movement rates of predators and their associated prey, which is expected to decrease predator hunting efficiency and ultimately reduce caribou mortality. We developed a new method for using cameras to measure fine-scale movement by measuring speed as animals traveled between cameras in an array. We used our method to quantify speed of caribou, moose (Alces alces), bears (Ursus americanus), and wolves (Canis lupus) on treated (restored) and untreated seismic lines. Restoration treatments reduced travel speeds along seismic lines of wolves by 1.38 km/h, bears by 0.55 km/h, and caribou by 1.57 km/h, but did not reduce moose travel speeds. Reduced predator and caribou speeds on treated seismic lines are predicted to decrease encounter rates between predators and caribou and thus lower caribou kill rates. However, further work is needed to determine whether reduced movement rates result in reduced encounter rates with prey, and ultimately reduced caribou mortality.

La fragmentación del bosque boreal causado por los accidentes lineales, incluyendo a las líneas sísmicas, ha desestabilizado las dinámicas depredador-presa, lo que resulta en la declinación de las poblaciones de caribú (Rangifer tarandus caribou). Por esto, la restauración del hábitat con alteraciones antropogénicas ha sido identificada como una herramienta fundamental de gestión para obtener poblaciones autosuficientes de esta especie. Sin embargo, no es hasta hace poco que se ha analizado la respuesta del caribú y otras especies a las actividades de restauración; los primeros trabajos se centraban en analizar los cambios en el uso que les daban las especies a las líneas sísmicas restauradas. Evaluamos si la restauración reduce las tasas de movimiento de los depredadores y sus presas asociadas, las cuales se esperan disminuyan la eficiencia de caza de los depredadores y por último reduzcan la mortalidad del caribú. Desarrollamos un nuevo método para usar las cámaras para medir el movimiento detallado mediante la medición de la velocidad con la que los animales se trasladan a lo largo de una serie de cámaras. Usamos nuestro método para cuantificar la velocidad del caribú, alces (Alces alces), osos (Ursus americanus) y lobos (Canis lupus) en líneas sísmicas tratadas (restauradas) y no tratadas. Los tratamientos de restauración redujeron la velocidad de movimiento de los lobos (reducción de 1.38 km/hora), osos (0.55 km/hora) y caribú (1.57 km/hora), pero no afectaron la velocidad de movimiento de los alces. Se pronostica que la reducción en la velocidad de movimiento sobre las líneas sísmicas disminuye la proporción de encuentros entre el caribú y sus depredadores y, por lo tanto, reduce la proporción de muertes del caribú. Sin embargo, se necesita un análisis más profundo para determinar si la tasa reducida de movimiento resulta en una tasa reducida de encuentros con depredadores y si, por último, esto reduce la mortalidad del caribú.

[Effect of a multidimensional intervention for prevention of falls in the eldery]. / Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas.

OBJECTIVE: To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN: Randomised clinical trial. SETTING: Family health centre, primary care. PARTICIPANTS: Independent elderly people living in the community. INTERVENTION: For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n=77), and those assigned to the control group (CG, n=77) received usual care in the family health centre. MAIN MEASUREMENTS: Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS: In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P<.001 and CG: P<.001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r=0.25) and shoes (r=0.24), as well as an increase in the perception of risk of falls associated with walking (r=0.21) and the presence of objects or furniture (r=0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P=.004). CONCLUSIONS: The multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.

Inequities in occupational diseases recognition in France.

BACKGROUND: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases. METHODS: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD. RESULTS: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases. CONCLUSION: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.

Lesiones por causa externa en el servicio de urgencias de un hospital en un periodo de cinco años.

