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Biomedical subjects

L M Day

Publications and source records attributed to L M Day.

At least 19 recordsLinked to original sources
PubMed2001

Evaluation of the Latrobe Valley Better Health Injury Prevention Program.

OBJECTIVE: To evaluate the Latrobe Valley Better Health Injury Prevention Program, a regional community based intervention in south east Victoria, Australia. METHOD: The evaluation design was quasiexperimental including pre-intervention and post-intervention observations in a predominately town dwelling population of approximately 76,000. There was no comparison community. Process measures included key informant interviews. Impact evaluation utilised self reported changes in injury risk and protective factors, gathered by a random household telephone survey. Outcome evaluation was based on five years of emergency department injury surveillance data for the Latrobe Valley. RESULTS: The program built strategic partnerships, increasing the emphasis on local safety. Activities were implemented in the targeted areas of home, sport, and playground injuries. Some 47,000 educational contacts were made with the community and at least 6,000 resource items distributed. There were significant increases in home safety knowledge. Some changes in the areas of playground and sport safety were achieved after partnership development with relevant agencies. Poisson regression models showed significant decreases in the presentation rate for all home injury and for the more severe home injuries. CONCLUSION: This study clearly demonstrates the difficulty of conducting robust evaluation in the absence of readily available and reliable data and adequate budgets. The Latrobe Valley Better Health Program activities contributed to structural, environmental, and organisational changes that have the potential to reduce injury. The extent of this contribution beyond that made by the statewide injury prevention strategy is not able to be determined.

Accident Prevention↗
PubMed2000

An impact evaluation of a falls prevention program among older people.

The aim of this evaluation study was to assess the impact of peer-presented education sessions on the falls-related attitude, knowledge and behaviour of older people. The evaluation was undertaken on the Bellarine Peninsula in Victoria, Australia, and adopted a non-randomised pre-test post-test design. Baseline, 3 and 12 months follow-up data were collected for 107 individuals who attended the education sessions and 116 controls, matched by age range and sex. The groups were not strictly equivalent at baseline, with the intervention group having a greater knowledge about falls and falls prevention. Analyses which controlled for baseline differences showed that those who attended the education sessions maintained a greater knowledge of factors that can prevent falls at 12 months follow-up. The intervention group also made more changes in and around their home to prevent falls by 3 and 12 months follow-up. Younger participants who reported a previous history of falls and having taken action to prevent falls were most likely to take additional action. The results can help target this type of education program and suggest that their major benefit may lie in providing those who voluntarily attend with the impetus to take the most effective preventative action.

Accidental Falls↗
PubMed1999

Unintentional poisoning hospitalisations among young children in Victoria.

OBJECTIVES: To describe the epidemiology of unintentional childhood poisoning hospitalisation in Victoria, Australia, in order to monitor trends and identify areas for research and prevention. METHODS: For children under 5 years, all Victorian public hospital admissions, July 1987 to June 1995, due to unintentional poisoning by drugs, medicines, and other substances were analysed. Similar cases were also extracted from the database of the Royal Children's Hospital intensive care unit, Melbourne for the years 1979-91. Log linear regression modelling was used for trend analyses. RESULTS: The annual average childhood unintentional poisoning rate was 210.7 per 100,000. Annual rates for males consistently exceeded those for females. The most common agents were those acting on the respiratory system and on smooth and skeletal muscles (muscle relaxants, cough and cold medicines, antiasthmatics), aromatic analgesics (paracetamol), and systemic agents (including antihistamines). Further investigation is justified for cardiac agents, some respiratory agents, and asthma medications. CONCLUSIONS: Childhood poisoning hospitalisation rates have not decreased in Victoria over recent years. A focused, agent specific approach, as well as a series of generic measures for the prevention of poisoning to children under 5 is advocated. The ongoing surveillance, collection and analysis of data, in addition to research on specific poisoning agents are essential components of any prevention strategy.

Child, Preschool↗
PubMed1998

Rediscovering method II as a reimbursement option.

