Showing papers in "Injury Prevention in 2016"

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Abstract: Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

161 An evaluation of CDC’s web-based injury statistics query and reporting system (WISQARS)

Abstract: Background WISQARS is an interactive, web-based data query system (WBDQS) that is accessible from the internet. It includes modules for fatal and non-fatal injuries, a separate module on violent deaths, and injury costs and maps. Data come from a variety of trusted sources, including national health surveys and health data repositories. CDC created WISQARS in 1999 to meet the data needs of injury practitioners in the United States. Since that time, the audience has expanded to include researchers, policy makers, media, and the general public. Objective The purpose of this evaluation was to assess the focus, quality, usefulness, impact, and outcomes of WISQARS; and to identify gaps and areas for improvement. Data were collected through peer-reviewed and grey literature searches, google searches, an environmental scan of internal and external WBDQS, and a series of stakeholder interviews. Results WISQARS is used as a data source by NGOs, academic institutions, other U.S. federal agencies, and social media websites. Stakeholders most frequently used the fatal and non-fatal modules. The most frequently accessed data were on suicides, poisonings, homicides, motor vehicle crashes, and falls. WISQARS is most often used to respond to data requests, educate decision makers, conduct basic analyses, and teach and plan. Areas for improvement included building more capacity for data visualisations and for users to export both data and graphics, allowing for full mobile responsiveness when accessing, expanding by incrementally including additional data, and developing better support information and guidance on use. Conclusions While WISQARS has been largely a success in expanding access to U.S. injury and violence surveillance data, there are several opportunities to enhance the functionality of the system for the end user. CDC is planning to use innovations in data science to enhance WISQARS’s capacity.

76 European facts and the global status report on road safety 2015

Abstract: Background Road traffic injuries are the leading cause of premature death in young people aged 5–29 years in the WHO European Region. The Decade of Action for Road Safety 2011–2020 was adopted by the United Nations General Assembly in 2010 to reduce the global toll of road traffic injuries by 2020. Methods This fact sheet describes the status of road safety in 52 out of the 53 Member States of the WHO European Region, representing 95% of the Region’s population. Experts from several sectors in each country reached consensus to complete a self-administered questionnaire. Furthermore, an independent expert analysis of national legislative documents was conducted. Results In 2013, there were almost 85 000 deaths from road traffic injuries in the WHO European Region. Although the regional mortality rate is the lowest when compared to other WHO regions, with 9.3 deaths per 100 000 population, there are wide disparities in the rates of road traffic deaths between countries of the Region. This requires more systematic efforts if the global target of a 50% reduction in road crash deaths is to be achieved by 2020. Laws and practices on key risk factors such as regulating speed appropriate to road type, drink–driving, and use of seat belts, motorcycle helmets and child restraints are assessed to reduce the risk of road traffic injury. While 95% of the population in the Region is covered by comprehensive laws in line with best practice for seat belts, only 47% of the population is adequately protected by laws for speed, 45% for helmet use, 33% for drink–driving and 71% for use of child restraints. Conclusions Many countries need to further strengthen their road safety legislation and enforcement in order to protect their populations, improve road user behaviour and reduce the number of crashes. Much can be gained from improving the safety of vehicles, having better road infrastructure and promoting sustainable physically active forms of mobility as alternatives to car use. Concerted policy efforts with systems approaches are needed to protect all road users in the Region.

Gun ownership and social gun culture

Abstract: We assessed gun ownership rates in 2013 across the USA and the association between exposure to a social gun culture and gun ownership. We used data from a nationally representative sample of 4000 US adults, from 50 states and District of Columbia, aged >18 years to assess gun ownership and social gun culture performed in October 2013. State-level firearm policy information was obtained from the Brady Law Center and Injury Prevention and Control Center. One-third of Americans reported owning a gun, ranging from 5.2% in Delaware to 61.7% in Alaska. Gun ownership was 2.25-times greater among those reporting social gun culture (PR=2.25, 95% CI 2.02 to 2.52) than those who did not. In conclusion, we found strong association between social gun culture and gun ownership. Gun cultures may need to be considered for public health strategies that aim to change gun ownership in the USA.

The National Violent Death Reporting System: overview and future directions

Abstract: Objective To describe the National Violent Death Reporting System (NVDRS). This is a surveillance system for monitoring the occurrence of homicides, suicides, unintentional firearm deaths, deaths of undetermined intent, and deaths from legal intervention (excluding legal executions) in the US. Design This report provides information about the history, scope, data variables, processes, utility, limitations, and future directions of the NVDRS. Results The NVDRS currently operates in 32 states, with the goal of future expansion to all 50 states, the District of Columbia, and US territories. The system uses existing primary data sources (death certificates, coroner/medical examiner reports, and law enforcement reports), and links them together to provide a comprehensive picture of the circumstances surrounding violent deaths. Conclusions This report provides an overview of the NVDRS including a description of the system, discussion of its expanded capability, the use of new technologies as the system has evolved, how the data are being used for violence prevention efforts, and future directions.

