Estimating the South African trauma caseload

A survey of medical superintendents revealed that an estimated 1.5 million trauma cases presented to South Africa's 356 secondary and tertiary level hospitals in 1999. Injury rates for traffic, violence and other injuries showed considerable inter-provincial variation, with violence accounting for more than half of the trauma caseload. This type of survey is a simple low cost alternative for monitoring injury patterns and supplementing burden of disease and injury costing studies.     

Interpersonal violence in the United Arab Emirates

We aimed to study the anatomical distribution, severity and outcome of hospitalised interpersonal violence-related injured patients in Al-Ain, United Arab Emirates so as to give recommendations regarding the magnitude of this problem, its causes and priorities of prevention. Data were retrieved from Al-Ain Hospital Trauma Registry, which was prospectively collected over three years. There were 75 patients (males = 85.3%) having a mean age of 30 years. Eighty-one percent had blunt trauma. The estimated annual injury hospitalisation of interpersonal violence in Al-Ain city was 6.7 per 100,000 population. Females were significantly more injured by a family member (p = 0.02), at home (p = 0.005), and had more severe injuries (p = 0.003). There was a trend for children less than 18 years old to have more penetrating trauma (p = 0.06) and to be injured by a family member (p = 0.09). There was only one case of woman sexual assault and two cases of child abuse. The mean (SD) hospital stay was 7.87 (14.1) days. Less than 3% (n = 2) were admitted to the intensive care unit with no deaths. In conclusion, the majority of patients in our study had minor injuries. Nevertheless, the psychological impact may be major. This highlights the need to develop suitable mental health services in support of victims of interpersonal violence.     

Violence against women and new venture initiation with microcredit: Self-efficacy,fear of failure,and disaster experiences

Domestic violence is the most prevalent form of gender-based violence that threatens the wellbeing and dignity of women. In this paper, we examine whether and how exposure to physical or sexual assault by male partners influences women's decision to initiate a new business when they have access to financing. We collected primary data from rural Bangladesh in collaboration with a microfinance institution that provided small collateral-free loans to a group of married women. We conducted a baseline survey before loan disbursement and then conducted a follow-up survey 12 to 15 months later to collect information on loan usage. We find that women who experienced physical or sexual violence by their husband before receiving a loan are less likely to initiate a new business with their loan than those who did not experience such violence. Exposure to domestic violence obstructs the initiation of new businesses through reduced entrepreneurial self-efficacy and increased fear of business failure. The adverse impact of domestic violence is more detrimental for women who recently experienced another potentially traumatic event—an environmental disaster—than for those without such an experience.     

Cumulative Table of Contents

Objective. To assess acute alcohol intoxication among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001.

Design. Cross-sectional surveys were conducted during a four-week period in each of the above sites in 1999, 2000 and 2001. The concept of an ‘idealised week’ was used to render representative samples. Breath-alcohol concentrations were assessed in a total of 1900 patients using a Lion SD2 alcolmeter.

Results. Over half of all the patients experienced violent injuries. Across sites and for each respective year of the survey, between 35.8% and 78.9% of patients tested positive for alcohol. Between 16.5% and 67.0% had a breath-alcohol concentration greater than or equal to 0.05g/100ml. Port Elizabeth consistently had the highest proportion of patients testing positive for alcohol. Patients injured as a result of violence were more likely to test positive for alcohol than patient who sustained road traffic or other unintentional injuries.

Conclusions. Alcohol involvement among trauma patients remained consistently high for each of the three study periods. Efforts to combat the abuse of alcohol would appear to paramount in reducing the burden of injuries on health care services.     

Estimating population-based injury prevention practices

This study piloted a survey suitable to generate statewide prevalence estimates for injury prevention practices and/or behaviours. A number of prevalence estimates of injury prevention practices and/or behaviours were generated in the pilot. For example, the prevalence of a household smoke alarm was high (732/1000 households) and yet only 44% of households had tested the functionality of the alarm in the 12 months preceding the survey. Findings of this kind point to an increasing need for primary care practitioners to play a leading role in targeting preventive strategies for injury. In addition, the survey methods and approach highlight the value of such information to health departments and non-government agencies in terms of targeting priority injury risk behaviours and the evaluation of injury-related intervention programmes. The survey has been designed so the methods can be applied nationally and internationally.     

