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. DESIGN: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES: Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS: 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION: There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

British public policy and multinationals during the “Dollar Gap” era, 1945–1960

This article examines the role of British exchange and import controls in stimulating the dramatic increase in overseas (particularly American) multinationals in Britain from the end of the Second World War to the late 1950s, together with the ways in which the government used controls to regulate the foreign direct investment (FDI) inflow. Exchange controls were both an important stimulus to inward investment and a powerful and flexible means of regulating its volume and character. Government was relatively successful in using these powers to maximize the dollar balance and industrial benefits of FDI to Britain, given initially severe dollar and capacity constraints, and in liberalizing policy once these constraints receded and competition from other FDI hosts intensified.

Public policy and foreign-based enterprises in Britain prior to the Second World War

This article examines the early evolution of British policy, prior to the Second World War. The British government adopted an ‘open’ policy towards foreign direct investment (FDI), despite periodic fears that some foreign acquisitions of UK firms in key sectors might be detrimental to the national interest, and a few ad hoc attempts to deal with particular instances of this kind. During the 1930s, when the inflow of foreign firms accelerated following Britain's adoption of general tariff protection, the government developed a sophisticated admissions policy, based on an assessment of the likely net benefit of each applicant to the British economy. Its limited regulatory powers were used to maximize the potential of immigrant firms for technology transfer, enhanced competition, industrial diversification, and employment creation (particularly in the depressed regions), while protecting British industries suffering from excess capacity.

Offensive advertising, public policy, and the law: the rulings on the Zagorka case

This paper examines the case of a controversial beer advertisement which was promulgated in Bulgaria in 2001, and which provoked eight lawsuits against the brewery, its advertising agency, and the Bulgarian National Television. The case set a precedent in Bulgaria and generated considerable public interest and debate. To the best of the authors’ knowledge this is the first case in Eastern Europe when individuals have challenged companies in the courts of law because of offence caused by an advertisement. The present study discusses how the public bodies responsible for protecting consumer interests and the courts of first instance assessed the advertisement in the context of Bulgarian public policy regarding offensive advertising.

The use of public participation and economic appraisal for public involvement in large-scale hydropower projects: Case study of the Nam Theun 2 Hydropower Project

Gaining public acceptance is one of the main issues with large-scale low-carbon projects such as hydropower development. It has been recommended by the World Commission on Dams that to gain public acceptance, publicinvolvement is necessary in the decision-making process (WCD, 2000). As financially-significant actors in the planning and implementation of large-scale hydropowerprojects in developing country contexts, the paper examines the ways in which publicinvolvement may be influenced by international financial institutions. Using the casestudy of the NamTheun2HydropowerProject in Laos, the paper analyses how publicinvolvement facilitated by the Asian Development Bank had a bearing on procedural and distributional justice. The paper analyses the extent of publicparticipation and the assessment of full social and environmental costs of the project in the Cost-Benefit Analysis conducted during the projectappraisal stage. It is argued that while efforts were made to involve the public, there were several factors that influenced procedural and distributional justice: the late contribution of the Asian Development Bank in the projectappraisal stage; and the issue of non-market values and discount rate to calculate the full social and environmental costs.

Public values and community energy: lessons from the US and UK

This paper examines some of the normative aspects of community energy programmes — defined here as decentralized forms of energy production and distributed energy technologies where production decisions are made as close as possible to sources of consumption. Such projects might also display a degree of separation from the formal political process. The development of a community energy system often generates a great deal of debate about both the degree of public support for such programmes and the values around which programmes ought to be organized. Community energy programmes also raise important issues regarding the energy choice problem, including questions of process, that is, by whom a project is developed and the influence of both community and exogenous actors, as well as certain outcome issues regarding the spatial and social distribution of energy. The case studies, drawn from community energy programmes in both the United States and the United Kingdom, allow for a careful examination of all of these factors, considering in particular the complex interplay and juxtaposition between the ideas of 'public value' and 'public values'.

Probiotics and prebiotics: prospects for public health and nutritional recommendations

Probiotics and prebiotics are useful interventions for improving human health through direct or indirect effects on the colonizing microbiota. However, translation of these research findings into nutritional recommendations and public health policy endorsements has not been achieved in a manner consistent with the strength of the evidence. More progress has been made with clinical recommendations. Conclusions include that beneficial cultures, including probiotics and live cultures in fermented foods, can contribute towards the health of the general population; prebiotics, in part due to their function as a special type of soluble fiber, can contribute to the health of the general population; and a number of challenges must be addressed in order to fully realize probiotic and prebiotic benefits, including the need for greater awareness of the accumulated evidence on probiotics and prebiotics among policy makers, strategies to cope with regulatory roadblocks to research, and high-quality human trials that address outstanding research questions in the field.