Recent discussions within the renal community confirm the following: we are in an evolving health care environment that obliges us to review reimbursement opportunities that promote patient care, contain costs, and maximize revenues. This article will look at a sometimes overlooked option--Method II reimbursement for home dialysis patients--as a way for dialysis facilities to work within the established rules to both benefit patients and the overall dialysis program.

Contract Services↗
PubMed1997

Eucalyptus oil poisoning among young children: mechanisms of access and the potential for prevention.

We studied unintentional paediatric eucalyptus oil poisoning to identify potential intervention strategies. The epidemiology of paediatric eucalyptus oil poisoning in Victoria was determined by analysis of four databases. The sequence of events preceding ingestion was examined by a telephone survey involving 109 parents or guardians of children under five years involved in an actual or suspected ingestion of eucalyptus oil. Such children were identified prospectively from all callers during a nine-month period to the Victorian Poisons Information Centre and those presenting to the emergency departments of the participating hospitals of the Victorian Injury Surveillance System. Eucalyptus oil was a leading agent associated with hospitalisation for poisoning among Victorian children aged under five years. In the telephone survey, 90 incidents were found to involve vaporiser solutions, 15 eucalyptus oil preparations, and the remainder other eucalyptus-oil-containing products of a medicinal nature. Regardless of the type of product, 74 per cent gained access via a home vaporiser unit, most frequently placed at ground level. Although amounts ingested are usually small, the reported range of toxic doses is wide, necessitating at least a medical assessment following ingestion. Potential countermeasures identified in a consultative workshop included: discontinuing the use of eucalyptus oil as a therapeutic agent; confirmation that vaporiser-well residues are nontoxic; removal of barriers to product reregistration following safety-related modifications; improved child-resistant closures; discouraging vaporiser use for respiratory infections among young children; and development and dissemination of protocols for treatment of suspected ingestion.

Child, Preschool↗
PubMed1996

Injury mortality in adults 25-64 years of age: implications for prevention.

The aim of this retrospective study was to identify major categories of death from injury in the age range 25 to 64 years and their potential for prevention. We analysed the Victorian Coroner's database of deaths from injury for the three years from 1989-90 to 1991-92. The major causes of death were suicide (39.9 per cent) and transport-related injury (30.2 per cent). Males accounted for 75.4 per cent of injury deaths. The highest mortality rate was in the youngest age group, 25 to 29 years. Deaths from injury in the study age range accounted for slightly more than half of all deaths from injury in Victoria, although this age group had a lower mortality rate than other age groups. Specific issues for prevention programs include reduction of access to carbon monoxide car emissions and prevention of transport-related injury to motor vehicle occupants. Data reliability issues identified in this study have implications for refinements of the Victorian Coroner's database and hence for the National Coronial Information System currently under development.

Adult↗
PubMed1996

Rodenticide poisoning among children.

We aimed to determine the nature, extent and sequence of events of accidental childhood poisoning with rodenticides and identify potential intervention strategies. Subjects were identified prospectively from callers to the Victorian Poisons Information Centre and those presenting to the Emergency Departments of hospitals participating in the Victorian Injury Surveillance System from 1 April to 31 December 1993. The events preceding rodenticide ingestion were examined via telephone questionnaire involving 128 parents or guardians of children under five years exposed to rodenticides. Rodenticides are not leading agents for severe poisoning but are a frequent and increasing cause of less severe poisoning. Most children (90 per cent) had obtained the rodenticide from the site at which it had been laid, usually by the caregiver (67 per cent), in the kitchen, lounge room or laundry, inside cupboards or-wardrobes. In 69 per cent of these cases, respondents thought the site would not normally allow access to children. Only 13 per cent of children were admitted to hospital, although 41 per cent sought medical attention. Most caregivers (90 per cent) were aware of some dangers associated with rodenticides. Children usually ingest insufficient amounts of rodenticide to cause serious effects. However, medical assessment and monitoring of prothrombin times is often indicated, with a consequent cost to the healthcare system. Potential countermeasures, focusing on packaging and positioning of rodenticide baits, product reformulation, and the distribution of management guidelines for health workers, were identified. Implementation of the identified countermeasures was initiated by a workshop involving stakeholders from industry, research and health professions.

