The establishment of injury surveillance in Thailand

The Provincial Injury Surveillance System was initiated in Thailand in 1993 to establish a database for assessment of the quality of acute care and referral services provided to the injured at the provincial level, and to facilitate injury prevention and control at both local and national levels. An injury surveillance system model that adopted a trauma registry as the record form, was established in five selected large hospitals, one from Bangkok and four from major regions of Thailand. Data analysis was undertaken and utilized at both local and national levels. The Epidemiology Division of the Ministry of Public Health supervised and assessed the data quality. Evaluators from the School of Public Health identified problems in operating the system at the provincial level and assessed the feasibility of expanding the project. The data of 66,895 injuries including 1,755 deaths reported in 1995; revealed fundamental problems in the emergency medical services. Causes of major injuries were identified and their epidemiology described. The coverage of reporting was over 90%. The completeness and reliability of recording ranged from 80.6–100%. This model of sentinel surveillance is appropriate for injury problems, which are of large magnitude and are at the early phase of problem solving. Development of the information systems administration and human resource in computer technology are necessary to cope with the problems of increased workload in data collecting and processing. This model of surveillance is feasible for expansion but its data system has to be appropriately integrated into the existing systems of the hospitals.     

The evaluation of a surveillance system for violent and non-intentional injury mortality in Colombian cities

Since 2002, the Institute for Peace Promotion and Injury/Violence Prevention (CISALVA) at the Universidad del Valle, Cali, Colombia and the Colombia Program at Georgetown University have developed and implemented 21 epidemiologically based municipal crime observatories in intermediate-sized municipalities in Colombia. These crime observatories serve as monitoring centres that provide low cost, geo-referenced methods of data collection and analysis, which allow cities to develop more responsive policies and prevention programmes and enhance governance. This article focuses on the methodology employed and lessons learned that may be applicable to similar settings. Worth noting within the results was a significant decrease in homicides after the first year of the programme. Whether or not such results could be attributed to the method or to the nature of the interventions and policy initiatives stemming from it remains open to conjecture.     

The use of injury surveillance databases to identify emerging injury hazards

Among the many valuable uses of injury surveillance is the potential to alert health authorities and societies in general to emerging injury trends, facilitating earlier development of prevention measures. Other than road safety, to date, few attempts to forecast injury data have been made, although forecasts have been made of other public health issues. This may in part be due to the complex pattern of variance displayed by injury data. The profile of many injury types displays seasonality and diurnal variance, as well as stochastic variance. The authors undertook development of a simple model to forecast injury into the near term. In recognition of the large numbers of possible predictions, the variable nature of injury profiles and the diversity of dependent variables, it became apparent that manual forecasting was impractical. Therefore, it was decided to evaluate a commercially available forecasting software package for prediction accuracy against actual data for a set of predictions. Injury data for a 4-year period (1996 to 1999) were extracted from the Victorian Emergency Minimum Dataset and were used to develop forecasts for the year 2000, for which data was also held. The forecasts for 2000 were compared to the actual data for 2000 by independent t-tests, and the standard errors of the predictions were modelled by stepwise hierarchical multiple regression using the independent variables of the standard deviation, seasonality, mean monthly frequency and slope of the base data (R = 0.93, R(2) = 0.86, F(3, 27) = 55.2, p < 0.0001). Significant contributions to the model included the SD (beta = 1.60, p < 0.001), mean monthly frequency (beta = -0.72, p < 0.002), and the seasonality of the data (beta = 0.16, p < 0.02). It was concluded that injury data could be reliably forecast and that commercial software was adequate for the task. Variance in the data was found to be the most important determinant of prediction accuracy. Importantly, automated forecasting may provide a vehicle for identifying emerging trends.     

