Injury control and safety promotion

(2004). Global road safety. Injury Control and Safety Promotion: Vol. 11, No. 2, pp. 141-143.

Background: Violence against women is recognized globally as a serious health and social problem that impedes development. Objectives: To determine the magnitude of physical intimate partner violence against women in six selected communities from Chile, Egypt, India and the Philippines. Design: Population-based household surveys. Settings: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum, and Vellore non-slum areas of India; and in Manila, the Philippines. Participants: Women aged 15–49 years who cared for at least one child younger than 18 years old. The number of participants per community was 442 (Santa Rosa, Chile), 631 (El-Sheik Zayed, Egypt), 506 (Lucknow, India), 700 (Trivandrum, India), 716 (Vellore, India) and 1000 (Paco, the Philippines). Main Outcome Measures: Lifetime and Current physical intimate partner violence (IPV) was measured using standard definitions and four behaviors or actions – namely slap, hit, kick and beat. Three derived variables for severity included: disabling IPV, IPV-related injury requiring health care and multiple severe IPV (presence of hit and kick and beat). Results: Percentages of lifetime and current physical intimate partner violence (IPV) against women in our sample of 3975 were as follows: 24.9 and 3.6 (Santa Rosa), 11.1 and 10.5 (El-Sheik Zayed), 34.6 and 25.3 (Lucknow), 43.1 and 19.6 (Trivandrum), 31.0 and 16.2 (Vellore), and 21.2 and 6.2 (Paco). Multiple severe physical IPV was more common in the three communities within India (9.0%, 5.9% and 8.0% in Trivandrum, Lucknow and Vellore) than the other three communities (Santa Rosa 2.1%; El-Sheik Zayed 2.9% and Paco 1.9%). Conclusions: Physical IPV was found to be a common phenomenon in all six communities. Overall, patterns of IPV behaviors were similar among the six communities.

Background. Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing pedestrian injury in children 0–14 years of age. Methods. A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study; target population was children under 14 years; outcome measure is either pedestrian injury rates or observed child pedestrian or vehicle driver behaviour; and use of a community control or an historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results. The review found four studies that met all the inclusion criteria. The three studies using injury as their outcome measure found a 12%, 45% and 54% reduction for all childhood injuries with the fourth showing improved traffic control at child pedestrian sites (9% reduction in traffic flow) and sustainable community safety promotion activity. Conclusion. There is a paucity of research studies in the literature from which evidence regarding the effectiveness of community-based programmes for the prevention of pedestrian injury in children can be drawn. However, the hypothesis that community-based interventions are effective in reducing the incidence of childhood pedestrian injury would appear to be supported, with the degree of success being cumulative depending on the complexity of individual strategies employed.

Sports venues are in a position to potentially influence the safety practices of their patrons. This study examined the knowledge, beliefs and attitudes of venue operators that could influence the use of protective eyewear by squash players. A 50% random sample of all private and public squash venues affiliated with the Victorian Squash Federation in metropolitan Melbourne was selected. Face-to-face interviews were conducted with 15 squash venue operators during August 2001. Interviews were transcribed and content and thematic analyses were performed. The content of the interviews covered five topics: (1) overall injury risk perception, (2) eye injury occurrence, (3) knowledge, behaviors, attitudes and beliefs associated with protective eyewear, (4) compulsory protective eyewear and (5) availability of protective eyewear at venues. Venue operators were mainly concerned with the severe nature of eye injuries, rather than the relatively low incidence of these injuries. Some venue operators believed that players should wear any eyewear, rather than none at all, and believed that more players should use protective eyewear. Generally, they did not believe that players with higher levels of experience and expertise needed to wear protective eyewear when playing. Only six venues had at least one type of eyewear available for players to hire or borrow or to purchase. Operators expressed a desire to be informed about correct protective eyewear. Appropriate protective eyewear is not readily available at squash venues. Better-informed venue operators may be more likely to provide suitable protective eyewear.

(2004). A benefit-cost analysis of the Harlem hospital injury prevention program. Injury Control and Safety Promotion: Vol. 11, No. 1, pp. 55-57.

