Use Of Protectors Research Articles

A Trail of Individual Education for Hearing Protection with an Instrument that Measures the Noise Attenuation Effect of Wearing Earplugs

The aim of this study was to investigate the effect of individual training of workers, using an instrument to quantitatively evaluate the noise attenuation gained with the use of earplugs, on the efforts to promote the use of hearing protection devices. The subjects were 68 male workers exposed to noise of above 80 dBA at an electronic parts manufacturer in Japan. They received group instruction on the prevention of noise-induced hearing loss, and individual education on the effect of the proper use of earplugs. The individual education was done with the use of an instrument that measures the noise attenuation effect of wearing earplugs. After the training, the prevalence of the regular use of hearing protectors increased. Among workers in loud working environments, it increased from 46% to 66% over two months after the training. The percentage of workers who obtained a sufficient noise attenuation effect of>or=25 dB in both ears with the proper use of earplugs also increased, from 46% before the training to 72% immediately afterward. These effects were still observed about two months after the intervention. The results suggest that the present individual training may be an effective means to increase both the usage rate and the proper use of hearing protection devices, perhaps because it deepens individuals' understanding of the effect of the proper use of such devices.

Educating nursing home staff on fracture prevention: a cluster randomised trial

to assess whether specialist osteoporosis nurses delivering training to care home staff can reduce fractures and improve the prescription of treatments to reduce fractures versus usual care. pragmatic cluster randomised controlled trial (RCT) with randomisation at the Primary Care Organisation (PCO) level. care homes (residential, nursing and EMI) across England and Wales within PCOs. all 300 PCOs in England and Wales were invited to take part. Of these, 58 agreed to participate and gained ethical approval in time to start the study: 29 clusters were randomised to the intervention group and 29 to the control. specialist osteoporosis nurses undertaking short training sessions with care home staff emphase the importance of fracture and fall prevention and train staff on how to identify those residents at high risk of fracture. Residents' risk of fracture and falls was reported to general practitioners (GPs) of patients along with treatment recommendations. primary outcome measures were total fractures over the past 12 months and total hip fractures over past the 12 months. Secondary outcome measures were total home falls, number of residents sustaining a fall, number of residents prescribed bisphosphonates, number of residents prescribed calcium and vitamin D and number of residents wearing hip protectors. All outcomes were measured at the care home level. of the 230 care homes randomised data were collected from 209 of these containing 5,637 residents. There were no differences between the groups in the incidence rate ratios (IRRs) for total fractures (IRR = 0.94 [0.71, 1.26] P = 0.70) or total hip fractures (IRR = 0.86 [0.63, 1.18] P = 0.36). No differences were found between groups for home falls or hip protector use. A significant increase in bisphosphonate prescription was seen in the intervention group over the control group (IRR = 1.50 [1.00, 2.24] P = 0.05). Calcium and vitamin D prescription was significantly increased in the intervention group over the control group (IRR = 1.64 [1.23, 2.18] P<0.01). the intervention significantly increased the prescription of bisphosphonates and calcium/vitamin D, but was not associated with a significant effect on the rate of falls or fractures.

Is the audiologic status of professional musicians a reflection of the noise exposure in classical orchestral music?

The sound in classical orchestral music is louder than noise emissions allowed by national rules in industry. We wanted to assess the audiologic status of professional musicians at different ages of their careers and to look for a coherence of declined hearing ability and the sound emissions in order to substantiate advices for hearing protection and occupational medicine in musicians. Data from questionnaires (anamnestic data on sound exposure in profession and leisure times, use of hearing protection, self-evaluation of hearing function and hearing deficits), audiometric data and amplitudes of OAE were evaluated from 109 professional musicians aged 30-69 years from three major German orchestras and from 110 students of an academy of music (aged 11-19 years). Sound emissions of the whole orchestra and of single instruments/instrument groups were measured at the orchestra stages and pits during rehearsals and performances. None of the musicians was engaged in noisy hobbies and only a few used hearing protectors regularly. More than 50% of the musicians had a hearing loss of 15 dB(A) and more. Highest losses were found among the strings and the brass players. DPOAE amplitudes coincidently declined with the duration of performing music in the orchestras. Professional musicians aged older than 60 years had a significantly greater hearing loss at 4 and 6 kHz than those aged 30-39 years. Among the strings in one orchestra a dominant hearing deficit in the left ears was observed. Musicians need the same health care for their hearing as workers in noisy industry. A better education on the hearing hazards (use of hearing protectors) as well as sound protection in the rehearsal rooms is necessary. Hearing loss in professional musicians should be accepted as an occupational disease.