Trauma's effects on shopper choice confusion: The role of psychological hardiness and retailer strategies as mitigating factors

Retailers must understand how trauma influences the consumer shopping journey and identify ways to mitigate any potential adverse effects. Two studies were conducted to explore trauma in the retail environment. First, a conceptual model was tested using structural equation modeling (SEM) based on survey data collected from 324 participants. Findings indicate that consumers who report previously experiencing traumatic events feel anxiety while shopping in retail environments, negatively influencing their ability to make purchase decisions. This outcome is due to challenges in adequately assessing stressful environmental stimuli and developing positive coping mechanisms. Consumer propensity for psychological hardiness was found to moderate this relationship. Next, a follow-up qualitative study from 110 consumers who reported experiencing instances of trauma identified potential ways for retailers to help consumers who have experienced trauma feel more comfortable in shopping environments. These findings extend research on trauma and consumer shopping behavior by identifying its impacts on choice confusion and stress appraisal and suggesting how retailers can support shoppers through a trauma-informed approach.     

Pedestrians: the daily underestimated victims on the road

Traffic-related pedestrian injuries (TRPI) are vulnerable to road users. In this study, we aimed to evaluate the demographic pattern of injury and outcome of TRPI. Patients with TRPI admitted between November 2007 and March 2010 to the only level 1 trauma centre in Qatar were included. A retrospective analysis was based on medical records and Emergency Medical Services run sheets. The spreadsheet included demographic data and pre-hospital transport, service admissions and injuries by system and mortality. Of 4077 patients who were admitted, 420 (10.3%) had TRPI. The mode of transportation included ambulances (91%), private vehicles (6%) and helicopters (3%). The direct dispositions were trauma intensive care units (38%), surgical wards (42%) and operating rooms (17%). Patients were classified according to Injury Severity Score (1–8 in 28%, 9–15 in 25%, 16–24 in 20% and 25–75 in 17% cases). Multisystem injuries were most characteristic. Of 804 injures, injury of extremities was predominant followed by head, thorax and abdomen. The overall mortality was 8%. Pedestrian injuries are a significant cause of serious trauma in Qatar. Motor vehicle/pedestrian interface contributes to this ongoing public health problem. Reducing pedestrian trauma requires recognition of the problem and implementing programmes to mitigate these largely preventable injuries.     

An Alternative to the Impasse

Abstract

The volume of violence portrayed in American mass media has caused concern for decades, but media self-interests, weak governmental policies, and the First Amendment protection for freedom of expression have stymied efforts to improve media content. Grassroots endeavors to alert parents to possible negative effects may be a more effective approach. “Pulling the Plug on Media Violence,” a campaign aimed at escalating consumer awareness, has been implemented by a volunteer group in North Carolina. This study, using the results of a statewide poll, evaluates the campaign's effectiveness and provides useful findings for future efforts devoted to similar issues. The survey shows that although awareness of the campaign was high, the level of concern about media effects was not influenced directly. Religiosity, gender and parenthood were found to be the most important factors linked to higher levels of concern about media violence. Future efforts to mobilize an anti-violence effort may want to target messages to parents (especially mothers) and work with churches in order to increase active involvement.     

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.     

Injury among migrant workers in Changning district, Shanghai, China

The objective of this study was to characterise the injury epidemic and injury prevention needs of migrant workers in Shanghai. Cluster random sampling was applied in selecting subjects in migrant gathering areas, and face-to-face interview survey was conducted in this study. In this survey, 1256 migrant workers were included, among which the injury incidence in last one year was 38.3%. The first four injuries were incised and penetrating injury (9.5%), falls (7.2%), traffic injury (6.3%) and burns (5.3%). The injury incidence of male workers was significantly higher than that of female workers (χ(2) = 22.7, P < 0.01). Electricians, safeguards and construction workers were at the highest risk of getting injured. About 60.7% of injury episodes happened at a residence. The longest period of absence from work was up to 3 months due to falls, while the highest medical expense was near 9999 CNY ($1464.2) caused by traffic injury. About 62.9% of migrant workers need services on injury prevention. It is concluded that compared with urban registered residents, migrant workers have significantly higher incidence of injury in Shanghai. Injury prevention services are in urgent demand among the migrant workers.     

