Indicators of injury burden: which types are the most important?

Injury indicators are used for monitoring the impact of injury prevention initiatives on the population burden of injury. The object of the present study was to identify the types of injury responsible for the major component of the population health burden of injury in a large cohort in Manitoba, Canada. Injury cases (ICD-9-CM 800-995) aged 18-64 years were identified from all Manitoba hospital data between 1988 and 1991. Morbidity data were obtained from hospital discharge abstracts 12 months prior to date of injury and for 12 months post-injury. Outcomes for individuals were calculated as the difference pre- and post-injury in hospital inpatient days. Death outcomes in the 12 months post-injury were obtained by linking the cohort with the population registry. Summed outcomes across the population were stratified into injury types based on the International Code of Diseases (ICD) code of the index injury. Outcomes were also stratified by injury severity score categories where the injury severity score was obtained using ICDMAP-90. When ranked by contribution to the cohort's cumulative hospital inpatient days in the 12 months post-injury, the six most common ICD subchapter groups accounted for 65% of the total inpatient days. These six injury types also accounted for 62% of the total number of deaths in this cohort in 12 months after injury. The suggested injury types to use as indicators of burden include fracture of the lower limb, fracture of the head and neck, poisonings, intracranial injury, fracture of the upper limb, and fracture of skull.     

How well do anatomical-based injury severity scores predict health service use in the 12 months after injury?

There is an acknowledged need for valid and reliable injury scores, suitable for use at the population level, which can accurately predict the long-term outcome of injury. The objective was to quantify the extent to which the abbreviated injury severity score (AIS) and the functional capacity index score (FCI) predict use of health services in the 12 months following an injury event. A cohort of injured people (ICD-9-CM 800-995) aged 18 - 64 years was identified from Manitoba hospital discharge abstracts from January 1988 to December 1991. For each member of the cohort whose injuries could be mapped to an abbreviated injury scale unique identifier, a maximum AIS (maxAIS) and a maximum FCI (maxFCI) were obtained. The cohort was linked with hospital discharge abstracts, physicians' claims and deaths from the population registry for the 12 months following injury. Negative binomial regression was used to model the relationships between the severity scores and the three outcome measures, while controlling for potential confounding variables. In total, 20 677 (97%) eligible cases were identified, of which 16 834 (81%) could be assigned a maxAIS and 15 823 (77%) a maxFCI. MaxAIS and maxFCI were significantly associated with total days in hospital following injury, but explained little of the variation in any of the health service use outcome variables (maxAIS, partial pseudo r2 ranging from < 0.001 to 0.041; and maxFCI, partial pseudo r2 ranging from < 0.001 to 0.018). It was concluded that anatomical damage is only partly responsible for long-term injury outcome. Additional variables would need to be included in predictive models of health outcomes of injury before these models could be reliable.     

No Pain,No Strain: Impact of Health on the Financial Security of Older Americans

This study uses data from the 2002 and 2004 Health and Retirement Study to investigate the impact that new and existing health problems have on the financial strain of older Americans. Two‐period models are estimated for a series of financial ratio guidelines that take into account household solvency, liquidity, and investment asset accumulation. We test our models using a subjective measure of self‐reported health status and two objective measures of health that control for the severity of specific health conditions. The results show that health problems significantly increase the likelihood of financial strain for older individuals, but the effects vary by the measure of financial strain used and how health status is defined. Specifically, existing health conditions were more likely to affect solvency and investment asset accumulation than liquidity, while new health events were more likely to affect solvency. The severity of the condition did not seem to matter as much as whether the condition was chronic. These results provide insight into the future financial security of older Americans and have important implications for health policy and research.     

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.     

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.     

Exploring quality perceptions of health care operations: a study of public hospitals of Mauritius

Patient care has become increasingly important in the health care environment of Mauritius. Patients' satisfaction and their expectations of health care are valid indicators of quality health care. The present paper reports the results of a survey of patient satisfaction with heath care, administered by face-to-face interview to 300 in-patient adults discharged from five main regional hospitals based in Mauritius. It examines the predictors and level of patients' satisfaction across the five regional hospitals of Mauritius. In this study, a modified version of HEALTHQUAL scale was used for determining patient satisfaction with health care in the regional public hospitals. Multiple regression analysis was conducted to understand the relationships among patients' perceptions of in-patient services and their overall perceptions of health care quality, and also satisfaction with their care and willingness to return or recommend the same hospital's services to others. The dimensions labelled as "Patients' perceptions of ward/hospital environment" and "Patients' perceptions of medical and nursing staff" served a significant impact on nearly all measures of patient satisfaction in the regional public hospitals of Mauritius.     

