You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.


Dissemination and implementation of best practice in falls prevention across Europe

28 Aug, 15 | by Bridie Scott-Parker

As injury prevention researchers, practitioners, and policy-makers, we are all aware that falls are an important public health issue. Today I wanted to profile a novel approach to preventing falls. Dr Helen Hawley-Hague of the University of Manchester is the Scientific Coordinator of ProFouND, the Prevention of Falls Network for Dissemination, and she has shared with me some information regarding this innovative injury prevention approach.

ProFouND is a European Commission-funded initiative dedicated to bring about the dissemination and implementation of best practice in falls prevention across Europe. ProFouND comprises 21 partners from 12 countries, with a further 10 associate members. ProFouND aims to

  • influence policy to increase awareness of falls and innovative prevention programmes among health and social care authorities, the commercial sector, NGOs and the general public,
  • ultimately increasing the delivery of evidence-based practice in falls prevention and
  • therefore reducing the numbers of falls and injurious falls experienced by older adults across Europe.

ProFouND contributes to the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), with the ultimate objective of adding an average of two active healthy life years to the lives of European citizens by 2020. ProFouND’s objective is to embed evidence-based fall prevention programmes for elderly people at risk of falls using novel ICT solutions in at least 10 countries/15 EU regions by the end of 2015, thus to reduce falls incidence in those regions by 2020. The following resources are available to support falls injury prevention:

  1. ProFouND Falls Prevention App (PFNApp), accessible for registered health care practitioners and available in multiple languages;
  2. Cascade training using face-to-face and e-learning approaches and available in multiple languages; and
  3. A free resources library, in addition to information regarding upcoming conferences, and other recent research.

Having seen the ramifications of falls in my own family, with my elderly grandmother fracturing both her pelvis and vertebrae in one fall, this program definitely seems like a step in the right direction!



Concern for prehospital care/ambulance services

10 Aug, 15 | by jmagoola

I spent last week travelling in Adjumani district (located in Northern Uganda) as part of an exercise in improving the quality of immunization data through support supervision and mentor-ship. This required us as a team to visit as many of the health facilities in the district as possible. Due to the limited sources of our country, we had to make do with one of the hospital ambulances as a means of transport. In between ferrying us from one health facility to another, the driver would get calls to go pick up emergency cases that required urgent transportation to hospital.

In this scenario, all the ambulance is manned by only a driver (no paramedic, no nurse) whose role is to pick you up and drop you at the nearest health facility. One of 2 ambulanes currently used by the district to transport patients during emergencies.No triage, no first aid, no prehospital care until arrival. This could contribute to the trauma mortality rates, which are already higher in rural areas before victims reach the hospital. It is known that travel time is a predictor of the outcome of an injury and as such many fatal injuries or their severity may be reduced by adequate prehospital trauma care. A previous study in Uganda found that fewer than 5% of injured patients are transported by ambulance to hospital  most of which ambulances are privately run and expensive. In neighboring Tanzania, a study evaluating access to prehospital care found there was no prehospital care in the region.

The interior of the ambulance, lacking paramedic supplies for first aid.

The interior of the ambulance, lacking paramedic supplies for first aid.

This highlights a major need to prioritize the development of prehospital trauma care if we are to address the issue of injuries. In addition, while the presence of an ambulance will reduce the travel time to hospital and thus increase the chance of survival, the ambulances themselves should be equipped with materials to offer some basic first aid during the course of transportation. They key policy and clinical practice questions we should ask ourselves should include; how equipped are the ambulances?; what should be the minimum standards a vehicle should attain before it is designated as an ambulance?


A walking aid can be a sign of an active senior

26 Jul, 15 | by Klara Johansson

I recently got back from vacation with some of my extended family, a really cool group of people between the ages of two and 92. At age 92, my grandmother still goes for long walks every day (that’s her in the picture below, in the pink jacket, with my mom and brother).

promenad o digitalis edit

Prevention of injury and promotion of physical activity are two issues that can have mutual benefits but can also appear to be in conflict, as has been discussed in recent blog posts about sports safety. Nowhere does this seem more complex to me than the elderly population. Old age is often accompanied by reduced balance and brittle bones, increasing the risk – and the fear – of falls and fractures. Physical activity thus becomes more of a hassle and a hazard. But of course – physical activity also contributes to maintained bone density, even at moderate levels of physical activity (and can improve balance and muscle strength). In addition, there are of course numerous other health benefits to physical activity, including positive effects on mental health and cognitive ability. Regular exercise is recommended as a component of falls prevention in elderly. The authors of a meta-review note that walking seems to be the least efficient part of those programs, but that walking at a moderate pace (avoiding fast walking) still is valuable both as a component of falls prevention and for other health issues, as long as the walking can be done in a safe way.

