Impact of social standing on injury prevention in a World Health Organization Safe Community--intervention outcome by household employment contract

BACKGROUND: Although social inequality in health has been an argument for community-based injury prevention programmes, intervention outcomes with regard to differences in social standing have not been analysed. The objective of this study was to investigate rates of injuries treated in health-care among members of households at different levels of labour market integration before and after the implementation of a WHO Safe Community programme. METHODS: A quasi-experimental design was used with pre- and post-implementation data collection covering the total populations <65 years of age during one year in the programme implementation municipality (population 41 000) and in a control municipality (population 26 000). Changes in injury rates were studied using prospective registration of all acute care episodes with regard to social standing in both areas during the study periods. RESULTS: Male members of households categorized as not vocationally active displayed the highest pre-intervention injury rates. Also after the intervention, males in households classified as not vocationally active displayed notably elevated injury rates in both the control and study areas. Households in the study area in which the significant member was employed showed a post-intervention decrease in injury rate among both men (P < 0.001) and women (P < 0.01). No statistically significant change was observed in households in which the significant member was self-employed or not vocationally active. In the control area, only an aggregate-level decrease (P < 0.05) among members of households in which the significant member was employed was observed. CONCLUSIONS: The study displayed areas for improvement in the civic network-based WHO Safe Community model. Even though members of non-vocationally active households, in particular men, were at higher pre-intervention injury risk, they were not affected by the interventions. This fact has to be addressed when planning future community-based injury prevention programmes.     

Impact of an alcohol misuse intervention for health care workers --2: Employee assistance programme utilization,on-the-job injuries,job loss and health services utilization

AIMS: We evaluated the effects of an enhanced substance misuse (SM) prevention/early intervention programme on referrals to an employee assistance programme, health care utilization rates, on-the-job injury rates and job termination rates among health care professionals employed in a managed care organization. METHODS: The intervention was implemented at one site, with the remaining sites serving as the comparison group. Existing data from hospital databases were used to compare events occurring in the periods before and after initiation of the intervention. To account for baseline differences in age, gender and job class, logistic regression models produced adjusted means for events per employee month-at-risk. RESULTS: We found that employee assistance referrals and non-SM-related in-patient hospitalizations increased significantly post-intervention, while rates of total out-patient SM-related visits decreased at both the intervention and comparison sites post-intervention. There was a small, statistically significant decrease in the monthly rate (OR = 0.92) of non-SM out-patient utilization at the intervention site, once the intervention was in place. No differences potentially attributable to the intervention were detected in job turnover or injury rates. CONCLUSIONS: We conclude that, while the intervention did not appear to affect health care utilization for SM-related problems, it was associated with increased referrals for employee assistance.     

江西省O～17岁儿童交通伤害研究

目的 探讨江西省0～17岁儿童交通伤害发生情况、发生机制及其相应的疾病负担.方法 利用PPS抽样在江西省的住户中抽取约10万户进行入户调查,对样本户中的儿童进行交通伤害问卷调查.结果 江西省0～17岁儿童交通伤害死亡率为10.17/10万,病死率为1.36%;非致死性交通伤害发生率为7.40‰,其中男童发生率为8.29‰,女童为6.26‰;重度交通伤害发生率为1.79‰,其中城市儿童发生率为0.93‰,农村儿童为1.88‰,城乡重度伤害发生率之间差异有统计学意义.交通伤害发生时伤者主要是行人和骑自行车者,占总伤者的80.48%;平均每例交通伤害者的医疗费用为1369.57元,平均住院天数为3.63,平均休工(学)天数为8.79.结论 江西省农村地区的交通重度伤害发生率高于城市地区;男童的伤害发生率、死亡率均高于女童;交通伤害的疾病负担较重.     