Randomized Trial to Improve Fracture Prevention in Nursing Home Residents

Background Interventions to improve the fracture prevention in nursing homes are needed. Methods Cluster-randomized, single-blind, controlled trial of a multi-modal quality improvement intervention. Nursing homes (n = 67) with ≥10 residents with a diagnosis of osteoporosis or recent hip fracture (n = 606) were randomized to receive an early or delayed intervention consisting of audit and feedback, educational modules, teleconferences, and academic detailing. Medical record abstraction and the Minimum Data Set were used to measure the prescription of osteoporosis therapies before and after the intervention period. Analysis was at the facility-level and Generalized Estimating Equation modeling was used to account for clustering. Results No significant improvements were observed in any of the quality indicators. The use of osteoporosis pharmacotherapy or hip protectors improved by 8.0% in the intervention group and 0.6% in the control group, but the difference was not statistically significant ( P = .72). Participation in the intervention activities was low, but completion of the educational module (odds ratio [OR] 4.8, 95% confidence interval [CI], 1.9-12.0) and direct physician contact by an academic detailer (OR 4.5, 95% CI, 1.1-18.2) were significantly associated with prescription of osteoporosis pharmacotherapy or hip protectors in multivariable models. Conclusions Audit-feedback and education interventions were ineffective in improving fracture prevention in the nursing home setting, although results may have been tempered by low participation in the intervention activities.

Efficacy of a Hip Protector to Prevent Hip Fracture in Nursing Home Residents

Past studies of the efficacy of hip protectors to prevent hip fracture in nursing home residents have had conflicting results, possibly due to potential biases from clustered randomization designs and modest adherence to intervention. To determine whether an energy-absorbing and energy-dispersing hip protector would reduce the risk of hip fracture when worn by nursing home residents. Multicenter, randomized controlled clinical trial in which 37 nursing homes were randomly assigned to having residents wear a 1-sided hip protector on the left or right hip. Participants were 1042 nursing home residents (mean [SD] aged 85 [7] years; 79% women) who consented and adhered to the hip protector use during a 2-week run-in period and were enrolled. Participating facilities were in greater Boston, Massachusetts, St Louis, Missouri, and Baltimore, Maryland from October 2002 to October 2004. Mean duration of participation for nursing home residents was 7.8 months. None were withdrawn because of adverse effects. Undergarments with a 1-sided hip protector made of a 0.32-cm outer layer of polyethylene (2.7 kg/m3) backed by a hard high-density polyethylene shield (0.95 cm) that was backed by 0.9 kg/m3 of 1.27-kg ethylene vinyl acetate foam. Each facility was visited 3 times per week to assess adherence and provide staff support. Adjudicated hip fracture occurrences on padded vs unpadded hips. After a 20-month follow-up (676 person-years of observation), the study was terminated due to a lack of efficacy. The incidence rate of hip fracture on protected vs unprotected hips did not differ (3.1%; 95% confidence interval [CI], 1.8%-4.4% vs 2.5%; 95% CI, 1.3%-3.7%; P = .70). For the 334 nursing home residents with greater than 80% adherence to hip protector use, the incidence rate of hip fracture on protected vs unprotected hips did not differ (5.3%; 95% CI, 2.6%-8.8% vs 3.5%; 95% CI, 1.3%-5.7%; P = .42). Overall adherence was 73.8%. In this clinical trial of an energy-absorbing/shunting hip protector conducted in US nursing homes, we were unable to detect a protective effect on the risk of hip fracture, despite good adherence to protocol. These results add to the increasing body of evidence that hip protectors, as currently designed, are not effective for preventing hip fracture among nursing home residents. clinicaltrials.gov Identifier: NCT00058864.

Uptake and adherence with soft- and hard-shelled hip protectors in Norwegian nursing homes: a cluster randomised trial

A comparison between soft- and hard-shelled hip protectors in nursing homes shows no clinical relevant difference in acceptance and probability of continued use. However, significantly more users of the soft hip protector used the protector 24 hours a day. Uptake and adherence with the use of hip protectors are poor due to discomfort and impracticality. The aim of the study was to compare uptake and adherence between soft- and hard-shelled hip protectors. We hypothesized a higher uptake and adherence with soft hip protectors than with hard ones. This cluster randomized study was performed for 18 months in 18 Norwegian nursing homes. Each nursing home was randomly allocated either soft or hard hip protectors. A total of 1,236 participants were enrolled in the study of which 314 and 290 started to use soft and hard hip protectors, respectively. The uptake among participants in nursing homes provided soft hip protectors was not significantly different from the uptake in nursing homes provided hard protectors. The probability of continued use was a little higher among users of soft hip protector. There were significantly more 24-hour users among those people using the soft protector. Our results indicate that changing the design might not solve the compliance issue, but may be a step in the right direction, especially for those people who are in need of 24-hour use.

