Showing papers in "Injury Prevention in 2017"

Perils of police action: a cautionary tale from US data sets

Abstract: Objective To count and characterise injuries resulting from legal intervention by US law enforcement personnel and injury ratios per 10 000 arrests or police stops, thus expanding discussion of excessive force by police beyond fatalities. Design Ecological. Population Those injured during US legal police intervention as recorded in 2012 Vital Statistics mortality census, 2012 Healthcare Cost and Utilization Project nationwide inpatient and emergency department samples, and two 2015 newspaper censuses of deaths. Exposure 2012 and 2014 arrests from Federal Bureau of Investigation data adjusted for non-reporting jurisdictions; street stops and traffic stops that involved vehicle or occupant searches, without arrest, from the 2011 Police Public Contact Survey (PPCS), with the percentage breakdown by race computed from pooled 2005, 2008 and 2011 PPCS surveys due to small case counts. Results US police killed or injured an estimated 55 400 people in 2012 (95% CI 47 050 to 63 740 for cases coded as police involved). Blacks, Native Americans and Hispanics had higher stop/arrest rates per 10 000 population than white non-Hispanics and Asians. On average, an estimated 1 in 291 stops/arrests resulted in hospital-treated injury or death of a suspect or bystander. Ratios of admitted and fatal injury due to legal police intervention per 10 000 stops/arrests did not differ significantly between racial/ethnic groups. Ratios rose with age, and were higher for men than women. Conclusions Healthcare administrative data sets can inform public debate about injuries resulting from legal police intervention. Excess per capita death rates among blacks and youth at police hands are reflections of excess exposure. International Classification of Diseases legal intervention coding needs revision.

We have the programme, what next? Planning the implementation of an injury prevention programme

Abstract: Background and aim The impact of any injury prevention programme is a function of the programme and its implementation. However, real world implementation of injury prevention programmes is challenging. Lower limb injuries (LLIs) are common in community Australian football (community-AF) and it is likely that many could be prevented by implementing exercise-based warm-up programmes for players. This paper describes a systematic, evidence-informed approach used to develop the implementation plan for a LLI prevention programme in community-AF in Victoria, Australia. Methods An ecological approach, using Step 5 of the Intervention Mapping health promotion programme planning protocol, was taken. Results An implementation advisory group was established to ensure the implementation plan and associated strategies were relevant to the local context. Coaches were identified as the primary programme adopters and implementers within an ecological system including players, other coaches, first-aid providers, and club and league administrators. Social Cognitive Theory was used to identify likely determinants of programme reach, adoption and implementation among coaches (eg, knowledge, beliefs, skills and environment). Diffusion of Innovations theory, the Implementation Drivers framework and available research evidence were used to identify potential implementation strategies including the use of multiple communication channels, programme resources, coach education and mentoring. Conclusions A strategic evidence-informed approach to implementing interventions will help maximise their population impact. The approach to implementation planning described in this study relied on an effective researcher-practitioner partnership and active engagement of stakeholders. The identified implementation strategies were informed by theory, evidence and an in-depth understanding of the implementation context.

Were they in the loop during automated driving? Links between visual attention and crash potential

Abstract: Background A proposed advantage of vehicle automation is that it relieves drivers from the moment-to-moment demands of driving, to engage in other, non-driving related, tasks. However, it is important to gain an understanding of drivers’ capacity to resume manual control, should such a need arise. As automation removes vehicle control-based measures as a performance indicator, other metrics must be explored. Methods This driving simulator study, conducted under the European Commission (EC) funded AdaptIVe project, assessed drivers’ gaze fixations during partially-automated (SAE Level 2) driving, on approach to critical and non-critical events. Using a between-participant design, 75 drivers experienced automation with one of five out-of-the-loop (OOTL) manipulations, which used different levels of screen visibility and secondary tasks to induce varying levels of engagement with the driving task: 1) no manipulation, 2) manipulation by light fog, 3) manipulation by heavy fog, 4) manipulation by heavy fog plus a visual task, 5) no manipulation plus an n-back task. Results The OOTL manipulations influenced drivers’ first point of gaze fixation after they were asked to attend to an evolving event. Differences resolved within one second and visual attention allocation adapted with repeated events, yet crash outcome was not different between OOTL manipulation groups. Drivers who crashed in the first critical event showed an erratic pattern of eye fixations towards the road centre on approach to the event, while those who did not demonstrated a more stable pattern. Conclusions Automated driving systems should be able to direct drivers’ attention to hazards no less than 6 seconds in advance of an adverse outcome.

