Trauma epidemiology in Puerto Rico: in-hospital morbidity and mortality from 2002 to 2011

This study aimed to describe the distribution of injury mechanisms and to assess the impact of those mechanisms on the morbidity and mortality of trauma. All patients admitted to Puerto Rico Trauma Hospital (2002–2011) for road-traffic collisions (RTCs, 5,371), gunshot wounds (GSWs, 2,946), falls (2,319), pedestrian accidents (1,652), and stab wounds (SWs, 1,073) were selected. Gunshot victims were 1.19 (95%CI: 1.07–1.33) times as likely as road-traffic victims to have an ISS ≥25. Pedestrians were 1.76 (95%CI: 1.49–2.09) times more likely to have a GCS ≤8 than road-traffic victims were. The risk of dying was 2.64 (95%CI: 2.20–3.16) times higher for gunshot victims and 1.51 (95%CI: 1.23–1.86) times higher for pedestrians compared to patients who had had RTCs. Gunshot victims and pedestrians had the worst clinical outcomes. Accordingly, these patients should receive the most aggressive clinical management. Furthermore, it is imperative to develop public health campaigns on trauma prevention.     

Exceeding the speed limit: prevalence and determinants in Iran

Speeding is one of the most common risk behaviours associated with crashes causing signficant injury. The objective of this study is to explore the prevalence and determinants of speeding on a road between Tehran and Hamadan, Iran. In a cross-sectional study in 2009, stretches of the road were studied including three groups of posted speed limits: < 50 km/h, 50–100 km/h and > 100 km/h. Each stretch was evaluated both in daylight and dark. Randomly identified driver's speed was checked by a handheld speed camera and then the driver was invited to participate in a survey. Statistical analysis was performed using Chi-Square, crude and adjusted odds ratio, 95% confidence interval and multiple logistic regression models. Overall, 52.8% of the drivers were travelling more than 10 km/h above the posted limit. Where limits were < 50 km/h, 74.6% of drivers were speeding. This declined to 46.9% for sections with limits between 50 and 100 km/h and to 36.9% for sections posted more than 100 km/h. Finally, more than half the drivers were observed to be speeding. Driving more than the posted limit was far more likely on the areas with the lowest posted speed limits, personal passenger vehicles, modern vehicles not using seat belts, and male drivers.     

Accidental injuries among the elderly within the Vienna community: Epidemiology,risk factors and preventive measures

Abstract

Unintentional injuries ('accidents’) among elderly people are a significant burden in public health because such accidents happen frequently and because the proportion of older age groups in the population will continue to rise during the coming decades. One aim of this study, which was done in Vienna, the capital of Austria, was to broaden the preventive concept, adding lifestyle and living conditions to already well-known risk factors following the health promotion approach. Furthermore, characteristics that predispose older residents to accidents should be identified in order to design preventive measures for reducing injuries in this age group.

809 interviews with people 60 years of age and over were conducted, concerning accidents, outcomes of accidents, physical fitness, drug intake, type of house or dwelling, equipment in the household incorporating safety features, psychological well-being and social relations. The information collected was used to draw cross-sectional comparisons between participants who reported having experienced at least one accident in the previous 12 months and those who did not. Furthermore, the accident incidents were classified into 2 groups: incidents without injuries and injurious accidents. The latter served as a base for the epidemiology of injuries for people 60 years of age and over within the Vienna community.

20% of all senior citizens suffer at least one unintentional injury every year, in addition to which 8% experience critical incidents (mostly falls) without injury. Most accidents occur at home or involve pedestrians in public traffic areas. Over 90% of all accidents are falls, and 20% result in fractures. The most important risk factors for accidents in the elderly are gender, increasing age, poor physical fitness and low physical activity, the type of household and household equipment, poor psychological well-being, low income and loneliness.

The findings regarding falls suggest some possible opportunities for reducing the risk of falls by improving buildings and dwellings of the elderly. A promising attempt at practical implementation of these findings is being conducted by the Vienna-based Austrian Institute for Home and Leisure Safety in cooperation with the Vienna City Council. These two organizations are implementing a long-term program that aims at mobilizing institutions and organizations involved in working with the elderly.     

Linkage Disequilibrium Mapping of Disease Susceptibility Genes in Human Populations

The paper reviews recent work on statistical methods for using linkage disequilibrium to locate disease susceptibility genes, given a set of marker genes at known positions in the genome. The paper starts by considering a simple deterministic model for linkage disequilibrium and discusses recent attempts to elaborate it to include the effects of stochastic influences, of "drift", by the use of either Writht-Fisher models or by approaches based on the coalescence of the genealogy of the sample of disease chromosomes. Most of this first part of the paper concerns a series of diallelic markers and, in this case, the models so far proposed are hierarchical probability models for multivariate binary data. Likelihoods are intractable and most approaches to linkage disequilibrium mapping amount to marginal models for pairwise associations between individual markers and the disease susceptibility locus. Approaches to evalutation of a full likelihood require Monte Carlo methods in order to integrate over the large number of unknowns. The fact that the initial state of the stochastic process which has led to present-day allele frequencies is unknown is noted and its implications for the hierarchical probability model is discussed. Difficulties and opportunities arising as a result of more polymorphic markers and extended marker haplotypes are indicated. Connections between the hierarchical modelling approach and methods based upon identity by descent and haplotype sharing by seemingly unrelated case are explored. Finally problems resulting from unknown modes of inheritance, incomplete penetrance, and "phenocopies" are briefly reviewed.     