This is not my area of expertise, but I’m interested because of Gran’s story. I have her permission to share this story and the photos – she says she is happy to share, if it can help others. If any of you readers are working in this field, please comment and let me know if I have missed or misunderstood anything important about this issue!

My Gran is very healthy for a 92-year old, and moves around with ease and a straight back. But three years ago, she had heart surgery. For a long time before the surgery, she had spells of fainting in public, something she remembers vividly. Once, she fell off the stairs of the bus and onto the sidewalk. (Thankfully with no serious injury, which she attributes to her habit of doing Chi Gong every morning, but that’s another story.) Despite this, she had been reluctant to start using walking aids, since she didn’t actually have any walking difficulties and didn’t want to seem more infirm than she was. (I haven’t found any research on this, but by experience I would think this is a common attitude. If you know of any research, please let us know!)

After surgery, she was at first weak-kneed and still afraid of losing her balance, but was encouraged by doctors to engage in regular physical activity. Feeling that she owed them to do her best, since they had chanced a heart surgery on an 89-year old, she accepted the walker-rollator*, the most common walking aid in Sweden, for using on walks (in addition to engaging in other, scheduled exercise activities). She has never regretted that decision, and is very fond of her walking aid, and the freedom and safety it gives her.


Gran and her rollator now go for long walks every day. She has learned to walk with a straight back also with the rollator – placing both hands on the handles, which are adjusted to her height. She even gets compliments from strangers on how beautifully straight-backed she walks with the rollator. She is no longer afraid of falling, and has a high confidence in her own walking fitness and independence. She insists on her daily walks, feeling that if she fails them, her health will suffer.

Gran’s rollator, as most Swedish rollators, has four wheels, hand brakes, a basket at the front lower end and a little “bench” to sit on.

On the little basket she can carry home the groceries – or bring an extra jacket for herself or for a grandchild. When she gets tired, she finds a spot off to the side, applies the brakes and sits on the bench for a while. Thus, she also decreases the risk of falling from fatigue. At home, she walks with one of her best friends, at least one hour per day, and when they get tired, they sit down on their rollators and talk over a cup of coffee – which they bring in a thermos in the rollator’s basket. During vacation, she walks alone or with children, grandchildren and great-grandchildren. For Gran, the rollator is her enabler of these walks, and she praises the benefits of the rollator and encourages others in her situation to start using one.

A walking aid is often seen as a sign of age or infirmity. But a study shows that for people over 75, walking with a rollator can be considered moderate to high intensity physical activity, enough to improve aerobic fitness. Thus, I see the walker-rollator as a sign of an active – and safe – senior.


* I was unsure what the correct term in English is, but after a quick scan of the Internet I think a walker-rollator is the best term for the four-wheel walker.

All photos are taken by me, and published with permission of family members who are in the photos.

More background on our blogging team

19 Jun, 15 | by Bridie Scott-Parker

Blog 3: So today I wanted to share some more background on our blogging team. As an applied social psychologist, I find this information very interesting indeed!

What excites you about being part of the Injury Prevention social media editorial team?  

Sheree Bekker: The invaluable conversation that has sprung up around scholarly work through the collaborative power of social media and blogs inspires me to no end. I tend to find more relevant scholarly content through Twitter than through traditional platforms, and Injury Prevention has played a big part in that. As researchers, I believe that we should own our voice on social media, and constructively add value to this conversation.

David Bui: Through my studies in medical school I have seen the costs of injuries to society and individuals worldwide.  This is a great opportunity to harness the underutilised power of Social Media in health promotion and Injury Prevention, across multiple disciplines and multiple borders.

Angy El-Khatib: Being a part of the Injury Prevention social media editorial team is a great opportunity personally and collectively. By being a part of the social media editorial team, I am able to stay up to date on various topics within the realm of Injury Prevention while acquiring different perspectives from individuals from different backgrounds, disciplines, and locations. I’m also excited to be able to potentially increase readership and engage readers to create a conversation around the latest Injury Prevention research and ideas.