Accident Prevention↗
PubMed1996

What are the options for nephrologists under capitation?

Nephrologists will play a pivotal role in changing tomorrow's renal delivery system. Nephrologists still control patients and drive the health care delivered to patients suffering from ESRD. As a result, practice management companies, independent consulting firms, renal societies, hospitals, dialysis providers, insurance companies, managed care plans, government agencies, and, yes, even independent practice groups are exploring business strategies that will unite nephrologists under a common goal--that of an integrated renal delivery network. Nephrologists face what is probably their professional career's most important business decision: Partner with such organizations as hospitals, dialysis providers, or practice management companies, or form an independent nephrologist owned IPA and contract with an MSO. As nephrologists evaluate the options, they should seek partners that will at a minimum provide the following: a business plan that spells out the relationships of all the players; practice evaluations that can improved efficiencies; skilled day-to-day practice management; model legal documents; human resource management; expert, pro-physician reimbursement negotiation, coupled with a system to track contract profitability; case management, critical paths, practice guidelines; and renal industry expertise. Above all, nephrologists should seek partners in the formation of an integrated delivery system that offer an attitude dedicated to physician empowerment in the interest of good patient care.

Capitation Fee↗
PubMed1995

Injury morbidity in Victoria among adults 25 to 64 years of age: implications for prevention.

The aim of this retrospective study was to complete the baseline descriptive epidemiology of hospital-treated injury for all ages in Victoria, by focusing on the age group, 25 to 64 years, to identify major categories of injury and the potential for prevention. We analysed injury databases for hospital admissions and emergency department presentations for major variables influencing injury frequency and rates. We found that nearly 40 per cent (158 537) of all hospitalisations for injury occurred in the study age range. The major causes of injury were health-care related causes (32 per cent), falls (15 per cent), transport (14 per cent), and intentional causes (10 per cent). The leading reason for emergency department presentation (excluding admission) was unintentional cutting or piercing injury. The home was the major location of injury. Vehicles, man-made and natural surfaces, knives, and floors and flooring materials were among the leading five factors potentially associated with both admissions and presentations. Injury prevention in this age range will be largely addressed by the injury-prevention strategy being implemented in Victoria. However, specific additional issues were identified, including falls from ladders and scaffolds, pedestrian and female passenger injury, and injury associated with power tools, chain saws, and knives.

Adult↗
PubMed1992

Tumor-associated karyotypic lesions coselected with in vitro macrophage differentiation.

Several cytogenetic lesions in chromosomes 2, 5, 12, and 16 have been repeatedly coselected with in vitro macrophage differentiation in a clonal murine thymic tumor cell line. Parental-type subclones, which show an extremely immature hemopoietic phenotype, do not carry the aberrations. The frequency of the stable differentiated variants is elevated by 5-azacytidine and bromodeoxyuridine, consistent with chromosome breakage being responsible for the phenotype. The frequency is also raised by dexamethasone. Since variants are 300-3,000-fold more resistant to dexamethasone than parental clones, we interpret this to be largely due to selection. Three of the lesions, on chromosome 2, match those previously described as associated specifically with in vivo-generated murine myeloid tumors, induced by X irradiation and corticosteroid treatment. Several implications follow from these observations. (1) In vitro differentiation in clonal tumor cell lines can be used to select for tumor-associated lesions. This should allow genetic and molecular analysis of the chromosome 2 lesions and of others that may pinpoint genes critical to macrophage differentiation and transformation. (2) Myeloid and lymphoid tumors that occur in response to X irradiation may diverge from a common initiating tumor. (3) The hemopoietic lineage switch phenomenon, previously described by several authors, may be caused by similar or identical chromosome aberrations.

Abelson murine leukemia virus↗