The article "Trends in the drowning mortality rate in Iran" by Pegah Derakhshan et al. in Injury Prevention · August 2020 DOI: 10.1136/injuryprev-2019-043225 is a valuable contribution to understanding the trend of drowning in Iran. However, It is true that the authors of the article used statistical methods to estimate the levels and trends of drowning mortality rate based on Death Registry System (DRS) data, which is known to be incomplete and subject to misclassification. In Iran, data sources for attributing fatal and non-fatal drowning are include DRS, FMS and INDR. However, it is important to note that drowning incidents and fatalities are universally underreported in the Iran.
The Death Registry System (DRS) is a new system, managed by Iran’s Ministry of Health, is currently being expanded to the whole of Iran. Records for this registry system are also generated using death certificate information. If not available – by verbal autopsy. DRS that information is collected from records generated by many other sources: rural health house, health and treatment centres (rural, urban), hospitals, register offices (1). Previous study resulted that DRS registry reported 60% of all rural cases, while the records reported a slight majority of urban cases (about 51%) (2).
Iran's Forensic Medicine Organization manages the Forensic Medical System (FMS), which is used to identify many injury-related deaths in the country. The FMS records are based on inf...
The article "Trends in the drowning mortality rate in Iran" by Pegah Derakhshan et al. in Injury Prevention · August 2020 DOI: 10.1136/injuryprev-2019-043225 is a valuable contribution to understanding the trend of drowning in Iran. However, It is true that the authors of the article used statistical methods to estimate the levels and trends of drowning mortality rate based on Death Registry System (DRS) data, which is known to be incomplete and subject to misclassification. In Iran, data sources for attributing fatal and non-fatal drowning are include DRS, FMS and INDR. However, it is important to note that drowning incidents and fatalities are universally underreported in the Iran.
The Death Registry System (DRS) is a new system, managed by Iran’s Ministry of Health, is currently being expanded to the whole of Iran. Records for this registry system are also generated using death certificate information. If not available – by verbal autopsy. DRS that information is collected from records generated by many other sources: rural health house, health and treatment centres (rural, urban), hospitals, register offices (1). Previous study resulted that DRS registry reported 60% of all rural cases, while the records reported a slight majority of urban cases (about 51%) (2).
Iran's Forensic Medicine Organization manages the Forensic Medical System (FMS), which is used to identify many injury-related deaths in the country. The FMS records are based on information from death certificates, local police departments, and for drowning cases often include information from reports made by the Red Crescent Society, which employs many of the lifeguards and health care providers in the area. The completeness of the FMS records for drowning was found to be 54.4% in a study that compared the FMS records with the Death Registry System records(3).
Iran National Registry of Drowning (INRD), which is the national statistical database of Iran for registering drowning cases.
It is believed that using a combination of DRS, FMS and INDR databases with other available sources can improve the accuracy and completeness of drowning data collection in Iran. Statistical estimation alone may not provide accurate data, and a more comprehensive approach is needed to better understand the burden of drowning in Iran and develop effective prevention strategies.
According to the results of the article, it is necessary to address the insufficiency of Death Registry System (DRS) and the underestimation of drowning rates in certain areas to improve the accuracy of drowning data collection in Iran. For example, Guilan and Mazandaran provinces in northern Iran bordering the Caspian Sea are tourist destinations, and if a tourist person drowns in a specific area (Guilan province), but their residence is in another area (for example, Qom province in central Iran), the drowning data is added to the area of residence, leading to inaccurate data. It is worth noting that many provinces in central Iran, such as Qom and Yazd, which do not have access to water, have been estimated to have high rates of drowning. Therefore, it is important to use a combination of DRS and Forensic Medicine Service (FMS) databases with other available sources to improve the accuracy and completeness of drowning data collection in Iran.
In addition, according to the previous study, children aged 11-15 years and boys are particularly at risk of drowning in Iran, with a boy to girl ratio of approximately 2:1 (4). However, the results of the study mentioned in the previous question may not be in accordance with this finding due to the incomplete dataset used. One study published in Guilan and Mazandaran provinces in northern Iran revealed a male-to-female relative risk of 5.84 in the resident population during the first year of measurement, which rose to 10.9 during the final year of the study period (5). However, it is not clear how this finding relates to the overall trend in drowning mortality rate in Iran, which has been reported to have decreased from 1990 to 2015, with an annual percentage change of -5.28% for males and -10.73% for females.
Furthermore, the method section of the article mentioned that to estimate the rate of death due to drowning in the Iranian population from 1990 to 2015, ICD-10 codes V90, V90.0, V90.01–V90.9, V92–V92.9, W65–W70.9, and W73–W74.9 were considered as drowning, while there is no dataset in Iran that is based on ICD-10. However, the Iran National Registry of Drowning (INRD), has recently been established as the national statistical database of Iran for registering drowning cases based on ICD-10 in northern Iran.
Efforts to improve data collection methods and accuracy can help address this public health problem and reduce the burden of drowning in Iran. Some studies have suggested that drowning prevention programs can be effective in reducing drowning mortality rates in Iran, and high-quality local drowning data can be employed to target and model prevention effort.
Ali Davoudi Kiakalayeh MD, PhD, Assistant Professor, Department of Preventive and Social Medicine, School of Medicine, Guilan University of Medical Sciences. Rasht, Iran, davoudikiakalayeh@gmail.com
1. Davoudi-Kiakalayeh A, Dalal K, Yousefzade-Chabok S, Jansson B, Mohammad R. (2011). Costs related to drowning and near drowning in northern Iran (Guilan province). Ocean & coastal management 54 (3), 250-255.
