To evaluate the effectiveness of the immersion protection requirements of a voluntary safety standard for portable handheld hair dryers in preventing electrocution deaths in the USA.
The present work was an interrupted time series study design. Data on annual hair dryer-related electrocution deaths resulting from water contact were developed for the 1980–2007 study period. A multivariate Poisson regression model for rate data was used to evaluate the impact of the immersion protection requirements during the post-intervention period. The analysis controlled for the estimated number of hair dryers in use and the estimated number of US homes equipped with ground fault circuit interrupters, safety devices that would address hair dryer electrocutions even in the absence of the immersion protection requirements of the voluntary standard. The implementation of the 1987 and 1991 immersion protection requirements of the voluntary standard for portable handheld hair dryers was the intervention studied. The main outcome measure was the estimated reduction in the hair dryer electrocution rate associated with the immersion protection requirements of the voluntary standard.
After controlling for covariates, the immersion protection requirements were estimated to reduce the rate of hair dryer immersion electrocution deaths by 96.6% (95% CI, 90.8% to 98.8%). This suggests the prevention of about 280 immersion electrocution deaths involving hair dryers during the post-intervention period (1987–2007).
The immersion protection requirements of the voluntary safety standard for hair dryers have been highly effective in reducing hair dryer electrocutions.
To assess the personal, physical and psychosocial factors associated with wrist or hand pain in Australian hospital-based nurses.
Wrist or hand pain, associated disability and sickness absence, demographic, occupational, physical, psychosocial and personal factors among nurses working for three hospitals in Melbourne, Australia, were assessed in a cross-sectional study. Factors associated with wrist or hand pain in the past month were assessed using logistic regression.
This analysis was based on 1111 participants. The prevalence of wrist or hand pain in the past month was 15.3%. Repeated movements of the wrist or finger >4 h (OR 2.63, 95% CI 1.80 to 3.84), high job strain (1.54, 1.04 to 2.28), job insecurity (1.55, 1.04 to 2.28), somatisation tendency (2.73, 1.75 to 4.26), pain catastrophising (1.56, 1.03 to 2.37), better mental (0.97, 0.95 to 0.99) and physical (0.96, 0.94-0.98) health and well-being were associated with wrist or hand pain in the past month, after adjusting for possible confounding factors. When all significant factors were examined in the same model, repeated movements of the wrist or finger >4 h (2.50, 1.71 to 3.67), somatisation (2.61, 1.65 to 4.13) and better physical health and well-being (0.96, 0.94 to 0.99) remained independently associated with wrist or hand pain in the past month.
This study highlights that wrist or hand pain is prevalent in hospital nurses. Workplace physical factors and personal factors were associated with wrist or hand pain. Further longitudinal investigation is needed to examine the predictive nature of these factors.
It common in sport for the most severe injuries to be considered as those leading to missed-time from the sport.
Of course, at some level, every program is targeted. Clinicians don't offer smoking cessation advice to non-smokers. Nor do we typically discuss child safety restraint with non-parenting adults. Similarly, most intervention...]]>
Clinical studies increasingly report brain injury and not pulmonary injury following blast exposures, despite the increased frequency of exposure to explosive devices. The goal of this study was to determine the effect of personal body armour use on the potential for primary blast injury and to determine the risk of brain and pulmonary injury following a blast and its impact on the clinical care of patients with a history of blast exposure.
A shock tube was used to generate blast overpressures on soft ballistic protective vests (NIJ Level-2) and hard protective vests (NIJ Level-4) while overpressure was recorded behind the vest.
Both types of vest were found to significantly decrease pulmonary injury risk following a blast for a wide range of conditions. At the highest tested blast overpressure, the soft vest decreased the behind armour overpressure by a factor of 14.2, and the hard vest decreased behind armour overpressure by a factor of 56.8. Addition of body armour increased the 50th percentile pulmonary death tolerance of both vests to higher levels than the 50th percentile for brain injury.
These results suggest that ballistic protective body armour vests, especially hard body armour plates, provide substantial chest protection in primary blasts and explain the increased frequency of head injuries, without the presence of pulmonary injuries, in protected subjects reporting a history of blast exposure. These results suggest increased clinical suspicion for mild to severe brain injury is warranted in persons wearing body armour exposed to a blast with or without pulmonary injury.
In 2009, more than 9000 children and adolescents 0–19 years old in the USA died from an unintentional injury—with the main causes of these injuries being motor vehicle crashes, suffocation, drowning, poisoning, fire and falls.
To test the predictive ability of multinomial regression method in obtaining category of death distribution for cases with unknown/ill-defined mortality codes.
The authors evaluated the performance of the multinomial regression model by fitting the model to trial datasets from 2004 Mexican vital registration data. To predict category of death, the regression method makes use of explanatory variables, such as gender, age, place of crash, place of residence, education and insurance type. The authors compared the results of a full model regression with those of a reduced model that only contained gender and age as explanatory variables. For this comparison, the authors constructed two forms of data: dummy variable adjustment method and case-wise deleted method. The comparison was made through estimated area under the curve (AUC) for each outcome variable.
The full model significantly outperformed the gender-age (reduced) model using both datasets. In the case-wise deleted method, the AUC was increased from 0.55 to 0.7 for the reduced model and from 0.64 to 0.84 for the full model. Improvement in AUC using the dummy variable adjustment method was less significant.
To predict ill-defined categories of death, adding relevant explanatory variables to gender and age is recommended. Multiple imputations may perform even better than this model especially when significant portion of the data are missing.
Many residential fire deaths occur in homes with no or non-functioning smoke alarms (SAs). Self-reported SA coverage is high, but studies have found varying validity for self-report measures. The authors aim to: (1) determine over-reporting of coverage, (2) describe socio-demographic correlates of over-reporting and (3) report reasons for over-reporting.