Paid family leave's effect on hospital admissions for pediatric abusive head trauma

Abstract: Paediatric abusive head trauma (AHT) is a leading cause of fatal child maltreatment among young children. Current prevention efforts have not been consistently effective. Policies such as paid parental leave could potentially prevent AHT, given its impacts on risk factors for child maltreatment. To explore associations between California's 2004 paid family leave (PFL) policy and hospital admissions for AHT, we used difference-in-difference analyses of 1995–2011 US state-level data before and after the policy in California and seven comparison states. Compared with seven states with no PFL policies, California's 2004 PFL showed a significant decrease in AHT admissions in both <1 and <2-year-olds. Analyses using additional data years and comparators could yield different results.

Violence Against Children Surveys (VACS): towards a global surveillance system

Abstract: Objective To describe the Violence Against Children Surveys (VACS). The survey is a national, household survey that systematically measures the prevalence, nature and consequences of sexual, physical and emotional violence against children. Design This report provides information about the history, implementation, ethical protections, utility, results, limitations, and future directions of the VACS work. Results The study has been implemented in 11 countries in Africa, Asia and the Caribbean, providing each of these countries with baseline data and momentum to address violence against children as a public health and human rights priority. These data are novel in each country, and VACS is well poised to contribute to an existing surveillance system or be used as the basis of a periodic surveillance system. Conclusions Without ongoing surveillance to assess prevalence and the impact of policy, prevention and response programming, violence will likely continue to be overlooked as the linchpin public health crisis that it is, globally and in individual countries.

Preventing Australian football injuries with a targeted neuromuscular control exercise programme: comparative injury rates from a training intervention delivered in a clustered randomised controlled trial.

Abstract: Background Exercise-based training programmes are commonly used to prevent sports injuries but programme effectiveness within community men9s team sport is largely unknown. Objective To present the intention-to-treat analysis of injury outcomes from a clustered randomised controlled trial in community Australian football. Methods Players from 18 male, non-elite, community Australian football clubs across two states were randomly allocated to either a neuromuscular control (NMC) (intervention n=679 players) or standard-practice (control n=885 players) exercise training programme delivered as part of regular team training sessions (2× weekly for 8-week preseason and 18-week regular-season). All game-related injuries and hours of game participation were recorded. Generalised estimating equations, adjusted for clustering (club unit), were used to compute injury incidence rates (IIRs) for all injuries, lower limb injuries (LLIs) and knee injuries sustained during games. The IIRs were compared across groups with cluster-adjusted Injury Rate Ratios (IRRs). Results Overall, 773 game injuries were recorded. The lower limb was the most frequent body region injured, accounting for 50% of injuries overall, 96 (12%) of which were knee injuries. The NMC players had a reduced LLI rate compared with control players (IRR: 0.78 (95% CI 0.56 to 1.08), p=0.14.) The knee IIR was also reduced for NMC compared with control players (IRR: 0.50 (95% CI 0.24 to 1.05), p=0.07). Conclusions These intention-to-treat results indicate that positive outcomes can be achieved from targeted training programmes for reducing knee and LLI injury rates in men9s community sport. While not statistically significant, reducing the knee injury rate by 50% and the LLI rate by 22% is still a clinically important outcome. Further injury reductions could be achieved with improved training attendance and participation in the programme.

Fatal river drowning: the identification of research gaps through a systematic literature review.

Abstract: Introduction Drowning is a leading cause of unintentional death. Rivers are a common location for drowning. Unlike other location-specific prevention efforts (home swimming pools and beaches), little is known about prevention targeting river drowning deaths. Methods A systematic literature review was undertaken using English language papers published between 1980 and 2014, exploring gaps in the literature, with a focus on epidemiology, risk factors and prevention strategies for river drowning. Results Twenty-nine papers were deemed relevant to the study design including 21 (72.4%) on epidemiology, 18 (62.1%) on risk factors and 10 (34.5%) that proposed strategies for prevention. Risk factors identified included age, falls into water, swimming, using watercraft, sex and alcohol. Discussion Gaps were identified in the published literature. These included a lack of an agreed definition for rivers, rates for fatal river drowning (however, crude rates were calculated for 12 papers, ranging from 0.20 to 1.89 per 100 000 people per annum), and consensus around risk factors, especially age. There was only one paper that explored a prevention programme; the remaining nine outlined proposed prevention activities. There is a need for studies into exposure patterns for rivers and an agreed definition (with consistent coding). Conclusions This systematic review has identified that river drowning deaths are an issue in many regions and countries around the world. Further work to address gaps in the published research to date would benefit prevention efforts.

Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits

Abstract: Background Firefighting is a hazardous profession and firefighters suffer workplace injury at a higher rate than most US workers. Decreased physical fitness is associated with injury in firefighters. A physical fitness intervention was implemented among Tucson Fire Department recruit firefighters with the goals of decreasing injury and compensation claims frequency and costs during the recruit academy, and over the subsequent probationary year. Methods Department injury records were analysed and described by body part, injury type and mechanism of injury. Injury and workers’ compensation claims outcomes from the recruit academy initiation through the 12-month probationary period for the intervention recruit class were compared with controls from three historical classes. Results The majority of injuries were sprains and strains (65.4%), the most common mechanism of injury was acute overexertion (67.9%) and the lower extremity was the most commonly affected body region (61.7%). The intervention class experienced significantly fewer injuries overall and during the probationary year (p=0.009), filed fewer claims (p=0.028) and experienced claims cost savings of approximately US$33 000 (2013) from avoided injury and reduced claims costs. The estimated costs for programme implementation were $32 192 leading to a 1-year return on investment of 2.4%. Conclusions We observed reductions in injury occurrence and compensation costs among Probationary Firefighter Fitness (PFF-Fit) programme participants compared with historical controls. The initiation of the PFF-Fit programme has demonstrated promise in reducing injury and claims costs; however, continued research is needed to better understand the programme's potential effectiveness with additional recruit classes and carryover effects into the recruit's career injury potential.

Home safety assessment and modification to reduce injurious falls in community-dwelling older adults: cost-utility and equity analysis

Abstract: Background This study aimed to improve on previous modelling work to determine the health gain, cost-utility and health equity impacts from home safety assessment and modification (HSAM) for reducing injurious falls in older people. Methods The model was a Markov macrosimulation one that estimated quality-adjusted life-years (QALYs) gained. The setting was a country with detailed epidemiological and cost data (New Zealand (NZ)) for 2011. A health system perspective was taken and a discount rate of 3% was used (for both health gain and costs). Intervention effectiveness estimates came from a Cochrane systematic review and NZ-specific intervention costs were from a randomised controlled trial. Results In the 65 years and above age group, the HSAM programme cost a total of US$98 million (95% uncertainty interval (UI) US$65 to US$139 million) to implement nationally and the accrued net health system costs were US$74 million (95% UI: cost saving to US$132 million). Health gains were 34 000 QALYs (95% UI: 5000 to 65 000). The incremental cost-effectiveness ratio (ICER) was US$6000 (95% UI: cost saving to US$13 000), suggesting that HSAM is highly cost-effective. Targeting HSAM only to older people with previous injurious falls and to older people aged 75 years and above were also cost-effective (ICERs=US$1000 and US$11 000, respectively). There was no evidence for differential cost-effectiveness by gender or by ethnicity (Indigenous New Zealanders: Māori vs non-Māori). Conclusions As per other studies, this modelling study indicates that the provision of an HSAM intervention produces considerable health gain and is highly cost-effective among older people. Targeting this intervention to older people with previous injurious falls is a promising initial approach before any scale up. Trial registration number ACTRN12609000779279.

Harnessing information from injury narratives in the 'big data' era: understanding and applying machine learning for injury surveillance.

Abstract: Objective Vast amounts of injury narratives are collected daily and are available electronically in real time and have great potential for use in injury surveillance and evaluation. Machine learning algorithms have been developed to assist in identifying cases and classifying mechanisms leading to injury in a much timelier manner than is possible when relying on manual coding of narratives. The aim of this paper is to describe the background, growth, value, challenges and future directions of machine learning as applied to injury surveillance. Methods This paper reviews key aspects of machine learning using injury narratives, providing a case study to demonstrate an application to an established human-machine learning approach. Results The range of applications and utility of narrative text has increased greatly with advancements in computing techniques over time. Practical and feasible methods exist for semiautomatic classification of injury narratives which are accurate, efficient and meaningful. The human-machine learning approach described in the case study achieved high sensitivity and PPV and reduced the need for human coding to less than a third of cases in one large occupational injury database. Conclusions The last 20 years have seen a dramatic change in the potential for technological advancements in injury surveillance. Machine learning of ‘big injury narrative data’ opens up many possibilities for expanded sources of data which can provide more comprehensive, ongoing and timely surveillance to inform future injury prevention policy and practice.

Use of syndromic surveillance data to monitor poisonings and drug overdoses in state and local public health agencies

Abstract: Background The incidence of poisoning and drug overdose has risen rapidly in the USA over the last 16 years. To inform local intervention approaches, local health departments (LHDs) in North Carolina (NC) are using a statewide syndromic surveillance system that provides timely, local emergency department (ED) and Emergency Medical Services (EMS) data on medication and drug overdoses. Objective The purpose of this article is to describe the development and use of a variety of case definitions for poisoning and overdose implemented in NC9s syndromic surveillance system and the impact of the system on local surveillance initiatives. Design, setting, participants Thirteen new poisoning and overdose-related case definitions were added to NC9s syndromic surveillance system and LHDs were trained on their use for surveillance purposes. Twenty-one LHDs were surveyed on the utility and impact of these new case definitions. Results/Conclusions Ninety-one per cent of survey respondents (n = 29) agreed or strongly agreed that their ability to access timely ED data was vital to inform community-level overdose prevention work. Providing LHDs with access to local, timely data to identify pockets of need and engage stakeholders facilitates the practice of informed injury prevention and contributes to the reduction of injury incidence in their communities.