2. Kiakalayeh AD, Mohammadi R, Stark Ekman D, Yousefzade-Chabok S, Behboudi F, Jansson B. Estimating drowning deaths in Northern Iran using capture-recapture method. Health Policy (New York). 2011;100(2–3):290–6.
3. Ali Davoudi-Kiakalayeh, Reza Mohammadi, Shahrokh Yousefzade-Chabok, Sohiel Saadat. Road traffic crashes in rural setting: an experience of middle income country. Chinese Journal of Traumatology, 17(06):327-330, 2014.
4. Extent and trend of children drowning-A cohort study in northern Iran, Davoudi-Kiakalayeh et al, (Submitted).
5. Davoudi-kiakalayeh A, Mohammadi R, Yousefzade-Chabok S, Jansson B. Evaluation of a community-based drowning prevention programme in northern Islamic Republic of Iran. East Mediterr Heal J. 2013;19(7):629–37.
Thank you for reading the study. We appreciate your feedback and the suggestion of papers to include.
The Miller et al. 2021 paper was not yet indexed in EconLit at the time of the systematic review pull; therefore, was not included. However, even if we had identified the study it would not have been included in the final list of manuscripts as it does not include original analysis but rather combines previous estimates with new counts.
The Yang et al. 2014 paper was excluded during review as it included non-original analysis. This paper used several estimates from previously published literature and applied to Iowa counts.
Based on this response, we are issuing an erratum that clarifies that our manuscript only included research with original costs as inputs or outputs.
You are correct that we omitted several non-peer reviewed studies. In the study we state, “This review was limited to peer-reviewed publications and excluded books, non-peer reviewed publications, white papers and dissertations.”
This review has not considered several relevant previously published items. These include:
TR Miller, MA Cohen, D Swedler, B Ali, D Hendrie. Incidence and Costs of Personal and Property
Crimes in the United States, 2017, Journal of Benefit-Cost Analysis, 12:1, 24-54, 2021.
JZ Yang, TR Miller, N Zhang, B LeHew, C Peek-Asa. Incidence and Cost of Sexual Violence in Iowa,
American Journal of Preventive Medicine, 47:2, 198-202, 2014.
It also omits mention of Californian studies on the costs of sexual violence and on the costs of firearm
injury in Santa Clara County that are not in the peer-review journal literature, as well as the firearm
injury cost article in Mother Jones, and several other city firearm injury cost studies available on the
web.
Correspondence:
Nearly 60% of patients with traumatic spinal cord injury (SCI) experience different degrees of cognitive dysfunction, including impairment of memory and abstract reasoning.[1] A retrospective cohort study using Taiwan’s National Health Insurance Research Database revealed that SCI significantly increased the likelihood of dementia.[2] This result aligns with previous clinical reports stating that patients with SCI frequently develop long-term cognitive impairments.[1]
I read the article “Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years” [3] with deep interest. The study investigators have reported the outcomes from a comprehensive and long-term follow-up effort exploring the impact of traumatic SCI in Taiwan. In this study, Lien et al. classified traumatic SCI into traumatic quadriplegia and paraplegia with different mechanisms of injury. They reported that traumatic quadriplegia incurs higher lifetime medical costs than traumatic paraplegia.[3] Upon comparing the clinical characteristics of patients with traumatic quadriplegia and paraplegia, the prevalence of dementia after quadriplegia resulting from motor vehicle accidents (MVA) was found to be higher than that after paraplegia resulting from MVA (3.7% vs. 1.5%, p < 0.05).[3] The strength of this study lies in its comprehensive data on the SCI level, mechanisms of injury, and medical...
Correspondence:
Nearly 60% of patients with traumatic spinal cord injury (SCI) experience different degrees of cognitive dysfunction, including impairment of memory and abstract reasoning.[1] A retrospective cohort study using Taiwan’s National Health Insurance Research Database revealed that SCI significantly increased the likelihood of dementia.[2] This result aligns with previous clinical reports stating that patients with SCI frequently develop long-term cognitive impairments.[1]
I read the article “Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years” [3] with deep interest. The study investigators have reported the outcomes from a comprehensive and long-term follow-up effort exploring the impact of traumatic SCI in Taiwan. In this study, Lien et al. classified traumatic SCI into traumatic quadriplegia and paraplegia with different mechanisms of injury. They reported that traumatic quadriplegia incurs higher lifetime medical costs than traumatic paraplegia.[3] Upon comparing the clinical characteristics of patients with traumatic quadriplegia and paraplegia, the prevalence of dementia after quadriplegia resulting from motor vehicle accidents (MVA) was found to be higher than that after paraplegia resulting from MVA (3.7% vs. 1.5%, p < 0.05).[3] The strength of this study lies in its comprehensive data on the SCI level, mechanisms of injury, and medical costs. However, the study did not control for potential confounders, such as concurrent traumatic brain injury (TBI), dementia, and Charlson Comorbidity Index, that may have influenced medical costs. In patients with SCI, neurodegeneration and neuroinflammation after a traumatic injury may increase the risk of dementia. Wu et al. conducted SCI studies using animal models and demonstrated that chronic neuroinflammation with microglial activation is associated with neurodegeneration,[4] a pathogenesis similar to that of Alzheimer’s disease. Consequently, identifying potential risk factors of dementia in traumatic SCI patients and establishing a preventive strategy are essential in public health. A recent nationwide cohort study revealed that rehabilitation training (physical therapy and occupational therapy) in traumatic SCI lowers the risk of psychiatric disorders, including dementia and depression, after controlling for potential confounders, such as sex, age, and comorbidities.[5] If the authors want to compare the risk of dementia in SCI patients with quadriplegia and paraplegia, controlling for possible confounding factors, such as sex, age, and TBI, should be considered. Further studies exploring alternative interventions to prevent cognitive deterioration among individuals with traumatic SCI, especially among individuals with quadriplegia, are warranted.