New directions in injury surveillance: Development of a model for continuous monitoring of direct medical costs

Information on the costs of injuries is an important additional instrument in setting priorities for injury prevention. The importance of this instrument is increasingly being recognized by health policy makers. The objective of this study was to develop a model which continuously monitors the direct medical costs of injuries in The Netherlands. This model should provide information on the direct medical costs of injuries at any time and for any selection of injury categories. It is an incidence-based model according to the ‘bottom up’ principle. Homogeneous patient groupings with respect to health care use are defined. The groupings are based on existing classifications from the literature and the experience of medical experts, and are defined by means of seven criteria: nature of care provided, body region of the injury, type of injury, severity of injury, age, complications, and sex of the patient. Several cost elements are distinguished (e.g., general practitioner help, hospital care, nursing home care). For each cost element, relevant patient groupings are determined. The new Dutch Injury Surveillance System (LIS) for injuries treated in an A&E department is an important source for incidence data. This article presents the design of the model as adopted by the Working Group on the Costs of Injuries of the European Consumer Safety Association (ECOSA).     

Using consumer perceived ethicality as a guideline for corporate social responsibility strategy: A commentary essay

“Consumer Perceived Ethicality” presents a framework of perceived consumer ethicality as summarized from in-depth interviews with 20 citizens of the United Kingdom and Germany. The framework identifies six broad domains and 36 sub-items (6 for each domain) that serve as examples of consumer-generated “unethical corporate behaviors.” This commentary highlights the contributions, discusses the limitations and presents an alternative perspective on the study of consumer perceived ethicality.     

Fracture incidence among elderly people in institutional care: linking injury surveillance data with a postal code-based register of residential and nursing homes

Fracture prevention strategies will be most cost-effective if targeted at groups of frail elderly people who are at particularly high risk of falls and fractures. Elderly people living in residential and nursing homes are one potential target population, but fracture incidence in this setting remains poorly defined in many countries. We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of people aged over 65 living in the city of Cardiff. We linked a postal code-based register of all care homes in the city with injury data from Cardiff’s only Accident and Emergency department. Cardiff has 47,520 residents aged over 65, and 1,874 (3.9%) live in residential or nursing homes. Fracture incidence was 25/1,000/year overall, and 5/1,000/year for hip fracture. During 1997, the care home residents suffered 162 fractures, 82 of which were of the hip; an incidence of 86/1,000/year overall, 44/1,000/year for hip fracture. Even after adjustment for the age and sex profile of the care home population, fracture incidence remained 2.3 times higher and hip fracture incidence 3.6 times higher than in the general elderly population. Such figures support the potential cost-effectiveness of strategies that prevent fractures in care homes, and are of special interest to those planning intervention studies in this setting.     

Adolescents as victims of familial violence: a hospital based surveillance

Adolescent abuse is an important and understudied issue in society. The objective of this study was to examine the epidemiology of physical injuries due to maltreatment among adolescents aged 10-19 years. Subjects came from seven hospitals/trauma centres in Washington DC that were involved in the Washington DC Initiative to Reduce Infant Mortality and Prevention of Childhood Injuries Study. From 1996-1998, information was gathered about all injuries to adolescents aged 10-19 years that resulted in a visit to a participating emergency department. This paper focuses on the subset 178 adolescents aged 10-19 years who presented with physical injuries due to maltreatment. It was found that 55% of victims of abuse were female. Abuse victims were more likely to be female than those with unintentional injury. The most common injuries were contusions to the extremities (29%). Mothers were the most common perpetrators (48%). A total of 64% of victims were assaulted with an object/weapon and the most common object used was a belt. There are some similarities and some important differences between patterns of maltreatment in adolescents vs. younger children. Increased awareness of maltreatment among older children is a critical step in increasing and improving screening and prevention practices among health-care professionals.     

The disappearing data source: Ameliorating relations between academics and business

Growing corporate disillusionment with survey research has put a strain on the relationship between businessmen and academicians. The situation is becoming critical, and researchers may lose access to a rich data base if ways of alleviating the friction are not found. The authors look for causes (one is the sheer bulk of questionnaires received), and suggest approaches that researchers can take to elicit the support of businessmen. If the researcher is to enjoy the cooperation of practitioners, he must be aware of several points: the executive is a valuable resource; if he participates in a study he can legitimately expect that the results will be accurately reported; and his company must somehow profit from the study.     