Developing the evidence-base for Safe Communities: a multi-level, partly randomised, controlled trial

Safe Communities, representing a global activation of the public health logic, may be strengthened through theoretical, methodological and empirical support. In the spirit of this Special Issue that aims to analyse the achievements and challenges inherent to Safe Communities, we offer our contribution in the form of a methodology of a multi-country child safety, peace and health promotion study. The study, situated within an African-centred initiative called Ukuphepha - an isiZulu word meaning demonstrating African safety - is underpinned by four theoretical claims that frame injury and violence prevention as a multi-disciplinary issue to be addressed through a suite of interventions to family and extended social systems. The interventions, sensitive to the priorities of each participating country, have been informed by the literature on effective interventions and the authors' joint experiences of community development. The study is designed as a population-based, multi-level, multi-intervention partly randomised controlled trial, and there are potentially 24 participant communities representing South Africa, Mozambique, Egypt, Zambia, Uganda, Bangladesh, Malaysia and Australia - over three commencement phases. Whereas process evaluation will focus on community engagement, impact evaluation will consider risk and protective factors, and outcome evaluation will examine the overall effectiveness of the interventions. Notwithstanding the many challenges, the study will provide insights into the methodology and mechanisms of ecologically-oriented interventions that locate injury and violence prevention as an activity arising from safety, peace and health promotion.     

A survey of inventions aimed at preventing drowning

To identify, describe and compare injuries among three water sport activities: kite surfing (KS), personal watercraft (PWC) and towed water sports (TWS). The study was a cross sectional, online survey. The setting was on Perth, Western Australia's popular beaches and riverbanks. Main outcome measures were number of injuries and level of severity; level of exposure and protection measures. Overall, 43% reported at least one injury in the past 12 months, a rate of 22.3 injuries per 100 h. Kite surfers were more likely to report an injury than PWC or TWS. One-half of injuries occurred while on the water. Most injuries were caused by landing awkwardly (56%) and/or trying new tricks (41%). Despite 90% of respondents having used at least one personal protective equipment (PPE) item, half (49%) reported always using a personal floatation device. This study provided information on KS, PWC and TWS injuries as well as a range of safety behaviours. It is recommended that these results form the basis of further research to reduce injury rates and encourage the use of PPE items.     

International Validation of the Corruption Perceptions Index: Implications for Business Ethics and Entrepreneurship Education

International government and corporate corruption is increasingly under siege. Although various groups of researchers have quantified and documented world-wide corruption, apparently no one has validated the measures. This study finds a very strong significant correlation of three measures of corruption with each other, thereby indicating validity. One measure was of Black Market activity, another was of overabundance of regulation or unnecessary restriction of business activity. The third measure was an index based on interview perceptions of corruption (Corruption Perceptions Index or CPI) in that nation. Validity of the three measures was further established by finding a highly significant correlation with real gross domestic product per capita (RGDP/Cap). The CPI had by far the strongest correlation with RGDP/Cap, explaining over three fourths of the variance.Corruption is increasingly argued to be a barrier to development and economic growth. Business students often do not see ethics courses as being as relevant as other value-free disciplines or core courses. The data in this study suggests otherwise. Sustainable economic development appears very dependent on a constant, virtuous cycle that includes corruption fighting, and the maintenance of trust and innovation, all reinforcing each other.     

The validation of the generic service quality dimensions: an alternative approach

This study focuses on generic service quality dimensions, which have empirical and conceptual support in the literature. The purpose of this research is to try to validate these dimensions using two measuring procedure that are different from the common ones used in this area. The Guttman scaling procedure and Q-sort test are the two new measuring procedure used in this validation process. The outcome of this study is that of the six dimensions tested, only four are found to be valid. Also, a three-dimensional scale is recommended to measure service quality.     