Conflict of interest statement
The author has no conflict of interest to declare.
References:
1. Davidoff GN, Roth EJ, Richards JS. Cognitive deficits in spinal cord injury: epidemiology and outcome. Arch Phys Med Rehabil 1992;73:275–84.
2. Huang SW, Wang WT, Chou LC, et al. Risk of dementia in patients with spinal cord injury: A nationwide population-based cohort study. J Neurotrauma 2017;34:615–22.
3. Lien WC, Wang WM, Wang F, et al. Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years. Inj Prev 2021;injuryprev-2020-043943. [published online ahead of print: 22 Jan 2021]. doi:10.1136/injuryprev-2020-043943.
4. Wu J, Stoica BA, Luo T, et al. Isolated spinal cord contusion in rats induces chronic brain neuroinflammation, neurodegeneration, and cognitive impairment. Involvement of cell cycle activation. Cell Cycle 2014;13:2446–58.
5. Wan FJ, Chien WC, Chung CH, et al. Association between traumatic spinal cord injury and affective and other psychiatric disorders–a nationwide cohort study and effects of rehabilitation therapies. J Affect Disord 2020;265:381–8.
Partner violence during the COVID-19 pandemic: an emergency into the emergency
Pietro Ferrara, MD 1 *
Luciana Albano, MD 2
Affiliation
1. Center for Public Health Research, University of Milano – Bicocca, Monza, Italy
2. Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
* Corresponding author:
Pietro Ferrara
Center for Public Health Research, University of Milan - Bicocca
Via Cadore 48, I-20900 Monza, Italy
Phone +39 (0)39-2333097/8 p_ferrara@alice.it
To the Editor,
With interest, we read the publication by Jetelina and coll., titled “Changes in intimate partner violence during the early stages of the COVID-19 pandemic in the USA” [1], in which authors described changes in patterns of intimate partner violence (IPV) during lockdown restriction implemented in response to novel coronavirus disease (COVID-19) outbreak.
Similarly in Italy, a significant increase of IPV cases was recorded as early as the first weeks of March, when social isolation forced people to stay at home after the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, the government instituted the free phone number 1522 as help line for IPV victims, with the aim to reach mainly women, who always experience the greater burden of domestic violence and abuse [2]. The National Institute of Statistics (ISTAT) rel...
Partner violence during the COVID-19 pandemic: an emergency into the emergency
Pietro Ferrara, MD 1 *
Luciana Albano, MD 2
Affiliation
1. Center for Public Health Research, University of Milano – Bicocca, Monza, Italy
2. Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
* Corresponding author:
Pietro Ferrara
Center for Public Health Research, University of Milan - Bicocca
Via Cadore 48, I-20900 Monza, Italy
Phone +39 (0)39-2333097/8 p_ferrara@alice.it
To the Editor,
With interest, we read the publication by Jetelina and coll., titled “Changes in intimate partner violence during the early stages of the COVID-19 pandemic in the USA” [1], in which authors described changes in patterns of intimate partner violence (IPV) during lockdown restriction implemented in response to novel coronavirus disease (COVID-19) outbreak.
Similarly in Italy, a significant increase of IPV cases was recorded as early as the first weeks of March, when social isolation forced people to stay at home after the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, the government instituted the free phone number 1522 as help line for IPV victims, with the aim to reach mainly women, who always experience the greater burden of domestic violence and abuse [2]. The National Institute of Statistics (ISTAT) released data on the utilization of the 1522 line from March to June 2020, highlighting an increase of 119.7% of phone and chat contacts compared with the same period of 2019 (6,956 vs. 15,280). The majority of registered calls were attributable to violence and stalking cases, followed by questions on type of service offered and modality of access [3]. Interestingly, the time-trend analysis of calls showed that their number diminished during the weekend days as well as in correspondence of religious and national holidays (such as Easter April 12th; Liberation Day April 25th; Labor Day May 1st), likely attributable to a more control over victims’ freedom of movements.
Alongside the Italian data, findings from Jetelina and coll. described an emergency into the emergency, being also more severe than that came out from presented research and report. Indeed, coverage of data informing on IPV are limited and potential reporting biases should be related to sparsity and uncertainty in rural and peripheral areas, where people are less prone to trusting the provided services [2].
In this frame, further research is needed to provide more accurate estimates of the burden of IPV during the COVID-19 pandemic worldwide, in order to provide actionable metrics for the implementation of specific public health measures and social actions.