Fatigue in transportation: NTSB investigations and safety recommendations

Abstract: Objective We aim to place into the scientific literature information on the prevalence of operator fatigue as a factor in causing transportation mishaps, and the categories of improvements identified to address fatigue in transportation. Methods We analyzed the number of major National Transportation Safety Board (NTSB) investigations that identified fatigue as a probable cause, contributing factor, or a finding. We divided all NTSB recommendations addressing fatigue issued since the agency was founded into 7 subject categories, and placed each recommendation into the appropriate category. This information was then analyzed to determine the number of recommendations in each category, both overall and by transportation mode. Analysis was also performed regarding the types of organizations that received the recommendations, whether the recommended actions have been taken, and the NTSB9s evaluation of whether the action taken satisfied a given recommendation. Results We reviewed 182 major NTSB investigations completed between 1 January 2001 and 31 December 2012 and found that 20% of these investigations identified fatigue as a probable cause, contributing factor, or a finding. The presence of fatigue varied between among the modes of transportation, ranging from 40% of highway investigations to 4% of marine investigations. The first NTSB recommendation to address the safety risks associated with human fatigue was issued over 40 years ago, in 1972. Since then, the NTSB has issued 205 separate fatigue-specific recommendations. Scheduling policies and practices was the most common subject category accounting for 40% of all recommendations issued. Federal agencies received 54% of all recommendations, with 22% to transportation operators, and 16% to associations. Of all NTSB fatigue recommendations, 24% were open ranging from a low of 9% in highway to 39% in aviation. Overall, only 3% of open recommendations were classified “unacceptable,” whereas 16% of all closed recommendations were classified “unacceptable.” Conclusions Although there has been over 100 years of progress in recognizing and addressing the safety risk posed by human fatigue in transportation, 20% of recent NTSB investigations have identified fatigue as a probable cause, contributing factor or finding. This analysis represents the first-ever examination of fatigue identified in major NTSB investigations across modes and of the focus, recipients, and classification status of fatigue-related safety recommendations. It demonstrates that fatigue remains a significant transportation safety risk.

Official government statistics of road traffic deaths in India under-represent pedestrians and motorised two wheeler riders

Abstract: Background Reliable data on traffic deaths are important for planning road safety programmes and evaluating progress. Although pedestrians comprise approximately 40% of traffic deaths in low-income and middle-income countries, official government statistics in India suggest that pedestrians comprise less than 10% of deaths. Objective To assess the accuracy of official tabulations of traffic deaths among various road users in India. Method We reviewed police first information reports (FIRs) of traffic deaths in one district (Belgaum) in 2013 and 2014 and extracted information about crash victims. We validated the FIRs by linking with case files from four police stations in the district. Finally, we compared the information on types of road users killed based on FIRs with the district9s official tabulations. Results We found that the distribution of deaths by types of road users reported in official tabulations differed substantially from the underlying police reports. While official tabulations reported that only 9% of deaths in 2013 were pedestrians and 37% were riders of motorised two wheelers, FIRs showed that these groups accounted for 21% and 49% of deaths, respectively. Discussion Official tabulations of traffic deaths in India do not correctly represent the types of roads users killed. Until the Indian National Crime Records Bureau has corrected the process of generating statistical tabulations from police reports, data on the types of road users killed in India should not be used for research and policy. In the interim, researchers and policy makers who need such information should extract it from police case files.

Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury : The brabant injury outcome surveillance (BIOS) study

Abstract: Introduction Trauma is a major public health problem worldwide that leads to high medical and societal costs. Overall, improved understanding of the full spectrum of the societal impact and burden of injury is needed. The main purpose of the Brabant Injury Outcome Surveillance (BIOS) study is to provide insight into prevalence, predictors and recovery patterns of short-term and longterm health-related quality of life (HRQoL) and costs after injury. Materials and methods This is a prospective, observational, follow-up cohort study in which HRQoL, psychological, social and functional outcome, and costs after trauma will be assessed during 24 months followup within injured patients admitted in 1 of 10 hospitals in the county Noord-Brabant, the Netherlands. Data will be collected by self-reported questionnaires at 1 week (including preinjury assessment), and 1, 3, 6, 12 and 24 months after injury. If patients are not capable of filling out the questionnaires, proxies will be asked to participate. Also, information about mechanism and severity of injury, comorbidity and indirect and direct costs will be collected. Mixed models will be used to examine the course of HRQoL, functional and psychological outcome, costs over time and between different groups, and to identify predictors for poor or good outcome. Relevance This study should make a substantial contribution to the international collaborative effort to assess the societal impact and burden of injuries more accurately. The BIOS results will also be used to develop an outcome prediction model for outcome evaluation including, besides the classic fatal, non-fatal outcome. Trial registration number NCT02508675.

A systematic review of technology-based interventions for unintentional injury prevention education and behaviour change

Abstract: Objective The aims of this literature review are to (1) summarise how computer and mobile technology-based health behaviour change applications have been evaluated in unintentional injury prevention, (2) describe how these successes can be applied to injury-prevention programmes in the future and (3) identify research gaps. Methods Studies included in this systematic review were education and behaviour change intervention trials and programme evaluations in which the intervention was delivered by either a computer or mobile technology and addressed an unintentional injury prevention topic. Articles were limited to those published in English and after 1990. Results Among the 44 technology-based injury-prevention studies included in this review, 16 studies evaluated locally hosted software programmes, 4 studies offered kiosk-based programmes, 11 evaluated remotely hosted internet programmes, 2 studies used mobile technology or portable devices and 11 studies evaluated virtual-reality interventions. Locally hosted software programmes and remotely hosted internet programmes consistently increased knowledge and behaviours. Kiosk programmes showed evidence of modest knowledge and behaviour gains. Both programmes using mobile technology improved behaviours. Virtual-reality programmes consistently improved behaviours, but there were little gains in knowledge. No studies evaluated text-messaging programmes dedicated to injury prevention. Conclusions There is much potential for computer-based programmes to be used for injury-prevention behaviour change. The reviewed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours.