Exposure to Refractory Ceramic Fibres in the Metal Industry

Refractory ceramic fibres (RCF) are used in thermal isolation in the metal industry where high temperatures are regularly employed. Asbestos materials were earlier commonly used for these purposes. In this work, two Finnish steel plants, three foundries and a repair shop were studied for the ceramic fibre exposure of their workers under normal production and during the replacement of oven insulation. Personal and stationary sampling was used together with a novel nasal lavage sampling for the evaluation of personal exposure. Fibres were counted with optical and electron microscopy and they were identified using an energy-dispersive X-ray analyser. Ceramic fibres were found in most production phases [range <0.01-0.29 fibres per cubic centimetre (f cm(-3))]. Considerably higher fibre counts were obtained during the maintenance work (range <0.01-14.2 f cm(-3)). Nasal sampling was found to correlate with the airborne fibre concentrations at the group level. The mean fibre concentrations varied from 34 to 6680 f ml(-1) of lavage liquid. Use of personal respiratory protectors diminished the exposure on the average as analysed in the lavage specimens, but the effect of respirator use did not appear clearly in the results. Because of the heat conditions, the workers used the respirators for a strict minimum period. A considerable exposure to RCF occurs in the studied plants. Its risk should be evaluated and managed more closely in view that the material is carcinogenic. Use of personal respiratory protectors should be encouraged. Their effective use could be verified by the nasal sampling for fibres after the work shift.

Evaluación del impacto asistencial de una vía clínica de trasplante renal

Aim To reassess the impact of a clinical pathway for kidney transplantation in a university hospital after a 4-year period. Material and method We performed an experimental “before and after” study with a retrospective control group. The experimental group was composed of patients who underwent kidney transplantation after the starting date of implementation of the clinical pathway (1999) at the Hospital La Paz (Madrid, Spain). The control group included a selection of patients who underwent the same procedure before 1999. Results There were 32 patients in the control group and 121 in the experimental group. The length of stay before discharge was reduced from 20 days in the control group to 14 days in the experimental group. The surgical site infection rate decreased from 12.5% to 1.7%. No differences were found in the development of other surgical complications or undesired events after discharge. The reduction observed in antibiotic use was non-significant, whilst a significant reduction was found in the use of gastric protectors. Moreover, the time elapsed from kidney transplantation to withdrawal of the vesical and central catheters diminished in both groups (from 12 to 8 days). Conclusions The clinical pathway has proved to be an effective and efficient tool to reduce the length of hospital stay and the development of undesired events, thus improving health care quality.

Severe spinal injuries in alpine skiing and snowboarding: a 6-year review of a tertiary trauma centre for the Bernese Alps ski resorts, Switzerland

Objective:To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe spinal injuries related to alpine skiing and snowboarding.Study design:A six-year review of all adult patients with severe...

The Use of Hip Protectors in Long-Term Care Facilities: A Survey of Nursing Home Staff

To determine the level of exposure to hip protectors and barriers to their use in nursing homes. We conducted a written survey of 160 staff (including administrators) in 5 nursing homes in the Hamilton-Wentworth region, Ontario, Canada. The results of primary analyses were expressed as percentage of respondents. Among respondents of respective institutions, the rate of prior exposure to hip protectors varied from 40.9% to 100.0% and the rate of prior experience applying these devices varied from 14.3% to 80.0%. The most frequently cited main barriers to the use of hip protectors in long-term care facilities included physicians not thinking to prescribe them, expense, lack of evidence of benefit in this population, wearer discomfort, and wearer removal. A lack of staff time to apply these devices was rarely cited. The majority of staff believed that nursing home residents with a prior history of fracture, those who fall frequently, or those who are unsteady on their feet should wear hip protectors. The exposure of surveyed nursing home staff to hip protectors was variable but most agreed that residents who are at increased risk of hip fracture should wear them. Some identified barriers to the use of hip protectors in long-term care facilities were physicians not thinking to prescribe them, expense, lack of evidence of benefit in this population, wearer discomfort, and wearer removal. Such barriers need to be addressed for hip protector implementation strategies to be successful in nursing homes.