INTRODUCCIÓN: En el Estado de México no existen investigaciones que proporcionen información para toma de decisiones y administración de recursos relacionados con la atención de las lesiones por causa externa (LCE). OBJETIVO: Describir las LCE en un servicio de urgencias durante un periodo de cinco años. MÉTODO: Se diseñó un estudio retrospectivo con pacientes que ingresaron al servicio de urgencias (2010-2015) por diagnóstico de LCE. Se realizó análisis descriptivo y de clúster. RESULTADOS: En el servicio de urgencias, 16.59 % de las atenciones derivaron de LCE. Se incluyeron 16 567 pacientes de 14 a 99 años (media o promedio = 37.7, DE = 17.28), 69.2 % fue del sexo masculino. Las LCE principalmente ocurrieron en la vía pública (26.3 %) y en el hogar (23.7 %). Las causas más frecuentes fueron agresiones fuera del hogar (32.7 %), en promedio a los 34 años; caídas (25 %) en promedio a los 45 años; accidentes ocasionados por vehículos de motor (9.7 %), en promedio a los 33 años. El análisis por clúster identificó cuatro grupos: agresiones fuera del hogar 32.7 % (5417), contactos traumáticos 26.30 % (4363), accidentes de tránsito 15.9 % (2,640) y caídas 25 % (4147). CONCLUSIÓN: Las LCE relacionadas con vehículos de motor mostraron consecuencias más severas. BACKGROUND: In the State of Mexico there are no investigations that provide information for decision-making and administration of resources related to the care of externally-caused injuries (ECI). OBJECTIVE: To describe ECIs seen in an emergency department over a 5-year period. METHOD: A retrospective study was designed with patients admitted to emergency department (2010-2015) with ECI diagnosis. Descriptive and cluster analyses were performed. RESULTS: At the emergency department, 16.59% of emergency care was related to ECI. A total of 16,567 patients of 14 to 99 years of age (average = 37.7; SD = 17.28) were included; 69.2% were males. ECIs occurred mainly in public places (26.3%) and at home (23.7%). The main causes were aggression outside the home (32.7%), on average at 34 years of age, falls (25%) on average at 45 years, and motor vehicle accidents (9.7%) on average at 33 years. The cluster analysis identified four groups: aggression outside the home 32.7% (5,417), traumatic contacts, 26.30% (4,363), road traffic accidents 15.9% (2,640) and falls 25% (4,147). CONCLUSIONS: Motor vehicle accident-related ECIs showed the most severe consequences.

Admission to Intensive Care for a trauma related to alcohol or drugs, a 'teachable moment' for the beginning of a change. / Ingreso en cuidados intensivos por un traumatismo relacionado con el consumo de alcohol o drogas, un «momento propicio de enseñanza¼ para el inicio del cambio.

OBJECTIVES: To estimate how many of the trauma patients admitted to ICU would be candidates for a secondary prevention programme for trauma related to alcohol or drug use by brief motivational intervention and to define what factors prevent that intervention being performed. METHODS: All 16-70year old trauma patients (n=242) admitted to ICU in 32 non-consecutive months (November 2011 to March 2015) were included in the study, coinciding with the implementation of a screening and brief motivational intervention programme for trauma patients related to substance consumption. The programme includes screening for exposure to substances at admission. Sociodemographic and clinical variables were collected prospectively. RESULTS: The screening for substances was not performed in 38 (15.7%) of all admitted patients. Of the patients screened, 101 (49.5%) were negative. The variables that in greater proportion impeded intervention between screening positive patients were neurological damage due to the trauma with 23 patients (37.1%) and prior psychiatric disorder with 18 (29%). Both variables were associated with substance consumption: negatives 9.9% vs positive 22.3% (P=.001) and negatives 3% vs positive 17.5% (P=.016) respectively. The number of candidates for motivational intervention was 41, 16.9% of all admitted patients. CONCLUSIONS: Almost 2 out of 10 patients were potential candidates. The factors that in a greater proportion precluded the intervention were the same as those associated with consumption. Mortality in ICU was associated with non-compliance with the screening protocol.

[Epidemiological profile of traumatic brain injury at the Dr. Rafael A. Calderón Guardia Hospital, Neurosurgery Department, during the period from 2007 to 2012]. / Perfil epidemiológico del traumatismo craneoencefálico en el Servicio de Neurocirugía del Hospital Dr. Rafael A. Calderón Guardia durante el período 2007 a 2012.

