To describe the process for implementing an intervention to prevent pedestrian injuries in Cuernavaca, Mexico, using a multidisciplinary and evidence-based approach.
This study included two phases with several stages. The first was an overall assessment of pedestrian mortality in Cuernavaca that included a comparison of pedestrian mortality between Cuernavaca and the rest of Morelos State (1998–2007), an analysis and geocoding of pedestrian injuries (2008–2009), and a description of techniques for selecting and analysing clustered events using road audits. The second phase focused on selecting an intervention through a review of the literature seeking the ‘best evidence’ adaptable to the local context and a methodological evaluation for implementation including techniques for cluster randomisation and for the evaluation of possible effects of the intervention.
Between 2008 and 2009, in Cuernavaca there were 620 pedestrian injury events: 59.4% were men, the mean age was 36.3 years, 70% occurred during daylight hours, 55% had mild severity and there were no differences by sex (p>0.05). We generated evidence, that when combined with the results from a systematic search of the literature, provided sufficient information for the implementation of a pedestrian injury prevention intervention.
A combination of strategies and disciplines makes it possible to comprehensively address this public health problem, allowing interventions to strengthen aspects of pedestrian safety while accounting for characteristics of the local context; the promotion of local measures, of low cost and high impact, with modifications to the road infrastructure, are more effective in addressing pedestrian vulnerabilities.
To estimate the likelihood of recovery at 1, 4 and 12 months post injury and investigate predictors of recovery in injured people attending an emergency department (ED) or admitted to hospital in the UK.
Participants completed questionnaires at recruitment and 1, 4 and 12 months post injury or until recovered. Data were collected on injury details, sociodemographic characteristics, general health prior to injury and recovery. We compared three age groups: 5–17, 18–64 and 65 years and above. Modified Poisson regression estimated the relative risk of recovery. Multivariable models were built using backward stepwise regression. Sensitivity analyses assessed the effect of missing data.
We recruited 1517 participants, 55% (n=836) ED attenders and 44% (n=661) hospital admissions. By 1 month after injury, 28% (285/968) had fully recovered, 54% (440/820) at 4 months and 71% (523/738) at 12 months. Recovery was independently associated with gender, admission status, injury severity, body region injured and place of injury for 5–17 year olds and 18–64 year olds and with gender, admission status, injury severity and long-term illness for those aged 65+. Injury severity and hospital admission were associated with recovery across all age groups, but not at every time point in each age group. Other factors varied between age groups or time points. Results were generally robust to imputing missing data.
A range of factors was found to predict recovery among injured people. These could be used to identify those at risk of delayed recovery and to inform the design of interventions to maximise recovery.
With ageing populations worldwide, mobility devices are used more than ever. In the current literature there is no consensus whether the available mobility devices safely improve the mobility of their users. Also, evidence is lacking concerning the risks and types of injuries sustained while using a four-wheeled walker.
To assess injury risks and injury patterns in older adults (≥65 years) who presented at Emergency Departments (ED) in the Netherlands with an injury due to using a four-wheeled walker.
In this study, the Dutch Injury Surveillance System was used to obtain a national representative sample of annual ED visits in the Netherlands in the adult population (≥65 years) sustaining an injury while using a four-wheeled walker. The numbers of four-wheeled walker users in the Netherlands were obtained from the national insurance board. The numbers of ED visits were divided by the numbers of four-wheeled walker users to calculate age- and sex-specific injury risks.
Annually 1869 older adults visited an ED after sustaining an injury while using a four-wheeled walker. Falls were the main cause of injury (96%). The injury risk was 3.1 per 100 users of four-wheeled walkers. Women (3.5 per 100 users) had a higher risk than men (2.0 per 100 users). Injury risk was the highest in women aged 85 years and older (6.2 per 100 users). The majority of injuries were fractures (60%) with hip fracture (25%) being the most common injury. Nearly half of all four-wheeled walker related injuries required hospitalisation, mostly due to hip fractures. Healthcare costs per injury were approximately 12 000.
This study presents evidence that older adults experiencing a fall while using a four-wheeled walker are at high risk to suffer severe injuries.
To evaluate the incidence of snow-sports-related head injuries among children and adolescents reported to emergency departments (EDs), and to examine the trend from 1996 to 2010 in ED visits for snow-sports-related traumatic brain injury (TBI) among children and adolescents.
A retrospective, population-based cohort study was conducted using data from the National Electronic Injury Surveillance System for patients (aged ≤17 years) treated in EDs in the USA from 1996 to 2010, for TBIs associated with snow sports (defined as skiing or snowboarding). National estimates of snow sports participation were obtained from the National Ski Area Association and utilised to calculate incidence rates. Analyses were conducted separately for children (aged 4–12 years) and adolescents (aged 13–17 years).
An estimated number of 78 538 (95% CI 66 350 to 90 727) snow sports-related head injuries among children and adolescents were treated in EDs during the 14-year study period. Among these, 77.2% were TBIs (intracranial injury, concussion or fracture). The annual average incidence rate of TBI was 2.24 per 10 000 resort visits for children compared with 3.13 per 10 000 visits for adolescents. The incidence of TBI increased from 1996 to 2010 among adolescents (p<0.003).