The municipality of Motala in Sweden introduced a local bicycle helmet ‘law’ on May 1, 1996. This is not a legally enacted ordinance, but instead a legislated recommendation backed up by information and education. Formally, the law applies to children (aged 6–12 years), although the intention is to increase helmet use by all cyclists. The objective of the present study was to quantitatively evaluate the impact of the Motala helmet law on observed use of helmets by children and adults. Bicycle helmet use was monitored in Motala (n = 2,458/year) and in control towns (n = 17,818/year) both before and after adoption of the helmet law (1995–1998). Chi-square tests showed that helmet wearing 1995–1998 increased in Motala among all bicyclists (from 6.1% to 10.5%) and adults biking on cycle paths (from 1.8% to 7.6%). Helmet use by school children aged 6–12 increased during the first 6 months after introduction of the law (from 65.0% to 75.7%) but then progressively decreased to the pre-law level. Considering children cycling on cycle paths and for recreation in housing areas, there was a tendency towards increased helmet use during the first post-law year, but this was followed by a reduction to a lower level in 1998 than in 1995. Logistic regression analysis taking into account data from the control towns indicated that the helmet law had a positive effect on children cycling to schools during the first 6 months, and a weak delayed but more long-term positive effect on adult cyclists on cycle paths. There were no positive effects on children in housing areas and on cycle paths. The Motala helmet law probably would have had greater and more lasting effects on helmet use by bicyclists, if certain problems had been avoided during the initiation phase. Moreover, although it did have a positive influence on both school children and adults, it is not legally binding, and hence no penalties can be imposed. Presumably, compulsory legislation would have a more substantial impact on helmet wearing than a non-mandatory helmet ‘law’ such as that introduced in Motala.

In spite of stringent regulations and much attention towards reducing risks in the physical environment, the mining industry continues to be associated with high levels of accidents, injuries and illnesses. Only engineering solutions to accident prevention are inappropriate unless coupled with focused attention to the attitudes and behaviours of the mineworkers in coping with the inherent physical, technical and situational risks. The present study identified these various risk factors and analysed their influences on work injury in a causal framework. Data were collected from an underground coalmine of India. The pattern and strength of relationships of 16 causal factors with work injuries were assessed through structural equation modelling. The case study results showed that negatively personified individuals are of major concern for safety improvement in the mine studied. They not only fail to avoid work injuries, they are unable to extend safe work behaviours in their work. The variable safety environment is negatively affected by personality, whereas social support has a positive relationship with safety environment. The variable job hazards appeared to have a significant relationship with job involvement, which has a negative relationship with work injury. Elimination of negative behaviours must be focused and committed by the mine safety management. Long term planning through (i) identification of negative individuals, (ii) proper councelling of adverse effects of negative behaviours, and (iii) special training with psychological treatment is highly required. Identification may begin while recruiting new workers through interview. Proper allocation of jobs (right person for right job) may be a judicial solution to this end.

Over many years, a great deal of effort has gone into reducing the number of people who are killed and injured as a result of performing construction work. Despite countless health and safety initiatives and campaigns, the industry remains dangerous. We believe that there are more effective ways of improving the safety of construction work. It must value and involve the people at risk.

The World Studies of Abuse in the Family Environment (WorldSAFE) designed and implemented a study of family violence – intimate partner violence and child abuse and neglect – using standardized methods to cover over 12,000 women in eighteen communities within five lesser-developed countries. The rationale, process and methods for developing the population-based survey are described. Standardized methods included common training of investigators and field staff, sampling strategies, eligibility criteria, instruments, data collection methods, operational definitions, analysis strategies and data management. Special features of the WorldSAFE model are described – namely an ecological conceptual framework, an extensive and broad-based dissemination strategy, and community advisory boards. The World Studies of Abuse in the Family Environment (WorldSAFE) Steering Committee and principal investigators are as follows: Bhopal (India): Gandhi Medical College, S.S. Bhambal (MD) and A.K. Upadhyaya (MD) Chapel Hill (USA): University of North Carolina at Chapel Hill, Shrikant Bangdiwala (PhD); Wanda Hunter (MPH); Desmond K. Runyan (MD, DrPH); and Laura S. Sadowski (MD, MPH) Chennai (India): Chennai Medical College, Saradha Suresh (MD) and Shuba Kumar (PhD) Delhi (India): All India Institute of Medical Sciences, R.M. Pandey (PhD) Ismailia (Egypt): Suez Canal University Faculty of Medicine, Fatma Hassan (MD, PhD) Lucknow (India): King George's Medical College, M.K. Mitra (MD) and R.C. Ahuja (MD) Manila (the Philippines): University of the Philippines School of Medicine, Laurie Ramiro (PhD); M. Lourdes Amarillo (MS); Bernadette Madrid (MD) Nagpur (India): Government Medical College, Dipty Jain (MD) São Paulo (Brazil): Escola Paulista de Medicina, Isabel Bordin (MD) and Cristiane Silvestre De Paula Temuco (Chile): Universidad de La Frontera, Sergio R. Muñoz (PhD) and Beatriz Vizcarra Thiruvananthapuram (India) formerly Trivandrum: Government Medical College, M.K.C. Nair (MD) and Rajamohanan Pillai (MD) Vellore (India): Christian Medical College, L. Jeyaseelan (PhD) and Abraham Peedicayil (MD)

