In New Zealand (NZ), 20% of adults report a disability, of which one-third is caused by injury. No prospective epidemiological studies of predictors of disability following all-cause injury among New Zealanders have been undertaken. Internationally, studies have focused on a limited range of predictors or specific injuries. Although these studies provide useful insights, applicability to NZ is limited given the importance of NZ’s unique macro-social factors, such as NZ’s no-fault accident compensation and rehabilitation scheme, the Accident Compensation Corporation (ACC).
(1) To quantitatively determine the injury, rehabilitation, personal, social and economic factors leading to disability outcomes following injury in NZ. (2) To qualitatively explore experiences and perceptions of injury-related outcomes in face-to-face interviews with 15 Maori and 15 other New Zealanders, 6 and 12 months after injury.
Four geographical regions within NZ.
Prospective cohort study with telephone interviews 1, 4 and 12 months after injury.
2500 people (including 460 Maori), aged 18–64 years, randomly selected from ACC’s entitlement claims register (people likely to be off work for at least 1 week or equivalent).
Telephone interviews, electronic hospital and ACC injury data. Exposures include demographic, social, economic, work-related, health status, participation and/or environmental factors.
Primary: disability (including WHODAS II) and health-related quality of life (including EQ-5D). Secondary: participation (paid and unpaid activities), life satisfaction and costs.
Separate regression models will be developed for each of the outcomes. Repeated measures outcomes will be modelled using general estimating equation models and generalised linear mixed models.
To determine risk factors among licensed firearm retailers for disproportionate sales of handguns that are later subjected to ownership tracing, generally after use in crime.
Case–control; the study period was 1998–2003. Cases were all eligible firearm retailers whose handguns were later traced at a rate that significantly (p<0.05) exceeded the expected value. Controls were a 4:1 random sample of the remainder. Data were obtained from sales and tracing records for 1998–2003 and site visits conducted August–December, 2004.
60 cases and 240 controls, from the 573 retailers in California selling >= 50 handguns annually during the study period.
Status as a case. Odds ratios were used to measure relative risk.
In multivariate analyses, cases had larger sales volumes, sold inexpensive handguns more often, had a higher percentage of sales denied because the prospective purchasers were prohibited from owning firearms, and were more likely to be in an urban area, in or near a city with a policy of tracing all recovered crime guns. The effects of several risk factors, including status as a pawnbroker and sales to law enforcement personnel, appeared to be mediated by purchaser characteristics for which denied sales are a proxy measure.
A number of factors—most of them characteristics of the retailers or of their handgun purchasers, and most of them available in existing data—were linked to disproportionate sales of handguns that are later used in crime.
There are no validated observational surveys to assess injury hazards in the home environment.
To evaluate the reproducibility and reliability of a survey quantifying home injury hazards for children.
A nested cohort of children in the intervention arm of the Home Observations and Measures of the Environment (HOME) Study trial were analysed. The number and density of hazards were quantified by research assistants in the homes of participants at a baseline visit (BHV) for four high-risk rooms (kitchen, main activity room, child’s bathroom and child’s bedroom) and stairways and later at an intervention planning visit (IPV) for the four high-risk rooms and entire household. Statistical analysis included Pearson correlation, Bland–Altman analysis of agreement, analysis of variance and statistics.
There were163 households with measurements at BHV and IPV. The number and density of hazards for the four high-risk rooms correlated significantly between BHV and IPV (r = 0.50 and 0.75, respectively). The number and density of hazards for the four high-risk rooms correlated significantly with that for the whole household at the IPV (r = 0.17 and 0.52, respectively). The number of injury hazards was significantly higher in the kitchen than in the other high-risk rooms, whereas density was highest in the child’s bathroom. Inter-rater reliability between research assistants, as measured by the statistic, was excellent with a mean of 0.81.
The HOME Injury Survey was a reliable and replicable tool for quantifying residential injury hazards. The density of injury hazards was a more stable and valid measure than the number of injury hazards.
To determine whether information on number of falls on a falls history screen predicts risk of non-vertebral and hip fracture.
A cohort of 5995 community-dwelling men aged 65 years and older (mean 73.7) was followed over 7.2 years for incident non-vertebral fractures. Cox proportional hazard models were used to calculate hazard ratios (HRs) (95% CI) for incident fracture comparing a history of one and two or more falls with no falls. Models were adjusted for age, clinic, body mass index, height, femoral neck bone mineral density and whether the participant had a non-trauma fracture after the age of 50. p<=0.05 was considered to denote significance.