Helmet regulation in Vietnam: impact on health, equity and medical impoverishment

Abstract: Background Vietnam9s 2007 comprehensive motorcycle helmet policy increased helmet use from about 30% of riders to about 93%. We aimed to simulate the effect that this legislation might have on: (a) road traffic deaths and non-fatal injuries, (b) individuals’ direct acute care injury treatment costs, (c) individuals’ income losses from missed work and (d) individuals’ protection against medical impoverishment. Methods and findings We used published secondary data from the literature to perform a retrospective extended cost-effectiveness analysis simulation study of the policy. Our model indicates that in the year following its introduction a helmet policy employing standard helmets likely prevented approximately 2200 deaths and 29 000 head injuries, saved individuals US$18 million in acute care costs and averted US$31 million in income losses. From a societal perspective, such a comprehensive helmet policy would have saved $11 000 per averted death or $830 per averted non-fatal injury. In terms of financial risk protection, traffic injury is so expensive to treat that any injury averted would necessarily entail a case of catastrophic health expenditure averted. Conclusions The high costs associated with traffic injury suggest that helmet legislation can decrease the burden of out-of-pocket payments and reduced injuries decrease the need for access to and coverage for treatment, allowing the government and individuals to spend resources elsewhere. These findings suggest that comprehensive motorcycle helmet policies should be adopted by low-income and middle-income countries where motorcycles are pervasive yet helmet use is less common.

Assessing global risk factors for non-fatal injuries from road traffic accidents and falls in adults aged 35-70 years in 17 countries: a cross-sectional analysis of the Prospective Urban Rural Epidemiological (PURE) study.

Abstract: Objectives To assess risk factors associated with non-fatal injuries (NFIs) from road traffic accidents (RTAs) or falls. Methods Our study included 151 609 participants from the Prospective Urban Rural Epidemiological study. Participants reported whether they experienced injuries within the past 12 months that limited normal activities. Additional questions elicited data on risk factors. We employed multivariable logistic regression to analyse data. Results Overall, 5979 participants (3.9% of 151 609) reported at least one NFI. Total number of NFIs was 6300: 1428 were caused by RTAs (22.7%), 1948 by falls (30.9%) and 2924 by other causes (46.4%). Married/common law status was associated with fewer falls, but not with RTA. Age 65–70 years was associated with fewer RTAs, but more falls; age 55–64 years was associated with more falls. Male versus female was associated with more RTAs and fewer falls. In lower-middle-income countries, rural residence was associated with more RTAs and falls; in low-income countries, rural residence was associated with fewer RTAs. Previous alcohol use was associated with more RTAs and falls; current alcohol use was associated with more falls. Education was not associated with either NFI type. Conclusions This study of persons aged 35–70 years found that some risk factors for NFI differ according to whether the injury is related to RTA or falls. Policymakers may use these differences to guide the design of prevention policies for RTA-related or fall-related NFI.

Masculine discrepancy stress, substance use, assault and injury in a survey of US men

Abstract: To understand and ultimately prevent injury and behavioural health outcomes associated with masculinity, we assessed the influence of masculine discrepancy stress (stress that occurs when men perceive themselves as falling short of the traditional gender norms) on the propensity to engage in stereotypically masculine behaviours (eg, substance use, risk taking and violence) as a means of demonstrating masculinity. Six-hundred men from the USA were recruited via Amazon's Mechanical Turk (MTurk) online data collection site to complete surveys assessing self-perceptions of gender role discrepancy and consequent discrepancy stress, substance use/abuse, driving while intoxicated (DWI) and violent assaults. Negative binomial regression analyses indicated significant interactive effects wherein men high on gender role discrepancy and attendant discrepancy stress reported significantly more assaults with a weapon (B=1.01; SE=0.63; IRR=2.74; p=0.05) and assaults causing injury (B=1.01; SE=0.51; IRR=2.74; p<0.05). There was no association of discrepancy stress to substance abuse, but there was a protective effect of gender role discrepancy for DWI among men low on discrepancy stress (B=-1.19, SE=0.48; IRR=0.30; p=0.01). These findings suggest that gender role discrepancy and associated discrepancy stress, in particular, represent important injury risk factors and that prevention of discrepancy stress may prevent acts of violence with the greatest consequences and costs to the victim, offender and society.

