Prevention of death and disability from injuries to children and adolescents

One million children and adolescents die each year from injuries and many-fold more suffer long-term disability. While there have been substantial reductions in injury mortality over the last 50 years, further decreases in morbidity and mortality will require consideration of additional factors. This article discusses five different components to further reduce the injury burden: consideration of the epidemiologic transition occurring in both high-income as well as low- and middle-income countries; expanding the concept of injury prevention to that of injury control, with substantial emphasis on acute care and rehabilitation of the injured child; inclusion of adolescents in paediatric injury control; improving the quality of research conducted; and changing the way priorities are determined in the injury field.     

Epidemiology of yoga-related injuries in Canada from 1991 to 2010: a case series study

The aim is to describe the epidemiology of yoga injuries presenting to select Canadian emergency departments (EDs). Those who presented with a yoga injury to a Canadian ED participating in the Canadian Hospitals Injury Reporting and Prevention Program and had completed a data collection form between 1991 and 2010 were included. Demographic and injury characteristics were tabulated and injury profiles of children were compared to adults. Sixty-six individuals (48 female, 18 male) who sustained 67 injuries were included. The median age was 19 (intraquartile range: 13, 32) and 73% of individuals were injured after 2005 (p = 0.0003). Sprain was the most common injury (23/67, 34%) and the most common body region injured was the lower extremity (27/67, 42%). Significantly more children were injured while being instructed than adults (p = 0.003) but more adults required treatment (p = 0.023). Although yoga-related injuries presenting to an ED are not common, the number of injuries are increasing.     

Strengthening care for injured persons in less developed countries: A case study of Ghana and Mexico

In all countries, the priority for reducing road traffic injuries should be prevention. Nonetheless, there are low-cost ways to strengthen the care of injured persons, that will help to lower the toll from road traffic. The purpose of this review was to elucidate ways to accomplish this goal in the context of less developed countries. Studies selected for this review were obtained by Medline review, selecting on key words such as trauma, injury, trauma care, essential health services, and developing country. Articles pertaining to any country and all available years were considered. In addition, the authors utilized articles from the gray literature and journals from Mexico and Ghana that are not Medline referenced. Studies surveyed point to road safety and other forms of injury prevention, as well as prehospital care, as likely priorities for developing countries. Nonetheless, hospital-based improvements can contribute to decreases in mortality and, especially, decreases in disability. For both prehospital and hospital based care, studies revealed several critical weak points to address in: (1) human resources (staffing and training); (2) physical resources (equipment, supplies, and infrastructure); and (3) administration and organization. The ‘essential services’ approach, which has contributed to progress in a variety of fields of international health, needs to be developed for the care of the injured. This would define the trauma treatment services that could realistically be made available to virtually every injured person. It would then address the inputs of human resources, physical resources, and administration necessary to assure these services optimally in the different geographic and socioeconomic environments worldwide. Finally, it would identify and target deficiencies in these inputs that need to be strengthened.     

Short Reports

As the US population ages, more older adults will face transportation and mobility challenges. This study examines the characteristics and contributing circumstances of nonfatal older adult pedestrian injuries. Data were obtained from the National Electronic Injury Surveillance System-All Injury Programme (NEISS-AIP) for the years 2001 through 2006. Cases included persons aged 65 years and older who were nonfatally injured on a public roadway. The results indicated that on average, an estimated 52,482 older adults were treated in emergency departments each year for nonfatal pedestrian injuries. Falling and being hit by a motor vehicle were the leading mechanisms of injury, resulting in 77.5% and 15.0% of older adult pedestrian injuries, respectively. More than 9000 older pedestrian fall-related injuries each year involved a kerb. It is concluded that the growth in the older adult population could add to the overall burden of these nonfatal pedestrian injuries. Making transportation and mobility improvements, including environmental modifications, is important for preventing these injuries.     