Given the increasing incidence of TBI among adolescents and the increased recognition of the importance of concussions, greater awareness efforts may be needed to ensure safety, especially helmet use, as youth engage in snow sports.
To identify factors associated with non-participation at the 12-month and 24-month follow-up phases of a prospective cohort study of injury outcomes.
Associations between non-participation at follow-up phases and a range of sociodemographic, injury, health, outcome and administrative factors were examined.
An individual's non-participation at 12 months did not necessarily mean non-participation at 24 months. Sociodemographic factors were the most salient for non-participation, regardless of the number of follow-up phases or specific phase considered.
Retention rates in prospective cohort studies of injury outcome may be improved by follow-up of everyone irrespective of previous non-participation, focusing resources to retain men, young adults, indigenous people and those living with people other than family members, and by ensuring that multiple alternative participant contacts are obtained. There is sufficient evidence to be concerned about potential bias given that several of the factors we, and others, have identified as associated with non-participation are also associated with various functional and disability outcomes following injury. This suggests detailed investigations are warranted into the effect non-participation may be having on the estimates for various outcomes.
Rates of occupational injuries among firefighters are high because of the physically demanding and variable tasks required by their job. While descriptive data about injuries exist, few studies have explored individual risk factors and their relationship to occupational injury.
The current study presents data from a population-based sample of 462 career firefighters from 11 randomly-selected fire departments in the Missouri Valley region of the USA (Kansas, Missouri, Iowa, North Dakota, South Dakota, Colorado, Wyoming, Nebraska) who participated in a study evaluating risks for negative cardiovascular outcomes and injury. Relationships were examined between injury and demographic characteristics, body composition, fitness, and health behaviours.
Participants were most likely to be injured during physical exercise and those who reported regular on-duty exercise had a fourfold increase in risk for exercise-related injury compared with those who did not exercise on duty (OR=4.06, 95% CI 1.73 to 12.24). However, those who exercised were half as likely to sustain non-exercise injuries (OR=0.53, 95% CI 0.32 to 0.85).
Findings highlight the benefit of physical training for firefighters despite the risk of injury during exercise.
Road Traffic Injury (RTI) in Africa represents 14% of global RTI deaths. Lack of timely, reliable data undermines road safety interventions. Available fatality data are aggregated, limited in detail or scarce in surveys. This is the first fatal RTI surveillance study in Nigeria.
To pilot a systematic mortuary-based data collection in Ibadan, determine the nature and circumstances of fatal RTI and assess data quality against existing data sources.
Using a draft data collection system developed jointly by WHO and Monash University, the detailed information was prospectively collected on RTI University College Hospital mortuary admissions in Ibadan September 2010 to February 2011. Demographics, road user type, counterpart vehicle, intent, manner and medical cause of death were recorded.
Mortuary admissions included 80 fatal RTI cases: 81.3% males. By road user category, 28 (35.0%) were pedestrians; 28 (35.0%) motorised 2-wheeler users; 18.8% car occupants; and 11.3% bus occupants. In 70% of cases, medical cause of death was head injury, including 25 of 28 motorised 2-wheeler users (89.3%). Estimates from this study indicate apparent increased mortuary capture of fatal RTI compared with police data.
This study demonstrates the feasibility of collecting detailed, timely RTI fatality data through mortuary-based surveillance in Ibadan. While not all RTI deaths are reported to any authority in Ibadan, this large case series complements existing data sources and suggests that pedestrians and motorised 2-wheeler users die most often in road traffic crashes. Frequent head injuries among motorised 2-wheeler users strongly support the need for helmet wearing interventions.
Firearms may be obtained illegally from federally-licensed dealers and pawnbrokers through surrogate (straw) purchases, undocumented purchases and theft. Some retailers knowingly make illegal sales.
To obtain information about the frequency of and risk factors for these events, and retailers’ reactions to them, directly from licensed retailers.
Survey of a random sample of 1601 licensed dealers and pawnbrokers in 43 states who were believed to sell ≥50 firearms annually, conducted by mail during June–August 2011.
The response rate was 36.9%, typical of establishment surveys using such methods. In the preceding year, 67.3% of respondents experienced attempted straw purchases; 42.4% experienced undocumented purchase attempts. For each event, 10% reported ≥1 occurrence/month. A quarter (25.6%) experienced firearm theft in the preceding 5 years. Pawnbroker status, sales volume, denied sales and sales of firearms that were subsequently traced by law enforcement were associated with all outcomes in multivariate analysis. Estimates of retailer involvement in illegal sales (median 3%, IQR 1–10%) were related in multivariate analysis to respondents’ age and sex, and to denied sales. In a hypothetical case involving 50 illegal sales, respondents recommended prolonged incarceration (median 10 years, IQR 5–20 years) and a substantial fine (median $50 000, IQR $10 000–$250 000) for retailers and made similar recommendations for buyers.