Rethinking Urban Epidemiology: Natures,Networks and Materialities

How should we understand the relationship between urban environments and infectious diseases? This article addresses this question from three particular perspectives: that of the materialities of health, that of nature and that of networks. The first perspective analytically blends biological dynamics, environmental influence and social practice. The second perspective, mainly influenced by multispecies ethnographies, foregrounds the liveliness and unboundedness of cities. Finally, the third perspective analyses how health is drawn into the domain of security. The article argues that while globalization and urbanization are often discussed as having triggered the emergence and spread of pathogens, urban epidemics are not self‐evident and ‘natural' consequences of these pro‐cesses. They do not fall neatly into universal categories of space, modernity or risk; rather, they are produced and shaped by a range of social, political, biological and economic sites and scales. Accordingly, the emergence of pathogens depends on its articulation through specific analytical frameworks. This article suggests that a critical focus on how infectious diseases manifest themselves differently in different local contexts may not only provide insights into the manifold forms of urban life, but also into the multiple, complex and highly political constitution of health.     

社会流行病学与人口学的交叉研究进展

社会流行病学和人口学在研究内容、研究方法和疾病防治及卫生保健对策的研究等三个方面有着密切的联系。这些领域也是人口学研究方法在健康领域研究的渗透和应用。从研究内容上的人群层面的研究,研究方法上的多层分析方法和生命历程分析,以及疾病防治和卫生保健对策的研究等方面对社会流行病学与健康人口学的交叉研究进展作了综述。     

Hospitalized fall-related injury trends in Sweden between 2001 and 2010

Previous studies have indicated increasing trends of hospitalized fall-related injuries amongst elderly. Whether this is true also in Sweden is unknown though it is important to study considering the potential societal impact. Data were obtained regarding hospitalized injuries with falls as external cause among those aged 65 years and above with information on injury type, gender and age, on a yearly basis, from 2001 to 2010. Age- and sex-specific incidence rates were calculated (per 100,000 population) for all fall-related injuries, and for each injury type and trend lines were drawn. Linear regression analyses and percentage change were calculated for the types of fall-related injuries. A decreasing incidence was observed in the younger age groups (65–79 years) with greater decreases amongst women (women: ?14.6%, men 65–79 years: ?10.5%). However, increasing rates were observed in the older age group (80 years and above), with greater increases amongst men (women: 4.3%, men: 11.4%). Superficial injuries showed greater increases than fractures amongst those aged 80 years and above. This study indicates that older elderly in Sweden are increasingly being hospitalized for less serious injuries. This changing injury panorama is important to include in the future planning of both health care and fall-related prevention.     

Epidemiology of unintentional drowning in a metropolis of the French Mediterranean coast: a retrospective analysis (2000–2011)

Drowning affects more than 500,000 people worldwide and is responsible for at least 350,000 deaths each year. In France, 1235 drowning resulting in 496 deaths were recorded in the summer 2012. This retrospective study has investigated the epidemiology of drowning in the city of Marseille (South of France) between 2000 and 2011. We identified 449 cases of unintentional drowning. The highest incidence was found among males with a median age of 36 years. The incidence was 5.3 victims per 10,000 inhabitants with a mortality rate of 1.2 per 10,000. These accidents occurred mainly at sea (89%) and during the summer season. A majority of drowning victims (69%) were admitted in a hospital. This is the only study in France to analyse data on drowning throughout the year and over a long period. Drowning is a serious condition burdened by 22% of victims who die.     

The social construction of the tourism degrowth discourse in the Balearic Islands

Abstract

In recent years, overtourism and tourism gentrification have been a central feature of public debate in the Balearic Islands, one of the most touristified regions on the planet. In this context, the discourse of tourism degrowth has thrived, being discussed across the political spectrum and even serving to legitimize a sustainable tourism plan and a new Tourism Act. This article provides a brief analysis of the debate around tourism degrowth in the 2014–2019 period and differentiates between two approaches. On the one hand, tourism degrowth has been used by socio-environmental platforms as a byword for detourisfication and the politicization of the hegemonic consensus on tourism. On the other, degrowth has been adopted as a green washing rhetoric in order to justify public policies aimed at tourist decongestion through deseasonalizing, while promoting tourism expansion. This work brings into focus the social construction of the tourism degrowth narrative by applying critical discourse analysis. We conclude that the debate over tourism degrowth is not just a discrepancy between different approaches to deal with overtourism, tourism pressure and gentrification. It is also a social struggle where the discourse over tourism degrowth has helped new democratic political subjects to coalesce and organize in civil society.