Older adult pedestrian injuries in the United States: causes and contributing circumstances

As the US population ages, more older adults will face transportation and mobility challenges. This study examines the characteristics and contributing circumstances of nonfatal older adult pedestrian injuries. Data were obtained from the National Electronic Injury Surveillance System-All Injury Programme (NEISS-AIP) for the years 2001 through 2006. Cases included persons aged 65 years and older who were nonfatally injured on a public roadway. The results indicated that on average, an estimated 52,482 older adults were treated in emergency departments each year for nonfatal pedestrian injuries. Falling and being hit by a motor vehicle were the leading mechanisms of injury, resulting in 77.5% and 15.0% of older adult pedestrian injuries, respectively. More than 9000 older pedestrian fall-related injuries each year involved a kerb. It is concluded that the growth in the older adult population could add to the overall burden of these nonfatal pedestrian injuries. Making transportation and mobility improvements, including environmental modifications, is important for preventing these injuries.     

Does poverty lead to non-fatal unintentional injuries in rural Vietnam?

The aim of this study was to identify associations between poverty at the household level and unintentional injury morbidity. A cohort consisting of 24,874 person-time episodes, representing 24,776 people living in 5,801 households (classified into rich, middle income and poor by local authorities in 1999) was followed during 2000, in order to identify and assess non-fatal unintentional injuries. Incidence rate ratios were calculated using a Poisson regression model. The results showed that poverty was a risk factor for unintentional injuries generally. When looking at different types of injury, poverty was a risk for home, work and "other" injuries, protective for school injuries, while the risk of traffic injuries was not affected. The results also showed that communes in mountainous areas were at higher risk for home, work and other injuries. Overall, poverty was associated with unintentional injury morbidity. However, the relationship varied by sex, age and type of injury. Specifically, poverty increased the risk for children and elderly people being injured at home, and for adults (15-59 years) being affected by work injuries.     

Global collaboration on road traffic injury prevention

Worldwide, nearly 1.2 million people are killed in road traffic crashes every year and 20 million to 50 million more are injured or disabled. These injuries account for 2.1% of global mortality and 2.6% of all disability-adjusted life years (DALYs) lost. Low- and middle-income countries account for about 85% of the deaths and 90% of the DALYs lost annually. Without appropriate action, by 2020, road traffic injuries are predicted to be the third leading contributor to the global burden of disease. The economic cost of road traffic crashes is enormous. Globally it is estimated that US$518 billion is spent on road traffic crashes with low- and middle-income countries accounting for US$65 billion--more than these countries receive in development assistance. But these costs are just the tip of the iceberg. For everyone killed, injured or disabled by a road traffic crash there are countless others deeply affected. Many families are driven into poverty by the expenses of prolonged medical care, loss of a family breadwinner or the added burden of caring for the disabled. There is an urgent need for global collaboration on road traffic injury prevention. Since 2000, WHO has stepped up its response to the road safety crisis by firstly developing a 5-year strategy for road traffic injury prevention and following this by dedicating World Health Day 2004 to road safety and launching the WHO/World Bank World Report on Road Traffic Injury Prevention at the global World Health Day event in Paris, France. This short article highlights the main messages from the World Report and the six recommendations for action on road safety at a national and international level. It goes on to briefly discuss other international achievements since World Health Day and calls for countries to take up the challenge of implementing the recommendations of the World Report.     

List of Reviewers 2013

Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. The rate of road traffic accidents caused by four-wheeled vehicles is the highest globally reported road traffic accidents statistic. In Saudi Arabia, the motor vehicle is the main means of transportation with one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and/or drivers disobeying traffic signals. Road traffic injuries cause considerable economic losses to victims, their families, and to nations as a whole. Strategic prevention plans should be implemented soon by various sectors (health, police, transport, and education) to decrease the mortality and morbidity among adolescent and young age group. Strong and effective coordination between ministry of health and other ministries together with World Health Organization and other related organisations will be an important step towards implementing the international Decade of Action for Road Safety (2011–2020). The aim of this review article is to highlight some aspects of the health impacts of road traffic accidents.     

Child injuries in land vehicles that do not require restraints

Abstract

The goal of this study was to determine the injury profiles of Canadian children who presented to the Emergency Department from 1990 to 2016 due to an injury caused while traveling in a form of land transportation that did not require child restraint. A case series was conducted using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). Children who were injured while travelling on land transportation for which child restraint is not required, who presented to a Canadian Emergency Department that participates in eCHIRPP between April 1, 1990 to August 29, 2016, were included. Overall, 1856 children sustained 2139 injuries (mean age: 9.8?years (SD 4.5), 45.5% male). The majority of children were injured on a school bus (49.3%). The most commonly injured body part was the head or neck (52.6%). The most common type of injury was a superficial or open wound (33.1%), followed by traumatic brain injury (19.3%). Overall, 39.4% of injuries required no treatment in hospital. Overall, approximately 70 children presented to eCHIRPP EDs per year on a land transportation vehicle that does not require restraints. Biomechanical studies are needed to improve safety on land transportation vehicles that do not require seatbelts.     