Long-term mortality of patients surviving firearm violence

Abstract: Objective We aim to calculate the 5-year mortality after surviving to hospital discharge after a firearm injury and estimate the association of firearm injury with later mortality. Methods We performed a retrospective cohort study of patients from an urban emergency department (ED) and trauma centre in Oakland, California, USA, in 2007. We created three cohorts of patients presenting for (1) gunshot wound (GSW), (2) MVC and (3) assault without a firearm. Demographic and clinical information was obtained from the clinical chart, and the California Department of Public Health Vital Statistics and Social Security Death Master File (2007–2012) were queried to identify patients who died. Results We analysed 516 GSW patients, 992 MVC patients and 695 non-GSW assault patients. Of the GSW patients, 86.4% were alive at 5 years. All-cause 5-year mortality among GSW victims surviving to discharge after injury was 5.1%. Compared with MVC patients, both GSW and non-GSW assault patients have higher risk of death at 5 years (HR 2.54 (95% CI 1.41 to 4.59) and HR 1.64 (95% CI 1.01 to 2.68), respectively), adjusting for age, sex and race. Risk of death was higher in the first year for the GSW cohort (HR 6.14 (95% CI 2.35 to 16.08) and HR 5.06 (95% CI 1.88 to 13.63) as compared with MVC and non-GSW assault cohorts, respectively). Homicide was the cause of death in 79.2% of GSW patients who died after surviving the index injury. Conclusion Among individuals presenting to the ED after injury or assault and surviving to discharge, firearm injury exposure is an important predictor of death within 5 years and most pronounced in the first year after injury.

Identification of incident poisoning, fracture and burn events using linked primary care, secondary care and mortality data from England: implications for research and surveillance.

Abstract: Background: English national injury data collection systems are restricted to hospitalisations and deaths. With recent linkage of a large primary care database, the Clinical Practice Research Datalink (CPRD), with secondary care and mortality data we aimed to assess the utility of linked data for injury research and surveillance by examining recording patterns and comparing incidence of common injuries across data sources. Methods: The incidence of poisonings, fractures and burns was estimated for a cohort of 2,147,853 0-24 year olds using CPRD linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality data between 1997-2012. Time-based algorithms were developed to identify incident events, distinguishing between repeat follow-up records for the same injury, and those for a new event. Results: We identified 42,985 poisoning, 185,517 fracture and 36,719 burn events in linked CPRD-HES-ONS data; incidence rates were 41.9 per 10,000 person-years (95% confidence interval 41.4–42.4), 180.8 (179.8–181.7) and 35.8 (35.4–36.1), respectively. Of the injuries, 22,628(53%) poisonings, 139,662(75%) fractures, and 33,462(91%) burns were only recorded within CPRD. Only 16% of deaths from poisoning (n=106) or fracture (n=58) recorded in ONS were recorded within CPRD and/or HES records. None of the 10 deaths from burns were recorded in CPRD or HES records. Conclusion: It is essential to use linked primary care, hospitalisation and deaths data to estimate injury burden, as many injury events are only captured within a single data source. Linked routinely-collected data offer an immediate and affordable mechanism for injury surveillance and analyses of population based injury epidemiology in England.

Injury prevention as social change

Abstract: We will not solve the public health problem of injury simply by educating individuals about the nature of injury risk, improving their risk assessment and providing these individuals with information to enable them to reduce the level of risk to which they are exposed. Substantial improvement in the societal injury burden will occur only when changes are made at the societal level that focus on reducing the population-level indicators of injury.1 ,2 The shift from an individual to a population perspective has substantial implications for the way we perceive, direct, undertake, and evaluate injury prevention research and practice. The analogy of ‘the population as patient’ provides a clear illustration of the foundational truths that underpin the preferred public health approach to the prevention of injury. Society is the system within which populations exist. Sustained change made at the societal level to reduce population-level indicators of injury morbidity and mortality involves systemic change. In this paper, we consider a shift from the contemporary systematic approach to unintentional injury and violence prevention,3 to a systemic approach4 more consistent with the principles of ecological public health.5 We consider the extent to which the logic of the systematic model, and the related misconceptions about the role of uncertainty in science, limit local, national and global efforts to minimise injury-related harm. We explore the implications of a systemic perspective for the field of injury prevention and conclude by delineating a new programme of work that could be of considerable benefit to the injury-related health of populations. ### Individual risk versus population frequency Should there be a perceived benefit of engaging in a risky driving behaviour, a person on a given day could double her or his risk of death without noticing the change in their likelihood of dying on the road. If, on that day, the …

Trends in paediatric sports-related injuries presenting to US emergency departments, 2001–2013

Abstract: This descriptive epidemiology study describes trends in paediatric sports-related injuries resulting from 21 selected sports presenting to US emergency departments (EDs) over a 13-year period. The study was a retrospective study using data from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) for years 2001-2013. Inclusion criteria included people in the NEISS for injuries related to one of the 21 selected sports and between the ages of 5 and 18 years. Frequencies and linear regressions were calculated using provided sample weights. The results indicated there was a statistically significant increase of 10 010 nationally estimated selected sports-related injuries per year. Football, basketball, soccer and baseball resulted in 74.7% of the total national estimate for sports-related injuries presenting to US EDs for 2001-2013 for children aged 5-18 years. The results indicate that the number of paediatric sports-related injuries treated in US EDs has increased annually from 2001 to 2013.