Attempts to acquire firearms illegally from licensed dealers and pawnbrokers are common. Characteristics associated with frequency of occurrence may facilitate prevention efforts. Licensed retailers consider selling and buying firearms illegally to be serious crimes.
Many colleges assess criminal histories during the admissions process, in part, to address violence on campus. This study sought to examine the utility of screening as a means of reducing violence.
Using cohort and case-control analyses, we identified college misconduct through college records and self-reports on a confidential survey of graduating seniors, and examined precollege behaviour as indicated on admissions records, a survey and criminal background checks.
One hundred and twenty students met our case definition of college misconduct, with an estimated OR of 5.28 (95% CI 1.92 to 14.48) associated with precollege misconduct revealed on the college application. However, only 3.3% (95% CI 1.0% to 8.0%) of college seniors engaging in college misconduct had reported precollege criminal behaviours on their applications and 8.5% (95% CI 2.4% to 20.4%) of applicants with a criminal history engaged in misconduct during college.
Though precollege behaviour is a risk factor for college misconduct, screening questions on the application are not adequate to detect which students will engage in college misconduct. This pilot work would benefit from replication to determine the utility of criminal background investigations as part of admissions.
This study examined the impact of transportation infrastructure at intersection and non-intersection locations on bicycling injury risk.
In Vancouver and Toronto, we studied adult cyclists who were injured and treated at a hospital emergency department. A case–crossover design compared the infrastructure of injury and control sites within each injured bicyclist's route. Intersection injury sites (N=210) were compared to randomly selected intersection control sites (N=272). Non-intersection injury sites (N=478) were compared to randomly selected non-intersection control sites (N=801).
At intersections, the types of routes meeting and the intersection design influenced safety. Intersections of two local streets (no demarcated traffic lanes) had approximately one-fifth the risk (adjusted OR 0.19, 95% CI 0.05 to 0.66) of intersections of two major streets (more than two traffic lanes). Motor vehicle speeds less than 30 km/h also reduced risk (adjusted OR 0.52, 95% CI 0.29 to 0.92). Traffic circles (small roundabouts) on local streets increased the risk of these otherwise safe intersections (adjusted OR 7.98, 95% CI 1.79 to 35.6). At non-intersection locations, very low risks were found for cycle tracks (bike lanes physically separated from motor vehicle traffic; adjusted OR 0.05, 95% CI 0.01 to 0.59) and local streets with diverters that reduce motor vehicle traffic (adjusted OR 0.04, 95% CI 0.003 to 0.60). Downhill grades increased risks at both intersections and non-intersections.
These results provide guidance for transportation planners and engineers: at local street intersections, traditional stops are safer than traffic circles, and at non-intersections, cycle tracks alongside major streets and traffic diversion from local streets are safer than no bicycle infrastructure.
To evaluate the validity of a parent-reported survey to identify children's moderate and serious injuries in seven specific body regions using medical records as the ‘gold standard’.
A prospective validation study was conducted in three urban paediatric emergency departments (EDs). 798 parents of 859 children treated for injuries at participating EDs between August 2010 and July 2011 completed either a telephone interview or self-administered paper survey at 2 weeks post-ED visit. Parents were asked to report child injuries to seven body regions: head, face, neck/spine/back, thorax, abdomen, upper extremities and lower extremities. Injury data were abstracted from medical records using a standardised protocol. Body region injury severity levels of none/minor, moderate or serious were assigned to each subject based on the Abbreviated Injury Scale.
The overall sensitivity, reflecting parents’ ability to identify a documented moderate or greater severity injury, was 0.95 (95% CI 0.92 to 0.97). Sensitivities were >0.90 for the face, upper extremity and lower extremity regions; 0.80–0.90 for head, abdomen and neck/back/spine regions; and <0.60 for the thorax region. The overall sensitivity for identification of a serious injury was 0.71 (0.60 to 0.80).
This survey enables parents to accurately identify moderate and greater severity injuries to body regions, though it does not accurately identify serious injuries in most body regions except the extremities. The survey could serve as a screening tool to identify moderate and greater severity injuries in population-based surveillance systems, or as the primary outcome of interest in injury prevention studies.
Few studies have investigated base rate estimates of risky driving behaviours among veterans of the wars in Afghanistan and Iraq despite evidence suggesting such behaviours result in increased death rates. In addition, published estimates of driving behaviours may be subject to a significant response bias via the impact of perceived mental health stigma on honest self-reporting.
The present study compared the unmatched count technique, a form of randomised response technique used to mitigate biased responding, with traditional anonymous self-report to gain information about base rates of risky driving behaviours among combat veterans.
Cross-sectional data gathered as part of a study of attitudes and behaviours related to military service provided estimates of target activities. Six facets of risky driving (horn honking, carrying firearms in the vehicle, drinking and driving, screaming at other drivers, following other drivers to complain, and tailgating) were assessed.
In our sample of 1351 combat veterans, the unmatched count technique revealed significantly higher rates relative to traditional anonymous assessment specifically for horn honking in anger (22.1% vs 13.6%), carrying firearms (51.1% vs 32.2%), and drinking and driving (77.8% vs 54.0%). There were no significant differences for the remaining three items.
