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Injury Prevention current issue



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Transitions and prospects

2017-11-23T03:24:03-08:00

This issue marks the end of my 10-year term as editor-in-chief of Injury Prevention. Rod McClure, the incoming editor, will assume his responsibilities with the next volume. I am extraordinarily pleased with his selection and look forward to seeing the evolution of the journal under his competent stewardship. As the transition approaches, I would like to offer a few thoughts and ideas from my time with the journal and the privileged position it has given me to observe our field and the many academics and practitioners who work therein.

I believe we have made progress over the last decade. It’s an exciting time to work in injury control. New opportunities and new issues arise daily. And while I don’t presume to know what is best for the field, there are some overarching themes that I think bear recognition.

We are getting better at gathering data for prevention. The Global Burden...




Healthy China 2030: a missed opportunity for injury control

2017-11-23T03:24:03-08:00

On 25 October 2016, the Central Committee of the Communist Party of China and the State Council of China released the Healthy China 2030 blueprint guide.1 For the first time, a long-term national health initiative includes injury control, as it specifies actions to improve occupational safety, road traffic safety and injury prevention. However, the blueprint misses a fundamental priority for injury control—no specific department or agency is assigned to lead and coordinate the efforts of the multiple departments and social partners working to prevent injuries in China.2 3

The absence of such a lead agency will seriously impede the development of injury control in China. Most prominently, a top-down professional team is not responsible for injury control, which can compromise nationwide implementation and the use of evidence-based, affordable and easy-to-implement interventions that are used in other nations. The lack of a centralised agency...




Redefining the child pedestrian safety paradigm: identifying high fatality concentrations in urban areas

2017-11-23T03:24:03-08:00

Objectives

Child pedestrians are some of the most vulnerable users of our transportation systems, and they deserve particular attention when we consider traffic safety. The objective of this work is to identify urban locations in which child pedestrians are at particular risk for fatal collisions with vehicles.

Methods

This paper examines 30 years of crash data for six American cities to locate areas with high child pedestrian fatality concentrations. Phase I of the study, which examines Denver, Colorado, USA, reveals higher concentrations of child pedestrian fatalities around parks as compared with other areas that children have been shown to frequent. In phase II of the study, we specifically examine fatality concentrations near parks as compared with schools.

Results

Statistical analyses suggest that, once exposure is controlled for, child pedestrian fatalities concentrate around parks in densities 1.04–2.23 times higher than around schools. Also, the concentration of child pedestrian fatalities around parks is 1.16–1.81 times higher than the respective citywide concentration.

Conclusion

Traffic risks for children around parks deserve further examination as we pursue the goals of Vision Zero and child safety on our streets.




Contributors to pedestrian distraction and risky behaviours during road crossings in Romania

2017-11-23T03:24:03-08:00

Objective

Pedestrian fatalities due to collisions with motor vehicles are a large public health problem in Romania, ranking them among the highest in Eastern Europe. The purpose of this study was to gain a better understanding of crash factors by examining how roadway and environmental characteristics contribute to pedestrian distraction and risky behaviours at pedestrian MVC (PMVC) locations in Cluj County, Romania.

Methods

A sample of PMVC locations was selected from the 2010 Cluj County police reported crash database for on-site examination. A total of 100 sites were visited to collect details on site characteristics and typical pedestrian and driver behaviours. Variable distributions were examined and rate ratios of pedestrian distraction and risky behaviours were calculated.

Results

Pedestrian distraction and risky behaviours were observed at rates of 6.3 and 24.3 per 100 observed pedestrians. The majority of distractions were related to electronic device use. Risky behaviours were evenly split between unpredictable, partial use of a crosswalk and midblock illegal crossings. Distractions and risky behaviours decreased as the number of pedestrians and average vehicle speeds at a site increased. RR of distraction was higher at intersections and locations with crosswalks.