Control of endemic dracunculiasis in Ebonyi state, south-eastern Nigeria

A field study was carried out in Ozibo and the Ebonyi local government area of Ebonyi state, south-eastern Nigeria to determine the effectiveness of several intervention strategies in the control of endemic dracunculiasis in that area. During the initial study prior to the application of such measures, 14,421 subjects were examined. A total of 8,688 (60.2%) persons had either Dracunculus ulcers or emergent worms. Sex-related prevalence rates were 56.1% and 63.9% for males and females respectively. Age specific prevalence rates increased with age in males, whereas highest infection rates were found in females younger than 20 years. Twenty-eight months after the introduction of intervention strategies the prevalence rate fell by 85.1% to 9% (males: by 88.2% to 6.6%, females: by 83.0% to 10.8%). Reduction rates of more than 90% were observed in males aged 10 to 19 and in females aged 0 to 9 years. Intervention measures included systematic pond treatment, distribution or replacement of filters, intensive health education, provision of hand-dug wells, regular bore-hole installation/rehabilitation as well as active case detection, containment, management, and prompt reporting. Active involvement of the endemic communities, governments and the Global 2000 staff regarding the control efforts is a necessity towards the final eradication of the disease in the near future. The relationship between some of these intervention strategies and community development are highlighted.     

School health education and gender: an interactive effect?

Post-primary school students (n = 2407) and young adults (n = 477) participated in a cross-sectional evaluation of a health education programme for schools. The Lifeskills programme is based on a philosophy of student empowerment, and aims to teach knowledge and skills relevant to health promoting behaviour. School students were recruited in schools, while young adults were opportunistically recruited in workplaces, training centres and on public transport. Those who attended schools where Lifeskills had been taught and who remembered such lessons were conservatively classified as the intervention group, while those who attended other schools and did not remember such lessons were classified as the comparison group. Participants completed questionnaires designed to collect data on health-related behaviours, indicators, knowledge and psychological health. School-level factors were employed as covariates in subsequent analyses of covariance. Amongst younger pupils, females reported more positive health behaviours but lower levels of psychological well-being and more symptoms. The impact of the programme became evident at ages 13-15. Those involved drank less and reported more positive adjustment to school. However, sex differences remained, with females reporting more health-promoting behaviour and more symptoms, and lagging behind males in self-esteem and general well-being. An interaction between gender and the intervention was identified among senior pupils. Exposure was especially beneficial for females. However, as young adults, the two main effects of gender and programme participation re-emerged as the most important independent variables, and the interaction between them was not significant. This pattern has implications for the interpretation of evaluations conducted on short-term interventions as well as for short-term impact evaluations.     

Unintentional injuries over a 1-year period in a rural Vietnamese community: describing an iceberg

OBJECTIVES: To document unintentional injuries in a rural community over a 1-year period as a basis for prioritizing preventive activities. STUDY DESIGN: Quarterly home visits over 1 year to elicit experience of injury among household members in the preceding 3 months. METHODS: In total, 24,776 people living in rural communities in the Bavi District, Northern Vietnam, were surveyed in home visits during 2000. In the home visits, injuries that needed care or disrupted normal activities were recorded, together with their circumstances. RESULTS: Overall, 2079 new non-fatal injuries were recorded over 23,338 person-years, a rate of 89/1000 person-years-at-risk. Males had a significantly higher injury rate than females for all age groups except for those aged 35-59 years and the elderly (P<0.05). The elderly were at highest risk of injury (P<0.05), particularly females. Home injuries occurred at the highest overall rate, particularly among the elderly. Road traffic injuries were most common among children. Most injuries involved contact with another object. Less than one-quarter of injury victims sought care at a health facility. CONCLUSIONS: Community-based household surveys revealed the hidden part of the injury iceberg, as well as showing high incidence rates, indicating that injury is an important public health problem which should be a priority for intervention in rural Vietnam, and probably elsewhere. This comprehensive study is intended to contribute evidence and methods to the Ministry of Health's national programme for injury prevention, and to a wider audience.     

Risk factors for back injury in 31,076 retail merchandise store workers.

Risk factors for work-associated strain or sprain back injuries were investigated in a cohort of 31,076 material handlers from 260 retail merchandise stores in the United States. The workers studied were those with significant material-handling responsibilities--daily lifting and movement of merchandise. Workers in jobs with the greatest physical work requirements had an injury rate of 3.64 per 100 person-years versus 1.82 in workers with lesser work requirements. The unadjusted injury rate for males was 3.67 per 100 person-years compared with 2.34 per 100 person-years for females, but the excess for males was confounded by higher physical work requirements for men in the stocker/receiver job category. The injury rate ratio for short versus long duration of employment was 3.53 (95% confidence interval: 2.90, 4.30); for medium versus long duration of employment, it was 1.38 (95% confidence interval: 1.18, 1.62). The elevated rate ratios were maintained when the data were stratified by subsets with different rates of turnover. The results suggest that workers with the greatest physical work requirements and those with the shortest duration of employment are at the highest risk of back injuries. However, selection forces causing worker turnover within this cohort of active workers are not well characterized and have the potential to bias the measures for time-related factors such as duration of employment.     