The cost-effectiveness of bike lanes in New York City

Abstract: Background Our objective is to evaluate the cost-effectiveness of investments in bike lanes using New York City's (NYC) fiscal year 2015 investment as a case study. We also provide a generalizable model, so that localities can estimate their return on bike lane investments. Methods and findings We evaluate the cost-effectiveness of bike lane construction using a two-stage model. Our regression analysis, to estimate the marginal addition of lane miles on the expansion in bike ridership, reveals that the 45.5 miles of bike lanes NYC constructed in 2015 at a cost of $8 109 511.47 may increase the probability of riding bikes by 9.32%. In the second stage, we constructed a Markov model to estimate the cost-effectiveness of bike lane construction. This model compares the status quo with the 2015 investment. We consider the reduced risk of injury and increased probability of ridership, costs associated with bike lane implementation and maintenance, and effectiveness due to physical activity and reduced pollution. We use Monte Carlo simulation and one-way sensitivity analysis to test the reliability of the base-case result. This model reveals that over the lifetime of all people in NYC, bike lane construction produces additional costs of $2.79 and gain of 0.0022 quality-adjusted life years (QALYs) per person. This results in an incremental cost-effectiveness ratio of $1297/QALY gained (95% CI −$544/QALY gained to $5038/QALY gained). Conclusions We conclude that investments in bicycle lanes come with an exceptionally good value because they simultaneously address multiple public health problems. Investments in bike lanes are more cost-effective than the majority of preventive approaches used today.

Risk factors associated with unintentional house fire incidents, injuries and deaths in high-income countries: a systematic review

Abstract: Objective To identify the distinguishing risk factors associated with unintentional house fire incidents, injuries and deaths. Study design Systematic review. Methods A range of bibliographical databases and grey literature were searched from their earliest records to January 2016. To ensure the magnitude of risk could be quantified, only those study types which contained a control group, and undertook appropriate statistical analyses were included. A best evidence synthesis was conducted instead of a meta-analysis due to study heterogeneity. Results Eleven studies investigating a variety of risk factors and outcomes were identified. Studies ranged from medium to low quality with no high quality studies identified. Characteristics commonly associated with increased risk of house fire incidents, injuries and fatalities included: higher numbers of residents, male, children under the age of 5 years, non-working households, smoking, low income, non-privately owned properties, apartments and buildings in poor condition. Several risk factors were only associated with one outcome (eg, living alone was only associated with increased risk of injurious fires), and households with older residents were at increased risk of injurious fires, but significantly less likely to experience a house fire in the first place. Conclusions This best evidence synthesis indicates that several resident and property characteristics are associated with risk of experiencing house fire incidents, injuries or death. These findings should be considered by the Fire and Rescue Services and others with a role in fire prevention. Future research should adopt robust, standardised study designs to permit meta-analyses and enable stronger conclusions to be drawn.

School shootings during 2013–2015 in the USA

Abstract: Background Data on the factors associated with school shootings in the USA are limited. The public conversation has often suggested several factors that may be linked to these events, however with little empirical support. Aiming to fill this gap, we describe the characteristics of school shooting incidents in the USA between 2013 and 2015 and explore whether four factors that represent domains of firearm policy, educational policy and epidemiological risk factors for intentional firearm injuries-background check (BC) policies, per capita mental health expenditures (MHE), K-12 education expenditure (KEE) and urbanicity—were associated with school shootings during this period. Methods We searched LexisNexis, a newspaper and broadcast media databases for school shooting incidents from 1 January 2013 to 31 December 2015. Presence of BC laws was extracted from legal information in LexisNexis. State-level covariates of per capita MHE (2013), KEE (2013) and urbanicity (2010) rates were obtained from publicly available data sources. We used negative binomial regression models accounting for clustering by state to explore unadjusted associations between the BC laws, state-level covariates and school shootings to report IRR and 95% CI. Results We documented 154 school shootings (35, 55 and 64 each year). In unadjusted models, BC for firearm purchase (IRR=0.55, 95% CI 0.39 to 0.76), ammunition purchase (IRR=0.11, 95% CI 0.05 to 0.27), log per capita MHE (IRR=0.58, 95% CI 0.37 to 0.90), log per-capita KEE (IRR=0.09, 9% CI 0.02 to 0.29) and urbanicity (IRR=0.97, 95% CI 0.96 to 0.99) were associated with school shooting. Conclusions School shootings are less likely in states with BC laws, higher MHE and KEE, and with greater per cent urban population.