References
1. Jetelina KK, Knell G, Molsberry RJ Changes in intimate partner violence during the early stages of the COVID-19 pandemic in the USA Injury Prevention Published Online First: 01 September 2020. doi: 10.1136/injuryprev-2020-043831
2. James SL, Castle CD, Dingels ZV, et al Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017 Injury Prevention Published Online First: 24 April 2020. doi: 10.1136/injuryprev-2019-043494
3. Istituto Nazionale di Statistica (ISTAT). Il numero verde 1522 durante la pandemia (periodo marzo - giugno 2020). August 2020. Available at: https://www.istat.it/it/archivio/246557. Last accessed on September 3, 2020
4. Istituto Nazionale di Statistica (ISTAT). L’allerta internazionale e le evidenze nazionali attraverso i dati del 1522 e delle Forze di Polizia. La violenza di genere al tempo del coronavirus: Marzo - Maggio 2020. Available at: https://www.istat.it/it/files//2020/05/Dati-del-1522-e-delle-Forze-di-Po... accessed on September 3, 2020
Your air pollution reduction benefit is based on a very poor
assumption of all new cyclists were former drivers (per Rabl and De
Nazelle) could be no more wrong than in NYC with the biggest public
transit system in the US, lowest per capita car ownership and miles driven
of any major city, and where over 56% of workers use public transit, and
over 10% walk. Even the estimated 30% who drive or cab to work are
unlikely to...
Your air pollution reduction benefit is based on a very poor
assumption of all new cyclists were former drivers (per Rabl and De
Nazelle) could be no more wrong than in NYC with the biggest public
transit system in the US, lowest per capita car ownership and miles driven
of any major city, and where over 56% of workers use public transit, and
over 10% walk. Even the estimated 30% who drive or cab to work are
unlikely to convert to bicycling given how they might be elderly/disabled,
choose not to even walk to public transit bus stops and subway stations,
or may drive cabs or delivery vehicles for work.
Unless you get accurate survey information of mode shifts from new
cyclists since bike lane institution, you have no basis to make your huge
claims of air pollution reduction, and thus can't claim even 25% of the
air quality benefit you do to non-riders. In Rabl and De Nazelle cyclists
suffer from greater exposure to air pollution in traffic than non-riders.
Rider positive benefit is limited to added exercise.
I hope you reconsider your assumptions and calculations to produce a
more accurate estimation of bike lane cost-effectiveness.
On 25 April 2015 Nepal witnessed a huge earthquake of 7.8 magnitude
claiming over 8000 lives and injuring more than 23,000[1].Those injured
incurred either crush injuries, fractures or head and spinal cord trauma.
WHO estimates,over 400 people have sustained spinal cord injuries owing to
earthquake.[2]. They have become either paralyzed or developed weakness of
limbs (paraparesis) extending from neck downward (quadriparesi...
On 25 April 2015 Nepal witnessed a huge earthquake of 7.8 magnitude
claiming over 8000 lives and injuring more than 23,000[1].Those injured
incurred either crush injuries, fractures or head and spinal cord trauma.
WHO estimates,over 400 people have sustained spinal cord injuries owing to
earthquake.[2]. They have become either paralyzed or developed weakness of
limbs (paraparesis) extending from neck downward (quadriparesis) or in
lower limbs (paraparesis) with bladder and bowel dysfunction.
While many sustained primary injuries due to earthquake, many others
sustained secondary injuries due to improper transportation of these
patients to health facilities. Much of the reachable health facilities
were damaged by earthquake and thus patients needing immediate spinal
support were further deteriorated by this situation. In addition, majority
of the health care providers involved in the search ,rescue and the
evacuation were unaware of the concept of correct immobilization, log roll
and transport technique. The use of the spinal board was hardly seen. This
resulted in the neurological and vertebral damage further worsening to
complete SCI(Spinal Cord Injuries).
Spinal cord injury has a devastating effect in a person's life ranging
from psychosocial impact to the different grades of disability. The
challenges posed by spinal cord injuries vary in wide spectrum,
particularly treatment of which demands clinician's technical expertise
and advanced surgical facilities. Even in an advanced technical facility,
treatment requires a concentrated effort and dedication of both the
clinicians and the patients. With the good medical, nursing and
physiotherapy most of the cases can be revived back to the normal.
In Nepal, the only rehabilitation center, situated in Kavre district has
received 150 patients with spinal injuries during the period of April to
August 2015.There might have been several other cases of spinal cord
injuries which might have been undocumented. Many undocumented cases might
have been either unable to reach health center particularly, spinal cord-
treating centres or might have given up hopes. This suggests the need of
spinal injury treatment centres and inadequacy of current level of health
facilities.
Incomplete quadriplegia has good recovery while complete have bad
prognosis. In Saga Spinal cord injury treatment center, among the treated
cases, no death has been reported so far, however, the complications like
Pressure sore has been reported in 16 patients. Impairment of autonomous
dysfunction such as Urinary Treatment Centre has been reported in 50
patients and DVT (Deep Venous Thrombosis) in 6 patients. Out of the total
150 cases managed in this spinal cord treatment center, 50% underwent
surgery for unstable fracture of spine while remaining were managed
conservatively.
In Nepal there are 20 spinal surgeons, 12 physiotherapists and 6
occupational therapists. These professionals are overburdened by current
level of work. This necessitates the immediate need of further technical
human resources.
References:
1. Nepal, G.o., Post Disaster Needs Assessment. 2015: Nepal.
2. WHO, WHO mobilizes funds for long-term spinal cord treatment after
Nepal earthquake. 2015: Nepal.
We read with interest the article named 'Prevention and treatment of
decompression sickness using training and in-water recompression among
fisherman divers in Vietnam' that was published in Injury Prevention 2016
February issue. We want to share our opinion about some parts of the
article, especially in three subjects.
It was mentioned that, the aim of the study was to investigate the
impact o...
We read with interest the article named 'Prevention and treatment of
decompression sickness using training and in-water recompression among
fisherman divers in Vietnam' that was published in Injury Prevention 2016
February issue. We want to share our opinion about some parts of the
article, especially in three subjects.