The Finnmark Intervention Study: do community-based intervention programmes threaten self-rated health and well-being? Experiences from Båtsfjord, a fishing village in North Norway

AIM: Examine negative side-effects on self-rated health and well-being of a community-based intervention in a fishing community in the Norwegian Arctic. METHOD: A cohort study with quasi-experimental design with one intervention community and three control communities from the same area. There was a baseline screening (1987), three years intervention (1988-1991) and a rescreening (1993). Of the invited (aged 20-62 years in 1987), 668 (64%) males and 656 (72%) females met at both screenings. The main outcome variables were self-rated health, mental health variables, and preoccupation with health. Those answering the relevant questions at both screenings were analysed. High-risk and low-risk males were analysed separately. There were too few females in the high-risk group to do separate analyses. RESULTS: The main findings among the low-risk group were: Males in Batsfjord did not differ from males in the control communities. Among females, there was a reduction in the proportion depressed of 20.4% points in Batsfjord and 9.6% in the control communities (p adjusted=0.060). There was also a decrease in the proportion lonely of 19.2% points and 5.8% respectively (p adjusted=0.005). In the male high-risk group there was a decrease in the proportion lonely by 14.7% points in Batsfjord and an increase by 5.9% in the control communities (p adjusted=0.004). CONCLUSION: We have not found that an intervention programme using local empowerment, mass strategies, and intervention on high-risk cases has serious negative side effects on self-rated health, well-being or preoccupation with health.     

Sugary drink consumption behaviours among young adults at university

Aim: Sugary drink consumption is associated with weight gain, and young adults are the highest consumers. To inform a university healthy beverage intervention, we studied the settings and the types and amounts of sugary drinks consumed by a sample drawn from the student population. Methods: Fifty university students (24 male) were recruited to keep records of all beverages consumed over four consecutive days. The records were analysed by gender, drink category and consumption setting. Results: Males drank marginally more sugary drinks than females (median daily intake of 526 mL compared with 300 mL, P = 0.06). Median energy intake from sugary drinks was 928 kJ for males and 481 kJ for females. Carbonated soft drinks and fruit‐based drinks accounted for 64% of energy from sugary drinks for males; and fruit and sweetened milk‐based drinks accounted for 68% of energy for females. Half of all sugary drink consumption occurred at home followed by social settings. Conclusion: Health promotion programmes aiming to reduce sugary drink consumption in this group would benefit from gender‐differentiated strategies with respect to types of drinks consumed with a focus on the home and social settings.     

A multifactorial fall prevention programme in the community-dwelling aged: predictors of adherence

BACKGROUND: Overall adherence rates have usually been reported in fall prevention studies, but predictors of adherence have rarely been described. The aim of this study was to determine the adherence rates and the predictors of adherence in four key activities of a multifactorial fall prevention trial. METHODS: This study is part of a multifactorial fall prevention programme implemented among the 65-year-old or older community-dwelling aged who had fallen at least once during the previous 12 months. Subjects (n = 591) were randomly assigned to an intensive prevention programme or to a counselling group. Four key activities of prevention programme included physical exercise in small groups, psychosocial group activities, lectures and home exercises. Associations between adherence rates and potential predictors were analysed using cumulative logistic regression. RESULTS: The mean adherence rate was 58% in the physical exercise groups, 25% in the psychosocial groups and 33% in lectures. Subjects performed home-exercises on average 11 times per month. In multivariate analyses, infrequent feelings of loneliness, low self-perceived probability of falling at home and good physical functional abilities were significant predictors of active physical exercise group adherence. Good physical and cognitive functional abilities predicted active psychosocial group adherence. Female gender and good physical and cognitive functional abilities predicted more active lecture adherence. CONCLUSION: Persons with the poorest physical, cognitive and psychological functional abilities representing the part of the population at highest risk of falling do not seem reachable in multifactorial risk-based intervention.     