Decomposing change in China's suicide rate, 1990–2010: ageing and urbanisation

Abstract: Objective The study empirically quantifies the contributions of age composition and urbanisation to changes in the suicide rate in China over the periods 1990–2000 and 2000–2010. Methods A decompositional method was used to quantify the absolute and relative contributions of the age structure; the age-specific proportion of the urban population and the suicide rate of each age-specific, gender-specific and urban/rural cohort to the overall suicide rates in the two 10-year intervals. Results In the period between 1990 and 2000, a significant decline in the suicide rate among younger age groups (especially young rural women) was identified as the main driving force of the downward trend in the overall suicide rate. In 2000–2010, the rate of decline in suicide was predominantly explained by the drop in the suicide rate among all age groups in rural areas, with the exception of those aged over 80. The positive impact of urbanisation on the decline of the suicide rate has gradually diminished relative to the earlier period. Conclusion As the positive impact of urbanisation on suicide rates is diminishing, further urbanisation and rapid change in society may induce stress and adjustment problems that are not conducive to the promotion of well-being. Furthermore, as China is facing the prospects of slower economic growth and a rapidly ageing population, suicides among older adults may also be elevated, particularly among those in rural areas with insufficient healthcare and social support. In order to maintain the decreasing trend of suicide in China, it is important for the Chinese government to pay more attention to the mental well-being of the population and to mitigate the stress of urban life and to provide timely support to older adults especially in rural areas.

Functioning and health-related quality of life following injury in older people: a systematic review.

Abstract: Aim and background There is growing evidence around the impact of injury and recovery trajectories but little focuses on older people, despite rising burden. The aim of this review was to describe the evidence for postinjury functioning and health-related quality of life (HRQoL) in older people. Method A systematic search of three databases and an extensive search of the grey literature was carried out on prospective injury outcome studies in older people (age ≥65 years) that used a generic health status outcome measure. The search results were reported using PRISMA reporting guidelines, and risk of bias was assessed using a modification of the Quality in Prognosis Studies tool. Results There was limited evidence on functioning and HRQoL postinjury in older people. There were 367 studies identified, with 13 eligible for inclusion. Most focused on hip fracture or traumatic brain injury. Older people appeared to have poorer postinjury functioning and HRQoL compared with younger adults or preinjury levels. Poor preinjury function, pre-existing conditions and increasing age were associated with poorer outcomes, whereas preinjury-independent living was associated with better outcomes. Discussion The studies were heterogeneous, limiting synthesis. There was a lack of evidence around the impact of injury on older people in terms of paid work and unpaid work. It was unclear if existing injury outcome guidelines are appropriate for older people. Conclusions Further research is required on older people9s postinjury course, outcomes and determinants. This will require standardised methodologies and qualitative studies. The findings will inform clinical care, policy development, health and compensation systems.

“I wasn't texting; I was just reading an email …”: a qualitative study of distracted driving enforcement in Washington State

Abstract: Background In response to the rise of distracted driving, many countries and most US states have adopted laws to restrict the use of handheld phones for drivers. Specific provisions of each law and the overall social mores of distracted driving influence enforceability and impact. Objectives Identify multilevel interdependent factors that influence distracted driving enforcement through the perspective of police officers. Design/methods We conducted focus group discussions with active duty law enforcement officers from three large Washington State counties. Our thematic analysis used descriptive and pattern coding that placed our findings within a social ecological framework to facilitate targeted intervention development. Results Participants reported that the distracted driving law posed challenges for consistent and effective enforcement. They emphasised the need to change social norms around distracted driving, similar to the shifts seen around impaired driving. Many participants were themselves distracted drivers, and their individual knowledge, attitude and beliefs influenced enforcement. Participants suggested that law enforcement leaders and policymakers should develop and implement policies and strategies to prioritise and motivate increased distracted driving enforcement. Conclusions Individual, interpersonal, organisational and societal factors influence enforcement of distracted driving laws. Targeted interventions should be developed to address distracted driving and sustain effective enforcement.

Cost–benefit analysis of fall injuries prevented by a programme of home modifications: a cluster randomised controlled trial

Abstract: Background Injuries due to falls in the home impose a huge social and economic cost on society. We have previously found important safety benefits of home modifications such as handrails for steps and stairs, grab rails for bathrooms, outside lighting, edging for outside steps and slip-resistant surfacing for outside areas such as decks. Here we assess the economic benefits of these modifications. Methods Using a single-blinded cluster randomised controlled trial, we analysed insurance payments for medically treated home fall injuries as recorded by the national injury insurer. The benefits in terms of the value of disability adjusted life years (DALYs) averted and social costs of injuries saved were extrapolated to a national level and compared with the costs of the intervention. Results An intention-to-treat analysis was carried out. Injury costs per time exposed to the modified homes compared with the unmodified homes showed a reduction in the costs of home fall injuries of 33% (95% CI 5% to 49%). The social benefits of injuries prevented were estimated to be at least six times the costs of the intervention. The benefit–cost ratio can be at least doubled for older people and increased by 60% for those with a prior history of fall injuries. Conclusions This is the first randomised controlled trial to examine the benefits of home modification for reducing fall injury costs in the general population. The results show a convincing economic justification for undertaking relatively low-cost home repairs and installing safety features to prevent falls. Trial registration number ACTRN12609000779279.