Precision prevention: time to move beyond universal interventions

Abstract: Nearly two decades ago, the Institute of Medicine (IOM) in the USA recognised that many adverse health outcomes result from behavioural tendencies that place individuals at risk. Programmes designed to change these behaviours could have long-term salutary effects. They further noted the heterogeneity within and across populations and over time in the nature and severity of unhealthy behaviours. To address the disparate needs of individuals in a population, the IOM proposed a multi-tiered framework for prevention that provides differential and increasingly more intense preventive intervention as a function of level of risk and response to prior intervention.1 This framework has been adopted for a wide range of educational and behavioural health issues; for example, in the school setting, the prevention and early intervention for preschool children at risk for learning or behaviour problems;2 ,3 in the community setting, the management of blood pressure4 and in the inpatient clinical setting, the secondary prevention of traumatic stress.5 However, unintentional injury prevention still relies largely on ‘one-size-fits-all’ or universal strategies (eg, laws and their enforcement and education campaigns). While such ‘universal’ injury prevention strategies can reach the widest audience, complementary targeted risk approaches are necessary to meet the needs of minority, higher risk populations, and to increase the value of prevention strategies. Injury prevention recognises the concept of ‘tailored interventions’ that deliver culturally sensitive or other adapted measures depending upon the characteristics of the target audience. These include altering the language in which an intervention is delivered6 to a population or varying the implementation of an intervention to accommodate important individual differences, for example, through kiosk-delivered tailored messaging7 ,8 or safety technology tailored to the characteristics of the vehicle occupant. When air bags were first introduced, they were largely one-size-fits-all and children and short-statured women …

Safety in numbers for cyclists beyond national-level and city-level data: a study on the non-linearity of risk within the city of Hong Kong

Abstract: Objective This paper examines the relationship between bicycle collisions and the amount of cycling at the local level. Most previous research has focused on national and city comparisons, little is known about differences within a city (the mesoscale). Methods This study mainly used three types of data sets relating to bicycle collisions, use of bicycles and local neighbourhood characteristics in Hong Kong. In particular, bicycle usage, measured as bicycle-kilometres travelled, was estimated from travel surveys following the activity-based approach. Negative binomial regression models were established to model the relationship between the amount of cycling and the occurrence of bicycle collisions at the spatial scale of the Tertiary Planning Unit, which is the smallest planning unit of the city. Results The numbers of bicycle collisions went up with the increasing use of bicycles, but the increase in the number of collisions in a given community was less than a linear proportion of the bicycle flow. When other local neighbourhood variables are controlled, the amount of cycling is a statistically significant variable in accounting for the number of collisions. Conclusions Even in a highly motorised city where bicycles are a minor transport mode, cyclists are less likely to be involved in road collisions in communities with higher cycling volume. Since cycling activities are likely to vary within a city, a more local-based approach in promoting cycling is needed. In particular, the higher safety risks in neighbourhoods of low bicycle usage, especially at an initial stage of promoting cycling, need to be addressed properly.

Trends and sex differences in prescription opioid deaths in British Columbia, Canada

Abstract: Increasing rates of prescription opioid-related death are well documented in Ontario (ON) but little is known about prescription opioid-related harms in other Canadian provinces. Using administrative mortality data from 2004 to 2013, we found that rates of prescription opioid-related death in British Columbia (BC) were higher but more stable than published rates for ON over the same period. Methadone was involved in approximately 25% of the prescription opioid-related deaths in BC. The majority of prescription opioid-related deaths among men and women were unintentional. Men had higher overall rates of prescription opioid-related deaths in BC; women had lower rates of prescription opioid-related deaths but a larger proportion of them were suicides. Efforts to reduce prescription opioid-related deaths must consider sex differences in patterns of prescription opioid use and associated harms.