Knowledge,attitudes and beliefs towards injury prevention: a population-based telephone survey

Public knowledge and beliefs about injury prevention are currently poorly understood. A total of 1030 residents in the State of Queensland, Australia, responded to questions about injury prevention in or around the home, on the roads, in or on the water, at work, deliberate injury and responsibility for preventing deliberate injury allowing for comparison with reported injury prevalence data. Overall, the youngest members of society were identified as being the most vulnerable to deliberate injury with young adults accounting for 59% of responses aligning with reported data. However, younger adults failed to indicate an awareness of their own vulnerability to deliberate injury in alcohol environments even though 61% of older respondents were aware of this trend. Older respondents were the least inclined to agree that they could make a difference to their own safety in or around the home but were more inclined to agree that they could make a difference to their own safety at work. The results are discussed with a view to using improved awareness of public beliefs about injury to identify barriers to the uptake of injury prevention strategies (e.g. low perceived injury risk) as well as areas where injury prevention strategies may receive public support.     

Knowledge, attitudes and beliefs towards injury prevention: a population-based telephone survey

Public knowledge and beliefs about injury prevention are currently poorly understood. A total of 1030 residents in the State of Queensland, Australia, responded to questions about injury prevention in or around the home, on the roads, in or on the water, at work, deliberate injury and responsibility for preventing deliberate injury allowing for comparison with reported injury prevalence data. Overall, the youngest members of society were identified as being the most vulnerable to deliberate injury with young adults accounting for 59% of responses aligning with reported data. However, younger adults failed to indicate an awareness of their own vulnerability to deliberate injury in alcohol environments even though 61% of older respondents were aware of this trend. Older respondents were the least inclined to agree that they could make a difference to their own safety in or around the home but were more inclined to agree that they could make a difference to their own safety at work. The results are discussed with a view to using improved awareness of public beliefs about injury to identify barriers to the uptake of injury prevention strategies (e.g. low perceived injury risk) as well as areas where injury prevention strategies may receive public support.     

Road traffic injury among child motorcyclists in Vientiane Capital,Laos: a cross-sectional study using a hospital-based injury surveillance database

This study investigated the distribution of motorcyclists, including drivers and passengers, who were involved in road traffic crashes and admitted to hospital in Vientiane Capital, Laos. The focus was on child motorcycle drivers and passengers under 15 years. A hospital-based injury surveillance database in Vientiane Capital was used. The surveillance was performed in two hospitals. From 1 September to 31 December 2009, 3968 patients were admitted to the participating hospitals with road traffic injuries. Patients under 15 years accounted for 10.8% (427/3968). The majority of patients under 15 years were motorcycle drivers or passengers (71.7%, 306/427). Child motorcyclists including drivers and passengers were less likely to wear a helmet than adults (adjusted odds ratio [OR], 0.3, 95% confidence interval [CI], 0.2–0.5, for children 10–14 years; adjusted OR: 0.1, 95% CI, 0.05–0.4, for children under 10 years). It is suggested that stricter regulation enforcement for child motorcycle drivers and passengers may be needed. In addition, barriers against wearing helmets for motorcycle drivers and passengers in Laos should also be examined in further studies.     

Using local injury surveillance for community-based injury prevention: an analysis of Scandinavian WHO Safe Community and Canadian Safe Community Foundation programmes