The role of intersection and street design on severity of bicycle-motor vehicle crashes

Abstract: Background Safety concerns are a major barrier to cycling. Intersection and street design variables such as intersection angles and street width might contribute to the severity of crashes and the safety concerns. In this study we examined whether these design variables were associated with bicycle-motor vehicle crashes (BMVC) severity. Methods Using the geographical information system and latitudes/longitudes recorded by the police using a global positioning device, we extracted intersection angles, street width, bicycle facilities, posted speed limits and annual average daily traffic from 3266 BMVC data from New York City police records. Additional variables about BMVC, including age and sex of the bicyclist, time of the day, road surface conditions, road character, vehicle type and injury severity, were obtained from police reports. Injury severity was classified as severe (incapacitating or killed) or non-severe (non-incapacitating, possible injury). The associations between injury severity and environment design variables were examined using multivariate log-binomial regression model. Findings Compared with crashes at orthogonal intersections, crashes at non-orthogonal intersections had 1.37 times (95% CI 1.05 to 1.80) and non-intersection street segments had 1.31 times (95% CI 1.01 to 1.70) higher risk of a severe injury. Crashes that involved a truck or a bus were twice as likely to result in a severe injury outcome; street width was not significantly associated with injury severity. Conclusion Crashes at non-orthogonal intersections and non-intersection segments are more likely to result in higher injury severity. The findings can be used to improve road design and develop effective safety interventions.

Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey.

Abstract: Background Although opioid abuse is a rising epidemic in the USA, there are no studies to date on the incidence of persistent opioid use following injuries. Therefore, the aims of this study are: (1) to examine the incidence of persistent opioid use among a nationally representative sample of injured and non-injured populations; (2) to evaluate whether an injury is an independent predictor of persistent opioid use. Method Data from the Medical Expenditure Panel Survey were pooled (years 2009–2012). Adults were followed for about 2 years, during which they were surveyed about injury status and opioid use every 4–5 months. To determine whether injuries are associated with persistent opioid use, weighted multiple logistic regressions were constructed. Results While 2.3 million injured individuals received any opioid during the follow-up, 371 170 (15.6%) individuals became persistent opioid users (defined as opioid use across multiple time points). In a multiple logistic regression analysis adjusting for sociodemographic characteristics and self-reported health, those who sustained injuries were 1.4 times (95% CI 1.1 to 1.9) more likely to report persistent opioid use than those without injuries. Conclusions We found injuries to be significantly associated with persistent opioid use in a nationally representative sample. Further investment in injury prevention may facilitate reduction of persistent opioid use and, thus, improve population health and reduce health expenditures.

Sports Biostatistician: a critical member of all sports science and medicine teams for injury prevention

Abstract: Sports science and medicine need specialists to solve the challenges that arise with injury data. In the sports injury field, it is important to be able to optimise injury data to quantify injury occurrences, understand their aetiology and most importantly, prevent them. One of these specialty professions is that of Sports Biostatistician. The aim of this paper is to describe the emergent field of Sports Biostatistics and its relevance to injury prevention. A number of important issues regarding this profession and the science of sports injury prevention are highlighted. There is a clear need for more multidisciplinary teams that incorporate biostatistics, epidemiology and public health in the sports injury area.

Exploring optimal air ambulance base locations in Norway using advanced mathematical modelling

Abstract: Background Helicopter emergency medical services are an important part of many healthcare systems. Norway has a nationwide physician staffed air ambulance service with 12 bases servicing a country with large geographical variations in population density. The aim of the study was to estimate optimal air ambulance base locations. Methods We used high resolution population data for Norway from 2015, dividing Norway into >300 000 1 km×1 km cells. Inhabited cells had a median (5–95 percentile) of 13 (1–391) inhabitants. Optimal helicopter base locations were estimated using the maximal covering location problem facility location optimisation model, exploring the number of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, both in green field scenarios and conditioning on the current base structure. We reanalysed on municipality level data to explore the potential information loss using coarser population data. Results For a 45 min threshold, 90% of the population could be covered using four bases, and 100% using nine bases. Given the existing bases, the calculations imply the need for two more bases to achieve full coverage. Decreasing the threshold to 30 min approximately doubles the number of bases needed. Results using municipality level data were remarkably similar to those using fine grid information. Conclusions The whole population could be reached in 45 min or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases. Municipality level data appears sufficient for proper analysis.

Contributors to pedestrian distraction and risky behaviours during road crossings in Romania

Abstract: Objective Pedestrian fatalities due to collisions with motor vehicles are a large public health problem in Romania, ranking them among the highest in Eastern Europe. The purpose of this study was to gain a better understanding of crash factors by examining how roadway and environmental characteristics contribute to pedestrian distraction and risky behaviours at pedestrian MVC (PMVC) locations in Cluj County, Romania. Methods A sample of PMVC locations was selected from the 2010 Cluj County police reported crash database for on-site examination. A total of 100 sites were visited to collect details on site characteristics and typical pedestrian and driver behaviours. Variable distributions were examined and rate ratios of pedestrian distraction and risky behaviours were calculated. Results Pedestrian distraction and risky behaviours were observed at rates of 6.3 and 24.3 per 100 observed pedestrians. The majority of distractions were related to electronic device use. Risky behaviours were evenly split between unpredictable, partial use of a crosswalk and midblock illegal crossings. Distractions and risky behaviours decreased as the number of pedestrians and average vehicle speeds at a site increased. RR of distraction was higher at intersections and locations with crosswalks. Conclusions Pedestrian distraction was highly correlated with pedestrian risky behaviours at PMVC locations in Romania. Higher pedestrian volume was protective against pedestrian distraction and risky behaviours. Locations with painted crosswalks had increased distraction. Targeted distraction prevention, particularly at intersections and crosswalk locations, may contribute to the prevention of PMVCs.