Poison prevention practices and medically attended poisoning in young children: multicentre case–control study

Abstract: Introduction Childhood poisonings are common, placing a substantial burden on health services. Case-control studies have found inconsistent evidence about modifiable risk factors for poisonings amongst 0-4 year olds. This study quantifies associations between poison prevention practices and medically attended poisonings in 0-4 year olds. Methods Multicentre case-control study conducted at hospitals, minor injury units and family practices from four study centres in England between 2010 and 2013. Participants comprised 567 children presenting with unintentional poisoning occurring at home, and 2320 community control participants matched on age, sex, date of event and study centre. Parents/caregivers provided data on safety practices, safety equipment use, home hazards and potential confounders, by means of self-completion questionnaires. Data were analysed using conditional logistic regression. Results Compared with community controls, parents of poisoned children were significantly more likely not to store medicines out of reach (adjusted odds ratio (AOR) 1.59; 95%CI, 1.21, 2.09; population attributable fraction (PAF) 15%), not to store medicines safely (locked or out of reach (AOR 1.83; 95%CI 1.38, 2.42; PAF 16%) and not to have put all medicines (AOR 2.11; 95%CI 1.54, 2.90; PAF 20%) or household products (AOR 1.79, 95%CI 1.29, 2.48; PAF 11%) away immediately after use. Conclusions Not storing medicines out of reach or locked away and not putting medicines and household products away immediately after use increased the odds of secondary care attended poisonings in 0-4 year olds. If associations are causal, implementing these poison prevention practices could each prevent between 11% and 20% of poisonings.

The design and evaluation of a system for improved surveillance and prevention programmes in resource-limited settings using a hospital-based burn injury questionnaire.

Abstract: Background Limited and fragmented data collection systems exist for burn injury. A global registry may lead to better injury estimates and identify risk factors. A collaborative effort involving the WHO, the Global Alliance for Clean Cookstoves, the CDC and the International Society for Burn Injuries was undertaken to simplify and standardise inpatient burn data collection. An expert panel of epidemiologists and burn care practitioners advised on the development of a new Global Burn Registry (GBR) form and online data entry system that can be expected to be used in resource-abundant or resource-limited settings. Methods International burn organisations, the CDC and the WHO solicited burn centre participation to pilot test the GBR system. The WHO and the CDC led a webinar tutorial for system implementation. Results During an 8-month period, 52 hospitals in 30 countries enrolled in the pilot and were provided the GBR instrument, guidance and a data visualisation tool. Evaluations were received from 29 hospitals (56%). Key findings Median time to upload completed forms was Conclusions The GBR was shown to be simple, flexible and acceptable to users. Enhanced regional and global understanding of burn epidemiology may help prioritise the selection, development and testing of primary prevention interventions for burns in resource-limited settings.

Laundry pod and non-pod detergent related emergency department visits occurring in children in the USA.

Abstract: Objective Previous studies have reported that children are at risk of severe injuries from exposure to laundry detergent pods. For the first time, this study sought to compare demographic and exposure characteristics and risk among children exposed to pod and non-pod laundry detergents presenting to emergency departments (EDs). Methods Data from the National Electronic Injury Surveillance System (NEISS) from 2012–2014 were used. All observations with injuries involving laundry detergent (NEISS code 0949) were included in this study. The χ2 test was used for bivariate analysis and logistic regression was used to determine the OR and 95% CI of hospitalisation for pod related versus non-pod laundry detergent exposures. Results From 2012–2014, there were an estimated 26 062 non-pod and 9814 pod laundry detergent related exposures among those aged 18 years and younger. For pod detergent, children aged 0–5 years had the most injuries. Poisoning (71.3%) was the most common diagnosis for pod detergent while contact dermatitis (72.2%) was most common for non-pod detergent. Hospitalisation occurred in 12.5% of pod detergent cases and just 3.0% of non-pod cases. Compared with non-pod detergent, those exposed to pod detergent were 4 times as likely to be hospitalised (OR 4.02; 95% CI 1.96 to 8.24). Conclusions A greater effort should be made to appropriately educate the public about the dangers of laundry detergents, specifically pods, so a safe home environment can be established. While new regulations such as childproof containers, opaque packaging, and less appealing and colourful pods could reduce the number of pod related ED visits for children, caregivers should store detergents, along with other chemicals, in a secure location where children cannot easily access them.

420 Development of the safety management system at enterprises

Abstract: Background Safety management system (SMS) can be considered as a key concept in the success of high level of occupational health and safety in the industrial enterprises. However establishing an SMS may only formally lead to excessive bureaucracy, window coupling and additional costs, especially for small and medium-sized enterprises. The paper concentrates on the analysis of relationships between the key elements in safety management and finding solutions to enhance safety level in different types of the industrial companies. Methods Safety auditing by the MISHA method was used as the main tool to study the current safety level in the manufacturing companies. Additionally, qualitative data from safety interviews were studied and interpreted. During the study in 2014, 24 safety interviews were conducted in 16 Estonian manufacturing companies. The investigated enterprises were first divided into two groups: OHSAS 18001-certified and OHSAS 18001 non-certified. But the latter proved to have a significant difference in the safety level based on its affiliation: corporated enterprises showed better results in the safety activities than locally owned companies. Results The study showed that the implementation of OHSAS 18001 will not automatically ensure high safety activities in the company. However, holding an OHSAS 18001 certification creates a basis for the systematic work in the area of safety management, hazards identification and prevention, and promotes strong improvement process put in use. The novelty of the paper lies in the conceptual model of the safety management system, that provides the key elements in formal, real and combined safety using qualitative and quantitative processing of audit results. Conclusions The research revealed that OHSAS 18001 certification contributes strongly to formal safety elements. However – its contribution to the real safety elements was partial, e.g., to such elements as top management commitment to the safety policy, dissemination of safety policy and resources. For many real safety elements strong demands from corporations influence safety activities more than requirements derived from OHSAS 18001 standard, for example suggestions for improvements; general communication procedures; promotion, rewards and career planning and safety knowledge among supervisors, line managers and top managers. Concerning combined elements, many of them – such as workplace hazards analysis, assessments of working environment, evaluation of safety training needs are dependent on OHSAS 18001 certification.