Injuries,inequalities and health in Europe

Injuries account for a significant burden of mortality, morbidity, disability and health care costs. They differentially affect age and sex groups and reveal massive inequalities in occurrence within and between countries in Europe. Within countries, the poor suffer most and have least ability to change their exposures to risk. Addressing inequalities in injury occurrence would play a valuable role in reducing the differential burden of ill-health between rich and poor. Despite the evidence for many effective injury-related interventions, limited attention has been devoted to addressing injuries as a public health priority. This paper questions why attention has been limited to date and suggests policy action to support injuries being addressed as a mainstream concern by national and international health policy-makers. The paper briefly highlights the public health burden of injuries and violence; illustrates the range of inequalities that characterise their occurrence; highlights the scope for public health action and considers the extent to which policies that reduce the overall burden of injuries may also reduce inequalities in their occurrence; and finally examines why there has been a limited policy response to date and suggests ways of advancing the agenda.     

Prevalence of mortality in cannabis consumer motorcyclists: meta-analysis of international studies

Abstract

The purpose of this study was to estimate prevalence of mortality in cannabis consumer motorcyclists across the world. A systematic review was conducted from publications PubMed/Medline, ISI Web of Knowledge, EMBASE, Scopus, and Google Scholar from August 2010 to March2019. The variances of each study were calculated using the binomial distribution formula and the heterogeneity among the studies was analyzed by Q-Cochran test with a significant level less than 0.1 and the index of changes attributed to I² heterogeneity. The prevalence of mortality in cannabis consumer motorcyclists was estimated 0.15 (95% CI = 0.08–0.22). Subgroup analysis based on country type showed that the mortality rate of cannabis consumer motorcyclists in developed countries is 16% (0.08–0.24) and in developing countries is 8% (0.04–0.10). These findings have implications for developing interventions through presenting appropriate solution, educating people and raising awareness to address the changing nature of drug use among motorcyclists in the world.     

Homeless in America: injuries treated in US emergency departments, 2007–2011

Despite being a high-risk population, epidemiological research about injuries among homeless individuals is limited. We sought to describe injury characteristics among individuals identified as homeless in the National Electronic Injury Surveillance System (NEISS), and to compare them to age- and sex-matched controls. We searched text narratives for all patients with product-related injuries who presented to NEISS emergency departments from 2007 to 2011 to identify homeless cases (N = 268). A random sample of 2680 age- and sex-matched controls was identified for the same time period. The incident location differed between groups, and the mention of substance use was significantly more common among homeless cases than controls. The body part injured differed significantly between cases and controls for all age groups, with the exception of older adults. Among homeless cases, injuries occurred most frequently to the lower extremities, and sprains/strains, contusions/abrasions and burns were most common. Additional research on injury among homeless individuals is warranted in order to identify meaningful preventive strategies for this at-risk population.     

Prehospital trauma care evolution,practice and controversies: need for a review

Abstract

Modern medicine and surgery is historically very recent, and most interventions that are so commonly done in a hospital now are only 60 to 70?years old. Understanding of emergency care of the injured is more recent; however, for the sake of temporal convenience trauma care has become compartmentalized into phases: first aid, bystander care, prehospital care, emergency care, definitive levels of care and rehabilitation. The injured patient’s body physiology is changing continuously from the time of the impact at the injury site.. The outcome of trauma is dependent not only on what is done in the prehospital phase but also on hospital care and rehabilitation. Our understanding of the changes and the response to interventions in a trauma patient has been evolving over the years. This paper discusses the need to review recent advances in our understanding of the care process and how we need to improve it and how there is a pressing need to generate valid evidence on what we do in emergency care.     