Association between maternal depression and anxiety episodes and rates of childhood injuries: a cohort study from England

Abstract: Background: Maternal depression is common and associated with several child health outcomes. The impact on childhood injuries is underexplored, with existing studies relying on maternal reporting of injury occurrences. Using population healthcare databases from England, we assessed the association between maternal depression and/or anxiety episodes and rates of child poisonings, fractures, burns and serious injuries. Methods: We conducted a prospective cohort study of 207,048 mother-child pairs with linked primary care and hospitalisation data from the Clinical Practice Research Datalink and Hospital Episode Statistics, 1998-2013. Episodes of maternal depression and/or anxiety were identified using diagnoses, prescriptions and hospitalisations, with the child’s follow-up time divided into exposed and unexposed periods. Adjusted incidence rate ratios (aIRR) for child injury during maternal mental health episodes were estimated using Poisson regression. Results: 54,702 children (26.4%) were exposed to maternal depression and/or anxiety when aged 0-4 years. During follow-up 2,614 poisonings, 6,088 fractures and 4,201 burns occurred. Child poisoning rates increased during episodes of maternal depression (aIRR 1.52, 95% confidence interval 1.31-1.76), depression with anxiety (2.30, 1.93-2.75) and anxiety alone (1.63, 1.09-2.43). Similarly, rates of burns (1.53, 1.29-1.81) and fractures (1.24, 1.06-1.44) were greatest during depression with anxiety episodes. There was no association between maternal depression and/or anxiety and serious child injuries. Conclusions: Maternal depression and/or anxiety episodes were associated with increased rates of child poisonings, fractures and burns. Whilst mechanisms are unclear, prompt identification and treatment of maternal depression and/or anxiety and provision of safety advice (e.g. safe medication storage) may reduce child injury risk.

Paediatric injury from indoor trampoline centres.

Abstract: Indoor trampoline parks are increasing as a source of injuries among children. We conducted a prospective cohort study, with semi-structured interview and medical record review, of children aged <17 years presenting to a paediatric emergency department following an injury at an indoor trampoline park. In a 6-month period in 2014, 40 such children (55% female) presented to the department. Common mechanisms were individual jumpers falling while attempting a somersault or trick, landing awkwardly on an obstacle such as a ball or protective padding, and multiple users on a single trampoline. Most sustained soft tissue injuries (n=22, 55%) and fractured bones (n=15, 37.5%). One child sustained an unstable cervical fracture/dislocation. Unlike domestic trampolines, where the majority of injuries occur from falling off, most trampoline-park injuries occur on the trampoline surface. These differences require injury prevention strategies that engage children, carers and businesses to meet best practice design and management standards.

Evaluating a smartphone application to improve child passenger safety and fire safety knowledge and behaviour.

Abstract: Background Although proven measures for reducing injury due to motor vehicle collision and residential fires exist, the number of families properly and consistently using child passenger restraints and smoke alarms remains low. This paper describes the design of the Safety In Seconds (SIS) 2.0 study, which aims to evaluate the impact of a smartphone app on parents9 use of child restraints and smoke alarms. Methods SIS is a multisite randomised controlled trial. Participants are parents of children aged 4–7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service. Parents are randomised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app. A baseline and two follow-up surveys at 3 months and 6 months are conducted. Primary outcomes are: (1) having the correct child restraint for the child9s age and size; (2) restraining the child in the back seat of the car; (3) buckling the child up for every ride; (4) having the restraint inspected by a child passenger safety technician; (5) having a working smoke alarm on every level of the home; (6) having hard-wired or lithium battery smoke alarms; (7) having and (8) practising a fire escape plan. Discussion Finding ways to communicate with parents about child passenger and fire safety continues to be a research priority. This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use. Trial registration number NCT02345941; Pre-results.

Not an ‘iron pipeline’, but many capillaries: regulating passive transactions in Los Angeles' secondary, illegal gun market

Abstract: California has strict firearm-related laws and is exceptional in its regulation of firearms retailers. Though evidence suggests that these laws can reduce illegal access to guns, high levels of gun violence persist in Los Angeles (LA), California. This research seeks to describe the sources of guns accessed by active offenders in LA, California and reports offenders' motivations for obtaining guns.Los Angeles County Jail (LACJ) system (four facilities).Random sampling from a screened pool of eligible participants was used to conduct qualitative semistructured interviews with 140 incarcerated gun offenders in one of four (LACJ) facilities. Researchers collected data on firearm acquisition, experiences related to gun violence, and other topics, using a validated survey instrument. Grounded theory guided the collection and analysis of data.Respondents reported possession of 77 specific guns (79.2% handguns) collectively. Social networks facilitate access to illegal guns; the majority of interviewees acquired their illegal guns through a social connection (85.7%) versus an outside broker/unregulated retailer (8.5%). Most guns were obtained through illegal purchase (n=51) or gift (n=15). A quarter of gun purchasers report engaging in a passive transaction, or one initiated by another party. Passive gun buyers were motivated by concerns for personal safety and/or economic opportunity.In LA's illegal gun market, where existing social relationships facilitate access to guns across a diffuse network, individuals, influenced by both fear and economic opportunity, have frequent opportunities to illegally possess firearms through passive transactions. Gun policies should better target and minimise these transactions.