Severity of alcohol-related motor vehicle crashes in British Columbia: case - control study

The objective of the present study was to compare the injury severity and vehicle damage severity rates of alcohol-related crashes with rates of non-alcohol-related crashes in British Columbia (BC). Injury severity rates and vehicle damage severity rates were taken from 2002 Insurance Corporation of British Columbia traffic collision data. The data were computed in order to compare the differences in injury severity and vehicle damage severity rates of alcohol-related vs. non-alcohol-related motor vehicle crashes. Case - control methods were used in this study to analyse the risk of alcohol-related crashes compared to non-alcohol-related crashes in BC. Odds ratios (OR) and 95% CI were calculated to estimate relative risks. In the case - control analysis, the risk of fatal collision was increased for those drinking and driving compared with those driving sober (OR 4.70; 95% CI 3.15 - 7.01). Risk of injury collision was increased for those drinking and driving compared with those driving sober (OR 1.32; 95% CI 1.19 - 1.37). Importantly, the risk of vehicle damage severity was increased for those drinking and driving compared with those driving sober (write-off vehicle OR 4.24; 95% CI 3.70 - 4.86, severely damaged vehicles OR 1.98; 95% CI 1.77 - 2.21). The study reinforces existing literature to suggest that current evidence is sufficient to show an increased risk of injury and fatality to drivers and occupants in alcohol-related crashes. This paper not only emphasizes this well-known relationship, but also such consequences as increased vehicle damage severity. The connection between drinking and severity of motor vehicle crashes is popularly believed and has now received substantial scientific support. There is strong justification for injury prevention experts and policy-makers to step up motor vehicle crash injury prevention advocacy by implementing evidence-based policies to reduce rates of alcohol-impaired driving in the province of BC. Most unintentional injuries in BC are related to motor vehicle crashes. Significant improvements can be made in these statistics by: increasing the use of occupant protection (safety belt and child restraint seats); reducing alcohol-related injuries through multiple strategies including corrections in the physical environment, extensive enforcement of drinking and driving laws and health promotion/education.     

Social factors and company location decisions: Technology,quality of life and quality of work life concerns

A number of factors must be considered in facility location decisions. Recent research on job design suggests that the effects jobs may have on quality of work life and quality of life in general should be considered in facility location decisions in addition to other normal factors. The present study was designed to examine quality of work life and quality of life factors of residents in a low income and low education area. The intent was to determine what types of jobs might have the most positive effect on people in this type of region. Data were collected from 409 households in a low income/education region. The results showed that people from this region were as satisfied with their quality of work life and quality of life as people in other regions with better jobs, higher incomes, and better general life situations. Results are discussed in light of facility location decisions and types of jobs having the most positive impact.     

Impact of youth injuries on the uninsured farm family's economic viability

The objective of this study is to estimate the impact of youth injuries on the uninsured farm family's economic viability. Using farm prototypes, we compared farm profits with costs of farm youth injuries. We built profit models for two types of farms, dairy and soybean farms. Then we estimated the cost impact of farm youth injuries of different levels of severity on a farm family with no health insurance. A severe child injury that requires at least 10 days of hospitalisation would cost almost equal to the operating profit of the average dairy farm with no health insurance and would turn the operating profit of the average soybean farm into a severe loss of $99,499. Prevention of child agricultural injuries would significantly improve the financial situation for farm families that lack health insurance.     

Impact of youth injuries on the uninsured farm family's economic viability

The objective of this study is to estimate the impact of youth injuries on the uninsured farm family's economic viability. Using farm prototypes, we compared farm profits with costs of farm youth injuries. We built profit models for two types of farms, dairy and soybean farms. Then we estimated the cost impact of farm youth injuries of different levels of severity on a farm family with no health insurance. A severe child injury that requires at least 10 days of hospitalisation would cost almost equal to the operating profit of the average dairy farm with no health insurance and would turn the operating profit of the average soybean farm into a severe loss of $99,499. Prevention of child agricultural injuries would significantly improve the financial situation for farm families that lack health insurance.     

Home-related injuries among under-five-year children and mothers' care regarding injury prevention in rural areas

This cross-sectional study was conducted in rural areas of Twiserkan (Toyserkan) County, in Iran, to assess factors associated with home-related injuries among under-five-year children and their mothers’ care regarding injury prevention. Mothers who had their under-five-year-old children injured within a 12-month period were identified from recorded information in Twiserkan Health Center. Then, data were gathered using pre-tested questionnaire and through interview with injured children's mothers. The questions were about characteristics of the children's injuries and their mothers’ care regarding injury prevention, using PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation) model with focus on knowledge and attitude; enabling and reinforcing factors; and mothers' preventive behaviours. The study results showed that 197 out of 210 total identified mothers took part in the study. The reported injuries were 11.68%, 39.09%, and 49.24%, respectively, for severe, moderate, and mild cases. Fall was the most frequent injury with 35%. Among PRECEDE model constructs, there was a statistically significant correlation between mothers' knowledge and injury severity among children. Home-related injuries are an important health problem among study population and their prediction and prevention are necessary. Enhancement of mothers’ knowledge can be helpful to improve child injury prevention.     