It was mentioned that, the aim of the study was to investigate the
impact of training programmes run over a period of 3 years, focusing on
preventing DCS by reducing unsafe diving practices and treating DCS by
means of IWR, in the last sentence of introduction. So we understood that
the main subject of the study is forcing fisherman divers to make safe
dives resulting in decrease in DCS and also to treat urgently with IWR if
disease occurs. Therefore this education only involves lowering DCS and
treating with IWR. But it is remarked as "Since implementing IWR training,
annual mortality and morbidity incidence rates due to neurological DCS
were reduced in our pilot sample" in second sentence of discussion. It was
understood from the article, prior to 2009, annual mortality due to diving
was estimated 4?1 cases per 1000 fisherman divers and annual incidence of
DCS was 8?2 cases. Between 2009 and 2012 fatality rate dropped 1 per 1000
divers and annual incidence of DCS dropped 2?1 per 1000 divers. However we
know it is unlikely to have a mortality rate of four cases in every eight
DCS cases before 2009 and also one fatal case within two cases of DCS
between 2009 and 2012. Many studies was reported before about this issue,
in one of them Xu et al. showed nine deaths of 5278 consecutive DCS cases
with a incidence of 0.17% in a decade (1). It seems suspicious that one in
a two cases DCS mortality rate as mentioned in the article. Probably the
mortality reasons must be other than DCS, e.g. drowning, nitrogen narcosis
and diving related accidents, before 2009 and also between 2009 and 2012
in these dive sites. We found it very challenging; two days 10 subjects
IWR training courses reduced annual mortality rates due to the DCS.
On the other hand, in the treatment of DCS, there appears three main
goals; [1] immediate reduction in bubble size, [2] to increase the washout
of inert gas and [3] to provide oxygen delivery to the tissues to restore
normal functions (2). If we put an order in terms of treatment efficacy;
standart recompression treatment in chamber (oxygen, 45-60 feet), IWR with
oxygen, breathing oxygen at surface, IWR with air at working depth
(fisherman divers' traditional IWR), IWR with air (Clipperton Protocol, 9
m.) had superiority each other, respectively in the treatment of DCS. It
is well known that, in the absence of a hyperbaric chamber treatment, IWR
with oxygen of course superior to breathing oxygen at surface in DCS.
Known risks of IWR are drowning, applying difficulties, hypothermia and
disability to transfer patient to chamber because of being underwater. It
has been shown that IWR with air at 9 meters has no significant benefit in
DCS; also authors mentioned in the article IWR with air is useless which
the fisherman divers used to do traditionally. Nevertheless authors
advised to divers apply IWR with air at nine meters, which is the last
choice in treatment of DCS but they did not mention exactly why divers
should follow this protocol. If it is done with oxygen it should be
helpful but not with air. According to our knowledge IWR with air should
not be performed, if it is to be done deep treatment protocols must be
chosen, not at shallow depth like nine meters (3).
The last point we want to take attention is that only eight of 24 DCS
patients have been treated with oxygen, the rest were treated with air.
Unfortunately the number of divers, which were treated with oxygen, is
very low. However, two of eight of these patients (%25) started with
oxygen but continued with air, because the cases were not able to breathe
from a second stage regulator. In our opinion, if the rate (%25) is really
in high ranges like this, there could be given educations about using
hoses without second stage regulator.
Declaration of conflicting interests:
The authors declared no conflicts of interest with respect to the
authorship and/or publication of this letter.
Funding:
No author or related institution has received any financial benefit for
this letter.
References
1. Xu W1, Liu W, Huang G, Zou Z, Cai Z, Xu W. Decompression illness:
clinical aspects of 5278 consecutive cases treated in a single hyperbaric
unit. PLoS One. 2012;7(11):e50079.
2. Diving and Subaquatic Medicine, Fifth Edition. Carl Edmonds, Michael
Bennett, John Lippmann, Simon Mitchell. 2015. p. 167
3. 6th ed. USA: U.S. Navy Diving Manual, 2008
A survey of jail inmates done by J P May, D Hemenway, and A Hall
indicated that, among those who admitted to having been shot, 91% reported
having gone to the hospital for treatment. This comment explains why this
finding cannot be taken seriously.
Put yourself in the position of a jail inmate who was part of this
survey. Most jail inmates are awaiting trial. They are the most legally
vulnerable of all crimina...
A survey of jail inmates done by J P May, D Hemenway, and A Hall
indicated that, among those who admitted to having been shot, 91% reported
having gone to the hospital for treatment. This comment explains why this
finding cannot be taken seriously.
Put yourself in the position of a jail inmate who was part of this
survey. Most jail inmates are awaiting trial. They are the most legally
vulnerable of all criminals - unlike uncaught criminals they are subject
to legal punishment, yet unlike prison inmates, the punishment they will
receive is still to be determined - the hammer has not yet come down.
This is a set of criminals who are understandably obsessed with not
looking any more criminal to the authorities than they already appear.
How is this relevant to the jail survey conducted by May et al.? Suppose
you were a jail inmate who had been shot, but did not seek medical
treatment because you were shot while committing a crime, and knew that if
did go to the hospital, police would interrogate you as to how you got
shot and possibly connect you to the crime.
When such a jail inmate was asked whether they had ever been shot,
either of 2 things would happen. The inmate would either accurately
answer "yes" or would falsely deny having been shot, for the same reason
that they did not seek hospital treatment - they did not want to be
connected to the crime they were committing when they were shot. These
inmates would not be asked the follow-up question "Did you go to the
hospital for treatment of that wound?" They would simply be excluded from
further analysis, and therefore would not go into the computation of the
percent of the 307 gunshot-wounded inmates who had sought hospital care.