The authors surveyed 603 households in a large, urban area about fire safety behaviours and then tested all SAs in the home. 23 participants who over-reported their SA coverage were telephoned and asked about why they had misreported.
Full coverage was reported in 70% of households but observed in only 41%, with a low positive predictive value (54.2%) for the self-report measure. Most over-reporters assumed alarms were working because they were mounted or did not think a working alarm in a basement or attic was needed to be fully protected.
If alarms cannot be tested, researchers or those counselling residents on fire safety should carefully probe self-reported coverage. Our findings support efforts to equip more homes with hard-wired or 10 year lithium battery alarms to reduce the need for user maintenance.
Apprentice thoroughbred racing jockeys have a higher fall rate than their more experienced counterparts. The authors describe rates of occurrence and investigate risk factors for falls among less-experienced thoroughbred flat racing jockeys in Australia who commenced their race riding career between August 2002 and July 2009.
Data on race-day falls were extracted from stewards' reports. Denominator data were provided by Racing Information Services Australia on races conducted in Australia. HRs were estimated using time-to-event (survival analysis) methods.
Factors found to be associated with falls by less-experienced jockeys (as indicated by number of career rides or career stage) were older jockey age at commencement of career (p=0.001), fewer previous rides this meeting (p<0.001), fewer previous starts by the horse (p<0.001), younger horse age (p<0.001), lower race grade (p<0.001), lower prize money (p<0.001), shorter race distance (p<0.001) and drier track rating (p<0.001). Apprentice experience was inversely and strongly associated with increased rates of falls (p<0.001). Three indicators of less accomplished horses (lower race grade, fewer previous starts by the horse and less prize money at stake) and two race conditions (drier tracks and shorter race distance) were found to be associated with a progressively higher hazard of falls for less-experienced jockeys.
This study identified factors that preferentially contribute to falls by inexperienced jockeys. The authors suggest that consideration be given to restricting apprentice jockeys with little race-riding experience from riding horses that have not yet won a race (maiden) or that have had few previous race starts.
Suicides among active duty US Army personnel have been increasing since 2004, surpassing comparable civilian rates in 2008. This analysis uses US military data to assess suicide rates for the 2-year period 2007–8, and examines relative risks (RR) of suicide associated with mental health disorders.
Historical trends of US Army suicides were assessed using 1977–2008 data from Army G-1 (Personnel). Suicide rates, RR and the 2000–8 trends of mental health disorders were calculated using data from the Defense Casualty Information Processing System and Defense Medical Surveillance System.
A total of 255 soldiers committed suicide in 2007–8 (2008 rate 20.2 per 100 000). Factors associated with higher suicide risk included male gender, lower enlisted rank and mental health disorders treated on an outpatient basis (RR 3.9), as well as a number of mental health disorders (mood disorders, anxiety disorders, post-traumatic stress disorder, personality/psychotic disorders, substance-related disorders and adjustment disorder; RR range 4.7–24.5). Analysis of historical trends suggested that 25–50% of the suicides that occurred in 2008 might have been related to the major commitment of troops to combat beginning in 2003.
The recent increase in suicides parallels an increase in the prevalence of mental disorders across the army. This finding suggests that increasing rates of clinically treated psychopathology are associated with increasing rates of suicides; these rates probably serve as sentinels for suicide risk in this population. Soldiers seeking treatment for mental disorders and substance abuse should be a focus for suicide prevention.
To determine whether pedestrian countdown signals (PCS) reduce pedestrian–motor vehicle collisions in the city of Toronto, Canada.
A quasi-experimental study design was used to evaluate the effect of PCS on the number of pedestrian–motor vehicle collisions in the city of Toronto, from January 2000 to December 2009. Each intersection acted as its own control. We compared the number of pedestrian–motor vehicle collisions per intersection-month before and after the intervention. Stratified models were used to evaluate effect modification by pedestrian age, injury severity and location (urban vs inner suburbs). Poisson regression analysis with repeated measures (generalised estimating equations) was used to estimate the RR and 95% CI.
The analysis included 9262 pedestrian–motor vehicle collisions at 1965 intersections. The RR of collisions after PCS installation was 1.014 (95% CI 0.958 to 1.073), indicating no statistically significant effect of PCS on collisions. There was no evidence to suggest effect modification between PCS and collisions by age, injury severity or location.
The installation of PCS at 1965 signalised intersections in Toronto did not reduce the number of pedestrian–motor vehicle collisions at these intersections.
An International Classification of Diseases code-based case definition for non-fatal abusive head trauma (AHT) in children <5 years of age was developed in March 2008 by an expert panel convened at the Centers for Disease Control and Prevention (CDC). This study presents an application of the CDC recommended operational case definition of AHT to US hospital inpatient data to characterise the AHT hospitalisation rate for children <5 years of age.
Nationwide Inpatient Sample (NIS) data from the Healthcare Cost and Utilisation Project from 2003 to 2008 were examined.
Inspection of the NIS data resulted in the identification of an estimated 10 555 non-fatal AHT hospitalisations with 9595 classified as definite/presumptive AHT and 960 classified as probable AHT. The non-fatal AHT rate was highest among children aged <1 year (32.3 per 100 000) with a peak in hospitalisations between 1 and 3 months of age. Non-fatal AHT hospitalisation rates for children <2 years of age were higher for boys (21.9 per 100 000) than girls (15.3 per 100 000). The non-fatal AHT hospitalisation rate showed little variation across seasons.
To reduce the burden of AHT in the USA, a preventable public health problem, concerted prevention efforts targeting populations at risk should be implemented. This report demonstrates a model procedure for using the new CDC definition for public health surveillance and research purposes. Such findings can be used to inform parents and providers about AHT (eg, dangers of shaking, strategies for managing infant crying) as well as to monitor better the impact of prevention strategies over time.
Despite the fact that the A6 mortality reporting system has been operating for almost 20 years in Vietnam, there has been no systematic evaluation of the system. This study assesses the completeness, sensitivity and positive predictive value of the system in relation to injury related mortality.