In Finland, the Finnish Association for Swimming Instruction and Life Saving (SUH) and Statistics Finland (SF) both provide nationwide data on unintentional drowning. The SUH database relies on rapid reporting from a newspaper clipping service and additional local police information, whereas the SF database relies on the later release of the death certificate information, which is based on extensive medico-legal investigation. The aim of the study was to explore the main differences between the SUH and SF databases for drowning and to evaluate the capacity of the former to characterize drowning events in Finland from 1998 to 2000. Computerized files of death certificates tabulated by SF were linked with the SUH database by deterministic methods. SF and SUH databases allowed the identification of 704 and 567 unintentional drownings, respectively, giving an unintentional drowning rate of 4.5 and 3.6/100?000 per year. Of the 704 drownings described by SF, 418 (59.4%) were also found in the SUH database. The SUH database markedly underreported drowning fatalities in certain settings, such as bath, ditch and swimming pool drownings; fall- and land-traffic-related drownings; and drownings occurring in South Finland. The narrative text of SUH drownings contributed limited information to characterize the drowning events. It was concluded that the newspaper-based SUH data provide more timely data on individual drownings but are not representative of all drownings. Conversely, the SF vital statistics data are more accurate but may take up to 2 years to become available. Both SUH and SF data provide little detailed information on drowning events. A multidisciplinary national surveillance system for drowning is necessary to provide more accurate and timely drowning data, analyse risk factors and design follow-up studies for developing and monitoring prevention strategies.     

Using local injury surveillance for community-based injury prevention: an analysis of scandinavian WHO safe community and canadian safe community foundation programmes

Injury surveillance is widely recognized as a critical prerequisite for effective injury prevention, yet few studies have investigated its use by community-based injury prevention programmes. This study examined the extent to which local injury data were collected, documented, analysed, linked to injury prevention action and used for evaluation among WHO Safe Communities in Scandinavia (25 programmes) and the Canadian Safe Community Foundation (SCF) network (16 programmes). For each programme, a key informant with relevant local knowledge was selected to respond to an emailed questionnaire. The study demonstrates that community-based injury prevention programmes experience difficulties accessing and effectively utilizing local injury surveillance data. The findings suggest that the responding SCF programmes approach injury prevention more scientifically than the Scandinavian WHO-designated Safe Community programmes, by making greater use of injury surveillance for assessment, integration into prevention strategies and measures, and evaluation. Despite study limitations, such as the low response rate among Canadian programmes and a large number of non-responses to two questions, the results highlight the importance of, and need for, greater use of local injury surveillance.     

Market share as a source of market power: Implications and some evidence

This paper investigates the proposition that firms with a high market share enjoy a unique form of market power—“inherent product differentiation.” The analysis is based on a sample of 6492 banks, during the 1970s. Tests tend to control for market concentration, scale economies, and explicit product differentiation as factors influencing rates of return. Test results indicate that market share per se is a source of high profits, regardless of the level of concentration and after controlling for firm size. These findings question the Demsetz (1973) view that high profits of market leaders are due to efficiency rather than to some form of market power.These findings suggest that traditional market models that account only for a single price may be incomplete. The paper suggests a kind of simple model that would account for the existence of multiple prices in a market.     

Tracing the utility of injury surveillance data in Pretoria (South Africa) and Borås (Sweden)

Our research attempted to study the factors that influenced the use of injury data in two cities, representing different injury and socio-economic profiles. In Pretoria, the South African capital city, injury data uptake was constrained by, among other factors, the transitional institutional environment, stakeholders' suspicion of research and the absence of safety promotion champions. In the Swedish city of Borås, injury data uptake was facilitated by well-established research agency–municipality partnerships, injury prevention champions, a receptive political and knowledge driven environment and dedicated resources. The study signified the role of a range of content issues, contextual arrangements, social actors who may or may not operate from a perspective of sufficient consensus and institutional communication processes that may either facilitate or hinder the multiple employment and rapid movement of data along the ‘ladder of knowledge utilisation’. Safety promotion researchers may need to expand their roles beyond data production to improve data utility.     

Women and minorities as a professional resource: a study of progress and change

For the first time in the nation's history, it is now certain women will soon constitute a significant professional resource, not only qualitatively, but quantitatively. Unprecedented rising enrollment in professional training extends across the entire occupational spectrum: the elite professions, business disciplines, and doctoral programs including engineering and the sciences. Minority students are also rapidly increasing their share of professional enrollments which already approaches their proportion of the population. Unexplained is the fact that minority women are enrolling in top-level training much more rapidly than minority men as compared with majority students.