Although studies have documented the association between Intimate Partner Violence (IPV) and mental health, few have been done in developing countries. In this study, the association between IPV and mental health in women from different developing countries was established. Women, 15 to 49 years old with at least one child 18 years old or younger, were randomly selected from communities in Chile, Egypt, India, and the Philippines (N = 3974). The Self Report questionnaire (SRQ) was used to assess mental health. Women with a score on the SRQ of 8 or more, or who reported ever attempting suicide, were classified as having poor mental health. Physical IPV was defined as being slapped, hit, kicked, beaten or threatened by a male partner during the past year. Psychological violence included being insulted or belittled, threatened or abandoned. Between 22.5% (in Egypt) to 41% (in Chile) of participating women reported a score of eight or more on the SRQ. High scores on the SRQ were significantly associated with current physical and psychological IPV in the samples from all participating countries except Chile. Twelve percent of women in Chile, 2.6%, in Egypt, 7.5% in India and 1.6% in the Philippines reported attempting suicide. Suicide attempts were also associated with current physical IPV in the Philippines, Egypt, and India, and with psychological violence in Egypt and India. IPV is a significant risk factor for poor mental health in these developing countries. Efforts to reduce IPV should be considered as part of a mental health program.

"Foreword: injury in Asia and the Pacific." Injury Control and Safety Promotion, 11(3), pp. 151–152

Injury surveillance has, and will continue to have, a critical role to play in reducing injury. If injury surveillance is going to realise its full potential in reducing injury, however, there are a number of challenges we need to address. These include: (1) agreeing on what is an injury, (2) focusing on important injuries, (3) improving surveillance of important injury events, and (4) improving surveillance of risk and protective factors.

Fundamental to any epidemiological research is the recruitment of a representative sample of participants. Selection bias can occur if volunteers self-select if they are worried about the specific exposure or injury outcome. Minimising selection bias is a particular concern when recruiting participants into a randomised controlled trial (RCT) of the effectiveness of a new intervention. Group RCTs, which randomly allocate a ‘pre-formed’ group rather than individuals to each study arm, can help to remove bias and eliminate contamination effects. Group randomisation of teams of players is an appropriate strategy for sports injury studies since there is a natural grouping of players into teams under the wider control of a single coaching team. However, teams of players are still required to volunteer for such studies. Ideally this should be done before randomisation to intervention arms. The Australian Football Injury Prevention Project (AFIPP) was an RCT to examine the effectiveness of headgear and mouthguards in Australian football. Community football teams from clubs in metropolitan Melbourne, Victoria were allocated to four intervention arms: (a) soft-shell headgear, (b) custom-made, tri-laminate mouthguards, (c) headgear and mouthguards, and (d) control. The sampling process required clubs to nominate whole teams of players to the same intervention arm. Clubs were not aware a priori of what protective equipment, if any, their players would be required to wear during the study. The aim of this study reported here was to identify any selection bias in the volunteering of clubs for AFIPP. Methods and procedures