Maximum Potential Preventive Effect of Hip Protectors

To estimate the maximum potential preventive effect of hip protectors in older persons living in the community or homes for the elderly. Observational cohort study. Emergency departments in the Netherlands. Hip fracture patients aged 70 and older who visited the emergency departments of five hospitals in the Netherlands (n=520). Using the risk score of the Dutch Guidelines for Osteoporosis, how many patients had a high risk for fractures was retrospectively assessed. In addition, the circumstances of the hip fracture were assessed (n=299). Four factors were specified that might influence the maximum potential preventive effect of hip protectors: (1) hip fracture occurred in persons having a low risk, (2) hip fracture was not the consequence of a fall, (3) hip fracture occurred during circumstances that preclude the use of hip protectors, and (4) hip fracture occurred during the night. When providing hip protectors to women at high risk of fractures, 48.2% of all hip fractures could have been prevented. Many hip fractures occur in persons with a low risk for hip fracture or under circumstances that preclude the use of hip protectors. It was estimated that the maximum potential preventive effect of hip protectors is approximately 50% in older women living in the community or homes for the elderly. The actual preventive effect will be lower and depends on the acceptance and effectiveness of hip protectors and adherence to wearing them.

Can Hip Protector Use in the Nursing Home Be Predicted?

OBJECTIVES: To identify resident‐ and caregiver‐related factors that influence hip protector (HP) usage.DESIGN: Prospective observational cohort study over 6 weeks.SETTING: A 409‐bed nursing home located in New York City.PARTICIPANTS: Fifty‐two residents and 60 certified nursing assistants (CNAs).INTERVENTION: Free HPs were provided to residents enrolled in the study.MEASUREMENTS: HP adherence (number of hours HPs were worn/shift); HP users (subjects who used HPs for more than 1 hour during any 8‐hour shift as recorded by CNAs in week 6 or who used HPs at checks performed by research staff in week 6 and intended future use); CNAs' scores on a questionnaire quantifying osteoporosis knowledge, opinions on HPs, job satisfaction, and health locus of control.RESULTS: Sixty‐eight percent of residents were HP users. Factors independently associated with this outcome included male sex, age, Parkinson's disease, family involvement, impaired cognition, dependent ambulation, and CNAs' sense that chance affects health outcomes. In multivariate models, anxiety, resistive behaviors, ambulation, and fall history in residents and CNAs' perceptions of HPs and their sense of how chance or other staff determine health outcomes predicted HP adherence.CONCLUSION: Resident‐related factors and CNAs' sense of external controls predicted HP users and HP adherence. CNAs' understanding of osteoporosis and HP affected only HP adherence. Most resident‐related factors were not remediable but might help to target likely HP users. To improve HP adherence, educational programs should be designed to improve CNAs' understanding of osteoporosis and HP. Larger studies are needed to confirm these findings.

Hearing threshold shift measured by otoacoustic emissions after shooting noise exposure in soldiers using hearing protectors

The aim of the study was to assess the influence of short-term impulse noise to temporary threshold shift in soldiers using hearing protectors. The study included 80 subjects with correct tympanic membrane and thresholds measured by pure-tone audiometry less than 20 dB. There were two groups: 40 soldiers protected during shooting and 40 young males who didn't shoot. TEOAE were performed by ILO 292 Echoport Otodynamics device 3 to 5 minutes before shooting and 2 minutes and 1, 2, and 3 hours after shooting. Short-term exposure to impulse noise generated by five gunshots from the rifle kbk AKMS hasn't induced temporary threshold shift of hearing for chosen frequencies in soldiers using hearing protectors. Spectral analysis for chosen frequencies revealed that measurement reproducibility, stimuli level, and probe stability appeared to be comparable and repeatable. Our results show that the use of hearing protectors safeguarded against impulse noise. The use of earmuffs is strongly recommended because they seem to sufficiently attenuate shooting noise.

Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses

Objectives To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment....

Do hip protectors decrease the risk of hip fracture in elderly?