OBJECTIVE: To determine the epidemiological profile of the patients who suffered traumatic brain injury (TBI) and were treated at the Dr. Rafael A. Calderón Guardia Hospital (HCG) Neurosurgery department, during the period from 2007 to 2012. MATERIAL AND METHODS: An observational, descriptive, retrospective and cross section study was performed on all the patients with TBI and who were admitted to the emergency room of the HCG during the period 2007 to 2012. There were a total of 721 cases, of which 566 records were obtained of patients who had the variables established in this study, excluding those with incomplete or inconsistent information. RESULTS: The present study established the epidemiological profile of the TBI in the population seen during the period 2007 to 2012 at the HCG. It was determined that the male sex made up the majority of the cases were male, with mean age of 46 years. The mortality rate was 12.69% (n=69). Car accidents were the most frequent cause of TBI (n=259 persons) in the age group of 25 to 44 years, followed by falls (n=174). It was observed that the majority were farmers, followed by students, and then construction workers. No chronic illnesses were recorded in 71.6% of the medical charts. No alcohol or other drugs were reported in 74.9% of the cases, while there was evidence of the presence of alcohol recorded in 22.8%. The clinical and laboratory parameters that had statistical significance (P<.05) were GCS equal to less than 8 (P=.035), presence of mydriasis (P=.00), deviation of the LM (P=.006), cranial fracture (P=.04), lack of endotracheal intubation on admission (P=.007), prolonged PT (P=.04), prolonged PTT (P=.025), and MAP<60 (P=.002). The most frequent surgical procedure in the study population was craniotomy with hematoma drainage alone or associated with some other procedure (esquillectomy or monitoring of PIC) (n=298). CONCLUSIONS: There is great difficulty in determining the epidemiology of TBI worldwide, due to the lack of standardisation of the international studies. From the present study, it can be concluded that the population that mainly suffers from this type of lesion are adults under 45 years old, with car accidents being the main cause of these lesions (45.8%) in combination with alcohol consumption. Also, the consequences of such are aggravated when the victims present with chronic diseases such as, systemic arterial hypertension and mellitus diabetes. As regards the post-traumatic indicators directly related to a poor outcome, it was determined that a GCS score equal to or less than 8, a mean blood pressure less than 60, the prolongation of the coagulation times, the presence of mydriasis, and skull fractures, have a direct association with the negative or fatal outcome for the victim.

Differential patterns, trends and hotspots of road traffic injuries on different road networks in Vellore district, southern India.

OBJECTIVE: To describe spatial and temporal profiles of Road Traffic Injuries (RTIs) on different road networks in Vellore district of southern India. METHODS: Using the information in the police maintained First Information Reports (FIRs), daily time series of RTI counts were created and temporal characteristics were analysed with respect to the vehicle, road types and time of the day for the period January 2005 to May 2007. Daily incidence and trend of RTIs were estimated using a Poisson regression analysis. RESULTS: Of the reported 3262 RTIs, 52% had occurred on the National Highway (NH). The overall RTI rate on the NH was 8.8/100 000 vehicles per day with significantly higher pedestrian involvement. The mean numbers of RTIs were significantly higher on weekends. Thirteen percentage of all RTIs were associated with fatalities. Hotspots are major town junctions, and RTI rates differ over different stretches of the NH. CONCLUSION: In India, FIRs form a valuable source of RTI information. Information on different vehicle profile, RTI patterns, and their spatial and temporal trends can be used by administrators to devise effective strategies for RTI prevention by concentrating on the high-risk areas, thereby optimising the use of available personnel and resources.

Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT.

OBJECTIVE: To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. METHODS: We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016-2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. RESULTS: A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR+=0.87). Multifactorial (RR+=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. CONCLUSIONS: Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.

[Alusti test as a premonitory variable of adverse health events in a nursing home. Two-years follow-up]. / Test Alusti como variable premonitoria de procesos adversos de salud en una residencia de mayores. Seguimiento a 2 años.