Evaluation of the A6 system was undertaken in three (geographically distributed) provinces in Vietnam. Deaths identified in the A6 system were compared with deaths identified by an independent consensus panel to determine the per cent completeness of the A6 system. Verbal autopsies (VA) were conducted for all identified deaths from the consensus panels, and the sensitivity and positive predictive value of the A6 system were assessed using the VAs as the reference.
5273 deaths were identified from the A6 system with a further 340 cases identified by the independent consensus panel (total n=5613). Injury related deaths accounted for 13.6% (n=763) of all deaths with an overall injury mortality rate of 55.3 per 100 000 person years. The per cent completeness of the A6 system in relation to injury deaths was 93.9% with a sensitivity of 75.4%, specificity of 98.4% and positive predictive value of 88.4%.
The A6 mortality reporting system is embedded within the commune health system and is the lead mortality reporting system for the Ministry of Health. The system performs well in relation to its completeness and classification of injury related deaths. With further enhancements and ongoing support from government and donor agencies, the A6 system will be a valuable resource for identifying and planning preventive strategies targeting the leading causes of injury related deaths in Vietnam.
Child fatality review (CFR) is the systematic, interdisciplinary, multi-agency examination of paediatric deaths. While CFR findings may influence policies and reduce preventable fatalities, limited resources challenge accurate CFR data collection and prevention recommendations. Therefore, using technology to improve efficiency of reviews and access to remote participants could enhance the CFR experience. This project aimed to adapt a previously developed collaborative web-based appliance for remote, secure, collaborative review of crash investigations for use with CFR.
The user-centred design and evaluation process included: (1) key informant interviews and visits to CFR sessions to determine current practices, (2) an anonymous, qualitative, internet-based survey of 64 Pennsylvania CFR team leaders, (3) redesign and adaptation of the Telecenter appliance based on survey results and team feedback and (4) pilot-testing of the adapted Telecenter application at an actual local CFR.
The qualitative informant interviews identified facilitators and barriers for adoption of the Telecenter. Facilitators included: team member training, improved communication and collaboration, more efficient reviews, and enhanced preventive efforts. Barriers identified included: concern for confidentiality and security, concern about accepting a novel CFR method, low interest in using technology, cost and maintenance. The survey of CFR team leaders identified themes for improving CFR team functioning including the need for evidence-based prevention resources, increased team training and efficient information gathering. The Telecenter was redesigned and adapted based on the information gathered and was successfully piloted for use with CFR.
Telecenter met the design goal to improve information dissemination and identification of fatality prevention strategies for CFR.
To assess pedestrians' perceptions of the walkability of the urban environment and pedestrian safety in Cali, Colombia.
Standardised intercept interviews were conducted of 400 pedestrians walking in 20 randomly selected urban zones to ascertain frequency of walking, and perceptions of safety, the built environment and security. Four focus group meetings were held with community members and students addressing these issues in an open-ended forum. The study analysed quantitative data collected in street interviews and qualitative information from focus groups addressing respondents' views on problems for pedestrians, how the built environment affects walking and ideal walking conditions.
Access to public transportation was deemed the most positive characteristic of the built environment and 61% of respondents liked walking in the street. When disaggregating street conditions, the majority of pedestrians were dissatisfied with their walking experiences. Pedestrians cited lack of respect for norms, personal safety and built environment characteristics as their main concerns. Among frequent walkers, residents tended to rate their neighbourhoods more negatively compared with non-residents. Through qualitative interviews it became apparent that narrow sidewalks that are frequently obstructed by motor vehicles are a key reason for pedestrian dissatisfaction. A perception of overall insecurity further determines how pedestrians assess or modulate their walking in this city.
Overall, walking in Cali was perceived negatively by pedestrians because of built environment characteristics and perceptions of insecurity. Qualitative information used to complement intercept surveys can provide a better way to identify pedestrian-specific transport-related problems.
The association between distraction caused by cell phone use while driving and driver/passenger fatalities has been documented, but the safety risks associated with headphone use by pedestrians remains unknown.
To identify and describe pedestrian–vehicle crashes in which the pedestrian was using headphones.
A retrospective case series was conducted by searching the National Electronic Injury Surveillance System, US Consumer Product Safety Commission, Google News Archives and Westlaw Campus Research databases for reports published between 2004 and 2011 of pedestrian injuries or fatalities from crashes involving trains or motor vehicles. Cases involving headphones were extracted and summarised. The likelihood of headphone involvement was graded on a three-tier scale based on the information found in the article or report.
There were 116 reports of death or injury of pedestrians wearing headphones. The majority of victims were male (68%) and under the age of 30 (67%). The majority of vehicles involved in the crashes were trains (55%), and 89% of cases occurred in urban counties. 74% of case reports stated that the victim was wearing headphones at the time of the crash. Many cases (29%) mentioned that a warning was sounded before the crash.
The use of headphones with handheld devices may pose a safety risk to pedestrians, especially in environments with moving vehicles. Further research is needed to determine if and how headphone use compromises pedestrian safety.
To describe child car safety practices among children aged 0–8 years. Eight schools from two local government areas (LGAs) were selected by simple random sampling. Passenger cars were observed for child seating position and restraint use at each selected school as children were being dropped off in the morning.
Observed child restraint use was very low, as was the rate of appropriate restraint for age (10.8% and 4.2%, respectively, in Eti-Osa, and 7.0% and 1.8% in Ikeja). Child restraint use decreased with increasing age group from 25% in those below 1 year, to 12% in those aged 1–3 years, and 7.4% in those aged 4–8 years. A large proportion of restrained passengers were inappropriately restrained in a seatbelt alone. Front seating among observed child passengers was not as high as in studies from similar environments (9.4% and 17.5% in Eti-Osa and Ikeja, respectively). Factors associated with child restraint use were number of child passengers in car, and whether or not the driver wore a seatbelt. Seating position of the child was significantly associated with the relationship of the driver to the child, and driver's gender.