Efforts aimed at preventing hip fractures include lifestyle advice for high-risk elderly, interventions to reduce the risk of falls and medication for osteoporosis. Alternative approach is the use of hip protectors. Hip protectors have pads designed to cover the greater trochanter and attenuate or disperse the force of a fall sufficiently to prevent a hip fracture. There are 14 randomized controlled trials (RCTs) included in the Cochrane systematic review until 2005. All RCTs were classified into three groups by the type of randomization; cluster randomized in institutions, individually randomized in institutions and individually randomized in community. There is little evidence to support the use of hip protectors outside the nursing home setting. Further research is required, primarily to produce a device that provide higher compliance, and which will then need to be tested in another RCT.

Further exploring hip protector use

Objective: To explore hip protector adherence in high‐risk older people. Methods: In‐depth interviews were conducted with 14 older people (and/or their carers) discharged from hospital with hip protectors. Four outpatients were recruited to supplement numbers. Thematic analysis was carried out on the interview data. Results: Hip protector use largely paralleled daily dressing routines, this contributed to periods of disuse and partial adherence. Another factor in abandoning hip protector use was a fatalistic view of an end of life stage, where injury prevention was not actively sought. Committed carers who demonstrated understanding and support were vital in encouraging ongoing use. Conclusion: Daily routines of a lifetime, reluctance to change, and a readiness to endure the potential risk of hip fracture discouraged use of hip protectors. Family and carer support was vital for continuation. These findings can assist with strategies to improve adherence.

Can Hip Protector Use Cost‐Effectively Prevent Fractures in Community‐Dwelling Geriatric Populations?

To estimate the cost-effectiveness from a societal perspective of a hip protector (HP) program over the remaining lifetime of individuals initially living at home. A state-transition Markov model considering outcomes of HP use in cohorts stratified by age, sex, and functional and residential status. Costs, transition probabilities, HP adherence, and efficacy were derived from published sources. Community and nursing homes in the United States. Hypothetical cohort of individuals aged 65 and older without a hip fracture and initially living at home. HP program. Fractures, life years, and dollars saved, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER). HP use prevented fractures and increased life expectancy in all cohorts. HP use saved costs and improved QALYs in women initiating HP use at age 80 and in men at age 85. In women initiating HP use at age 75, the HP ICER was 19,000 dollars/QALY. In men initiating HP use at age 80, HP use saved costs but slightly decreased QALYs. In younger cohorts, HP use was neither cost saving nor QALY improving. In sensitivity analyses, if there was no QALY loss from wearing a HP, the ICER was less than 50,000 dollars/QALY for all age and sex cohorts. If HP cost was reduced 50%, HP use was cost saving for women initiating HP use at age 75. In probabilistic sensitivity analyses, the HP ICER was less than 50,000 dollars/QALY in 68% of simulations for women initiating HP use at age 75 and 61% of simulations for men initiating at age 85. HP use saved costs and QALYs for older age cohorts of both sexes. Additional research on the quality-of-life effects and obstacles to wearing HP is warranted.

Traitements non médicamenteux de l'ostéoporose

Objectives Study the effectiveness of nonpharmacological treatments for osteoporosis. Method Review and qualitative analysis of the literature concerning the effectiveness of nonpharmacological treatments: physical exercise, rehabilitation aiming to prevent falls, spinal orthosis, and vertebro- and kyphoplasty. Results The level of evidence of the effectiveness of nonpharmacological treatment is unequal on the basis of randomized study. The practice of physical exercise by the ambulatory elderly people and home rehabilitation for those who have previously fallen prevent the occurrence of falls. For institutionalized people, the prevention of falls is achieved by multidisciplinary programs. The use of hip protectors to prevent fracture is controversial. Physical exercises prevent bone loss after menopause and during postmenopausaul and corticosteroid osteoporosis. The effectiveness of mobilization after fracture is not documented. Only one study concerning the use of spinal orthosis after vertebral fracture reports interesting results for pain and disability. No randomized study concerning vertebroplasty or kyphoplasty for osteoporotic vertebral fracture is described. Conclusion The nonpharmacological treatments of osteoporosis are considered therapeutic means of key importance. They aim at the prevention of falls and bone loss and the reduction of disability after fracture. Only physical exercise and rehabilitation have been shown to be effective in preventing falls or bone loss. Their ability to reduce the incidence of fractures remains to be evaluated.

Hip protector use amongst older hospital inpatients: compliance and functional consequences

Hip protector use amongst older hospital inpatients: compliance and functional consequences

Noise exposure and hearing loss prevention programmes after 20 years of regulations in the United States

Objectives: To evaluate noise exposures and hearing loss prevention efforts in industries with relatively high rates of workers’ compensation claims for hearing loss. Methods: Washington State workers’ compensation records were...