INTRODUCTION: Functional capacity is a good indicator of health, quality of life, and a good predictor of morbimortality. It is a priority to functionally assess the geriatric population through objective, precise, and simple instruments. The Alusti Test in its two versions, complete (TA) and abbreviated (TAA), is a scale that meets these criteria. OBJECTIVE: To determine the usefulness of the Alusti Test as a predictor of adverse health events: falls, hospitalizations, cognitive deterioration, and mortality in the elderly institutionalized population, with a two-year follow-up. MATERIAL AND METHODS: This observational study's sample included 176 persons admitted to a nursing home for 32months, with a mean age of 85.5years. The TA was performed on 138 and the TAA on 38. RESULTS: The ratio of falls is much higher in residents with mild dependence than in those with total dependence (P<.001). Hospitalizations increase as the results of the Alusti Test are more favorable. The risk of hospitalization in dependent patients is 50% lower (P<.001) than in those with preserved mobility. Cognitive impairment is similar in all the populations with some mild-moderate level of functional dependence and decreases in the population with preserved mobility. Categorization as total and mild/severe dependence is related to a 3-4times higher mortality at six months follow-up. CONCLUSIONS: A higher mild-moderate level of dependence on the AT correlates with a lower risk of falls, a lower rate of hospitalization, and a higher risk of mortality at six months.

[Incidence, circumstances and consequences of falls in subjects with stroke: One year of follow-up]. / Incidencia, circunstancias y consecuencias de caídas en sujetos con accidente cerebrovascular: un año de seguimiento.

INTRODUCTION: Falls are among the most frequent complications following stroke (CVA), and have a negative impact on rehabilitation. OBJECTIVES: To study the incidence, circumstances, and consequences of falls in stroke patients up to 12months after starting outpatient kinetic treatment. MATERIALS AND METHODS: Prospective design, case series. Consecutive sampling. Patients admitted to the day hospital between June 2019 and May 2020. Included: adults with a diagnosis of first supratentorial stroke and functional ambulatory category score ≥3. EXCLUSION CRITERIA: other condition affecting locomotion. MAIN VARIABLES: number of falls, circumstances, and consequences. Clinical, demographic, and functional characteristics were measured. RESULTS: Twenty-one subjects were included, 13 suffered at least one fall. The subjects reported 41 falls: 15 were to the most affected side, 35 inside the home, 28 without the indicated equipment, they were alone when the event occurred on 29 occasions, and in two situations medical assistance was required. There were statistically significant differences (P<.05) in functional performance (balance, gait velocity) between those who fell and those who did not. No significant differences were found between gait endurance and falls. CONCLUSION: More than half suffered a fall, alone, to the weaker side, and without the appropriate equipment. With this information the incidence could be reduced by preventive measures.

The factors that influence the adaptation process 6 months after a stroke: A path analysis.

OBJECTIVE: The purpose of this study was to identify the determinant factors that influence the adaptation process and quality of life after a stroke. METHODS: This study is an observational study using a cross-sectional design. Respondents were patients who were 6 months post-discharge after non-hemorrhagic strokae and their family caregivers. Information about respondents was taken from medical record data at two regional general hospitals in West Kalimantan Province, Indonesia. A total of 80 patients were selected using a consecutive sampling method. Theoretical models of patient and caregiver factors that influence adaptation responses and post-stroke quality of life were tested using path analysis. RESULT: Caregiver coping, self-efficacy, and illness acceptance had a direct effect on the post-stroke psychosocial adaptation response by 58.1%, with self-efficacy contributing the most (ß = 0.668, P < .0001). Self-efficacy, illness acceptance, and healthy behavior had a direct effect on the physiological adaptation response by 24.3%, where self-efficacy also contributed the most (ß = 0.272, P < .014). Psychosocial adaptation and physiological adaptation had a direct effect on the quality of life by 54.6%, where psychosocial adaptation showed the largest contribution (ß = 0.63, P < .0001). CONCLUSION: Self-efficacy contributes the most to both psychosocial and physiological adaptations 6 months after stroke. Psychosocial adaptation and self-efficacy have been proven to be the determinant factors that contribute the most to the quality of life of patients 6 months after stroke.