Body size and physical activity levels of adults on Rarotonga,the Cook Islands

Few studies of physical activity and energy expenditure have been carried out in the Pacific Region. In this study, the physical activity levels (PALs) of adult Cook Islanders living a largely modernised lifestyle by age group and occupation category were determined by a 3 day activity recall diary method. The period of observation included the previous Sunday, as a representative non-working day. A volunteer sample of 332 Cook Islanders aged 22 to 86 years was obtained from the total adult population of Rarotonga. Older adults are significantly less active than younger adults during the working week, but not during the weekend. Males are more physically active than females during the working week, but not on weekends. The mean weekday PAL of males engaged in traditional subsistence or who are unemployed is 1.88, while the mean weekday PAL of females engaged in traditional subsistence or who are housewives is 1.69. Male manual workers have a weekday PAL of 1.96, while female manual workers have a weekday PAL of 1.67. The weekday PAL values for those employed in clerical and administrative work are 1.82 (males) and 1.64 (females), while values for professionals are 1.76 (males) and 1.65 (females). Weekday physical activity is negatively associated with age, in nonlinear fashion. The PALs of adult Cook Islanders living a largely modernised lifestyle is lower in older age groups but does not vary by occupation category.     

Body size and physical activity levels of adults on Rarotonga, the Cook Islands

Few studies of physical activity and energy expenditure have been carried out in the Pacific Region. In this study, the physical activity levels (PALs) of adult Cook Islanders living a largely modernised lifestyle by age group and occupation category were determined by a 3 day activity recall diary method. The period of observation included the previous Sunday, as a representative non-working day. A volunteer sample of 332 Cook Islanders aged 22 to 86 years was obtained from the total adult population of Rarotonga. Older adults are significantly less active than younger adults during the working week, but not during the weekend. Males are more physically active than females during the working week, but not on weekends. The mean weekday PAL of males engaged in traditional subsistence or who are unemployed is 1.88, while the mean weekday PAL of females engaged in traditional subsistence or who are housewives is 1.69. Male manual workers have a weekday PAL of 1.96, while female manual workers have a weekday PAL of 1.67. The weekday PAL values for those employed in clerical and administrative work are 1.82 (males) and 1.64 (females), while values for professionals are 1.76 (males) and 1.65 (females). Weekday physical activity is negatively associated with age, in nonlinear fashion. The PALs of adult Cook Islanders living a largely modernised lifestyle is lower in older age groups but does not vary by occupation category.     

Systematic home screening for Chlamydia trachomatis infections of asymptomatic men and women in family practice by means of mail-in urine samples]

OBJECTIVE: To determine the prevalence and determinants of Chlamydia trachomatis (CT) infections among asymptomatic men and women in general practice. To determine participation rates in a systematic screening programme in general practice, using home obtained mailed urine samples. DESIGN: Cross-sectional study. METHODS: In 15 general practices in Amsterdam, the Netherlands, a sample of 11,005 persons (5541 women and 5464 men), aged 15-40 were invited to send in a urine sample and a completed questionnaire by mail. The urine samples were tested using the ligase chain reaction for DNA amplification. Patients diagnosed with CT were treated and partner notification was performed. RESULTS: 33% of invited males (1809/5464) and 50% of females (2751/5541) sent in the study material. Older patients participated more frequently than younger patients. Participation rates among persons with a Dutch background were higher than rates among persons from other ethnic groups. In 42 men and 79 women a CT infection was identified (2.3% and 2.9% respectively). Infections were more prevalent in patients from Surinam and the Dutch Antilles and in the age category 21-25 years. Type of health insurance as a proxy measure of socioeconomic status was not an indicator of infection. CONCLUSION: The participation in this systematic screening using mail-sent urine samples was 33% in men and 50% in women. The CT prevalences among asymptomatic men and women were 2.3% and 2.9% respectively.     