Klara Johansson: I am very interested to explore ways to share and disseminate knowledge and research results, outside the “old-school”, regular channels. I look forward to learning from my new co-editors, who all seem to be great communicators.

Joseph Magoola: The opportunity to work and collaborate with a variety of scholars on the injury prevention platform is nothing short of exciting. It also excites and inspires me to have an opportunity to represent Africa since low and medium income countries bear the brunt of the injury burden.

Julian Santaella-Tenorio: It is really exciting to be part of this team and to have a space to communicate and express ideas on ways to improve injury prevention, and to discuss about new studies and topics relevant to this field. I am very motivated to learn more and continue growing as a researcher as I walk through this experience.

What are you passionate about?

Sheree Bekker: Intersectional issues drive my life’s work, and my aim is that my research is, and always will be, an extension of that.

David Bui: Passionate about bringing people and ideas together.

Angy El-Khatib: I am passionate about translating scientific evidence and research into public health action. My goal is to improve the health and wellbeing of myself as well as my community. Outside of my work, I am passionate about health, fitness, and wellness.

Klara Johansson: Open discussions and innovative research in collaborative teams with high scientific ambition + high levels of tolerance and kindness; I also enjoy making difficult subjects understandable to students and the general population. Passions on my free time: nature, gardening, books, movies, writing fiction, playing music (clarinet, harmonium, piano, accordion).

Joseph Magoola: Writing on my social media accounts (facebook, twitter and my blog) as a way of reaching out to the masses. I am also interested travelling a lot, especially by road and as such, ensuring road safety is part and parcel of my aims to contribute towards reducing the carnage of our roads.

Julian Santaella-Tenorio: I am passionate about things that can make people have a better, healthier and happier life. I am inspired by ideas challenging previous knowledge, creative thinking finding answers from different angles, and the power of multidisciplinary groups. That is why I am passionate about public health research.


I hope you are looking forward to hearing from our bloggers, starting next month!

More background on our new blogging team

18 Jun, 15 | by Bridie Scott-Parker

Today I will share more about our blogging team members.

Blog 2: Explain your injury prevention research and interests.

Sheree Bekker: My research investigates safety promotion and injury prevention policy and practice within community sport in Australia. I have a particular interest in dissemination and social marketing. The overall purpose of my research is to allow people to be safe, as well as feel safe, whilst participating in sport or physical activity.

David Bui: Undertaking a number of different projects currently; my injury prevention research focuses on Hip fracture and Falls Prevention research, working with Neuroscience Research Australia. I am also looking into Social Media and its utility in healthcare and civilian settings, and I believe that it represents a powerful new medium in health promotion and injury prevention.

Angy El-Khatib: I am interested in integrating public health approaches with athletic training practice. Athletic training has traditionally focused on the individual but may be able to maximize the effectiveness of prevention efforts by using population-level approaches to improve health and wellness.

Klara Johansson: I am not currently doing research on injury/safety. But I am interested in social difference in injury risk – and also how perceived risk of injuries affects people’s daily lives, mobility, fears and physical activity; and how perceived and real injury risks interrelate with each other and with gender and socioeconomics. Main focus on adolescent safety; real and perceived. Also interested in open data and availability/accessibility of injury statistics globally.

Joseph Magoola: My research interests center around prevention of injury, especially through generation of data for evidence-based decision making and policy action. I am also interested in the use of media to disseminate research findings and for advocacy.

Julian Santaella-Tenorio: At the moment I conduct research on policy evaluation, specifically on policies that impact injury-related outcomes. I am interested in looking at substance use policies and firearm-related legislation and their effects on the health of populations.

Tomorrow: Learn about their passions!