Wet and wild: results from a pilot study assessing injuries among recreational water users in Western Australia

To identify, describe and compare injuries among three water sport activities: kite surfing (KS), personal watercraft (PWC) and towed water sports (TWS). The study was a cross sectional, online survey. The setting was on Perth, Western Australia's popular beaches and riverbanks. Main outcome measures were number of injuries and level of severity; level of exposure and protection measures. Overall, 43% reported at least one injury in the past 12 months, a rate of 22.3 injuries per 100 h. Kite surfers were more likely to report an injury than PWC or TWS. One-half of injuries occurred while on the water. Most injuries were caused by landing awkwardly (56%) and/or trying new tricks (41%). Despite 90% of respondents having used at least one personal protective equipment (PPE) item, half (49%) reported always using a personal floatation device. This study provided information on KS, PWC and TWS injuries as well as a range of safety behaviours. It is recommended that these results form the basis of further research to reduce injury rates and encourage the use of PPE items.     

A study of the effect of OHSAS 18001 on the occupational injury rate in Iran

The occupational health and safety management system (OHSMS) has been a widely used approach for managing occupational health and safety more effectively worldwide. Despite the interest of organizations in implementing OHSMS in recent decades, few studies have examined the effectiveness of these interventions. This study presents an empirical investigation of the effect of occupational health and safety assessment series (OHSAS) 18001 as a worldwide-accepted OHSMS on the occupational injury rate (OIR) in Iran. This study was carried out in six companies: three OHSAS 18001-certified, and three non-certified, including 998 occupational injuries for 15,842 person-months. A before–after analysis showed a positive safety performance change in one out of the three certified companies. For all 66 study years in the six companies, a negative binomial regression did not indicate a lower occupational injury during the certified years and a repeated measures analysis of variance (ANOVA) did not confirm the effect of certification. The results of this study indicated that the implementation of OHSAS 18001 is not a guarantee of improved safety.     

Exploring clinical metrics to assess the health impact of traffic injuries

In order to allow a deep knowledge of the nonfatal injuries, recently the European Commission adopted the maximum abbreviated injury scale classification which is based on medical diagnosis. This classification will open the door to a new source of information based on international hospital data such as diagnosis-related group and international classification of diseases. In this study, we seek to explore these clinical metrics, which are used to describe the diagnosis and the medical treatment, and to infer consequences of crashes mainly through the costs and severity. Therefore, statistical analyses were applied using generalized linear models selected depending on the type of response variable, i.e. discrete or continuous. Relationships between these metrics were identified revealing for instance that head is the region of the body associated with high severity as well as to higher health care costs. Additionally, a discussion is presented regarding study results and future developments of clinical metrics are pointed out.     

An exploratory study of the influences that compromise the sun protection of young adults

This paper reports on an exploratory research project designed to gain a deeper understanding of the influences on ultraviolet radiation (UVR) behaviours among high‐risk young adults to determine what compromises the adoption of protection measures for this group. A dual approach using focus groups and the Zaltman Metaphor Elicitation Technique was used to provide personal narratives related to UVR behaviour for tertiary education students. Results from both ‘conversations’ were content‐analysed using an iterative ‘bootstrapping’ technique to identify key themes and issues. This exploratory research identified a number of key themes including effect on mood, influence of culture, the value of tans, unrealistic optimism, risk‐orientation, and the role of experience. This group felt that they not been targeted effectively by public health campaigns and did not fully understand the dangers of high‐risk UVR behaviours. Although a number of previous studies have investigated the relationship between knowledge and behaviour, and largely concluded that increases in knowledge do not lead to increases in adoption of protection practices, the preliminary findings of this study reveal that the knowledge and perceived self efficacy of protective practices is extremely high, what is lacking is the perceived threat and thus the motivations to adopt such behaviours. The conclusions drawn from this research indicate that there are a variety of important influencing factors that compromise UVR behaviours, in particular, the lack of perceived seriousness and severity towards long term consequences such as skin cancer. The recommendation to address the imbalance of ‘perceived threat’ and ‘outcome expectations’ is to focus on increasing knowledge of skin cancer, particularly susceptibility to skin cancer and the severity of the condition.