Conclusions

Pedestrian distraction was highly correlated with pedestrian risky behaviours at PMVC locations in Romania. Higher pedestrian volume was protective against pedestrian distraction and risky behaviours. Locations with painted crosswalks had increased distraction. Targeted distraction prevention, particularly at intersections and crosswalk locations, may contribute to the prevention of PMVCs.




Association of sociodemographic and household characteristics with non-fatal burns among children under the age of 10 years in Sudan: an exploratory secondary analysis of the Sudan Household Health Survey 2010

2017-11-23T03:24:03-08:00

Background

Globally, children have the highest mortality rates from fire-related burns. Sudan is no exception, but there had been no prior investigations of potentially preventable risk factors. We undertook this analysis to investigate the role of various sociodemographic and household factors.

Methods

We used Sudan Household Health Survey 2010 data from a national stratified multistage cluster sample of 15 000 households. The dependent variable was whether the child had a non-fatal burn in the 12 months preceding the survey, based on the most recent injury. The independent variables tested were age, gender, urban/rural residence, wealth index, disability, mother's education and work, cooking fuel, cooking place, electricity in the house and crowdedness. A multivariable Poisson regression model with robust variance was used, and hypothesised interactions were tested.

Findings

Of 26 478 children under the age of 10 years, we identified 47 with injury caused by fire or hot substance. A significant association was found with child age (prevalence ratio (PR)=0.65, 95% CI 0.50 to 0.84). There was a significant interaction between area of residence and cooking place; cooking outdoors or elsewhere in the house was associated with burns in urban areas (PR=10.426, 95% CI 1.99 to 54.69) but not in rural areas. There was no evidence of an association with maternal factors or with cooking fuel.

Conclusions

The findings imply more potential for separate cooking facilities in preventing burns among children in Sudan than does a change in cooking fuel, although more evidence needs to be gathered, particularly around safety practices.




Firearm carrying and concurrent substance use behaviours in a community-based sample of emerging adults

2017-11-23T03:24:03-08:00

Introduction

This paper examines associations between high-risk gun carrying and substance use in emerging adults (ages 18–22). The coexistence of these high-risk behaviours in a general population of emerging adults can have disastrous consequences.

Methods

Dating it Safe is an ongoing longitudinal (2010–2016) survey of emerging adults recruited from seven high schools in five south-east Texas-area school districts (current sample n=684). Multiple logistic regression modelling was used to examine the association between past-year use of legal and illegal substances and past-year firearm carrying for a reason other than sport or hunting.

Results

6% of emerging adults carried firearms in the past year, with most (68%) carrying for protection. Use of cocaine, hallucinogens, methamphetamine, ecstasy and prescription medications in the past year, as well as episodic heavy drinking in the past month, was associated with increased risk of carrying a firearm (p<0.05 for all). After controlling for covariates, hallucinogens (OR 2.81, 95% CI 1.00 to 7.81), ecstasy (OR 3.66, 95% CI 1.32 to 10.14) and prescription medications (OR 2.85, 95% CI 1.22 to 6.68) remained associated with firearm carrying. Episodic heavy drinking was associated with firearm carrying, but only for those who had five or more episodes/month (OR 3.61, 95% CI 1.51 to 8.66).

Conclusions

In this community-based sample of emerging adults, firearm carrying, mostly for protection, was associated with a variety of past-year substance use behaviours. These findings extend previous research and suggest directions for further exploration of the clustering of high-risk behaviours in emerging adults.




Social environments, risk-taking and injury in farm adolescents

2017-11-23T03:24:03-08:00

Background

Farm environments are especially hazardous for young people. While much is known about acute physical causes of traumatic farm injury, little is known about social factors that may underlie their aetiology.

Objectives

In a nationally representative sample of young Canadians aged 11–15 years, we described and compared farm and non-farm adolescents in terms of the qualities of their social environments, engagement in overt multiple risk-taking as well as how such exposures relate aetiologically to their reported injury experiences.