The high level of morbidity associated with risky driving and motor vehicle crashes is a significant concern in the combat veteran population. These data suggest the presence of a strong response bias associated with endorsing certain risky driving behaviours, potentially leading to serious underestimation of these problem behaviours in standard anonymous questionnaires.
To compare the risk of road traffic injury calculated using an exposure measure based on people's mobility, person-hours travelled (person-hours), with the risk obtained using population census, vehicle fleet and vehicle-kilometres travelled.
The rate of road traffic injury on a working day in Catalonia in 2006 was calculated using the number of people injured from the Register of Accidents and Victims of the National Traffic Authority and as denominator: person-hours travelled, from the 2006 Daily Mobility Survey of Catalonia; population census and vehicle fleet, from the National Statistics Institute; and vehicle-kilometres, from the Ministry of Public Works.
Compared with person-hours travelled: population census may underestimate the risk in groups with low mobility; vehicle-kilometres may underestimate the risk in regions with high level of non-motorised mobility and high use of public transport; vehicle fleet may underestimate the risk for collective forms of transport such as buses and for motorcyclists who make many trips but of short duration.
Measures of exposure involving people's mobility should be used in the estimation of road traffic injury risk, instead of vehicle's mobility, population census or vehicle fleet.
Adverse living standards are associated with poorer child health and safety. This study investigates whether adverse housing and neighbourhood conditions contribute to explain country-level associations between a country's economic level and income inequality and child mortality, specifically injury mortality.
Ecological, cross-sectional study.
Twenty-six European countries were grouped according to two country-level economic measures from Eurostat: gross domestic product (GDP) and income inequality. Adverse country-level housing and neighbourhood conditions were assessed using data from the 2006 European Union Income Social Inclusion and Living Conditions Database (n=203 000).
Child mortality incidence rates were derived for children aged 1–14 years for all causes, all injuries, road traffic injuries and unintentional injuries excluding road traffic. Linear regression analysis was applied to measure whether housing or neighbourhood conditions have a significant association with child mortality and whether a strain modified the association between GDP/income inequality and mortality.
Country-level income inequality and GDP demonstrated a significant association with child mortality for all outcomes. A significant association was also found between housing strain and all child mortality outcomes, but not for neighbourhood strain. Housing strain partially modified the relationship between income inequality and GDP and all child mortality outcomes, with the exception of income inequality and road traffic injury mortality showing full mediation by housing strain.
Adverse housing conditions are a likely pathway in the country-level association between income inequality and economic GDP and child injury mortality.
To describe the law enforcement officer (LEO), encounter, perpetrator and victim characteristics of domestic disturbance-related LEO homicides in the USA from 1996 to 2010.
Narrative text analysis was conducted on the Federal Bureau of Investigation's annual report ‘Law Enforcement Officers Killed and Assaulted’. Potential cases were confirmed if the narrative included the term ‘domestic disturbance’ or a domestic disturbance situation was described.
116 LEOs were killed while responding to domestic disturbance calls. Ninety-five per cent of these homicides were committed with a firearm. Sixty-seven per cent of LEOs were wearing body armour when killed; however, 52% received the fatal wound to the head/neck. Sixty-one per cent of suspects had a criminal history mentioned within the narratives and perpetrators of intimate partner violence (IPV) were more likely to be killed by LEOs than suspects involved in other forms of domestic violence. Victims of the domestic disturbance were killed in 21% of the IPV-related LEO homicide cases as opposed to only 5% of other domestic disturbance calls. A firearm was the most common weapon used in the murder of a domestic disturbance victim (86%).
This study describes domestic disturbance-related LEO homicides. Future research in this area should further examine the dangers unique to domestic disturbance calls. A longitudinal analysis could provide greater understanding of the injury and mortality risks faced by LEOs, in order to inform homicide prevention among law enforcement.
To examine differences across age groups in patterns of injuries sustained from motorcycle crashes.
Cross-sectional data from the National Electronic Injury Surveillance System-All Injury Program were used to assess emergency department-treated injuries resulting from motorcycle crashes in the USA from 2001 to 2008. Trends in injury frequency, and types and severity of injuries sustained among those aged 20–39 years, 40–59 years, and 60+ years were compared.
An estimated 65 660 patients 60 years and older, 466 125 patients aged 40–59 years and 921 229 patients aged 20–39 years were treated in US emergency rooms for injuries sustained in motorcycle crashes from 2001 to 2008. The number of injuries increased in all groups from 2001 to 2008, with the greatest rate of increase occurring in the oldest age group. Older adults had a threefold increased rate of hospitalisation (OR=3.05; 95% CI 2.58 to 3.59) compared with younger adults. Middle age adults had a nearly twofold increased odds of hospitalisation (OR=1.89; 95% CI 1.70 to 2.11; p<0.0001) compared with younger adults. Analysis of injury severity showed a similar pattern with both older adults (OR=2.46; 95% CI 2.02 to 3.01) and middle age adults (OR=1.66, 95% CI 1.52 to 1.82) having significantly increased odds of severe injury compared with younger adults.