Instead, they would erroneously be placed in the set of 1,816 inmates who
did not report being shot. This is what is known to researchers as a
"censored sample" - the inmates who had been shot while committing a crime
and who did not seek hospital treatment would largely be "censored out" of
the sample, leaving mostly inmates who been shot in less incriminating
circumstances.
It is scarcely surprising that many of these 307 inmates had sought
medical treatment - those who were relatively "innocent victims" had no
reason not to go to the hospital. This sample, however, can tell us
nothing about the share of all criminals who are shot who received
hospital treatment, and certainly can tell us nothing about the share of
those shot by their victims while attempting a crime who received hospital
treatment.
Now consider those who accurately reported having been shot, among
those who had been shot by their victim while attempting to victimize
them, and who consequently did not go to the hospital. These inmates may
have been willing to report that they had been shot because they did not
anticipate the surveyors asking any follow-up questions, such as the one
concerning medical treatment. They were then asked the question as to
whether they went to the hospital to get treated. At that point, an
inmate of this sort could either accurately answer "no" or lie and answer
"yes."
How is such an inmate likely to perceive a truthful "no" answer? There is
no sensible legitimate reason why an innocent victim of a gunshot wound
would not seek professional medical treatment - being shot is a very
serious injury, and the medically sensible step is to seek professional
treatment of the injury. Only a person with something to hide from the
police in connection with that wounding would avoid going to the hospital.
The inmate knows this, and knows that the surveyors know it as well. So
how likely is it that this inmate, in these legally vulnerable
circumstances, would honestly answer "no"? Doing so would be tantamount
to confessing to yet another crime that the authorities did not yet know
about. Thus, there would be a powerful motivation to falsely answer
"Yes," and no strong motivation to accurately answer "No," beyond the
inmate's commitment to the general moral norm that one should not lie - a
commitment that is likely to be lower in a sample of jail inmates than in
the population as a whole.
In sum, (1) the subsample of jail inmates who had admitted having
been shot is likely to have excluded most of those who had avoided
hospital treatment because they were committing a crime when they were
shot, and (2) among those who admitted being shot, few inmates were
foolish enough to admit they had not sought medical treatment.
Consequently, the claim that 90% of the inmates who had been shot had gone
to the hospital cannot be given much credence.
The implicit underlying assumption of the researchers was that one
could expect truthful answers from jail inmates who had powerful reasons
to not be truthful. To be sure, those who had been shot as innocent
victims could afford to seek hospital treatment and could be truthful
about doing so when surveyed. These inmates probably account for most of
the 316 inmates who reported seeking treatment. In contrast, it is
extremely unrealistic to expect truthful answer from those who were shot
by their victims while committing crimes that the authorities either did
not know about, or did not know the inmate had committed. Inmates have no
reason to conceal crimes that the authorities already know about, and
prior research shows that they are indeed willing to self-report these
offenses in surveys. Crimes for which the offender was never arrested are
another matter entirely.
I
welcome Stevenson's participation and thank him for providing the
counterpoint to my commentary.[1, 2] Naturally I object to much of
it, starting with the title. We are not discussing the importance of
good science, rather what makes for it....
I
welcome Stevenson's participation and thank him for providing the
counterpoint to my commentary.[1, 2] Naturally I object to much of
it, starting with the title. We are not discussing the importance of
good science, rather what makes for it.
Stevenson
begins by taking us on a philosophical excursion: "The
underlying philosophy of science is that of [causal] determinism".
Determinism, causal or otherwise,[3] is but one item in an ontology,
and ontology is but one component of-- let us acknowledge that there
is still no unanimity[4, 5]-- a philosophy of science. Yet apart from
noting that transportation systems are systems, in terms of
philosophy my commentary concerned exclusively epistemological,
methodological and ethical matters. Thus the topic of determinism,
and Stevenson's entire introduction, is out of place. I don't know
how I could "totally dismis[s] the value of" something I
never touched upon.
Instead
of facing contemporary problems, Stevenson wishes I had used my
limited space to consider epidemiology's history, extolling in
particular much cited but nowadays little heeded works of Haddon[6]
and Gordon[7] (the bibliographic entry given here for the latter
being the correct one). Very well: Gordon emphasised the importance
of the accident-prone individual, and that injury could not be
effectively prevented without knowing the conditions under which
cases occur. To this end "causes are sought through direct
investigation of the site of the accident, of the associated
circumstances, and of the person who was injured", and further
that "The start is through field investigation, individual case
study of the patient, the family group, and the immediate
surroundings".
Does
this sound like the epidemiology of bicycling as we have known it--
or as countenanced by "evidence based medicine"?[8] Or did
the authors of highly consequential studies[9, 10, 11] use
improvised,
never-tested proxies?[2] Upon finding that none of their supposed
indicators of crash severity or street dangerousness accounted for
the outcomes of interest, did they get the idea that they had missed
the real factors;[2] or did they conclude to the contrary that
helmets were a virtual panacea and cycle tracks were safe without
qualification?
Elsewhere
Haddon,[12] citing the work of De Haven, himself famously a crash
survivor, emphasised that it was not impact velocity per se, but
impact conditions that determined injury outcome, and accordingly
placed emphasis on vehicle design. I discussed at relative length the
failure of epidemiologists to consider this. Haddon further
propounded that "measures which do not require the continued,
active cooperation of the public are much more efficacious than those
which do", and that operating to the contrary constitutes victim
blaming.[12] For the past three decades in the field of bicycling
safety, the public health community, with its all-helmets, all the
time approach, has devoted effectively all its efforts to violating
Haddon's prescriptions.