Virtual reality by mobile smartphone: improving child pedestrian safety

Abstract: Background Pedestrian injuries are a leading cause of paediatric injury. Effective, practical and cost-efficient behavioural interventions to teach young children street crossing skills are needed. They must be empirically supported and theoretically based. Virtual reality (VR) offers promise to fill this need and teach child pedestrian safety skills for several reasons, including: (A) repeated unsupervised practice without risk of injury, (B) automated feedback on crossing success or failure, (C) tailoring to child skill levels: (D) appealing and fun training environment, and (E) most recently given technological advances, potential for broad dissemination using mobile smartphone technology. Objectives and methods Extending previous work, we will evaluate delivery of an immersive pedestrian VR using mobile smartphones and the Google Cardboard platform, technology enabling standard smartphones to function as immersive VR delivery systems. We will overcome limitations of previous research suggesting children learnt some pedestrian skills after six VR training sessions but did not master adult-level pedestrian skills by implementing a randomised non-inferiority trial with two equal-sized groups of children ages 7–8 years (total N=498). All children will complete baseline, postintervention and 6-month follow-up assessments of pedestrian safety and up to 25 30-min pedestrian safety training trials until they reach adult levels of functioning. Half the children will be randomly assigned to train in Google Cardboard and the other half in a semi-immersive kiosk VR. Analysis of Covariance (ANCOVA) models will assess primary outcomes. Discussion If results are as hypothesised, mobile smartphones offer substantial potential to overcome barriers of dissemination and implementation and deliver pedestrian safety training to children worldwide.

Mandatory desexing of dogs: one step in the right direction to reduce the risk of dog bite? A systematic review.

Abstract: Introduction Preventing dog bites is an intractable problem given the complex dog bite injury environment. Desexing of dogs has the opportunity of creating a safer injury environment, given the potential links between desexing and behaviour change in dogs. Methods A systematic review of the literature was conducted to examine the evidence for desexing of dogs to reduce dog bite risk within a population health paradigm. Medline and CAB Abstracts were searched for studies that reported data on the association of dog neuter status with the risk of dog bite. All definitions of dog bite were included and all empirical studies were included in the review, limited to those published in English. Quality appraisal and data extraction were based on the 2013 evidence-based practice and critical appraisal tool from the University of Auckland. Results Five out of six observational studies, from four study populations found evidence that intact dogs were associated with an increased risk of dog bite compared with desexed dogs. The effect sizes ranged across the studies and given the heterogeneity of the studies no single effect size on the association between desexing and dog bite risk could be estimated. Conclusions There is consistent evidence that desexing dogs is associated with a reduced risk of dog bite, although the studies reflect association and may not be causal. Although recent publications have suggested desexing is associated with health and behavioural costs in some breeds, population level evidence supports desexed dogs having a longer lifespan, and being less likely to wander with the added benefit of reducing unwanted litters. Thus, mandatory desexing presents a possible opportunity for prevention of dog bites expanding dog bite prevention beyond an education-only approach.

Redefining the child pedestrian safety paradigm: identifying high fatality concentrations in urban areas

Abstract: Objectives Child pedestrians are some of the most vulnerable users of our transportation systems, and they deserve particular attention when we consider traffic safety. The objective of this work is to identify urban locations in which child pedestrians are at particular risk for fatal collisions with vehicles. Methods This paper examines 30 years of crash data for six American cities to locate areas with high child pedestrian fatality concentrations. Phase I of the study, which examines Denver, Colorado, USA, reveals higher concentrations of child pedestrian fatalities around parks as compared with other areas that children have been shown to frequent. In phase II of the study, we specifically examine fatality concentrations near parks as compared with schools. Results Statistical analyses suggest that, once exposure is controlled for, child pedestrian fatalities concentrate around parks in densities 1.04–2.23 times higher than around schools. Also, the concentration of child pedestrian fatalities around parks is 1.16–1.81 times higher than the respective citywide concentration. Conclusion Traffic risks for children around parks deserve further examination as we pursue the goals of Vision Zero and child safety on our streets.