Physical activity and change in body mass index from adolescence to mid-adulthood in the 1958 British cohort

BACKGROUND: Prevention of obesity has focused on childhood as a target period. Our aim was to assess whether frequency of adolescent physical activity affected subsequent body mass index (BMI) gain through to mid-adulthood. METHODS: The British birth cohort of all births in 1 week in March 1958, includes information on physical activity frequency and BMI for several ages, 11-45 years. We examined relationships between activity in adolescence and trajectories of BMI between 16 years (or 23 years) and 45 years using multi-level models. Effects of change in activity on BMI and on change in BMI were tested using ANOVA. RESULTS: Physical activity at 11 years had no effect on the BMI trajectories, in males or females. More active females at 16 years gained BMI more slowly than others, by 0.007 kg/m2/year per activity category over the period 16-45 years, whereas the most active males gained BMI faster than others, by 0.005 kg/m2/year per activity category. This effect in males was not evident on the BMI trajectory from 23 to 45 years. Consistent with these analyses, change in activity was associated with change in BMI in females, e.g. females active at 16 and 42 years gained less BMI than inactive females (2.1 vs 2.5 kg/m2/10 years). Results for males were inconsistent over the time periods examined. CONCLUSIONS: Physical activity may lessen the gains in BMI from adolescence onwards, but relationships vary with age, and in later adolescence show opposite effects for males and females. Decreasing activity between adolescence and mid-adulthood in males, and inactivity in both life stages in females may increase BMI gain.     

Sex and ethnic differentials in physical activity levels of adolescents in kuantan

A cross-sectional study was conducted to determine the physical activity levels of 400 adolescents (13 years old) in Kuantan, Pahang using the Physical Activity Questionnaire for Older Children (PAQ-C). The associations of physical activity levels with sex, ethnicity and body mass index were also determined. About one third (35.3%) of the adolescents were in the low physical activity level category, 61.5% in the moderate physical activity level and only 3.0% of the adolescents were in the high physical activity level category. More males (77.9%) were physically active than females (54.9%). Twice as many female adolescents (45.1%) were in the low physical activity level category compared to the male adolescents (22.1%). The associations between physical activity with ethnicity and body mass index were not significant. However, there was a significant interaction effect of sex and ethnicity in mean physical activity score (F = 2.36, p<0.01). Malay males had a significantly higher mean physical activity score as compared to Chinese males (t=2.13; p<0.05). Although Chinese females had a higher mean physical activity score than Malay females, the difference was not statistically significant. Conversely, there was no interaction effect of sex and BMI status in mean physical activity score. This study suggests that physical activity intervention to promote regular physical activity is needed since a high proportion of the adolescents fall within the low physical activity level category.     

Eating,weight, and dieting disturbances in male and female lightweight and heavyweight rowers

Rowers compete in a sport that allows comparison of male and female athletes and where some (lightweight) but not others (heavyweights) must meet specific weight criteria. Eating attitudes, dieting patterns, weight fluctuation, and methods of weight loss were evaluated in 162 rowers: 82 heavyweights (56 females, 26 males) and 80 lightweights (17 females, 63 males). Females displayed more disturbed eating practices and weight control methods than did males. Lightweights did not have more disturbed eating practices than heavyweights, but employed more extreme weight loss methods. Male rowers were more affected by weight restriction than were female rowers. Lightweight males showed greater weight fluctuation during the season and gained more weight during the offseason than did lightweight females and heavyweight males and females. These results indicate that rowing can join the growing list of sports where eating and weight disturbances may be present. Male athletes may be more vulnerable to these problems than previously recognized. © 1993 by lohn Wiley & Sons, Inc.     

A quasi-experimental epidemiological model for evaluating public health programmes: efficacy of a Chagas disease control programme in Brazil.

Reported is the assessment of a model to evaluate the efficacy of public health programmes, using the example of the Chagas Disease Control Programme in the State of Minas Gerais, Brazil. The reduction in Trypanosoma cruzi infection rates in areas where interventions had been carried out for 5 years and 10 years, respectively, were compared with those where there had been no intervention (controls). A random sample of 470 households was selected and blood samples were collected from the 2354 inhabitants, 854 (36.3%) of whom were born after the start of the control programme. The data routinely collected by the control programme were also analysed to correlate the results with the incidence of T. cruzi infection. The programme efficacy was estimated by comparing the infection rates found in the study with those published by the Chagas Disease Serological Study (1975-80). Cross-sectional comparison of the data for the age group 2-6 years indicated that there had been a reduction in T. cruzi infection incidences of 94.7%, 63.2%, and 65%, respectively, in areas where interventions had been carried out for 10 years, 5 years, and in the control areas. Cohort comparison indicated, however, that the reduction (52.6%) occurred only in the intervention-10 area.     