Mortality in elderly injured patients: the role of comorbidities

Home injuries in older people are an important cause of morbidity, disability and death. In addition, the presence of a pre-existing disease has generally been shown to be associated with higher mortality in this population. The objective of the study was to evaluate the association between pre-existing chronic conditions and risk of death among older trauma patients. A retrospective study was conducted in the Lazio Region, including the city of Rome. The study included all the people aged 65 years or older who were admitted to emergency departments in the year 2000 for home or road injuries, which was followed by hospitalisation within 24 hours. Comorbidities are quantified according to the Charlson Comorbidity Index (CCI). The outcome of interest was 30-day mortality. To measure the association between comorbidities and the probability of death, logistic regression was used, adjusting for triage code, sex, age and place of injury. An analysis stratified by triage was also performed. It was found that 17.9% of the injured subjects (8145) were affected by one or more chronic conditions. The probability of death was higher among males, older people, more severe patients and in cases of home accident. Risk of death for non-urgent and urgent patients increased with the increasing of the CCI score. Mortality among very urgent injured elderly was not affected by the presence of chronic conditions. It was concluded that chronic conditions are strong determinants of mortality, particularly for mild injuries.     

Crash-related factors associated with the severity of road traffic injuries in Iran

Although the impact of traffic crashes is very high in Iran, there are few works on the association of crash-related factors with injury severity. This study was conducted on 145 drivers injured on the Qazvin-Loshan road in order to assess this association. The New Injury Severity Score (NISS), based on the conditions of the injured drivers during their first visit to regional hospitals, was used as the main outcome measure. Multiple linear regression analysis was performed by considering logarithmic scale for NISS as response variable and adjusting for the confounding effects, including the transfer to hospital variables. The results showed that high-vehicle damage (i.e. damage with repair cost more than 25% of the pre-crash value of the driver's vehicle) and being trapped inside the motor vehicle raised the NISS by 5.25 (95% confidence interval (CI) 2.51-10.71) and 2.34 (95% CI 1.20-4.67), respectively.     

Toward understanding socio-economic inequalities in injury incidence and mortality

The existing knowledge on socio-economic inequality in injury risks is scarce and inconsistent and there is still a great need for sound epidemiological studies in this field. When performing these studies, the injury research community could benefit from the experience gained within other areas of public health. A recent project from the European Union has led, for example, to a set of proposed guidelines on several methodological aspects. Many of these are probably relevant for the injury problem field and will be addressed. Major issues are: – The distinction between individual-level and area-based studies; – The selection, measurement and classification of possible socio-economic indicators; – The expression of the magnitude of health inequalities with the help of possible summary indices; – The definition of the outcome measure (morbidity or mortality, general or specific). This paper illustrates the relevance of the aforementioned methodological issues with empirical data. Results are shown from both individual-level and area-based studies, using different socio-economic indicators and outcome measures. It is concluded that a systematic approach towards understanding socio-economic differences in injury incidence and mortality has not yet been conducted and seems highly needed. Future work in this area could benefit from experience gained within other areas of public health.     

Wie die deutsche Einheit die Länder im Finanzausgleich belastet hat

In Germany there is a political consensus that the economic and fiscal burden of the German reunification should be shared by all three jurisdictional levels of the federal system. According to existing law, the burden-sharing between the state and local authorities has to be confined to the excess burden which follows from the financing of the German Unity Fund as well as the integration of the eastern German states into the fiscal equalisation system. State and local authorities are in conflict with each other regarding an appropriate economic estimate of the excess burden to be caused by the fiscal equalisation system. Against this background, the paper estimates the average excess burden of the western German states as a whole as well as individual excess burdens of selected German states for the time period 1995 to 2009 by applying a multivariate data analysis.     

“营改增”政策对上市公司会计稳健性的影响——基于我国沪深A股上市公司样本的实证研究

制度环境是影响企业会计信息质量的重要因素。基于我国营改增改革实践,利用双重差分法研究营改增政策对企业会计稳健性的影响效应及作用路径,并进一步考察企业特征对上述影响效应的异质性。研究表明:营改增政策有助于缓解企业融资约束、降低企业税收负担,同时滋生企业高管攫取超额薪酬,进而降低企业会计稳健性。异质性检验表明,在非国有企业、年轻企业以及高成长性企业中,营改增降低会计稳健性的政策效应更加显著。本文的研究结论对“十三五”规划提出的进一步深化财税体制改革,提高经济运行信息的及时性和准确性具有借鉴意义。