Methods

Cross-sectional analysis of survey reports from the 2014 (Cycle 7) Canadian Health Behaviour in School-Aged Children study was conducted. Children (n=2567; 2534 weighted) who reported living or working on farms were matched within schools in a 1:1 ratio with children not living or working on farms. Scales examining quality of social environments and overt risk-taking were compared between the two groups, stratified by gender. We then related the occurrence of any serious injury to these social exposures in direct and interactive models.

Results

Farm and non-farm children reported social environments that were quite similar, with the exception of overt multiple risk-taking, which was demonstrably higher in farm children of both genders. Engagement in overt risk-taking, but not the other social environmental factors, was strongly and consistently associated with risks for serious injury in farm as well as non-farm children, particularly among males.

Conclusions

Study findings highlight the strength of associations between overt multiple risk-taking and injury among farm children. This appears to be a normative aspect of adolescent farm culture.




Association between maternal depression and anxiety episodes and rates of childhood injuries: a cohort study from England

2017-11-23T03:24:03-08:00

Background

Maternal depression is common and associated with several child health outcomes. The impact on childhood injuries is underexplored, with existing studies relying on maternal reporting of injury occurrences. Using population healthcare databases from England, we assessed the association between maternal depression and/or anxiety episodes and rates of child poisonings, fractures, burns and serious injuries.

Methods

We conducted a prospective cohort study of 207 048 mother-child pairs with linked primary care and hospitalisation data from the Clinical Practice Research Datalink and Hospital Episode Statistics, 1998–2013. Episodes of maternal depression and/or anxiety were identified using diagnoses, prescriptions and hospitalisations, with the child's follow-up time divided into exposed and unexposed periods. Adjusted IRRs (aIRR) for child injury during maternal mental health episodes were estimated using Poisson regression.

Results

54 702 children (26.4%) were exposed to maternal depression and/or anxiety when aged 0–4 years. During follow-up, 2614 poisonings, 6088 fractures and 4201 burns occurred. Child poisoning rates increased during episodes of maternal depression (aIRR 1.52, 95% CI 1.31 to 1.76), depression with anxiety (2.30, 1.93 to 2.75) and anxiety alone (1.63, 1.09 to 2.43). Similarly, rates of burns (1.53, 1.29 to 1.81) and fractures (1.24, 1.06 to 1.44) were greatest during depression with anxiety episodes. There was no association between maternal depression and/or anxiety and serious child injuries.

Conclusions

Maternal depression and/or anxiety episodes were associated with increased rates of child poisonings, fractures and burns. While mechanisms are unclear, prompt identification and treatment of maternal depression and/or anxiety and provision of safety advice (eg, safe medication storage) may reduce child injury risk.




Functioning and health-related quality of life following injury in older people: a systematic review

2017-11-23T03:24:03-08:00

Aim and background

There is growing evidence around the impact of injury and recovery trajectories but little focuses on older people, despite rising burden. The aim of this review was to describe the evidence for postinjury functioning and health-related quality of life (HRQoL) in older people.

Method

A systematic search of three databases and an extensive search of the grey literature was carried out on prospective injury outcome studies in older people (age ≥65 years) that used a generic health status outcome measure. The search results were reported using PRISMA reporting guidelines, and risk of bias was assessed using a modification of the Quality in Prognosis Studies tool.

Results

There was limited evidence on functioning and HRQoL postinjury in older people. There were 367 studies identified, with 13 eligible for inclusion. Most focused on hip fracture or traumatic brain injury. Older people appeared to have poorer postinjury functioning and HRQoL compared with younger adults or preinjury levels. Poor preinjury function, pre-existing conditions and increasing age were associated with poorer outcomes, whereas preinjury-independent living was associated with better outcomes.

Discussion

The studies were heterogeneous, limiting synthesis. There was a lack of evidence around the impact of injury on older people in terms of paid work and unpaid work. It was unclear if existing injury outcome guidelines are appropriate for older people.

