Manejo de Riesgo Mercado FOREX

In chapter 8-9 the Johns Hopkins Home Safety Project was evaluated to examine its effect on smoke alarm installations and hot water safety at the 6-month follow- up visit.

The Johns Hopkins Home Safety Project was a community intervention trial which evaluated the impact of an enhanced fire department home visiting programs on community participation and installation of 10-year lithium battery smoke alarms. Chapter 8 describes the rate of fire and burn hazards observed in homes. Communities were randomly assigned to receive either a standard or enhanced home visiting program. During a one-year intervention period, 171 fire department home visit events took place with 8,080 homes. Households in the enhanced area received pre-notification about an impending visit from the Baltimore City Fire Department to install smoke alarms. Fire department personnel visited homes in the standard community without pre-notification. At baseline, 60% of homes did not have working smoke alarms on every level of their homes; 44% had unsafe water temperatures; and 72% did not have carbon monoxide alarms. Residents in the enhanced community, relative to those in the standard community, were significantly more likely to let the fire fighters into their homes (75% vs 62%). Among entered homes, those in the enhanced community were significantly more likely to agree to have smoke alarms installed (95% vs

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92%), to be left with a working smoke alarm on every level of the home (84% vs 78%), and to have more smoke alarms installed per home visited (1.89 vs 1.74). Previously reported, smoke alarm distribution programs have used various combinations of community volunteers, paid staff, and fire personnel with mixed results [24-26] . Our study is most similar to the earlier work by Schwarz et al, [24] who hired community liaisons to engage community members at the block level in advance of having safety inspectors go door-to-door. Similar to Schwarz’s work, we too found that advance notice, provided by a recognized community representative, resulted in increased access to homes. We were surprised, however, that the advance notice did not result in more residents being home on the day of the event; how to address the 60% of residents who were not home remains a challenge. Prior smoke alarm distribution programs that have evaluated their impact on fire deaths have had mixed results, [25,26] Programs evaluating the impact of home visiting and installation of 10-year lithium battery alarms have demonstrated their benefit as compared to typical 9-volt alarms. [28] The Johns Hopkins Home Safety Project also provided an opportunity to test an intervention aimed at decreasing risks from scald burns by educating families about unsafe water temperatures during an enhanced home safety visit. (Chapter 9) We aimed to determine whether households who participated in an enhanced home safety visit demonstrated improved safety behaviors about hot water compared to homes receiving a standard home visit. Hot water temperature and self-reported prevention behaviors were recorded at a baseline visit and retested 6-9 months later in sub sample of homes who agreed to participate in the follow- up visit. At baseline families in the enhanced group received a tailored educational message aimed at having them retest and adjust the water heater gage when an unsafe water temperature had been observed. Families in the standard group were informed of their water temperature but were not provided with a tailored educational message. Residents whose hot water temperatures remained at an unsafe temperature were asked why they did not adjust the temperatures. Demographic data were also recorded. A total of 708 households participated in both the baseline and follow-up visits. No significant difference emerged between the two study groups in the proportion of households observed to have adjusted their hot water temperature to safe levels between the baseline and follow-up visits (t = 1.24; P = 0.22). Residents who received the enhanced education were more likely to report testing their water temperature (27% vs 11%; P < .01) and turning their hot water temperature below 49°C/120°F (43% vs 32%; P = .08). Among those who had unsafe temperature levels and did not reduce the water temperature, the most common reason (26%) offered was that they “liked it hot.” These results demonstrate that water temperatures are unsafe in many urban homes. The effect of educational interventions may be mitigated by personal preferences of hot water temperature. Our work supports the results of Babul et al which demonstrated that families receiving a home safety intervention

General Discussion

were two times more likely to adjust their hot water temperature to safe levels than families who did not receive a home safety intervention [29] .

This evaluation further supported our recommendation of the need for the thermostatic mixing valve as an engineering solution for the water heater. An intervention by Kendrick et al demonstrated that installing thermostatic mixing valve anti-scald devices at the tap have shown promise in protecting people from scalding water. [30] Kendrick et al has demonstrated a decrease in scald burns after utilizing this passive intervention [30] .This recommendation should be considered concurrently with the risk from legionnaires disease in water storage tanks. There were 6,100 cases of Legionnaires’ disease reported by US health departments in 2016 [31] . Legionnaires disease outbreaks are commonly associated with water systems in large buildings with complex water systems. [32] The work of Alary et al [32] examined residential water heaters in Quebec Canada and found no risk of legionella in gas and furnace powered water heaters and minimal risk in electric water heaters. In contrast the observations we have conducted demonstrates the risk of hot tap water scalds burns in 40% of homes in Baltimore . [18] The proposed engineering solution, a thermostatic mixing valve; allows water to be stored at higher temperature in the tanks before it is mixed with colder water upon leaving the tank prior to exiting faucets where residents would be exposed to it. The engineering solution decreases the risk of both legionella at hot tap water scald burn injuries and is already required in part of the plumbing code in Australia as well as in Ontario, Canada. [33,22]

The Johns Hopkins Home Safety project was effective at increasing smoke alarm coverage for both the standard and enhanced groups in the community interventional trial. The enhanced group had significantly better outcomes for allowing fire personnel into their homes and allowing alarms to be installed. The Johns Hopkins Home Safety Project was also successful at improving water testing and adjusting behavior in the enhanced group but was not successful at reducing unsafe water temperatures.

Question 4. Which strategies can be used to improve adoption of home safety