Quebecers horrified by seniors fire deaths

9 Feb, 14 | by Barry Pless

At least 24 seniors in a private nursing home at L’Isle-Verte in eastern Quebec died when fire engulfed the mostly wooden residence. Many believe the deaths were preventable if several obvious measures had been taken. Most important (and most contentious) is the absence of a sprinkler system even though the provincial code requires them – but makes bizarre exceptions depending on the mobility of the residents. Another factor was the construction of wood. Ironically, a part of the building that was added recently and used different materials was not burned. Finally, the staffing at night when the fire occurred was reduced. For me the most baffling argument is one put forward by a fire prevention officer who claimed that smoke detectors were more important than sprinklers because people die of smoke inhalation, not of burns. True; but somehow the fact that sprinklers extinguish fires before they get to the smoking stage seems to have escaped this expert. She goes to suggest that  there is no “magic solution” to fires like that at L’Isle-Verte. I see this as an invitation to inaction. The solution is  not magic; it is basic science, solid technology, and injury prevention of the highest order. In case she somehow forgot, smoke comes from fire. She acknowledges that sprinklers prevent a fire from spreading, and then argues that what is needed is more smoke detectors not sprinklers! This is an astonishing observation, especially coming from someone with her responsibilities. Her remarks would certainly lend support to those who oppose establishing sprinkler systems in all homes, and especially in facilities serving the elderly and infirm. She implies we cannot insist on requiring both. It is like saying that for car safety you cannot have both brakes and mirrors; you must choose one or the other. Just because the cost of smoke detectors is much less than that of a sprinkler system is no reason not to require both. It is nonsense to say ‘smoke detectors are more important in saving lives’ and thereby imply that sprinklers are not needed. Her bizarre views should not be used as an excuse for avoiding the installation of these systems; they have proven to be highly effective and could save many many lives.

Choking: Super scary when you are the victim

26 Nov, 13 | by Bridie Scott-Parker

Today I am writing more of a sharing-scary-experience blog, and some of my findings after a quick stickybeak on the internet.

Last night with my evening meal, I had corn as one of my 2-and-5 (for those outside Australia, a public health promotion encourages each Australian to eat two serves of fruit and five serves of vegetables each day as part of a balanced diet). Little did I know that my favourite vegetable was indeed a silent assassin!

As part of the dinner conversation, a particularly funny anecdote meant that I suddenly, and quite involuntarily, burst into laughter. I had virtually completed swallowing a mouthful of corn at the time, and the sudden whooping of air which occurred as part of my laughter meant that corn was sucked into my airway before it could safely traverse my oesophagus and enter my stomach. I could actually feel a corn kernel rattling about in my trachea as I struggled to propel it upwards using what little air I had left in my lungs (not a lot!).

Needless to say I am still here, so the extrication was successful. However my doting husband spent the 10 minutes or so it took me to get my breathing back under control, minus the killer corn, trying to convince me to administer Ventolin as I am an asthmatic. Given the logistics of aerosol reliever medication, and my inability to speak clearly during this time, there was much gesticulating and furrowed brow! My husband had no idea I was actually choking, despite said gesticulations, and this certainly did nothing to relieve my anxiety after the choking incident had been resolved. Thankfully I did not have an asthma attack, which I have found in my case ironically sometimes can be brought upon by a coughing attack.

So today I did a quick search of PubMed and found many articles regarding choking, even one reporting on the experiences of someone choking on a live fish! Hmmm, my killer corn seems quite tame in comparison. I also did a quick search for some general statistics regarding choking, and was alarmed to find that every five days one child in the US dies from choking (read more at Finding statistics regarding adult choking was more difficult, and I wonder just how many have a near-miss such as myself.

From now on we shall try to reduce the hilarity of our dinner conversation!

Oh, and when their breathing returns to normal, hug the poor person who had been choking – they are going to need it because it is a scary experience!

The oft-forgotten ally: Patients and injury prevention

17 Oct, 13 | by Bridie Scott-Parker

Unfortunately I have had the recent pleasure of injuring myself – not through any heroic activity such as lifting a crashed car off a small child, but, good grief, simply through removing an article of clothing – and to prevent a similar injury I had been counselled by those in the know that surgery was my only option. As a well-educated, articulate, and hopefully-well-presented ‘middle-aged’ lady I was appalled at the level of patronisation and discourtesy that I received during a pre-surgery consultation with said surgeon. In fact I felt so dissatisfied with my experience that I am seeking the services of another whom I expect will be more professional and remember that indeed not only am I person and as such I deserve to be treated with respect and to retain at least some modicum of dignity, but that I also play a key role in preventing further injury to the afflicted site post-surgery.

Still reeling from the unsavoury experience, I was delighted to see a paper in a recent search of PubMed which actually gives the patient a voice, instead of, perplexingly, trying to take them out of the equation as much as possible! Latimer, Chaboyer and Gillespie present their research regarding hospital in-patient participation in preventing pressure-related injuries framed within a nurse-led patient-centred care model.