There were 498 incident non-vertebral fractures (15.5/1000 person-years) and 121 incident hip fractures (3.6/1000 person-years). Compared with men who had had no falls, the risk of non-vertebral and lower extremity fractures was significantly higher in men with one fall (HR = 1.54 (95% CI 1.22 to 1.96) and 1.91 (95% CI 1.36 to 2.67), respectively) and men with two or more falls (HR = 1.81 (95% CI 1.40 to 2.34) and 1.79 (95% CI 1.23 to 2.61), respectively). The risk of head/chest, upper extremity and hip fractures (HR = 2.22 (95% CI 1.42 to 3.49), 2.08 (95% CI 1.01 to 4.28) and 1.79 (95% CI 1.07 to 2.98), respectively) was significantly higher for two or more falls than no falls; however, equivalent risks were not significantly higher (HR = 1.36 (95% CI 0.88 to 2.20), 1.55 (95% CI 0.74 to 3.25) and 1.41 (95% CI 0.87 to 2.27), respectively) comparing men with one fall versus no falls.
Expanding clinical screens to include an assessment of fall frequencies may improve prediction of older men at risk of head/chest, upper extremity and hip fractures.
To analyse the injury-related content of children’s television programmes preferred by boys and by girls, and to determine whether there are more televised models of unsafe behaviour in programmes preferred by boys.
Parents of 4–11-year-old children identified their children’s favourite television programmes. Content analysis of 120 episodes of children’s favourite programmes was used to quantify safe and risky behaviours, actual injuries and potential injuries. The gender of the characters portraying the behaviours was also analysed.
More risky behaviour was portrayed in the boys’ favourite programmes (mean per episode = 6.40) than in the girls’ favourite programmes (mean = 2.57). There were almost twice as many potential injuries (n = 310) as actual injuries (n = 157). Potential injuries were portrayed more often by male characters (mean = 1.92) than female characters (mean = 0.98), mostly in the boys’ favourite programmes. Actual injuries occurred more often to male characters (mean = 1.04) than to female characters (mean = 0.27) overall.
Television programmes preferred by this sample of boys portrayed male role models engaging in risky behaviours and injuries more often than the programmes preferred by the sample of girls.
New Mexico (NM) has the highest rate of non-firearm-related homicide in the USA and ranks 20th in firearm-related homicides. Because non-firearm-related homicides are inadequately described in the literature, characterisation of non-firearm-related homicide victims will enhance efforts to reduce homicides.
Homicide victims were identified through the Office of the Medical Investigator. Age-specific and age-adjusted homicide death rates were calculated for 2001–3 by sex and race/ethnicity, and associations between covariates and non-firearm-related homicide were measured.
Non-firearm-related homicides comprised 33% of US homicide victims, 47% of NM homicide victims, and 74% of NM American Indian (AI) homicide victims. Of 212 NM non-firearm-related homicide victims, 37% had been beaten, 32% had been stabbed, and 12% had been strangled. Females comprised 30% of non-firearm-related homicide victims and 18% of firearm-related homicide victims. A blood alcohol concentration (BAC) >=0.08 mg/dl was detected among 43% of non-firearm-related (61% of AI) and 33% of firearm-related (50% of AI) homicide victims. Non-firearm-related homicide rates were highest among AI men aged 25–34 years (31/100 000). Non-firearm-related homicide victims were more likely than firearm-related victims to be AI (adjusted odds ratio (AOR) 4.20; 95% CI 2.16 to 8.16) and female (AOR 2.05; 95% CI 1.27 to 3.31), and to have had a BAC >=0.08 mg/dl (AOR 1.65; 95% CI 1.08 to 2.52).
Homicide-prevention efforts among AIs in NM should focus on non-firearm-related homicides. The association between excessive drinking and non-firearm-related homicide should be further characterised. Continued surveillance for non-firearm-related homicides will assist these efforts.
To examine the risk factors and precipitating circumstances associated with firearm suicide.
Data from the restricted National Violent Death Reporting System (2003–6) for 25 491 male and female suicide decedents aged 18 and older were analysed by multiple logistic regression to estimate the relative odds of firearm use with 95% CIs.
Firearms were often used in male (58.1%) and female (31.2%) suicides. Among male decedents, older age, veteran status, residing in areas with higher rates of firearm availability, raised blood alcohol concentration, acute crisis and relationship problems were all associated with firearm use. Conversely, men with a diagnosis of a mental health problem, a history of suicide attempts or alcohol problems had lower odds of firearm use. Among female decedents, factors with a significant effect on firearm use included: being older, married, white and a veteran; residing in areas with higher rates of firearm availability; having an acute crisis; having experienced the death of a relative or friend; being depressed; and having relationship problems. Of note, women who had a treated DSM-IV-diagnosed problem, previous suicide attempts and physical health problems were less likely to use firearms.
These findings challenge the conventional view that those who are severely depressed and suicidal are prone to highly lethal methods, such as firearms. Rather, firearms users may be reacting to acute situations.
To demonstrate the effect of including both principal and secondary injuries in the calculation of national estimates of non-fatal motor vehicle-related injury, using the National Electronic Injury Surveillance System–All Injury Program (NEISS–AIP).
The setting was a stratified sample of 15 US hospital emergency departments selected among 50 NEISS–AIP hospitals which agreed to participate in the study. Non-fatal injury data from a special study of the 2004 NEISS–AIP were analysed which allowed up to five injuries to be coded per case. National estimates of number and rate of injuries for 2004 were calculated, first using principal injuries alone, then by including principal and secondary injuries.