Comedic violence in advertising: the role of normative beliefs and intensity of violence

Interest in the use of comedic violence in advertising has risen, but the research on this topic has been limited. Past studies have found positive effects of comedic violence in ads, with higher levels of violence increasing positive responses. However, given that the violence depicted in these ads is a violation of social norms, following the Social Norms Theory, it is proposed that individual norm beliefs about violence in advertising could be a significant factor in influencing ad outcome. Using an online panel of general consumers across two experiments, this study revealed that norm beliefs had a positive influence on comedic violence ad responses. In addition, when violence intensities of the ads were varied, individuals with lower norm beliefs responded more positively to low violence ads than high violence ads, whereas individuals with higher norm beliefs did not exhibit different responses to the two violence intensities. Mediation analyses were conducted to test for the underlying mechanisms. As comedic violence advertising may offend audiences, the findings provide targeting and design implications for advertisers interested in this strategy.     

Long-term mortality following injury in working-age adults: a systematic review

Priorities for prevention activities and planning for services depend on comprehensive knowledge of the distribution of the injury-related burden in the community. The aim of this systematic review was to quantify the effect of being injured, compared with not being injured, on long-term mortality in working age adults. Cohort studies were selected that were population-based, measured mortality post-discharge from inpatient treatment, included a non-injured comparison group and related to working-age adults. Data synthesis was in tabular and text form with a meta-analysis not being possible because of the heterogeneity between studies. Eleven studies met the inclusion criteria. All studies found an overall positive association between injury and increased mortality. While the greatest excess mortality was evident during the initial period post-injury, increased mortality was shown in some studies to persist for up to 40 years after injury. Due to the limited number of injury types studied and heterogeneity between studies, there is insufficient published evidence on which to calculate population estimates of long-term mortality, where injury is a component cause. The review does suggest there is considerable excess mortality following injury that is not accounted for in current methods of quantifying injury burden, and is not used to assess quality and effectiveness of trauma care.     

Addressing the worst cases

Child injury, regardless of intent, is a major public health issue in Australia and elsewhere. Child protection and injury prevention policies and practices are implemented in most countries in an attempt to manage and reduce the incidence of both intentional and unintentional injuries. While these systems are thought to assist in improving protection from violence, injury and neglect, one of the major limitations in understanding the effectiveness of child protection policy in Australia is a lack of reliable national data on child abuse and neglect. As a result there is a lack of an appropriate evidence base on which to guide the development of effective policies. A particular area where official figures may under-represent the true prevalence of child deaths is those which result from homicide. This article provides a review of the recent literature on child homicide, abuse and neglect, with the overall aim of understanding more fully the reasons for the possible under-representation of child homicides and provides recommendations to address this problem in Australia. Improvements in methods of identifying at risk children in addition to systematic investigations of child deaths to understand the risk factors and underlying contributing factors are required.     

Laypeople roles at road traffic crash scenes: a systematic review

This study aimed to identify the roles of laypeople at road traffic injuries (RTIs). A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of ‘laypeople’, ‘layman’, ‘layperson’, ‘bystander’, ‘first responder’, ‘lay first responder’, ‘road traffic’, ‘road traffic injury’, ‘crash injury’, ‘crash scene’, ‘emergency’, ‘trauma care’, and ‘prehospital trauma care’ were used in combination with the Boolean operators OR and AND. We did electronic search on Google Scholar, PubMed, ISI Web of Science, CINAHL, Science Direct, Scopus, ProQuest. Based on the reviewed studies, some factors such as cultural conditions, knowledge, relief agencies, and demographic factors affect the interventions of laypeople at the crash scene in functional areas. Regarding the permanent presence of people at the crash scene, the present study can provide an opportunity to reduce different side effects of RTIs imposed on the society.     