The level of child restraint use observed in this study is unacceptably low. The relatively low prevalence of front seating while riding in cars should however be further reduced. The study recommends the enactment of specific country legislation on the use of child restraints, accompanied by multifaceted intervention programmes to improve the availability and use of child car safety seats and booster seats.
Gang violence accounted for 20% of homicides in large cities from 2002 to 2006. Preventing gang affiliation (ie, youth who either desire or have gang membership) might reduce subsequent gang activity. Previous research has focused on identifying risk factors for gang affiliation; however, little information is available on protective factors.
To identify risk and protective factors to provide more direction for gang violence prevention strategies.
The author analysed cross-sectional survey data from 4131 youths in grades 7, 9, 11 and 12. Data were collected in 2004 from students in a high-risk, urban public school district. Regression analyses were conducted to assess the association between gang affiliation and alcohol and drug use, delinquency, depressed mood, suicidal ideation, peer victimisation, parental monitoring and positive reinforcement, adult, family and peer support, coping skills, and school connectedness. Analyses were controlled for sex, race/ethnicity and age.
An estimated 7% of youths were gang affiliated. Adjusting for all factors, gang affiliation was positively associated with engaging in any delinquent behaviours (prevalence OR: 2.07; 95% CI 1.18 to 3.64), frequent alcohol use (OR: 2.62; 95% CI 1.85 to 3.72) and frequent drug use (OR: 1.95; 95% CI 1.15 to 3.29). Gang affiliation was negatively associated with moderate levels of parental monitoring (OR: 0.67; 95% CI 0.54 to 0.85) and coping skills (OR: 0.54; 95% CI 0.42 to 0.71).
The findings suggest the potential benefit of increasing parental monitoring and coping skills and reducing delinquency, alcohol use and drug use to prevent gang affiliation.
To examine emergency department (ED) data sharing via a local injury surveillance system and assess its contribution to the prevention of violence and alcohol-related harms.
6-year (2004–2010) exploratory study analysing injury attendances to one ED in the North West of England using descriptive and trend analyses.
Over the 6-year period, there were 242 796 ED injury attendances, including 21 683 for intentional injuries. Compared with unintentional injury patients, intentional injury patients were more likely to be men, aged 18–34 years, live in the most deprived communities, have attended the ED at night/weekends, have been injured in a public place and have consumed alcohol prior to the injury. Detailed data collected on alcohol and violence-related ED attendances were shared with local partners to monitor local trends and inform prevention activity including targeted policing and licensing enforcement. Over the 6-year period, intentional ED injury attendances decreased by 35.6% and alcohol-related assault attendances decreased by 30.3%.
The collection of additional ED data on assault details and alcohol use prior to injury, and its integration into multi-agency policy and practice, played an important role in driving local violence prevention activity. Further research is needed to assess the direct contribution ED data sharing makes to reductions in violence.
Exploring the characteristics of recommendations generated from medicolegal death investigations is an important step towards improving their contribution to injury prevention. This study aimed to: (1) quantify coroners' recommendations; and (2) examine the nature of these recommendations according to public health principles of injury causation and prevention.
Deaths where coroners' recommendations were and were not made in the State of Victoria, Australia during the period 1 July 2000 to 30 June 2005 were compared by sex, age group and underlying cause of death. The nature of recommendations made was examined retrospectively using a derived model based on principles of injury causation and prevention, comprising seven elements: (1) priority population; (2) risk/contributing factors; (3) countermeasure; (4) level of intervention; (5) strategy for implementation; (6) organisation; (7) time frame for implementation.
Coroners' recommendations were relatively rare, made in only ~6% of external-cause deaths. When coroners did make recommendations, they were statistically significantly more likely for persons aged 0–14 years and deaths resulting from transport crashes, complications of medical and surgical care, drowning and inanimate mechanical forces. Of the coroners' recommendations, ~70% included at least four of the model's seven elements. The elements ‘countermeasure’ and ‘level of intervention’ were most commonly specified by coroners (~95%) in their recommendations.
This study shows that highly evolved medicolegal death investigation systems may not draw systematically from the scientific research evidence base to inform the formulation of coroners' public health and safety recommendations. To maximise its contribution to fatal injury prevention, the medicolegal death investigation may benefit from incorporation of a public health perspective.
Traumatic hand and finger amputations frequently lead to permanent disability.
To investigate their epidemiological characteristics and estimate the prevention potential among children 0–14 years old, through a cross-sectional survey.
Nationwide extrapolations were produced based on data recorded between 1996 and 2004 in the Greek Emergency Department Injury Surveillance System and existing sample weights. Incident and injury related characteristics were analysed to identify preventable causes.
Among 197 417 paediatric injuries, 28 225(14%) involved the hand and fingers resulting in 236 amputations (~1% of hand injuries). The annual probability to seek emergency department care for a hand injury was 3%. The estimated incidence rate (IR) of hand amputations was 19.7/100 000 person-years. Over 50% concerned children 0–4 years old (male:female=2:1), peaking at 12–24 months. Male preschoolers suffered the highest IR (38.7/100 000). Migrant children were overrepresented among amputees. Of all amputations, 64% occurred in the house/garden and 14% in day-care/school/sports activities, usually between 08:00 and 16:00 (61%). Doors were the product most commonly involved (55% overall; 72% in day-care/school/gym) followed by furniture/appliances (15%) and machinery/tools (7%). Crushing was the commonest mechanism. Inadequate supervision and preventive measures were also frequently reported. 5% of the amputees were referred to specialised units for replantation/reconstructive surgery.