Older adults involved in motorcycle crashes are prone to more severe injuries than younger adults. The increased number of older adults riding motorcycles should put further focus on risk of injury to this population.
Environmental audit tools must be reliable in order to accurately estimate the association between built environmental characteristics and bicycling injury risk.
To examine the inter-rater agreement of a built environment audit tool within a case-control study on the environmental determinants of bicycling injuries.
Auditor pairs visited locations where bicycling injuries occurred and independently recorded location characteristics using the Systematic Pedestrian and Cyclist Environmental Scan (SPACES). Two case groups were defined: (1) where a bicyclist was struck by a motor-vehicle (MV) and (2) where the bicyclist's injuries required hospitalisation. The two corresponding control groups were (1) where non-MV bicycle-related injuries occurred and (2) where minor bicycle-related injuries occurred. Inter-rater reliability of each item on the tool was assessed using observed agreement and with 95% CI.
Ninety-seven locations were audited. Inter-observer agreement was generally high (≥95%); most items had a 1–2% difference in responses. Items with ≥5% differences between raters included path condition, slope and obstructions. For land use, path and roadway characteristics, ranged from 0.3 for presence of offices and cleanliness to 0.9 for schools and number of lanes; overall, 78% of items had at least substantial agreement (≥0.61). For bicyclists struck by a MV the proportion of items with substantial agreement was 60%, compared with 73% for non-MV related injuries. For hospitalisations and minor bicycle-related injuries, 76% of items had substantial agreement.
Agreement was substantial for most, but not all SPACES items. The SPACES provides reliable quantitative descriptions of built environmental characteristics at bicycling injury locations.
Once again we face the humbling task of thanking the 288 individuals whose efforts as reviewers for the journal help us to insure the quality and relevance of the publication. It is remarkable to see the effort, care and thoughtful analysis that have gone into so many of the reviews we receive. Clearly, this feedback is invaluable to the authors and of great importance to the advancement of our field as a whole. Unfortunately, there is little we can do to properly thank those who give so generously of their time and expertise.
Our editorial board is comprised of our most productive reviewers. Because we strive to have every paper refereed by at least one board member, they all see at least four manuscripts annually. But here we would especially like to acknowledge a handful of non-board members whose productivity as reviewers in the last 12 months was outstanding: Mariana Brussoni, Peter...]]>
One such country is Afghanistan where people's livelihood has been ravaged by ongoing conflicts during the last 3 decades.
Young drivers are at increased crash risk as a result of adopting risky driving styles. The present work examines the development of risky attitudes from pre-driving to fully-qualified driving, focussing on speed related attitudes.
Data were drawn from a UK longitudinal study of adolescent behaviour development in the general population (the G1219 study). At baseline (modal age 17 years) there were 1596 participants, only 18% of whom were fully-qualified drivers. At follow-up (modal age 20 years) 64% were fully-qualified drivers. Attitudes to driving violations, particularly speeding, were measured in all participants at both assessments. Self-reported driving violations, also related to speeding, were measured in fully-qualified drivers at follow-up.
Attitudes became riskier with driver training/experience. Baseline attitudes measured in pre-drivers did not independently predict violations in those that had become fully-qualified drivers at follow-up. The attitudes of learner and fully-qualified drivers at baseline independently predicted violations at follow-up.
These results indicate that the driver training period offers a promising opportunity for interventions to develop safer driving attitudes.
Falls are an increasingly important and costly public health problem. Vision is key to postural stability as we age and this puts adults with visual impairments at greater risk of falls. Physical interventions improve balance in the general population and in older adults with visual impairments in residential care. They also prevent falls in the general community but to date have not been shown effective in community-dwelling adults with visual impairments.
To investigate, with a randomised controlled trial, whether the Alexander Technique (AT) can improve balance and mobility in the community-dwelling population with visual impairments and thus reduce the risk of falls. The AT is a form of physical re-education that has recently received attention for its possible value in rehabilitation.
One hundred and twenty people with visual impairments over 50 years of age will be recruited from Guide Dogs New South Wales/Australian Capital Territory (NSW/ACT). Participants will be independently mobile and cognitively able to take part in the programme. After baseline assessment participants will be randomly assigned to two groups. The control group will receive usual care from Guide Dogs NSW/ACT, and the intervention group will receive 12 weekly home-based lessons in the AT in addition to usual care. The primary outcome measures will be physical measures from the short physical performance battery at 3 months. Secondary outcome measures will be balance, mobility, social participation and emotional well-being at 3 and 12 months.
Trial registration number: The protocol is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000634077).
This study was performed to examine the potential contributions of sociocultural activities to reduce risks of death by homicide.
This study was designed as a case control study. Relatives of 90 adult homicide victims in Dar es Salaam Region, Tanzania, in 2005 were interviewed. As controls, 211 participants matched for sex and 5-year age group were randomly selected from the same region and interviewed regarding the same contents.