Stevenson
might consider that I am not the first to object to the
epidemiological approach to transportation safety. For one, the
eminent engineer Hauer already did so, for complementary reasons.[13]
Hauer was not unfair: he also skewered his own profession.[13, 14] I
recommend the public health community follow his example, and engage
in more profound self-criticism, and less profound
self-congratulation.
Rather
than continue with any of many further objections to Stevenson's
counterpoint, let me highlight a hidden agreement. Just as there is
no objection to harm reduction in drug policy, there is no objection
to evidence-based medicine, each being too vague a platitude. But
there is plenty of objection to Harm Reduction, and likewise to
Evidence Based Medicine: they are specific, institutionalised
implementations of contentious philosophies, albeit wrapped in the
corresponding platitudes. Stevenson says I suggest "that
epidemiology dismisses mechanism-based reasoning"; I do not. I,
and others, observe to the contrary that EBM dismisses
mechanism-based reasoning.[8, 15] In concert with other objections, I
therefore conclude that, in mistaking the wrapping for the content,
epidemiology has institutionalised an unrealistic philosophy (this
description was in response to reviewer objection: the original was
"primitive"). With his emphasis on causality and
mechanism-- each famously trans-empirical, not empirical[16] (the
work cited being Stevenson's choice[1], not mine)-- I am pleased to
see that Stevenson agrees.
References
1.
Stevenson M. Epidemiology and transport: good science is paramount.
Inj Prev (Published Online First 3 Sep 2014).
doi:10.1136/injuryprev-2014-041392
2.
Kary M. Unsuitability of the epidemiological approach to bicycle
transportation injuries and traffic engineering problems. Inj Prev
(Published Online First 14 Aug 2014).
doi:10.1136/injuryprev-2013-041130
3.
Bunge M. Does quantum physics refute realism, materialism and
determinism? Sci & Educ 2012;21:1601-1610.
doi:10.1007/s11191-011-9410-z
4.
Fishman YI, Boudry M. Does science presuppose naturalism (or anything
at all)? Sci & Educ 2013;22:921-949.
doi:10.1007/s11191-012-9574-1
5.
Mahner M. The role of metaphysical naturalism in science. Sci &
Educ 2012;21:1437-1459. doi:10.1007/s11191-011-9421-9
6.
Haddon W. On the escape of tigers: an ecologic note. Am J Pub Health
1970;60:2239-2234.
7.
Gordon JE. The epidemiology of accidents. Am J Pub Health
1949;39:504-515.
8.
OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence
2. Oxford Centre for Evidence-Based Medicine.
http://www.cebm.net/index.aspx?o=5653(accessed
Dec 2013).
9.
Thompson RS, Rivara FP, Thompson DC. A case-control study of the
effectiveness of bicycle safety helmets. N Eng J Med
1989;320:1361-1367.
10.
Thompson DC, Rivara FP, Thompson RS. Effectiveness of bicycle safety
helmets in preventing head injuries: a case-control study. JAMA
1996;276:1968-1973.
11.
Lusk AC, Furth PG, Morency P, et al. Risk of injury for bicycling on
cycle tracks versus in the street. Inj Prev 2011;17:131-135.
doi:10.1136/ip.2010.028696
12.
Haddon W. Advances in the epidemiology of injuries as a basis for
public policy. Pub Health Rep 1980;95:411-421.
13.
Hauer E. On exposure and accident rate. Traf Eng Cont
1995;March:134-138.
14.
Hauer E. A case for evidence-based road safety delivery. In:
Improving Traffic Safety Culture in the United States - The Journey
Forward, pp. 329-343. AAA Foundation for Traffic Safety: Washington,
DC, 2007. http://www.aaafoundation.org/pdf/Hauer.pdf(accessed
Dec 2013).
15.
Clarke B, Gillies D, Illari P, et al. The evidence that
evidence-based medicine omits. Prev Med 2013;57:745-747.
doi:10.1016/j.ypmed.2012.10.020
16.
Rosenberg A. Philosophy of Science: A Contemporary Introduction (2nd
ed.), 2005, pp. 35-37, 116-117. Routledge: New York.
The article "Trends in the drowning mortality rate in Iran" by Pegah Derakhshan et al. in Injury Prevention · August 2020 DOI: 10.1136/injuryprev-2019-043225 is a valuable contribution to understanding the trend of drowning in Iran. However, It is true that the authors of the article used statistical methods to estimate the levels and trends of drowning mortality rate based on Death Registry System (DRS) data, which is known to be incomplete and subject to misclassification. In Iran, data sources for attributing fatal and non-fatal drowning are include DRS, FMS and INDR. However, it is important to note that drowning incidents and fatalities are universally underreported in the Iran.
Show MoreThe Death Registry System (DRS) is a new system, managed by Iran’s Ministry of Health, is currently being expanded to the whole of Iran. Records for this registry system are also generated using death certificate information. If not available – by verbal autopsy. DRS that information is collected from records generated by many other sources: rural health house, health and treatment centres (rural, urban), hospitals, register offices (1). Previous study resulted that DRS registry reported 60% of all rural cases, while the records reported a slight majority of urban cases (about 51%) (2).