The majority of paediatric hand and finger amputations could be prevented in Greece, particularly among preschoolers, by a single product modification, namely door closure systems, coupled with improved supervision. Paediatricians should incorporate this advice into their routine child-safety counselling. This country-specific profile supports the need for maintaining similar databases as an indispensable tool for assisting decision-making and preventing disabling and costly injuries.
To examine falls in older people in the Wellington–Dufferin–Guelph (WDG) health region of Ontario, Canada, and to identify areas with excess RR and associated risk factors, particularly those related to private dwellings.
Cases of hospitalisation following falls among older people in the WDG health region between 2002 and 2006 were geocoded to the dissemination area level and used in the spatial analysis. The falls data and covariates from the 2006 Canadian census were analysed using Poisson log-linear models with (spatial and non-spatial) random effects at the dissemination area level. A Bayesian approach with Markov chain Monte Carlo simulation allowed the spatial random effects models to be fitted. Map decomposition was used to visualise the results.
The percentage of occupied private dwellings requiring repairs and median income were significantly associated with falls in older people in the WDG health region. Twenty-six dissemination areas with high RR of falls in older people in the WDG health region were identified. Map decomposition revealed that RR were also driven by unknown factors that have spatial patterns.
This research identified an association between falls in older people and housing conditions; the higher the percentage of dwellings requiring repairs in an area, the higher its risk of falls in older people. Bayesian spatial modelling accounts for measurement errors and unobserved or unknown risk factors that have spatial patterns. The findings have the potential to contribute to future research in reducing falls in older people and generate more interest in using Bayesian spatial modelling approaches in injury and public health research.
The suicide rate is a macro indicator of the population's psychosocial wellbeing and an evaluation criterion of the effectiveness of suicide prevention strategies. A high level of injury deaths of undetermined intent (UD) is usually discussed in connection with the validity of suicide statistics. An effort is made to develop a criterion to characterise the quality of suicide statistics.
Standardised rates of suicides (X60–X84) and UD (Y10–Y34) by the International Classification of Disease version 10 as an average for the past five available years were taken from the WHO European mortality database. Rate ratios were computed by dividing rates of UD by suicide rates.
There is considerable variation in suicide and UD rates among countries. The highest overall rates of UD were registered in Russia, Ukraine and Belarus, and the lowest in Greece, Spain and Italy. The EU-15 average UD rate of 1.97 and the rate ratio of 0.194 UD to suicides were combined into a ‘2-20 benchmark’, in which the primary indicator is 2.0 UD cases per 100 000 and the secondary indicator is the proportion of UD to suicides 0.20 (20%), which enables countries to be clustered according to the quality of suicide statistics. The following countries satisfied the benchmark: Greece, Norway, Spain, The Netherlands, Luxembourg, France, Austria, Italy, Romania, Hungary, Ireland and Finland.
This study used the developed ‘2-20 benchmark’ in Europe to assess suicide registration quality in a particular country, to compare the relative position of countries, and to set a target for those European countries that have not yet achieved the benchmark.
Although firefighting and emergency medical services are high-risk professions, few studies have identified the aetiology of injury in the fire service beyond the fireground.
Data were collected for work-related injuries in a medium-sized metropolitan fire department. In a descriptive study, the factors explored included the nature of injury, agent, mechanism, body location, environment, abbreviated injury scale (AIS), functional capacity index (FCI) and lost time status.
From 2004 to 2009, the annual injury incidence rate averaged 17.7 per 100 employees. One-third of all injuries (32.9%) resulted from physical exercise activities, while patient transport, training drills and fireground operations resulted in 16.9%, 11.1% and 10.2% of injuries, respectively. For all job operations, sprains and strains were the most prevalent type of injury (40.2–85.2%), followed by contusions and lacerations (7.7–26.1%). The third most common injury was related to the conventional hazards of the individual job operation. Most injuries (n=862, 95.6%) were minor in severity, while 4.3% of injuries were classified as having some impedance of normal function (FCI 3). Moderate injuries (AIS 2) were infrequent, but comprised a greater proportion of fireground injuries (8.7%) than the other activities (1.0–4.1%); however, lost time injuries were more frequent for patient transport (46.1%) than other operations (22.0–29.1%).
Physical exercise, patient transport and training activities were responsible for a greater percentage of injuries than fireground operations. Focused efforts to improve the characterisation of risks during these more diverse set of work processes should help guide the development of salient strategies for injury prevention.
This paper examines the relationship between the amount of bicycle use and the number of single-bicycle crashes (ie, only one cyclist involved) in Dutch municipalities. Previous research has focused on crashes between bicycles and motor vehicles; however, most cyclists admitted to hospital are victims of single-bicycle crashes.
This correlational study used three data sets which included data relating to single-bicycle crashes and kilometres travelled by bicycle. Negative binomial regression was used to compare the amount of bicycling with the number of injuries incurred in single-bicycle crashes in Dutch municipalities.
The likelihood of single-bicycle crashes varied inversely with the level of bicycle use. The exponent for the change in the number of single-bicycle crashes in response to changes in bicycle volumes was <1 in all analyses (ie, the increase in the number of single-bicycle crashes in a given municipality is proportionally less than the increase in the number of bicycle kilometres travelled by its inhabitants). The value was reduced in analyses of single-bicycle crashes with more severe injuries.
Cyclists are less likely to be involved in a severe single-bicycle crash in municipalities with a high amount of cycling. Given the large numbers of patients admitted to hospital as a result of single-bicycle crashes, it is important to include the risks of these in road safety and health effect evaluations, and to take into account the non-linearity of the relationship between single-bicycle crashes and bicycle use if road safety measures are to affect the level of bicycle use.
Falls are the leading cause of injury in older adults. Identifying people at risk before they experience a serious fall requiring hospitalisation allows an opportunity to intervene earlier and potentially reduce further falls and subsequent healthcare costs. The purpose of this project was to develop a referral pathway to a community falls-prevention team for older people who had experienced a fall attended by a paramedic service and who were not transported to hospital. It was also hypothesised that providing intervention to this group of clients would reduce future falls-related ambulance call-outs, emergency department presentations and hospital admissions.