Bivariate analysis revealed significant differences between victims and controls regarding educational status, occupation, family structure, frequent heavy drinking, hard drug use and religious attendance. Conditional logistic regression analysis indicated that the following factors were significantly related to not becoming victims of homicide: being in employment (unskilled labour: OR=0.04, skilled labour: OR=0.07, others: OR=0.04), higher educational status (OR=0.02), residence in Dar es Salaam after becoming an adult (compared with those who have resided in Dar es Salaam since birth: OR=3.95), living with another person (OR=0.07), not drinking alcohol frequently (OR=0.15) and frequent religious service attendance (OR=0.12).
Frequent religious service attendance, living in the same place for a long time and living with another person were shown to be factors that contribute to preventing death by homicide, regardless of place of residence and neighbourhood environment. Existing non-structural community resources and social cohesive networks strengthen individual and community resilience against violence.
Sleepiness has been shown to be a risk factor for road crashes in high-income countries, but has received little attention in low- and middle-income countries. We examined the prevalence of sleepiness and sleep-related disorders among drivers of four-wheel motor vehicles in Fiji.
Using a two-stage cluster sampling roadside survey conducted over 12 months, we recruited a representative sample of people driving four-wheel motor vehicles on the island of Viti Levu, Fiji. A structured interviewer-administered questionnaire sought self-report information on driver characteristics including sleep-related measures.
The 752 motor vehicle drivers recruited (84% response rate) were aged 17–75 years, with most driving in Viti Levu undertaken by male subjects (93%), and those identifying with Indian (70%) and Fijian (22%) ethnic groups. Drivers who reported that they were not fully alert accounted for 17% of driving, while a further 1% of driving was undertaken by those who reported having difficulty staying awake or feeling sleepy. A quarter of the driving time among 15–24-year-olds included driving while sleepy or not fully alert, with a similar proportion driving while chronically sleep deprived (ie, with less than five nights of adequate sleep in the previous week=27%). Driving while acutely or chronically sleep deprived was generally more common among Fijians compared with Indians.
Driving while not fully alert is relatively common in Fiji. Sleepiness while driving may be an important contributor to road traffic injuries in this and other low- and middle-income countries.
To quantify and describe non-fatal, unintentional bathroom injuries among children less than 15 years of age treated in US hospital emergency departments (EDs).
This study used 2008 data from a nationally representative sample of EDs, available from the National Electronic Injury Surveillance System-All Injury Program. We examined unintentional non-fatal bathroom injuries in any setting (eg, home, school or public place) among children less than 15 years of age and identified types of injuries, major locations within the bathroom and precipitating events.
Based on 1099 cases, an estimated 51 132 non-fatal bathroom injuries in children less than 15 years of age were treated in US EDs in 2008. Most injuries (73.8%) were caused by falls. The highest rate was for injuries that occurred in or around the shower or bathtub (65.9 per 100 000). Children less than 15 years of age sustained the greatest number of injuries and had the highest injury rate (151 per 100 000 (95% CI 108.7 to 193.3)), while children 10–14 years of age had the lowest rate (28.7 (95% CI 20.6 to 36.8)). The rates differed significantly by age group (p<0.001). A majority of the patients (96.9%) were treated in the ED and released.
Most bathroom injuries in children occurred while they were showering or bathing and were caused by falling or hitting an object. Such injuries might be reduced by improving caregiver supervision for younger children. For older children, a combination of bathroom safety education and environmental modifications, such as installing grab bars inside and outside the shower or tub, may reduce bathroom injuries.
The intent of a death from overdose can be difficult to determine. The goal of this study was to examine the association of psychiatric diagnoses among overdose deaths ruled by a medical examiner as intentional, unintentional and indeterminate intent.
All Veterans Health Administration patients in Fiscal Year 1999 (n=3 291 891) were followed through Fiscal Year 2006. We tested the relative strength of association between psychiatric disorders among types of overdoses (categorised by intent) using multinomial models, adjusted for age, sex, Veterans Affairs priority status and Charlson comorbidity scores. Data were from National Death Index records and patient medical records.
Substance use disorders (SUD) had a stronger association with indeterminate intent overdoses than intentional overdoses (adjusted OR (AOR)=1.80, 95% CI 1.47 to 2.22). SUDs also had a stronger association with unintentional overdoses than intentional (AOR=1.48, 95% CI 1.27 to 1.72), but the reverse was true for all other psychiatric disorders (except post-traumatic stress disorder).
Overdoses ruled indeterminate may be misclassified suicide deaths and are important to suicide surveillance and prevention efforts. Additionally, overdose deaths not classified as suicides may include some cases due to suicidal-like thinking without overt suicidal intent.
Unintentional injury is the leading cause of preventable death in children in the UK, and 0–4-year-olds frequently attend emergency departments following injuries in the home. Parenting programmes designed to support parents, promote behaviour change and enhance parent–child relationships have been shown to improve health outcomes in children. It is not known whether group-based parenting programmes have the potential to prevent unintentional injuries in preschool children.