An estimated 4 833 626 principal and secondary injuries were sustained by the estimated 2 893 782 motor vehicle occupants involved in a crash and treated in US hospital emergency departments (EDs) in 2004. This represents a 67% increase in the total number of injuries compared with an estimate of principal injury alone. Incidence of contusions/abrasions and lower trunk injuries rose most steeply among broad injury types, and whiplash injury rose 18% in number and rate. A significantly lower percentage of cases with a single listed injury were hospitalised (5%) compared with those who sustained multiple injuries (8%).
Based on an analysis of NEISS–AIP special study data, the inclusion of both principal and secondary injuries in national estimates of motor vehicle-related occupant injury would provide a more comprehensive report of non-fatal injuries treated in US hospital EDs. Other countries with ED-based surveillance systems could consider reporting multiple injuries when assessing injury count associated with motor vehicle trauma requiring ED care.
There is growing recognition that different research approaches are necessary to understand the complex interaction between individual and social processes that contribute to risk-taking and injuries. Therefore, qualitative studies have an important role in injury prevention research. This article describes qualitative research in general and outlines some of the ways qualitative research can add to our understanding of injury. It also describes the role, format and methods of interviews (person-to-person and focus groups) commonly performed in qualitative studies, and proposes a novel approach to interviewing that has special relevance and value in injury research with indigenous populations. This methodology adapts focus group methods to be consistent with the goals and procedures of the traditional First Nations communities’ Sharing Circles. This adaptation provides a culturally appropriate and sensitive method of developing a deep and broad understanding of indigenous participants’ verbal descriptions of their feelings, their experiences and their modes of reasoning. After detailing of this adaptation of the Sharing Circle as a vibrant and vital interview and analysis method, the use of Sharing Circle interview methodology will be illustrated in a study investigating how an Alberta First Nations community experiences and deals with disproportionate levels of injuries arising from impaired driving, outlining important findings uncovered using this novel interviewing method. These findings have been informative to First Nations communities themselves, have informed policy makers provincially and nationally, and have instigated culturally appropriate intervention techniques for Canadian First Nations communities.
]]>To appraise the published epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption among young and middle-aged adults.
Systematic review.
Data sources: searches of electronic databases (eg, Medline, EMBASE, CINAHL, PsycINFO, Scopus), websites of relevant organisations, major injury journals, reference lists of relevant articles, and contact with experts in the field. Inclusion criteria: epidemiological studies with an English language abstract investigating alcohol use as a risk factor (exposure) for unintentional falls or related injuries among individuals aged 25–60 years. Studies were critically appraised using the GATE LITE tool. Meta-analysis was not attempted because of the heterogeneity of the eligible studies.
Four case–control, three cohort and one case–crossover study fulfilled the inclusion criteria. The studies showed an increased risk of unintentional falls among young and middle-aged adults with increasing exposure to alcohol use. However, the magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. Modest evidence of a dose–response relationship with acute alcohol use was observed. The association between usual alcohol use and fall risk was inconclusive, and evidence of a gender difference was inconsistent.
Alcohol use appears to be an important risk factor for falls among young and middle-aged adults. Controlled studies with sufficient power that adjust effect estimates for potential confounders (eg, fatigue, recreational drug use) are required to determine the population-based burden of fall-related injuries attributable to alcohol. This can help inform and prioritise falls prevention strategies for this age group.
In New Zealand (NZ), 20% of adults report a disability, of which one-third is caused by injury. No prospective epidemiological studies of predictors of disability following all-cause injury among New Zealanders have been undertaken. Internationally, studies have focused on a limited range of predictors or specific injuries. Although these studies provide useful insights, applicability to NZ is limited given the importance of NZ’s unique macro-social factors, such as NZ’s no-fault accident compensation and rehabilitation scheme, the Accident Compensation Corporation (ACC).
(1) To quantitatively determine the injury, rehabilitation, personal, social and economic factors leading to disability outcomes following injury in NZ. (2) To qualitatively explore experiences and perceptions of injury-related outcomes in face-to-face interviews with 15 Maori and 15 other New Zealanders, 6 and 12 months after injury.
Four geographical regions within NZ.
Prospective cohort study with telephone interviews 1, 4 and 12 months after injury.
2500 people (including 460 Maori), aged 18–64 years, randomly selected from ACC’s entitlement claims register (people likely to be off work for at least 1 week or equivalent).
Telephone interviews, electronic hospital and ACC injury data. Exposures include demographic, social, economic, work-related, health status, participation and/or environmental factors.
Primary: disability (including WHODAS II) and health-related quality of life (including EQ-5D). Secondary: participation (paid and unpaid activities), life satisfaction and costs.
Separate regression models will be developed for each of the outcomes. Repeated measures outcomes will be modelled using general estimating equation models and generalised linear mixed models.