Development and validation of a new ICD-10-based trauma mortality prediction scoring system using a Japanese national inpatient database

Abstract: Introduction To develop and validate a new trauma mortality prediction scoring system based on International Statistical Classification of Diseases (ICD)-10 codes, using a Japanese administrative claims and discharge abstract database. Methods This retrospective observational study used the Japanese Diagnosis Procedure Combination database. Injuries were categorised into 33 groups with 5 additional groups based on injury sites and types. A multivariable logistic regression analysis was performed for in-hospital mortality in a derivation cohort after adjusting for the 38 groups, patient9s sex, age and Charlson Comorbidity Index score. Each variable was assigned a score that was equal to the value of the regression coefficient. The new severity score was defined as the sum of the scores. The new scoring system was tested in a validation cohort. Results The mortality rates were 2.4% (9270/393 395) and 2.5% (8778/349 285) in the derivation and validation cohorts, respectively. The area under the receiver operating curve (AUROC) of the new scoring system was 0.887 (95% CI 0.884 to 0.890) in the validation cohort. Subgroup analyses showed that the scoring system retained high predictive performance both for patients Conclusions A new ICD-10-based injury severity scoring system was developed and validated. Further studies are required to validate the scoring system in other databases.

Working in hot weather: a review of policies and guidelines to minimise the risk of harm to Australian workers

Abstract: Australia has experienced a number of lethal heatwaves, and hot summers are normal for most parts of the country.1 ,2 However, while there has been a strong research and policy focus to inform and support strategies to minimise harm from hot weather to vulnerable groups at the community level,3 less attention has been paid to the safety of people while they work. Heat-related workplace fatalities have been reported in Australia,4 ,5 and deaths of people of working age occurred in Victoria during a severe heatwave in 2009.6 A study set in Adelaide found the risk of occupational heat illness during heatwave periods to be approximately seven times higher than during non-heatwave periods, over the years 2001–2010.7 Workers, especially those engaged in heavy physical activity in outdoor or non-temperature-regulated indoor locations, face challenges to their health during hot weather as heat generated by muscle activity adds to their heat burden from the environment.8 Excessive heat stress arising from working in hot weather, in conjunction with inadequate replacement of water and electrolytes lost through sweating, can lead to a spectrum of acute heat-related illnesses ranging from heat rashes, cramps and heat exhaustion, to heat stroke, a severe potentially fatal illness requiring urgent medical attention.9 Working in hot weather has also been associated with an increased risk of work-related injury and renal disease.10 ,11 Sensitivity to hot weather is increased by factors that reduce the effectiveness of thermoregulation including dehydration, older age, obesity, skin conditions that limit sweating, heavy or impermeable clothing, chronic disease, some medications, alcohol and recreational drugs.12 ,13 Conversely, acclimatisation to heat and improved fitness increase thermoregulatory efficiency.14 The capacity of individual workers and the workplace to adapt to hot weather will be influenced by workplace …

Preventing violence-related injuries in England and Wales: a panel study examining the impact of on-trade and off-trade alcohol prices

Abstract: Objective To examine the influence of real on-trade and off-trade alcohol prices and socioeconomic and environmental factors on rates of violence-related emergency department (ED) attendances in England and Wales over an 8-year period. Methods Anonymised injury data which included attendance date, age and gender of patients aged over 18 years who reported injury in violence were collected from a structured sample of 100 EDs across England and Wales between 1 January 2005 and 31 December 2012. Alcohol prices and socioeconomic measures were obtained from the UK Office for National Statistics. Panel techniques were used to derive a statistical model. Results Real on-trade (β=−0.661, p<0.01) and off-trade (β=−0.277, p<0.05) alcohol prices were negatively related with rates of violence-related ED attendance among the adult population of England and Wales, after accounting for the effects of regional poverty, income inequality, youth spending power and seasonal effects. It is estimated that over 6000 fewer violence-related ED attendances per year in England and Wales would result from a 1% increase in both on-trade and off-trade alcohol prices above inflation. Of the variables studied, changes in regional poverty and income inequality had the greatest effect on violence-related ED attendances in England and Wales. Conclusions Small increases in the price of alcohol, above inflation, in both markets, would substantially reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales. Reforming the current alcohol taxation system may be more effective at reducing violence-related injury than minimum unit pricing.

Statistical process control charts for monitoring military injuries.

Abstract: Background An essential aspect of an injury prevention process is surveillance, which quantifies and documents injury rates in populations of interest and enables monitoring of injury frequencies, rates and trends. To drive progress towards injury reduction goals, additional tools are needed. Statistical process control charts, a methodology that has not been previously applied to Army injury monitoring, capitalise on existing medical surveillance data to provide information to leadership about injury trends necessary for prevention planning and evaluation. Methods Statistical process control Shewhart u-charts were created for 49 US Army installations using quarterly injury medical encounter rates, 2007–2015, for active duty soldiers obtained from the Defense Medical Surveillance System. Injuries were defined according to established military injury surveillance recommendations. Charts display control limits three standard deviations (SDs) above and below an installation-specific historical average rate determined using 28 data points, 2007–2013. Charts are available in Army strategic management dashboards. Results From 2007 to 2015, Army injury rates ranged from 1254 to 1494 unique injuries per 1000 person-years. Installation injury rates ranged from 610 to 2312 injuries per 1000 person-years. Control charts identified four installations with injury rates exceeding the upper control limits at least once during 2014–2015, rates at three installations exceeded the lower control limit at least once and 42 installations had rates that fluctuated around the historical mean. Conclusions Control charts can be used to drive progress towards injury reduction goals by indicating statistically significant increases and decreases in injury rates. Future applications to military subpopulations, other health outcome metrics and chart enhancements are suggested.