A neuropsychological approach in a paediatric acquired brain injury unit under the public health system.

INTRODUCTION: Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Niño Jesús is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. OBJECTIVE: This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. PATIENTS: Fifty-three patients aged between 3 months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. METHODS: All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. RESULTS: Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. CONCLUSIONS: The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.

[Social inequalities related to road traffic mortality]. / Desigualdades sociales relacionadas con la mortalidad por accidentes de tráfico.

OBJECTIVE: To synthesize the social inequalities related to mortality from traffic accidents reported in scientific publications. METHOD: A scoping review following the PRISMA-ScR guide was carried out. Using the MesH vocabulary, we systematically searched for articles in English, Portuguese and Spanish published in the EBSCO, Scielo, Scopus, Ovid, and PubMed databases. RESULTS: We identified 47,790 records in the initial search, of which 35 articles met the selection criteria. Nine out ten publications are in high-income countries; there is a greater interest in analyzing mortality in occupants and drivers of vehicles and motorcyclists. Half of the publications use race-ethnicity and geolocation as socioeconomic position variables. The articles included in this review indicate that groups of people with low socioeconomic positions have higher mortality due to traffic accidents. CONCLUSIONS: The highest mortality from traffic accidents occurs in people with low socioeconomic positions which suggests the development of road safety actions from a comprehensive, integrative perspective and linked to other political agendas to reduce their incidence by 2030. Although road traffic fatalities are higher in low and middle-income countries, few publications are available in these countries. It is necessary to strengthen the research capacities in these countries.

Traumatic brain injury in the new millennium: new population and new management.

INTRODUCTION: Traumatic brain injury (TBI) is one of the leading causes of death and disability globally. We present a study describing epidemiological changes in severe TBI and the impact these changes have had on management and analysing alternatives that may improve outcomes in this new population. MATERIALS AND METHODS: We performed a retrospective, descriptive, cross-sectional analysis of patients presenting severe TBI at our hospital in the period of 1992-1996 and 2009-2013. We analysed demographic data, including age, sex, mortality, aetiology, anticoagulation, treatment, and functional outcome. RESULTS: We reviewed data from 220 patients. In the second cohort, there were 40% fewer patients, mean age was 12 years older, patients were more frequently receiving anticoagulation therapy, and the percentage of interventions was halved. Aetiology varied, with traffic accidents being the main cause in the first group, and accidental falls and being hit by cars in the second group. There were no intergroup differences for mortality or functional outcomes. CONCLUSION: The age of patients admitted due to severe TBI has increased. As a result of this, the main cause of severe TBI in our population is accidental falls in elderly, anticoagulated patients. Despite the low-energy nature of trauma, patients in the second cohort presented a poorer baseline status, and were less frequently eligible for surgery, with no improvement in mortality or functional outcomes.

Incidence and characteristics of falls in hospitalized patients: A cohort study.

OBJECTIVE: To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls. METHODOLOGY: A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record. RESULTS: One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD: 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred. CONCLUSIONS: Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.

[Fall prevention in older people and their families: a qualitative synthesis]. / La prevención de las caídas de las personas mayores y sus familiares: una síntesis cualitativa.

OBJECTIVE: To analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providers METHOD: Qualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis. RESULTS: Care providing, and kinship relationships mediated family care providers' interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions. CONCLUSIONS: Taking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers.

[Unintentional asphyxia in Mexico: a hidden public health problem]. / Las asfixias accidentales en México: un problema de salud pública oculto.