Injury care in low- and middle-income countries: identifying potential for change

The epidemiologic, demographic, and socio-political transitions underway in many low- and middle-income countries (LMIC) are associated with a substantial burden of disease due to injuries. LMIC have devoted relatively little attention to the injury problem. This paper argues that whereas prevention remains paramount, improving health care services for injuries will also contribute to reducing the burden. It examines the reasons for the relative inaction in LMIC to date, and contrasts this to high-income countries (HIC) which have seen substantial falls in mortality from improved trauma care systems. Mortality data, although readily available, are the tip of the clinical iceberg and there is a need for better-quality hospital data that can be used to monitor any future improvements. Models of trauma care from HIC are reviewed. It is suggested that the greatest potential for improvement can be achieved if entire trauma systems are improved, including pre-hospital, hospital and rehabilitation care. LMIC may not be able to afford the whole system and improving the most sensitive components of the system may be a better option. Models of trauma care developed in HIC need careful consideration to determine their effectiveness, appropriateness, affordability and equity implications for LMIC. Imports of blueprints from elsewhere are likely to fail; context sensitive and appropriate policies need to be developed locally through a consultative process. Effective working needs to be across disciplines, involving consultation with stakeholders, and requires investment in education, training and equipment. The evidence base for trauma services in LMIC is almost non-existent, highlighting the urgent need for research in these settings.     

The Functional Capacity Index, second revision: morbidity in the first year post injury

As the field of injury outcomes measurement has moved beyond counting deaths and injuries, the need for instruments to measure long-term outcomes has increased. Early validation efforts indicated that the Functional Capacity Index (pFCI12) was a promising tool for predicting functional loss 12 months post trauma, but that the predictive validity for lower extremity fractures was low. The pFCI12 was recently revised in conjunction with the 2005 revision of the Abbreviated Injury Scale (AIS). This preliminary study was undertaken to assess the performance of the revised pFCI12 in predicting outcomes for patients with lower extremity trauma. This case review study used the Crash Injury Research and Engineering Research (CIREN) database which includes AIS codes, extensive clinical data and 3- and 12-month outcomes. Generally predicted functional loss at 12 months was greater with the pFCI12 (AIS 2005) than with the original FCI based on AIS 1990. All patients whose pFCI12 scores predicted functional loss experienced some morbidity at 1 year. The pFCI12 appears to provide improved predictions of functional outcome 12-months post-trauma for persons experiencing lower extremity trauma.     

An analysis of media violence in commercials aired during the telecasts of sports events

The violence contained in television commercials has received less attention than other areas of media violence research. This study analyzed violent content in the Super Bowl commercials that aired between 2001 and 2009. Twenty-two percent of the Super Bowl commercials appearing from 2001 to 2009 contained some type of violence. A number of quantifications related to types of violence, targets and perpetrators of violent acts, and reasons for violence, among others, are reported. Subsequently, the relationships between the contextual factors of the violence and commercial likeability were examined.     

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.     

The pattern and predictors of intentionally inflicted injuries on Greek adults; data from an Emergency Injury Surveillance System (EDISS)

Background Intentional injuries due to violence are both a social and a public health problem in most societies. This study assesses the patterns and some of the sociodemographic determinants of violence-related injuries among Greek adults. Methods Data recorded by the Emergency Department Injury Surveillance System (EDISS) during the two-year period 1996-1997 were used. This database relies on all age injury data collected in the emergency departments of three sentinel hospitals, covering both urban and rural population areas. Results Among 52026 recorded injuries, 1322 (3%) were violence related, excluding self-inflicted injuries, while the majority of injuries (28269) were attributed to home and leisure accidents. Weapons of any type were used only in 5% of violence-related injuries. In comparison to home and leisure injuries, the intentionally inflicted injuries occurred more frequently among men, among those 25-54 years old, and were particularly common among migrants and during late night and early morning hours. Violence-related injuries frequently occur in pubs, restaurants, cafeterias and other places of entertainment. However, 52% of violence-related injuries among women occurred at home. Intentional injuries were generally more severe than unintentional ones. Conclusions We conclude that violence is not a negligible public health problem in the Greek population, but is considerably less serious than in most other developed countries. In particular, firearms-related injuries represent a very small fraction of the generally low incidence of violence-related injuries in this Mediterranean country.