The researchers conducted a content analysis of the transcribed semi-structured interviews with 20 in-patients requiring assistance to ambulate/reposition in two metropolitan hospitals. For those interested in the research findings, three categories were identified:

1. experiencing pressure injury (including emotions, pain and odour)

2. participating in pressure injury prevention (including being involved in care decisions and self-determination)

3. resourcing pressure injury prevention and treatment (including cost, access, and prolonging healing)

I particularly loved the following sentences:

A. a sentence from the Discussion: “Participant’s interaction with clinicians, and nurses in particular, affected their emotional response to their pressure injury experience.” The importance of this sentence cannot be understated, especially as I am still reeling from my own relatively benign interaction.

B. the closing sentence of the Abstract: “If patient participation as a pressure injury prevention strategy is to be considered, nurses and organisations need to view patients as partners.” In an environment of increasing workload and competition for resources, not to mention my recent unsatisfactory experience, I would argue that “If” should be replaced with “As”.


Preventing injury by attending to the injured

7 Oct, 13 | by Bridie Scott-Parker

I came across a paper summarising the efforts of an osteoporotic fracture liaison service over the period of one year (July 2008-June 2009) which I thought may be of interest to readers of the Injury Prevention blog.

Now at first glance this may seem more like injury treatment, rather than injury prevention, however as Vaile, Sullivan, Connor, and Bleasel note,  “patients sustaining a first fracture are known to be at higher risk of sustaining future fracture“. Therefore, in addition to the noteworthy costs not only in terms of healthcare but also morbidity and mortality, treatment of at-risk patients (i.e., those have already sustained a fracture) has considerable implications for injury prevention efforts, particularly as many societies experience an ageing population.

From 768 eligible patients (aged over 50 with low trauma fracture) attending a major Australian metropolitan hospital and associated small local hospital, 570 patients attended the fracture clinic. Of these, 263 patients were deemed to not require additional treatment and fracture clinic was offered to 180 patients with a 90% participation rate. Treatment included vitamin D and calcium supplementation, bisphosphonate therapy, and for a small proportion strontium ranelate.

Of course, intervention efforts are not without difficulties, and pleasingly the Authors discuss at length some of the problems they experienced, including

* changes in coding patient histories, requiring review of every emergency department daily discharge diagnosis (approximately 1000 discharges per week) which was very time-consuming and therefore contributed to errors of inclusion and exclusion when identifying eligible patients;

* tracking eligible patients who did not attend the fracture clinic was very time-consuming;

* staffing issues including absence and time constraints which was further compounded by substantially increased staff workload; and

* no funding for ongoing secretarial or information technology support, meaning nursing staff undertake clerical support.

Notwithstanding these difficulties, the fracture liaison service enabled access to osteoporotic assessment to most low trauma fracture patients who were at risk of further fracture.





Injury Prevention and Alzheimer’s Disease

30 Jul, 13 | by Bridie Scott-Parker

A fascinating article in the August edition of Prevention Science has me looking at Alzheimer’s Disease in a whole different way. Rather than me seeing it as an outcome, a disease which today afflicts tens of millions of people around the world, I now see it as a brain injury which to some extent can be prevented. Hence I thought this article might be of interest to other injury prevention researchers: sometimes looking at a problem from a different angle can highlight research directions and solutions that otherwise may have remained hidden.

Anstey, Cherbuin and Herath considered Alzheimer’s Disease from a different perspective: rather than focussing on diagnoses, they focused on risk factors with the goal of developing prevention strategies that can be incorporated into populations across the globe. This is the approach they took:

1. They conducted a systematic search of the literature to identify both risk and protective factors in Alzheimer’s Disease, considering the effect sizes in the extant literature in particular. Four protective factors (fish intake, social engagement, cognitive activity, physical activity) and 11 risk factors (age, sex, education, body mass index, diabetes, depression, serum cholesterol, traumatic brain injury, smoking, alcohol intake, pesticide exposure) were gleaned from a possible 35 factors identified in the search.

2. They developed an algorithm to combine the odds ratios into a risk score for developing Alzheimer’s Disease, allowing for interactions amongst the risk and protective factors over the life course.

3. They developed a self-report questionnaire to assess the risk and protective factors.

This approach means that the findings are more generalisable than the findings from the traditional single-cohort cross-sectional study. Generalisability in particular is a research dimension that is often problematic, and it is a research dimension that can hamper the identification of effective avenues of intervention. Given the ageing population in societies such as Australia, identifying such interventions and thereby preventing Alzheimer’s Disease has never been more critical.



Latest from Injury Prevention

Latest from Injury Prevention