OBJECTIVE: To characterize the epidemiology of unintentional asphyxias in Mexico from 1999 to 2017. METHOD: Secondary analysis of vital registries, three national health surveys and information from the safety inspection program of the Ministry of Health in Mexico were used to characterize fatal and non-fatal drownings (ICD-10: W65-W74) and other asphyxias including suffocation, chocking and strangulation (ICD-10: W75-W84), and to estimate the level of exposure to different risk factors within households and daycares. RESULTS: 100,834 deaths were registered, 44.66% were drowning and 77.17% male. Drownings mainly affect children and adolescents, occur in April, July and August, on Sundays, during the afternoon. Other asphyxias affect children and the elderly more frequently, occur mainly from December to February, on Sundays and from 4 to 6h. According to ENSANut-2012, 53,065 individuals experience a non-fatal asphyxia per year, 26.21% of them with permanent consequences in their health and wellbeing. Important risks of unintentional asphyxias are present in 38% of daycares and 80% of households analyzed. CONCLUSIONS: Unintentional asphyxias are a major public health problem that needs to be urgently attended to achieve the Sustainable Development Goals, in particular the 3.2. Evidence presented in this work constitutes an input to inform and orient efforts directed to tackle this problem.

[Provincial savings of costs in road accidents in Spain (2000-2014)]. / Ahorros de costes provinciales en los accidentes viales en España (2000-2014).

OBJECTIVE: To quantify cost savings obtained before and after the implementation of the penalty-points driving licence on the interurban roads in Spain. METHOD: Descriptive study through the construction of three indicators that expressed the cost savings by the number of victims avoided. We defined two periods according to the objective and collected data on fatalities, serious injuries and slight injuries on interurban roads in 1999-2014 for each Spanish province. Thus, data for its population, GDP or number of vehicles-kilometres travelled on its roads (MVKT) were used for each province. The quantification of savings was obtained using official figures of costs for each type of victim in 2014 prices. RESULTS: The cost savings per inhabitant on fatalities in the period of validity of the penalty-points driving licence was between ⿬ 3.89 and ⿬ 19.65 per year. Savings on serious injuries by MVKT were reduced by 15%-66% between 2006 and 2014, being from ⿬ 449.15 to 1707.88 ⿬ annually. CONCLUSIONS: During the period of validity of the penalty-points driving licence, the Spanish provinces have achieved significant cost savings.

A neuropsychological approach in a paediatric acquired brain injury unit under the public health system. / Abordaje neuropsicológico en una unidad pediátrica de daño cerebral adquirido del sistema público de salud.

INTRODUCTION: Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Niño Jesús is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. OBJECTIVE: This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. PATIENTS: Fifty-three patients aged between three months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. METHODS: All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. RESULTS: Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. CONCLUSIONS: The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.

Implementation experience of a guideline on fall prevention in Centres Committed to Excellence in Care®. / Experiencia en la implantación de la Guía de prevención de caídas en Centros Comprometidos con la Excelencia en Cuidados®.

AIM: To describe the progress of implementing the «Preventing falls¼ Guideline of the Best Practice Spotlight Organization (BPSO®) Programme and fall outcomes in Centres Committed to Excellence in Care (CCEC®). METHOD: A Quasi-experimental study pre-post test from a multicentric approach carried out between 2012-2018. The study is focused on patients aged 65 or older, discharged from guideline implementation units, analysing sociodemographic variables (sex, age, hospitalization days; fall risk assessment on admission and patient in risk; fall prevention plan; incidence of falls. Data was compared from CCEC® programme indicators measured over the periods: baseline (T1), candidate during the first three years (T2), and sustainability (T3). Descriptive and inferential analysis was performed. RESULTS: 31,486 patients were evaluated in 7 centres (T1=465; T2=14,255; T3=16,766). Of the patients, 51.87% were men and average age was 79.06 years. Hospitalization was 8.15 days. Fall risk assessment on admission was performed in 81.96% of patients (T1=44.30%, T2=81.11%, T3=83.73%) and 52.31% patients had high risk. A prevention falls plan was registered in 47.75% of patients (T1=24.73%, T2=42.43%, T3=52.90%). Four hundred and twenty-three falls were recorded, 62.17% without injuries. CONCLUSIONS: Despite the differences between hospitals, such as structural characteristics, strategies, assessment tools and data progression pace; adherence to recommendations is proving successful, improving widely. Guideline implementation has allowed fall problems to be addressed, producing positive changes in the process and encouraging the implementation and sustainability of evidence-based nursing practice.