Changes in poisonings among adolescents in the UK between 1992 and 2012: a population based cohort study

Abstract: Background: Poisonings are a common cause of morbidity and mortality among adolescents. Yet surveillance data indicating current incidence rates (IRs) and time trends are lacking, making policy development and service planning difficult. We utilised population based primary care data to estimate adolescent poisoning rates according to intent across the UK. Methods: A cohort study of 1 311 021 adolescents aged 10–17 years, between 1992 and 2012, was conducted using routine primary care data from The Health Improvement Network. IRs and adjusted IRRs with 95% CIs were calculated for all poisonings, intentional, unintentional, unknown intent and alcohol related poisonings, by age, sex, calendar time and socioeconomic deprivation. Results: Overall poisoning incidence increased by 27% from the period 1992–1996 to 2007–2012, with the largest increases in intentional poisonings among females aged 16–17 years (IR 391.4/100 000 person years (PY), CI 328.9 to 465.7 for age 17 years in 1992–1996; 767.0/100 000 PY, CI 719.5 to 817.7 in 2007–2012) and alcohol related poisonings in females aged 15–16 years (IR 65.7/100 000 PY, CI 43.3 to 99.8 rising to 130.0/100 000 PY, CI 110.0 to 150.0 for age 15 years). A strong socioeconomic gradient for all poisonings persisted over time, with higher rates among the more deprived (IRR 2.63, CI 2.41 to 2.88 for the most vs least deprived quintile in 2007–2012). Conclusions: Adolescent poisonings, especially intentional poisonings, have increased substantially over time and remain associated with health inequalities. Social and psychological support for adolescents should be targeted at more deprived communities, and child and adolescent mental health and alcohol support service provision should be commissioned to reflect the changing need.

Data visualisation in surveillance for injury prevention and control: conceptual bases and case studies

Abstract: Background The complexity of current injury-related health issues demands the usage of diverse and massive data sets for comprehensive analyses, and application of novel methods to communicate data effectively to the public health community, decision-makers and the public. Recent advances in information visualisation, availability of new visual analytic methods and tools, and progress on information technology provide an opportunity for shaping the next generation of injury surveillance. Objective To introduce data visualisation conceptual bases, and propose a visual analytic and visualisation platform in public health surveillance for injury prevention and control. Methods The paper introduces data visualisation conceptual bases, describes a visual analytic and visualisation platform, and presents two real-world case studies illustrating their application in public health surveillance for injury prevention and control. Results Application of visual analytic and visualisation platform is presented as solution for improved access to heterogeneous data sources, enhance data exploration and analysis, communicate data effectively, and support decision-making. Conclusions Applications of data visualisation concepts and visual analytic platform could play a key role to shape the next generation of injury surveillance. Visual analytic and visualisation platform could improve data use, the analytic capacity, and ability to effectively communicate findings and key messages. The public health surveillance community is encouraged to identify opportunities to develop and expand its use in injury prevention and control.

Achieving all-age helmet use compliance for snow sports: strategic use of education, legislation and enforcement

Abstract: Background Nova Scotia is the first jurisdiction in the world to mandate ski and snowboard helmet use for all ages at ski hills in the province. This study represents a longitudinal examination of the effects of social marketing, educational campaigns and the introduction of helmet legislation on all-age snow sport helmet use in Nova Scotia. Methods A baseline observational study was conducted to establish the threshold of ski and snowboarding helmet use. Based on focus groups and interviews, a social marketing campaign was designed and implemented to address factors influencing helmet use. A prelegislation observational study assessed the effects of social marketing and educational promotion on helmet use. After all-age snow sport helmet legislation was enacted and enforced, a postlegislation observational study was conducted to determine helmet use prevalence. Results Baseline data revealed that 74% of skiers and snowboarders were using helmets, of which 80% were females and 70% were males. Helmet use was high in children (96%), but decreased with increasing age. Following educational and social marketing campaigns, overall helmet use increased to 90%. After helmet legislation was enacted, 100% compliance was observed at ski hills in Nova Scotia. Conclusions Results from this study demonstrate that a multifaceted approach, including education, legislation and enforcement, was effective in achieving full helmet compliance among all ages of skiers and snowboarders.