A study to develop a group-based parenting programme to prevent unintentional home injuries in preschool children, and assess the feasibility of evaluation through a cluster-randomised controlled trial. The intervention, designed for parents of children who have sustained a medically attended injury, will be developed with two voluntary sector organisations. The feasibility study will assess ability to recruit parents, deliver the programme and follow-up participants. Participants will complete questionnaires at baseline, 3 months and 6 months, and report injuries in their preschool children using a tool designed and validated for this study. Qualitative methods will assess user and deliverer perceptions of the programme.
This study will develop the first group-based parenting programme to prevent injuries in preschool children, and design tools for parent-reported injury outcomes. A key challenge will be to recruit parents to participate in a manner that is non-stigmatising, and does not result in feelings of guilt or belief that they are perceived to be a bad parent. The findings will be used to prepare a trial to assess the effectiveness and cost-effectiveness of the intervention.
In-hospital falls are common and pose significant economic burden on the healthcare system. To date, few studies have quantified the additional cost of hospitalisation associated with an in-hospital fall or fall-related injury. The aim of this study is to determine the additional length of stay and hospitalisation costs associated with in-hospital falls and fall-related injuries, from the acute hospital perspective.
A multisite prospective study will be conducted as part of a larger falls-prevention clinical trial—the 6-PACK project. This study will involve 12 acute medical and surgical wards from six hospitals across Australia. Patient and admission characteristics, outcome and hospitalisation cost data will be prospectively collected on approximately 15 000 patients during the 15-month study period. A review of all in-hospital fall events will be conducted using a multimodal method (medical record review and daily verbal report from the nurse unit manager, triangulated with falls recorded in the hospital incident reporting and administrative database), to ensure complete case ascertainment. Hospital clinical costing data will be used to calculate patient-level hospitalisation costs incurred by a patient during their inpatient stay. Additional hospital and hospital resource utilisation costs attributable to in-hospital falls and fall-related injuries will be calculated using linear regression modelling, adjusting for a priori-defined potential confounding factors.
This protocol provides the detailed statement of the planned analysis. The results from this study will be used to support healthcare planning, policy making and allocation of funding relating to falls prevention within acute hospitals.
All-terrain vehicles (ATVs) have steadily increased in popularity, size and speed, characteristics that likely contribute to the alarming rise in ATV-related fatalities. One potentially high-risk activity is riding on the road.
To compare fatal ATV crashes that occur on the roadway and off, to more fully understand factors that contribute to fatalities at each location.
Fatality data from the US Consumer Product Safety Commission (CPSC) were used for descriptive and comparative analyses. Multivariate logistic regression analysis was performed to determine relative risk.
Over 60% of all fatalities (1985–2009) resulted from roadway crashes. After 1998, roadway fatalities increased at over twice the rate of off-road fatalities. Roadway crashes were more likely than off-road crashes to involve multiple fatalities, carrying passengers, alcohol use, collisions and head injuries. Roadway victims were less likely to be helmeted than off-road victims. Passengers and operators with passengers were also less likely to be helmeted than operators riding alone. Helmeted victims were half as likely to suffer a head injury.
Fatal roadway crashes were more likely than off-road crashes to involve risk-taking behaviours (eg, carrying passengers) that could exacerbate the inherent difficulty of operating ATVs on roadway surfaces. Higher crash forces from greater speed, and lower use of protective equipment, may also have contributed to higher roadway mortality rates. Eliminating non-essential ATV road use may be an effective way to reduce ATV-related fatalities. This will likely require a substantial investment in rider education and better enforcement of ATV road use restriction laws.
The objective of the present work was to study the impact of technological and social distraction on cautionary behaviours and crossing times in pedestrians.
Pedestrians were observed at 20 high-risk intersections during 1 of 3 randomly assigned time windows in 2012. Observers recorded demographic and behavioural information, including use of a mobile device (talking on the phone, text messaging, or listening to music). We examined the association between distraction and crossing behaviours, adjusting for age and gender. All multivariate analyses were conducted with random effect logistic regression (binary outcomes) and random effect linear regression (continuous outcomes), accounting for clustering by site.
Observers recorded crossing behaviours for 1102 pedestrians. Nearly one-third (29.8%) of all pedestrians performed a distracting activity while crossing. Distractions included listening to music (11.2%), text messaging (7.3%) and using a handheld phone (6.2%). Text messaging, mobile phone use and talking with a companion increased crossing time. Texting pedestrians took 1.87 additional seconds (18.0%) to cross the average intersection (3.4 lanes), compared to undistracted pedestrians. Texting pedestrians were 3.9 times more likely than undistracted pedestrians to display at least 1 unsafe crossing behaviour (disobeying the lights, crossing mid-intersection, or failing to look both ways). Pedestrians listening to music walked more than half a second (0.54) faster across the average intersection than undistracted pedestrians.
Distracting activity is common among pedestrians, even while crossing intersections. Technological and social distractions increase crossing times, with text messaging associated with the highest risk. Our findings suggest the need for intervention studies to reduce risk of pedestrian injury.