An education package, referral pathway and follow-up procedures were developed. Both services had regular meetings, and work shadowing with the paramedics was also trialled to encourage more referrals. A range of demographic and other outcome measures were collected to compare people referred through the paramedic pathway and through traditional pathways.
Internal data from the Queensland Ambulance Service indicated that there were approximately six falls per week by community-dwelling older persons in the eligible service catchment area (south west Brisbane metropolitan area) who were attended to by Queensland Ambulance Service paramedics, but not transported to hospital during the 2-year study period (2008–2009). Of the potential 638 eligible patients, only 17 (2.6%) were referred for a falls assessment.
Although this pilot programme had support from all levels of management as well as from the service providers, it did not translate into actual referrals. Several explanations are provided for these preliminary findings.
To monitor accurately injury incidence trends, indicators should measure incidence independently of extraneous factors. Frequencies and rates of New Zealand's serious non-fatal self-harm indicators may be prone to fluctuations in reporting owing, for example, to changing social norms. Hence, they have been considered provisional.
To validate empirically the serious non-fatal self-harm indicators.
All serious non-fatal first admissions to hospital were identified and classified according to whether principal diagnosis (PDx) was injury or mental disorder, and conversely whether contributing diagnoses were mental disorder or injury. The proportion assigned self-harm external cause of injury code (E-code) was calculated for each year from 2001 to 2007. Subsequently, all cases with a self-harm E-code were identified, and the proportion with a PDx of injury and contributing diagnosis of mental disorder, or PDx of mental disorder and contributing diagnosis of injury over time, were determined.
No linear changes over time were detected in the proportion of cases assigned an injury PDx, or the proportion assigned a mental disorder PDx, or the proportion with a self-harm E-code. The estimated maximum observed increase in the frequency of serious non-fatal self-harm hospitalisation explained by changes in reporting was 19– 40%.
Identification of serious non-fatal self-harm events using an operational definition of PDx of injury, a self-harm first listed E-code, and an appropriate severity cut-off point, is a valid method of monitoring incidence and rates in New Zealand.
Millions of all-terrain vehicles (ATV) are used around the world for recreation by both adults and youth. This increase in use has led to a substantial increase in the number of injuries and fatalities each year. Effective strategies for reducing this incidence are clearly needed; however, minimal research exists regarding effective educational interventions.
This study was designed to assess rural ATV riders' preferences for and assessment of safety messages.
13 focus group discussions with youth and adult ATV riders were conducted. 88 formative research participants provided feedback on existing ATV safety materials, which was used to develop more useful ATV safety messages. 60 evaluative focus group participants critiqued the materials developed for this project.
Existing ATV safety materials have limited effectiveness, in part because they may not address the content or design needs of the target population. ATV riders want educational and action-oriented safety messages that inform youth and adult riders about their responsibilities to learn, educate and implement safety behaviours (eg, appropriate-sized ATV, safety gear, solo riding, speed limits, riding locations). In addition, messages should be clear, realistic, visually appealing and easily accessible. Newly designed ATV safety materials using the acronym TRIPSS (training, ride off-road, impairment, plan ahead, safety gear, single rider) meet ATV riders' safety messaging needs.
To reach a target population, it is crucial to include them in the development and assessment of safety messages. Germane to this particular study, ATV riders provided essential information for creating useful ATV safety materials.
To obtain national estimates of the annual cumulative incidence and incidence density of severe non-fatal injuries using compensation benefits data from the Brazilian National Social Security Institute (INSS), and to describe their sociodemographic distribution among workers aged under 25 years.
Data are records of health-related compensation benefits from the Ministry of Social Insurance's information system of compensation benefits of the INSS recorded in 2006. Injuries were cases classified under chapter XIX, ICD-10. The assessment of their relation with work was made by INSS's occupational physician experts. The study population comprised young workers aged 16–24 years.
59 381 workers received compensation benefits for injuries in the study year. Among them 14 491 (24.4%) were work related, 12 501 (86.3%) were male and 1990 were female workers (13.7%). The annual cumulative incidence rate of work-related injuries (ACI–WI) was 2.9x1000 workers, higher among men (4.2x1000) than women (1.0x1000). The incidence density rate (IDR–WI) was 0.7/1000 full-time equivalent (FTE), higher for men (0.97/1000 FTE) than women (0.24/1000 FTE). Both morbidity measures were higher in the younger group (16–19 years), and inversely related to wage, especially for women in the younger group. Logging, extraction, food/beverage and construction industries had higher ACI–WI and IDR–WI for adolescents and young adult workers of both sex groups.
These findings suggest that the Brazilian labour laws limiting young adult workers in hazardous settings need to be expanded, adding occupations in other extractive industries and certain types of work in the food/beverage manufacturing industries. Social inequalities associated with sex need to be examined further with more detailed data.
Taipei has seen a substantial increase in suicide rates during the past decade, with a significant rise between 2004 and 2006, the time of this study period.
A decompositional analytic method was used to quantify the relative contributions of age, sex and case fatality of methods to attempts and suicides.
From 2004 to 2006, the rate of fatal and non-fatal suicide attempts combined for population aged 15 years or above in Taipei increased by 37.3%, while the suicide rate increased by 29.2%. Three factors in these analyses contributed to the increase in suicide rates: (1) an increase in number of attempts, (2) a greater proportion of men among fatal and non-fatal attempts and (3) an increase in the use of a lethal method—burning of charcoal to produce carbon monoxide. The authors estimated that 74.5% and 25.6% among men and women, respectively, of the overall increased suicide mortality were attributable to increased ‘charcoal burning suicides.’