Gender Differences in Dating Aggression Among Multiethnic High School Students

PURPOSE: (1) To assess prevalence of physical dating aggression and victimization among high school students; (2) to assess prevalence of mutual and exclusive aggression; (3) to determine whether aggression differs across ethnic groups and relationship type; and (4) to ascertain the likelihood of injury and breakup in individuals who reported that they were the recipients of physical aggression. METHODS: Students (N = 2363) from seven multiethnic high schools participated. Because males in high school date females younger than they and the reverse for females, and because males and females may underreport aggression, only within gender comparisons were conducted. RESULTS: More females reported engaging in physical aggression (40%) than reported being victims of aggression (30%). Fewer males reported engaging in physical aggression (24%) than reported being victims of physical aggression (31%). If physical aggression occurred, typically both partners were aggressive. For females, exclusive engagement in physical aggression (perpetration) was reported at higher rates than exclusively being the recipient of physical aggression (victimization) and vice versa for males. Dating aggression was less prevalent among male Asian students than other ethnic groups. Engaged males and females reported the highest rates of physical aggression. Injury was reported by over 25% of males and females who reported being the recipients of physical aggression. CONCLUSIONS: Dating aggression intervention programs should address physical aggression of both males and females. Because approximately 30% of the high school males and females reported being the recipients of physical aggression by their partners, primary prevention efforts should occur before high school.     

2012—2021年重庆市儿童青少年交通伤害死亡特征及变化趋势

目的 了解2012—2021年重庆市儿童青少年交通伤害死亡特征及变化趋势,为开展交通伤害干预提供建议。方法 2012—2021年重庆市儿童青少年交通伤害死亡(ICD-10:V01-V99)个案信息来自重庆市死因监测系统,采用SPSS 25.0统计分析死亡率、构成比,不同性别、地区死亡率比较采用χ²检验,死亡率的趋势分析采用年度变化百分比(annual percent of change, APC)表示。结果 重庆市儿童青少年交通伤害死亡率由2012年的6.80/10万下降至2021年的1.83/10万,APC为-14.62%,变化趋势差异有统计学意义(t=15.088,P<0.001)。2016年前男性交通伤害死亡率高于女性,2014年前农村地区交通伤害死亡率高于城市,差异均有统计学意义(P<0.05)。男性、女性、城市、农村儿童青少年交通伤害死亡率分别以年均14.96%、14.02%、10.60%、15.21%下降,变化趋势差异均有统计学意义(P<0.05)。0～4岁、5～9岁、10～14岁、15～17岁交通伤害死亡率分别以年均13.84%、1...     

Production of a fall prevention exercise programme considering suggestions from community-dwelling elderly

OBJECTIVES: A fall prevention exercise programme, which elderly persons could undertake in their home alone to maintain and improve leg muscle strength, body balance ability and flexibility, was developed. The programme consisted of number of movements from which the best were selected on the basis of participant evaluation. The purpose of this report is to document the actual contents and an examination of the effects of this exercise programme in elderly people. METHODS: A total of 551 elderly persons, aged 75 years and over, not needing the support of elderly care insurance in S town, Miyagi Japan, were the subjects of this study. An intervention area and a non-intervention area were set in the study region. In the intervention area, 85 elderly people of high-risk for falls were selected to perform a longitudinal intervention study for one year. The selection criteria were as follows: 1) Maximum walking speed slower than median value, 2) Falls had been experienced in the past year. Forty elderly persons (15 men and 25 women) participated in the class. Thirty movements designed to improve flexibility, leg muscle strength, and body balance, and to prevent tripping were executed and evaluated. Effects of this intervention on participants in the fall prevention class were examined using a follow-up survey one year after the baseline survey. The outcome of the fall prevention exercise programme was measured in terms of incidence of falls. RESULTS: A final fall prevention exercise programme consisting of ten movements was produced by the intervention. In addition, seven movements using a chair were part of the exercise programme. METS of the exercise programme for students, leaders, and elderly persons were 3.41 +/- 0.37, 3.16 +/- 0.47, and 3.08 +/- 0.4, respectively. The incidence of falls over one year of the participants in the class significantly decreased from 48.4% at baseline survey to 25.8% at follow-up survey, but that of non-participants did not change. One-leg standing times with eyes open of the female participants significantly extended from the baseline survey to the follow-up survey, but not that of non-participants. CONCLUSIONS: This result of intervention suggested that incidence of falls was decreased by the execution of the exercise programme in twelve sessions of fall prevention class and at home.