Iran's Forensic Medicine Organization manages the Forensic Medical System (FMS), which is used to identify many injury-related deaths in the country. The FMS records are based on inf...
Thank you for reading the study. We appreciate your feedback and the suggestion of papers to include.
The Miller et al. 2021 paper was not yet indexed in EconLit at the time of the systematic review pull; therefore, was not included. However, even if we had identified the study it would not have been included in the final list of manuscripts as it does not include original analysis but rather combines previous estimates with new counts.
The Yang et al. 2014 paper was excluded during review as it included non-original analysis. This paper used several estimates from previously published literature and applied to Iowa counts.
Based on this response, we are issuing an erratum that clarifies that our manuscript only included research with original costs as inputs or outputs.
You are correct that we omitted several non-peer reviewed studies. In the study we state, “This review was limited to peer-reviewed publications and excluded books, non-peer reviewed publications, white papers and dissertations.”
This review has not considered several relevant previously published items. These include:
TR Miller, MA Cohen, D Swedler, B Ali, D Hendrie. Incidence and Costs of Personal and Property
Crimes in the United States, 2017, Journal of Benefit-Cost Analysis, 12:1, 24-54, 2021.
JZ Yang, TR Miller, N Zhang, B LeHew, C Peek-Asa. Incidence and Cost of Sexual Violence in Iowa,
American Journal of Preventive Medicine, 47:2, 198-202, 2014.
It also omits mention of Californian studies on the costs of sexual violence and on the costs of firearm
injury in Santa Clara County that are not in the peer-review journal literature, as well as the firearm
injury cost article in Mother Jones, and several other city firearm injury cost studies available on the
web.
Correspondence:
Nearly 60% of patients with traumatic spinal cord injury (SCI) experience different degrees of cognitive dysfunction, including impairment of memory and abstract reasoning.[1] A retrospective cohort study using Taiwan’s National Health Insurance Research Database revealed that SCI significantly increased the likelihood of dementia.[2] This result aligns with previous clinical reports stating that patients with SCI frequently develop long-term cognitive impairments.[1]
I read the article “Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years” [3] with deep interest. The study investigators have reported the outcomes from a comprehensive and long-term follow-up effort exploring the impact of traumatic SCI in Taiwan. In this study, Lien et al. classified traumatic SCI into traumatic quadriplegia and paraplegia with different mechanisms of injury. They reported that traumatic quadriplegia incurs higher lifetime medical costs than traumatic paraplegia.[3] Upon comparing the clinical characteristics of patients with traumatic quadriplegia and paraplegia, the prevalence of dementia after quadriplegia resulting from motor vehicle accidents (MVA) was found to be higher than that after paraplegia resulting from MVA (3.7% vs. 1.5%, p < 0.05).[3] The strength of this study lies in its comprehensive data on the SCI level, mechanisms of injury, and medical...
Show MorePartner violence during the COVID-19 pandemic: an emergency into the emergency
Pietro Ferrara, MD 1 *
Luciana Albano, MD 2
Affiliation
1. Center for Public Health Research, University of Milano – Bicocca, Monza, Italy
2. Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
* Corresponding author:
Pietro Ferrara
Center for Public Health Research, University of Milan - Bicocca
Via Cadore 48, I-20900 Monza, Italy
Phone +39 (0)39-2333097/8
p_ferrara@alice.it
To the Editor,
Show MoreWith interest, we read the publication by Jetelina and coll., titled “Changes in intimate partner violence during the early stages of the COVID-19 pandemic in the USA” [1], in which authors described changes in patterns of intimate partner violence (IPV) during lockdown restriction implemented in response to novel coronavirus disease (COVID-19) outbreak.
Similarly in Italy, a significant increase of IPV cases was recorded as early as the first weeks of March, when social isolation forced people to stay at home after the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, the government instituted the free phone number 1522 as help line for IPV victims, with the aim to reach mainly women, who always experience the greater burden of domestic violence and abuse [2]. The National Institute of Statistics (ISTAT) rel...
Your air pollution reduction benefit is based on a very poor assumption of all new cyclists were former drivers (per Rabl and De Nazelle) could be no more wrong than in NYC with the biggest public transit system in the US, lowest per capita car ownership and miles driven of any major city, and where over 56% of workers use public transit, and over 10% walk. Even the estimated 30% who drive or cab to work are unlikely to...
On 25 April 2015 Nepal witnessed a huge earthquake of 7.8 magnitude claiming over 8000 lives and injuring more than 23,000[1].Those injured incurred either crush injuries, fractures or head and spinal cord trauma. WHO estimates,over 400 people have sustained spinal cord injuries owing to earthquake.[2]. They have become either paralyzed or developed weakness of limbs (paraparesis) extending from neck downward (quadriparesi...
Sir,
We read with interest the article named 'Prevention and treatment of decompression sickness using training and in-water recompression among fisherman divers in Vietnam' that was published in Injury Prevention 2016 February issue. We want to share our opinion about some parts of the article, especially in three subjects.
It was mentioned that, the aim of the study was to investigate the impact o...
A survey of jail inmates done by J P May, D Hemenway, and A Hall indicated that, among those who admitted to having been shot, 91% reported having gone to the hospital for treatment. This comment explains why this finding cannot be taken seriously.
Put yourself in the position of a jail inmate who was part of this survey. Most jail inmates are awaiting trial. They are the most legally vulnerable of all crimina...
I welcome Stevenson's participation and thank him for providing the counterpoint to my commentary.[1, 2] Naturally I object to much of it, starting with the title. We are not discussing the importance of good science, rather what makes for it....
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