Conclusions

Further research is required on older people's postinjury course, outcomes and determinants. This will require standardised methodologies and qualitative studies. The findings will inform clinical care, policy development, health and compensation systems.




Are rural places less safe for motorists? Definitions of urban and rural to understand road safety disparities

2017-11-23T03:24:03-08:00

The objectives of the study are to understand road safety within the context of regional development processes and to assess how urban–rural categories represent differences in motor vehicle occupant fatality risk. We analysed 2015 motor vehicle occupant deaths in Wisconsin from 2010 to 2014, using three definitions of urban–rural continua and negative binomial regression to adjust for population density, travel exposure and the proportion of teen residents. Rural–Urban Commuting Area codes, Beale codes and the Census definition of urban and rural places do not explain differences in urban and rural transportation fatality rates when controlling for population density. Although it is widely believed that rural places are uniquely dangerous for motorised travel, this understanding may be an artefact of inaccurate constructs. Instead, population density is a more helpful way to represent transportation hazards across different types of settlement patterns, including commuter suburbs and exurbs.




Statistical process control charts for monitoring military injuries

2017-11-23T03:24:03-08:00

Background

An essential aspect of an injury prevention process is surveillance, which quantifies and documents injury rates in populations of interest and enables monitoring of injury frequencies, rates and trends. To drive progress towards injury reduction goals, additional tools are needed. Statistical process control charts, a methodology that has not been previously applied to Army injury monitoring, capitalise on existing medical surveillance data to provide information to leadership about injury trends necessary for prevention planning and evaluation.

Methods

Statistical process control Shewhart u-charts were created for 49 US Army installations using quarterly injury medical encounter rates, 2007–2015, for active duty soldiers obtained from the Defense Medical Surveillance System. Injuries were defined according to established military injury surveillance recommendations. Charts display control limits three standard deviations (SDs) above and below an installation-specific historical average rate determined using 28 data points, 2007–2013. Charts are available in Army strategic management dashboards.

Results

From 2007 to 2015, Army injury rates ranged from 1254 to 1494 unique injuries per 1000 person-years. Installation injury rates ranged from 610 to 2312 injuries per 1000 person-years. Control charts identified four installations with injury rates exceeding the upper control limits at least once during 2014–2015, rates at three installations exceeded the lower control limit at least once and 42 installations had rates that fluctuated around the historical mean.

Conclusions

Control charts can be used to drive progress towards injury reduction goals by indicating statistically significant increases and decreases in injury rates. Future applications to military subpopulations, other health outcome metrics and chart enhancements are suggested.




Sports Biostatistician: a critical member of all sports science and medicine teams for injury prevention

2017-11-23T03:24:03-08:00

Sports science and medicine need specialists to solve the challenges that arise with injury data. In the sports injury field, it is important to be able to optimise injury data to quantify injury occurrences, understand their aetiology and most importantly, prevent them. One of these specialty professions is that of Sports Biostatistician. The aim of this paper is to describe the emergent field of Sports Biostatistics and its relevance to injury prevention. A number of important issues regarding this profession and the science of sports injury prevention are highlighted. There is a clear need for more multidisciplinary teams that incorporate biostatistics, epidemiology and public health in the sports injury area.




Evaluation of the Effectiveness and Implementation of the BokSmart Safe Six Injury Prevention Programme: a study protocol

2017-11-23T03:24:03-08:00

Background

The injury burden in rugby union (‘rugby’) is high. While exercise-based injury prevention programmes have successfully reduced injuries in other sports such as football, there is minimal research on this topic in rugby union.

Objective

To evaluate the effectiveness and implementation of an exercise-based intervention (BokSmart Safe Six) in junior rugby players that aims to reduce the injury risk profile and burden of injury.

Setting

14–16-year-old junior rugby players in two geographically separated locations in South Africa over the 2017 rugby playing season.