The rise in suicide rate reflected an increase in attempts and an influx of working-age men joining the pool of people attempting suicide. The much larger size of the attempter pool had the effect of reducing the case fatality even as the suicide rate climbed. The increase in the number of suicide attempts and the rise in the suicide rate were age-, sex-, and method-specific. These results strongly support the concept that reducing the total number of attempts is a central element to curbing suicides.
To investigate the association of carbonated non-diet soft drink consumption and violence perpetration in a sample of Boston adolescents.
In a survey of Boston public high schools, respondents were asked how often they drank non-diet soft drinks and whether they had carried a weapon or engaged in physical violence with a peer. Regression analysis was used to determine the role of soft drink consumption in these behaviours.
Adolescents who drank more than five cans of soft drinks per week (nearly 30% of the sample) were significantly more likely to have carried a weapon and to have been violent with peers, family members and dates (p<0.01 for carrying a weapon and p<0.001 for the three violence measures). Frequent soft drink consumption was associated with a 9–15% point increase in the probability of engaging in aggressive actions, even after controlling for gender, age, race, body mass index, typical sleep patterns, tobacco use, alcohol use and having family dinners.
There was a significant and strong association between soft drinks and violence. There may be a direct cause-and-effect relationship, perhaps due to the sugar or caffeine content of soft drinks, or there may be other factors, unaccounted for in our analyses, that cause both high soft drink consumption and aggression.
In March of 2008, an expert panel was convened at the Centers for Disease Control and Prevention to develop code-based case definitions for abusive head trauma (AHT) in children under 5 years of age based on the International Classification of Diseases, 10th Revision (ICD-10) nature and cause of injury codes. This study presents the operational case definition and applies it to US death data.
National Center for Health Statistics National Vital Statistics System data on multiple cause-of-death from 2003 to 2007 were examined.
Inspection of records with at least one ICD-10 injury/disease code and at least one ICD-10 cause code from the AHT case definition resulted in the identification of 780 fatal AHT cases, with 699 classified as definite/presumptive AHT and 81 classified as probable AHT. The fatal AHT rate was highest among children age <1 year with a peak in incidence that occurred at 1–2 months of age. Fatal AHT incidence rates were higher for men than women and were higher for non-Hispanic African–Americans compared to other racial/ethnic groups. Fatal AHT incidence was relatively constant across seasons.
This report demonstrates that the definition can help to identify population subgroups at higher risk for AHT defined by year and month of death, age, sex and race/ethnicity. This type of definition may be useful for various epidemiological applications including research and surveillance. These activities can in turn inform further development of prevention activities, including educating parents about the dangers of shaking and strategies for managing infant crying.
Interurban roads account for a significant proportion of traffic deaths in developing countries. In this pilot study, hazard perceptions of interurban road sites involved in ≥3 injury road traffic crashes were compared with those not involved in road traffic crashes on the same road sections.
Karachi–Hala (Pakistan) and Yaoundé–Douala (Cameroon) road sections were the main study settings.
Videos of 26 high-risk sites and 26 low-risk sites from Karachi–Hala (Pakistan) and Yaoundé–Douala (Cameroon) roads, matched for the road section, were shown to 100 voluntary Pakistani drivers. Variations in perceived site hazardousness and preferred speed for each site pair were assessed.
Factors associated with incorrect hazard perception of high-risk sites (perceived as safe) were assessed by multinomial logistic regression analyses.
Drivers reported a higher hazard perception and a lower preferred speed for high-risk sites than for their matched low-risk sites in less than half of pairs (n=12, p≤0.02). Factors associated with increased likelihood of identifying a high-risk site as safe were as follows: flat road profile (adjusted OR=2.00, 95% CI 1.55 to 2.57), intersections (OR=1.96, 95% CI 1.43 to 2.68), irregular road surface (OR=3.56, 95% CI 2.68 to 4.71), nearby road obstacles (OR=2.57, 95% CI 1.96 to 3.39) and visible rain (OR=1.85, 95% CI 1.48 to 2.32).
The methods used in this study might be useful in prioritising cost-effective improvements at high-risk sites.
The aim of this study was to compare attitudes regarding ski helmet use in helmet wearers and non-wearers.
In total, 924 persons ≥18 years (52% men and 48% women) participating in sport programmes at the University Sports Institute Innsbruck/Austria were interviewed about their attitudes regarding ski helmets and scored 14 statements on a five-level Likert Scale. A factor analysis was employed to determine clusters of underlying attitudes that have subsequently been used as predictors of helmet non-use in a conditional logistic regression analysis.
In total, 65% of participants declared to use a helmet during their preferred winter sport activity while more than 80% of helmet wearers and non-wearers totally agreed that helmets protect from head injuries. According to the factor analysis, attitudes about ski helmets clustered around four major dimensions—subjective disadvantages, safety awareness, comfort/style and risk compensation. Adjusted ORs of regression analysis showed that helmet non-use increased with age and decreased with increasing skill level (beginner: OR 5.4, 95% CI 2.6 to 11.1; intermediate: OR 4.3, 95% CI 2.4 to 7.9; advanced: OR 3.1, 95% CI 1.7 to 5.4). In addition, helmet non-use was associated with subjective disadvantages (OR 2.3, 95% CI 1.8 to 2.9). However, a negative association between helmet non-use and safety awareness (OR 0.3, 95% CI 0.2 to 0.4) was found.
Helmet use was associated with higher safety awareness, while most arguments against helmet use seem to belong to subjective perception and to represent anticipatory negative cognitions, poorly supported by evidence. Therefore, evidence-based information about wearing a ski helmet should be implemented in preventive helmet campaigns focusing on non-wearers. In addition, health communication programmes should be instituted to get non-helmeted skiers and snowboarders to try out helmets to eliminate their potential prejudices.
This study assesses the impact on safety of a system designed to enhance sleep in car passengers. The system holds the head posteriorly and limits its rotation in the sagittal and frontal planes, modifying the occupant's head position. This device may have an influence on the interaction between the occupant and the vehicle restraint systems.