BACKGROUND:China has made tremendous progress in its economic development in the past two decades. Accompanying this economic development has been an evident shift in the modes of transport, from walking and cycling to the use of motorcycles and, increasingly, four-wheel vehicles. Such changes are likely to have also produced changes in the patterns and numbers of road traffic injuries, including increases in motorcycle injuries. However, such changes have not been well documented. The work described in this paper sought, therefore, to document the changes in motorcycle ownership, motorcyclist mortality and injury rates in China since 1987.METHODS:National traffic ownership and injury data from 1987 to 2001 were obtained from the National Bureau for Traffic Administration. Additionally, traffic ownership and injury records from 1997 to 2001 were collected from local police offices from 20 counties in Guangxi Region. Population data were obtained from the national and county statistics bureaus. Motorcycle ownership, fatality and injury trends over time were calculated.RESULTS:Nationally, motorcycles accounted for 23.4% of all registered motor vehicles in 1987, increasing to 63.2% in 2001. Motorcyclist fatalities and injuries increased 5.5-fold and 9.3-fold, respectively, between 1987 and 2001. In 1987, 7.5% of all traffic fatalities and 8.8% of all traffic injuries were sustained by motorcyclists, with the corresponding proportions increasing to 18.9% and 22.8%, respectively, in 2001. The changing proportions of both traffic fatalities and injuries sustained by motorcyclists were positively correlated with the change in the proportion of motorcycles among all motor vehicles. In the 20 counties in Guangxi, motorcyclist fatality and injury rates also increased between 1997 and 2001. Moreover, these rates were considerably higher than the national rates.CONCLUSIONS:Motorcyclist injury in China is a serious public health problem. Motorcyclist fatalities and injuries are likely to continue to increase unless appropriate intervention programmes are implemented.

(2004). Guidelines for conducting community surveys on injuries and violence. Injury Control and Safety Promotion: Vol. 11, No. 4, pp. 303-306.

OBJECTIVES:This paper compares the different types of injury burden measures in common use and examines criteria that may be useful to consider when selecting between alternative measures.METHODS:A review was conducted of relevant literature relating to burden of injury measures, important characteristics of data information systems and ethical frameworks for normative analysis in the health sector.RESULTS:Four broad types of burden of injury measures can be distinguished: mortality-related indices; morbidity-related indices; composite measures combining mortality and morbidity; and monetary costs. Each type of measure uses its own construct of injury burden. For example, mortality data defines the injury burden as comprising only fatalities whereas comprehensive costs attempt to capture the total wellbeing lost through injury. Different measures of the burden of injury present differential rankings of the causes and intent of injury, thus the question arises as to what criteria should be used in selecting the best measure. Each measure of the burden of injury has merits and limitations. In selecting between injury measures, consideration should be given to the nature of the policy question, the construct of injury burden that each measure assesses, the availability of data for the measure and its quality and the ethical values inherent in each measure.CONCLUSIONS:Measures of the burden of injury play a useful role in positioning injury as a major public health problem and in policy work relating to injury prevention and control. No single measure of the burden of injury is ideal and several measures can be used together if necessary to provide different perspectives on an injury problem.

Objectives. Bicycle-related injury remains a major cause of death and injury hospitalization among Australian children. The study aimed to assess the effectiveness of a whole-school intervention to increase the correct wearing of bicycle helmets by primary school children. Methods. A randomized intervention trial was conducted in 27 Western Australian primary schools. A major component of the intervention was a peer-led classroom curriculum for 10–12 year old children. Helmet use by cyclists was observed as children were leaving school at baseline (May 2000) and after the first year and second year of the intervention. A cohort of 10–11 year old children in study schools completed a self-administered questionnaire at the same three data collection points. Results. Over the 2 years of the study, observed helmet wearing rates declined by 13% in the control group (from 93% at baseline to 80% at post-test 2) and by 5% in the intervention group (from 89% to 84%) (F = 1.745, p = 0.185). Among the Grade 5/6 cohort students who were regular riders, the likelihood of reporting always wearing a helmet was 1.9 times higher at post-test 1 (z = 2.51, p = 0.012) and 1.7 times higher at post-test 2 (z = 2.13, p = 0.033) for the intervention group than the control group students who did not always wear a helmet at baseline. Conclusions. The data suggest that school-based activities can arrest the rate of decline in helmet use by children. Using peer teachers is a useful strategy to engage students in normative-based protective behaviours. The logistical challenges this strategy presents appear to be worth the outcomes.