Methods

A cluster-randomised controlled trial where the teams are allocated to groups that either (1) have a coach-delivered exercise intervention in their warm-up (BokSmart Safe Six) or (2) continue with their warm-up ‘as usual’ (control group). Injury risk profiles will be assessed through musculoskeletal screening on all players performed at the beginning, middle and end of the trial. Epidemiological measurements include injury surveillance at all matches and training sessions, and exposure to the various warm-up exercises (including BokSmart Safe Six exercises). Behavioural determinants of coaches will be assessed through standardised theory of planned behaviour questionnaires and focus groups before and after the intervention.

Outcome measures

Comparison in injury risk profiles and burden of injury between the intervention and control groups. Changes in the behavioural determinants of coaches.

Trial registration number:

PACTR201608001730223. Pre-Results.




Subsequent Injury Study (SInS): Improving outcomes for injured New Zealanders

2017-11-23T03:24:03-08:00

Background

Subsequent injury (SI) is a major contributor to disability and costs for individuals and society.

Aim

To identify modifiable risk factors predictive of SI and SI health and disability outcomes and costs.

Objectives

To (1) describe the nature of SIs reported to New Zealand's no-fault injury insurer (the Accident Compensation Corporation (ACC)); (2) identify characteristics of people underaccessing ACC for SI; (3) determine factors predicting or protecting against SI; and (4) investigate outcomes for individuals, and costs to society, in relation to SI.

Design

Prospective cohort study.

Methods

Previously collected data will be linked including data from interviews undertaken as part of the earlier Prospective Outcomes of Injury Study (POIS), ACC electronic data and national hospitalisation data about SI. POIS participants (N=2856, including 566 Māori) were recruited via ACC's injury register following an injury serious enough to warrant compensation entitlements. We will examine SI over the following 24 months for these participants using descriptive and inferential statistics including multivariable generalised linear models and Cox's proportional hazards regression.

Discussion

Subsequent Injury Study (SInS) will deliver information about the risks, protective factors and outcomes related to SI for New Zealanders. As a result of sourcing injury data from New Zealand's ‘all injury’ insurer ACC, SInS includes people who have been hospitalised and not hospitalised for injury. Consequently, SInS will provide insights that are novel internationally as other studies are usually confined to examining trauma registries, specific injuries or injured workers who are covered by a workplace insurer rather than a ‘real-world’ injury population.




Review of the book Confronting Gun Violence in America by Thomas Gabor

2017-11-23T03:24:03-08:00

In 2014, an estimated 115 000 individuals in the USA sustained a firearm-related injury, 34 000 of whom died.1 There are also 40 times as many non-fatal firearm-related crimes as there are firearm deaths.2 Extensive evidence clearly indicates that firearm-related violence constitutes one of the most pressing public health and public safety issues of our time in the USA. While the public health approach has demonstrated notable success in reducing morbidity and mortality from an impressive array of illnesses and injuries over the past few decades,3 we have made little progress in reducing the rate of firearm-related violence. Confronting Gun Violence in America4 is a valuable addition to the existing literature and enhances our understanding of the scope, determinants and consequences of this major problem in the USA.

The book is organised into five parts that comprehensively examine the scale of America's gun...




Global news highlights

2017-11-23T03:24:03-08:00

More on guns in America

As this column was being finalised, news of the latest mass shooting in the USA reached us. It is so appalling that it feels futile to rant again about America’s unchanging gun culture. Instead, I provide a few facts: 59 people were killed and at least 500 others were injured when a lone gunman fired from a building near an open air concert in Las Vegas. The gunman had 19 rifles in his hotel room. In a press conference, US President Trump described the shooting as ‘an act of pure evil’ but did not address gun control. In contrast, former Vice-president Joe Biden, wrote: ’How long do we let gun violence tear families apart? Enough. Congress & the White House should act now to save lives. There’s no excuse for inaction'. America has nearly 30 times more gun deaths per capita than the UK. Comment:...