Musculoskeletal problems are common in professional orchestral musicians, and little is known about effective prevention strategies. Exercise is suggested to help in reducing work-related upper limb disorders and accordingly a trial of a specific exercise programme for this population was planned. Formative and process evaluation procedures were undertaken during the development of the programme to ensure high methodological credibility.
Literature reviews on exercise interventions for musicians as well as for neck, shoulder, abdominal, lower back and hip/pelvic body regions were undertaken. Current preventative and rehabilitation models were reviewed including undergraduate curriculums, postgraduate training programmes, and opinion from academic and clinical physiotherapists. Five series of progressive exercises were developed as a result. These were reviewed by expert physiotherapists who were blinded to the proposed progression difficulty of the exercises. A revised draft was produced for further review. This final programme was pilot trialed and feedback from the participants and physiotherapist instructors were obtained.
No evidence-based literature regarding an exercise programme for professional orchestral musicians was found. An exercise programme was subsequently developed with progressive stages that followed an adapted exercise prevention and rehabilitation model. The blinded ranking of each exercise series produced varied results particularly in the abdominal and shoulder series. Feedback from the participants and instructors in the pilot study resulted in changes to the exercise difficulty, and the class format and structure.
Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice, a specific exercise programme was developed to prevent and/or reduce occupational injuries in professional orchestral musicians.
Pedestrians account for a third of the 1.2 million traffic fatalities annually worldwide, and men are overrepresented. We examined the factors that contribute to this male-female discrepancy: walking exposure (kilometres walked per person-year), vehicle-pedestrian collision risk (number of collisions per kilometres walked) and vehicle-pedestrian collision case fatality rate (number of deaths per collision).
The decomposition method quantifies the relative contributions (RCs) of individual factors to death rate ratios among groups. The male-female ratio of pedestrian death rates can be expressed as the product of three component ratios: walking exposure, collision risk and case fatality rate. Data sources included the 2008–2009 US Fatality Analysis Reporting System, General Estimates System, National Household Travel Survey and population estimates.
USA.
Pedestrians aged 5 years and older.
Death rate per person-year, kilometres walked per person-year, collisions per kilometres walked and deaths per collision by sex.
The pedestrian death rate per person-year for men was 2.3 times that for women. This ratio of male to female rates can be expressed as the product of three component ratios: 0.995 for walking exposure, 1.191 for collision risk and 1.976 for case fatality rate. The RCs of these components were 1%, 20% and 79%, respectively.
The majority of the male-female discrepancy in 2008–2009 pedestrian deaths in the US is attributed to a higher fatality per collision rate among male pedestrians.
Pre-injury disability must be determined when assessing whether treatment programs return people to pre-injury status, however there is little empirical evidence to support recommendations that this be done as soon as possible after injury to prevent recall bias.
To determine disagreement between recall of pre-injury disability at different time points post-injury and bias towards under- or overestimating pre-injury disability.
Self-reported pre-injury global disability was assessed within days, 6 months and 12 months post-injury in patients admitted to two level 1 adult trauma centres. Kappa statistics and multiple logistic regression models identified predictors of disagreement between time-points.
Pre-injury disability was measured at all time-points in 801 patients. Pre-injury disability at baseline was rated as none, mild, moderate, marked and severe in 80%, 12%, 5.1%, 1.9% and 1.0% respectively. Absolute agreement between baseline and 6 and 12 months respectively, was 79% and 80%. Corresponding kappa values (95% confidence intervals) were 0.33 (0.26–0.40) and 0.32 (0–25–0.38). Patients over 65 years or not completing high school were more likely to report less pre-injury disability at 6 and 12 months than at baseline with adjusted odds ratios (95% confidence intervals) for these groups being 8.24 (4.32–15.72) and 1.93 (1.03–3.64) respectively.
There was little evidence of recall bias in an adult trauma population if self-reported global pre-injury disability was assessed 6 months post-injury. The recall of pre-injury disability up to 6 months post-injury can be used to determine return to pre-injury status, if assessment is not feasible shortly after injury.
This combined cross-sectional/cohort study addressed research gaps by estimating the rate of non-fatal occupational injury and identifying potential determinants among a population of adolescent farmworkers who are largely Hispanic and migrant.
The cohort included 410 farmworkers (aged 13–19 years) attending high school in South Texas along the border with Mexico. Data collection involved a self-administered, Web-based survey that solicited information on demographics, farm work variables including person-time at risk, occupational injury, health status and health risk behaviours. Cox regression was used to identify potential risk factors for non-fatal injury events experienced during a 9-month recall period.
Depending on the definition of injury, the rate of non-fatal injury ranged from 27.0–73.6/100 full time equivalents. Variables with an increased and statistically significant HR in an adjusted Cox model included: age groups <15 years-old (5.82) and 16 years-old (4.47), usually sleeping <8 h during the week (2.10), feeling tense, stressed or anxious sometimes/often (2.25), not watching TV (2.65), working around ditches (2.01) and detasseling (2.70).
The high observed rates of non-fatal injury combined with the potential negative consequences and cost of these injuries signifies a compelling need for injury prevention efforts targeting adolescent, Hispanic, farmworkers.