Objectives. To evaluate the incidence and the pattern of skiing and snowboarding injuries in South Tyrol and their impact on the emergency medical system in the winter season 2001–2002 in an attempt to rationalize and improve the emergency care and assist in prevention strategies. Methods. All medical records of patients referred to our emergency department (ED) that sustained a skiing or snowboarding injury during the study period were retrospectively reviewed. Age, sex, local or non-local residency, type of injury, data and time of accident, type of transport to the hospital, hospital admission or ED discharge, Injury Severity Score, outcome (including mortality) were evaluated. On site mortality data were obtained from the emergency call-center registry. Ski resorts utilization was estimated from the data published by the Regional Office of Cable Transport. Results. For the period analyzed approximately 2,500,000 skier and snowboarder days were recorded in the whole region of which about 500,000 were attributed to the four nearby ski resorts that refer to our hospital. Of the 1087 patients, 794 were skiers and 294 were snowboarders. Snowboarders were younger than skiers (mean age 20 and 36 respectively, p = 0.001). Females were equally represented in the two groups. Male patients, children, senior skiers and non-local residents suffered from more severe injuries than their corresponding classes (p < 0.01, p = 0.002, p = 0.02, p = 0.000 respectively). Critical injuries (ISS ≥ 25) were homogeneously spread in the groups, with the exception of the non-local resident patients that showed a higher incidence (p < 0.02). No difference in severity was found between skiers and snowboarders. The incidence was 2.05 per 1,000 skier-days. Mortality rate was 1.6 per 1,000,000 skier-days. The pattern of injury was different: snowboarders showed more forearm and wrist trauma and skiers more lower extremity injuries. 208 patients were hospitalized and the mean length of stay was 4.5 days. Head trauma and fractures were the most common diagnosis of admission. The lack of field triage led to 12% of unjustified helicopter transfer and 9.6% of avoidable ambulance transport. Conclusions. Incidence, pattern of injuries and mortality from skiing and snowboarding accidents in South Tyrol resemble those reported in other part of the world. Nevertheless, strategies for prevention are needed. The routine use of helmets should be enforced by law. Dangerous behaviors should be prosecuted. Skiers and snowboarders should be made aware that skiing beyond their technical ability can be life-threatening.

OBJECTIVES:To measure GPs' and paediatricians' expectations, attitudes, priorities and demands in the area of promoting safety and preventing accidents in the home involving children under 15 years of age.METHODS:A phone survey of a random sample of GPs and paediatricians in the French-speaking community of Belgium (Wallonia and Brussels) conducted in the course of September and October 2000.RESULTS:Close to two-thirds of the physicians surveyed stated that they had been contacted at least once in the 2 weeks preceding the survey to handle an injury. Of the physicians, 80% mention accident prevention after a childhood injury, but only 46% mention it during a routine consultation (whatever the reason of the latter may be). The main obstacles to mentioning prevention during routine consultation put forward by the interviewees are: 1) reasons for consultations that do not permit such an approach (79%); 2) the fact that injuries are not priorities for them (66%); 3) the lack of interesting materials to provide the subject with documentation (63%); 4) the unsuitability of the place where the contact occurs for such discussion, given the time required (56%); 5) insufficient information on the subject (41%); and 6) the patient's lack of interest (39%). An overwhelming majority (98%) nevertheless feel that they have a role to play in preventing children's accidents in the home, with 72.5% seeing this as informative (recommendation on safety rules). More than two-thirds of the respondents feel that they have enough requisite information to play such a role. Those who declare that they have not enough information (34%) proposed some priority subjects about which they would like to find information or additional information to be more effective in preventing accidents. The information needs mentioned most frequently were a systematic review of the risks, of the effective prevention strategies and epidemiological data.CONCLUSIONS:The present study clearly reveals the interest of physicians for accident prevention and puts forward the current obstacles to offering prevention advice during routine consultation. The obstacles mentioned are fairly comparable to those mentioned in other studies, namely, because the reason for the visit does not give such an opening, the lack of appropriate materials and information, the lack of time, the patient's lack of interest, the fact that the issue is not a priority, etc. The problem of lack of priority for certain practitioners underlines the importance of making accident mortality and morbidity statistics available to doctors in order to improve their perception of the magnitude of the problem. The lack of interesting education materials and useful information seems to be a major reason for their failure to carry out such prevention work successfully. These factors should thus be taken into account when developing any policy and/or programme aimed at 'using' GPs and paediatricians in the prevention strategies that are adopted.