It was a randomised, prospective, single-blind, cross-over controlled study in which 41 volunteers were exposed to using the system while riding as car passengers. Whether the device influenced the posture of the occupants and prevented them from adopting out-of-position (OOP) configurations was also analysed. Occupants were videotaped while they were using both the innovative system (cases) and their normal sleeping device (controls), if any.
Controls were exposed to OOP situations in 825 occasions (18.4%; 95% CI 17.3% to 19.6%), while cases were exposed in 416 occasions (9.3%; 95% CI 8.4% to 10.2%). The paper also analysed how many cases and controls were exposed at least once to a particular event and how frequent a single participant incurred in an OOP situation. In both cases, the innovative device showed a reduction in exposition. When OOP situations were grouped into severe, moderate and minor events, the innovative device produced a statistically significant reduction in the occurrence of severe and moderate events.
A device originally designed to improve comfort and rest in car passengers has been found to reduce the exposure of the occupants to being OOP while resting in the car.
http://www.ClinicalTrials.gov, NCT01062295.
This study was conducted to examine whether passage of the mandatory motorcycle helmet law in 1997 reduced the regional inequality in mortality from road traffic injuries (RTIs) across 22 cities/counties in Taiwan.
We calculated the absolute (between-group variance, BGV) and relative (rate ratio between the city/county with the highest and lowest rate, RR) terms of inequality for the overall and motorcycle-related RTI mortality rates, the rate of helmet use and three other explanatory factors associated with RTI mortality at the city/county level from 1997 through 2008.
The BGV of the overall and motorcycle-related RTI mortality rates across the 22 cities/counties showed persistently decreasing trends from 1997 to 2008; however, the RR of RTI mortality first increased and then levelled off from 2002. The decreasing trend in inequality was most prominent in males aged 0–24 years. The BGV and RR of the rate of motorcycle helmet use decreased after passage of the law but increased from 2002 onwards.
In Taiwan, passage of the mandatory motorcycle helmet law reduced the regional inequality in RTI mortality; however, a resurgence in regional inequality in the helmet use rate years after passage of the helmet law was noted. It is therefore necessary to monitor the helmet use rate after passage of such a law to ensure the effect of a reduction in regional inequality in RTI mortality.
Slips and falls are a leading cause of injury at work. Several studies have indicated that slip-resistant shoes can reduce the risk of occupational slips and falls. Few studies, however, have examined the determinants of slip-resistant shoe use. This study examined the individual and workplace factors associated with slip-resistant shoe use.
475 workers from 36 limited-service restaurants in the USA participated in a study of workplace slipping. Demographic and job characteristic information about each participant was collected. Restaurant managers provided information on whether slip-resistant shoes were provided and paid for by the employer and whether any guidance was given regarding slip-resistant shoe use when they were not provided. Kitchen floor coefficient of friction was measured. Slip-resistant status of the shoes was determined by noting the presence of a ‘slip-resistant’ marking on the sole. Poisson regression with robust SE was used to calculate prevalence ratios.
320 participants wore slip-resistant shoes (67%). In the multivariate analysis, the prevalence of slip-resistant shoe use was lowest in 15–19-year age group. Women were more likely to wear slip-resistant shoes (prevalence ratio 1.18, 95% CI 1.07 to 1.31). The prevalence of slip-resistant shoe use was lower when no guidance regarding slip-resistant shoes was given as compared to when they were provided by the employer (prevalence ratio 0.66, 95% CI 0.55 to 0.79). Education level, job tenure and the mean coefficient of friction had no significant effects on the use of slip-resistant shoes.
Provision of slip-resistant shoes was the strongest predictor of their use. Given their effectiveness and low cost, employers should consider providing slip-resistant shoes at work.
Comparison of characteristics of fire with non-fire households to determine factors differentially associated with fire households (fire risk factors).
National household telephone survey in 2004–2005 by the US Consumer Product Safety Commission with 916 fire households and a comparison sample of 2161 non-fire households. There were an estimated 7.4 million fires (96.6% not reported to fire departments) with 130 000 injuries.
Bivariate analysis and multivariate logistic regression analyses to assess differences in household characteristics.
Significant factors associated with fire households were renting vs. owning (OR 1.988 p<0.0001); household members under 18 year of age (OR 1.277 p<0.0001); lack of residents over 64 years old (OR 0.552 p=0.0007); and college or higher education (some college OR 1.444 p=0.0360, college graduate OR 1.873, p<0.0001, postgraduate OR 2.156 p<0.0001). Not significant were age of house; race; ethnicity; and income. Number of smokers was borderline significant (OR 1.132 p=0.1019) but was significant in the subset of fire households with non-cooking fires (OR 1.383 p=0.0011). Single family houses were associated with non-fire households in the bivariate analysis but not in the multivariate analyses.
Renting, household members under 18 years old and smokers are risk factors for unattended fires, similar to the literature for fatal and injury fires. Differences included household members over 65 years old (associated with non-fire households), college/postgraduate education (associated with fire households) and lack of significance of income. Preventing cooking fires (64% of survey incidents), smoking prevention efforts and fire prevention education for families with young children have the potential for reducing unattended fires and injuries.
Cars fitted with aircraft-style black boxes which can send video footage about driving behaviour during crashes to the police and insurance companies are being developed. ‘The car will record information about the vehicle speed, steering and braking along with video footage from inside and outside the vehicle. This would be automatically sent to police and insurance companies in the event of an accident to make it easier to determine the cause of car crashes and identify the person responsible.’ The Daily Telegraph TGM (CTVglobemedia Publishing Inc).
As reported in Traffic Injury Prevention, in a 1-year period, the cost of medical care and productivity losses associated with injuries from motor vehicle crashes in the USA exceeded US$99 billion, with the cost of direct medical care accounting for US$17 billion—that is, nearly US$500 for each licensed driver.