A review of national policies and programs to prevent unintentional injuries in the Americas

Injuries are a global public health problem, with injury mortality increasing in many regions. We describe a survey of injury policies and programs in 23 countries in the Americas. Most countries surveyed (87%) perceived unintentional injuries to be a significant public health problem. When asked about actual policy agendas, however, just one-fourth (26%) of the countries ranked unintentional injuries among policy makers’ top five concerns. Approximately half of the countries reported having a national injury prevention strategy, injury prevention coordinator, or consultative group. Virtually all countries with national strategies and consultative groups had established them in the 1990s, suggesting that concern about injuries is both recent and growing. Three-fourths (74%) reported that their country had a surveillance system to monitor injury-related mortality and, to a lesser extent, morbidity. The study’s results suggest that most policies and programs for the prevention and control of unintentional injuries have been developed in the past 10 years, and primarily address motor vehicle injuries. It is essential that current efforts be both broadened and strengthened so that the societal burden of unintentional injuries in the Americas can be reduced.     

Patterns of injuries and motor-vehicle traffic accidents in Athens

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The 'Asclepeion' of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1,000,000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the 'Asclepeion' of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 - 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at 'Asclepeion' of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.     

Surveillance in Employment: The Case of Teleworking

This paper looks at various ways teleworking can be linked to surveillance in employment, making recommendations about how telework can be made more acceptable. Technological methods can allow managers to monitor the actions of teleworkers as closely as they could monitor "on site" workers, and in more detail than the same managers could traditionally. Such technological methods of surveillance or monitoring have been associated with low employee morale. For an employer to ensure health and safety may require inspections of the teleworkplace. When the teleworkplace is in the home, there may be an invasion of privacy associated with such inspections, that could be perceived and resented as surveillance. A problem of telework is that teleworkers may feel isolated. Methods to counter this could be associated with further forms of surveillance, and fear of such surveillance may inhibit them from reaching their potential as methods to counter isolation. The idea that teleworking may also allow communications to be intercepted by third parties is also looked at. Some, but not all, of the issues considered are applicable, to some extent, in non-teleworked employment situations. The overall conclusion of the paper is that the potential exists for surveillance to be associated with telework. Fears of such surveillance may turn actors against telework. However, much can be done to reduce such fears.     

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.     

Patterns of injuries and motor-vehicle traffic accidents in Athens

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The ‘Asclepeion’ of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1 000 000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the ‘Asclepeion’ of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 – 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at ‘Asclepeion’ of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.     

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.     

Non-seatbelt use and associated factors among passengers

Seatbelt use is the most effective way to save lives and reduce severe injuries. However, the percentage of non-seatbelt use is still high among drivers and passengers. Although the factors related to non-seatbelt use among drivers have been widely studied, the factors associated with non-seatbelt use among passengers have not been well documented. In addition, recent surveys showed that the driver's attitude has a significant impact on the passenger's seatbelt use. However, the lower response rate and less accurate of self-reported seatbelt use in survey studies, especially among participants who had a high level perception of penalty for non-seatbelt use. Therefore, we examined the association between passenger's seatbelt use and driver's seatbelt use with a statewide injury surveillance system. 36,012 passengers who were involved in motor vehicle crashes (MVC) in 2004–2013 were included in this study. Our results showed that if a driver wore a seatbelt, 92.6% of his/her passengers also wore seatbelts while if a driver did not wear a seatbelt, only 19.1% of his/her passengers wore seatbelts. Compared to the passenger whose driver wore a seatbelt, the passenger had a significantly higher probability of non-seatbelt use (odds ratio = 46.7; 95% confidence intervals, 42.7–51.1) if his/her driver did not wear a seatbelt. The driver has the greatest influence on the passenger's seatbelt use. The findings will provide important information for future public health practices to increase seatbelt use at the highest possible rate for passengers, such as educational interventions for drivers and seatbelt reminders use.     

The cost of childhood injury in France

Injuries are a major public health problem worldwide. In the USA, injuries cause 146, 400 deaths annually, with 31 million non-fatal injury visits to emergency departments (EDs). EDs thus represent an important source of injury data. The primary objective of the current study was to describe the epidemiology of injury-related ED visits and assess injury-related utilization of health care resources in an inner-city hospital in Indiana, using data stored in a computerized medical record system. It involved a retrospective review of the records for injury visits to EDs and injury admissions over a 3-year period. The variables extracted and analysed included patients' demographics, external cause of injury, diagnosis, length of stay, ED and hospital charges. A total of 60,470 injury-related ED visits were made, the majority of patients were male (61.6%), uninsured (63.1%), treated in ED and discharged (98.4%). The leading causes of injury were falls (18.8%), motor vehicle crashes (18.4%), assaults (17.6%), being struck (11.2%) and overexertion (10.6). Firearms caused most injury deaths (32.4%; n = 314); motor vehicle crashes were the leading cause of hospitalization (26.6%; n = 642) and also the most expensive to treat as inpatients (mean charge $19,190). The mean charge per patient treated and discharged was $150 compared to $11,116 for patients admitted. These findings demonstrate the value of computerized medical records in capturing and storing E-coded injury data. The system generates data that can be used for epidemiological surveillance and injury prevention at the local level, and for assessment of impact of specific injuries on health care resources.     

On the epidemiology of injury in developing countries: A one-year emergency room-based surveillance experience from León,Nicaragua

Background Regularly available data has been shown to be inadequate for developing, implementing, and evaluating injury prevention and control programs in Nicaragua. A specific prevention-oriented local injury surveillance system has therefore been set up in the city of León. Objectives The aim of this paper is to describe the epidemiology of fatal and non-fatal injuries over a one-year period in a well-defined local population in Nicaragua, as emerging from the perspective of emergency room and inpatient treatments over a one-year period. Methods A hospital-based injury surveillance system was established to collect data for different levels of severity. All treated unintentional and intentional injuries were registered, including information on the external causes according to the ICD-9. Results Of all emergency room visits, 15.9% (9,970) were injuries. For every death due to injuries, there were 31 hospital admissions and 253 emergency room visits. Home and street/roads were the main arenas for the accidents. The estimated underreporting rate was about 6%, and in 20.3% of the cases, no E-code was assigned. The overall incidence and mortality rates were 56.2 per 1,000 and 20 per 100,000 inhabitants, respectively. However, comparison with a parallel household survey showed that the reporting rate of the surveillance system is only about 9%. The overall ratio of male to female injury rates was 2.1 to 1. The main causes of non-fatal injuries were falls, whereas the main cause of death was traffic accidents. Conclusions Hospital discharge and emergency room data systems are effective and feasible means for collecting the data needed to prevent injuries. However, in a country like Nicaragua with limited access to hospital health services, it is necessary to supplement such a system with additional sources of information in order to gain a more comprehensive picture of injury occurrence.     

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.     

Capture and surveillance of quad-bike (ATV)-related injuries in administrative data collections

Identifying quad-bike-related injuries in administrative data collections can be problematic. This study sought to determine whether quad-bike-related injuries could be identified in routinely collected administrative data collections in New South Wales (NSW), Australia, and to determine the information recorded according to World Health Organization (WHO) injury surveillance guidelines that could assist injury prevention efforts. Five routinely collected administrative data collections in NSW in the period 2000–2012 were reviewed. The WHO core minimum data items recorded in each of the five data collections ranged from 37.5% to 75.0%. Age and sex of the injured individual were the only data items that were recorded in all data collections. The data collections did not contain detailed information on the circumstances of quad bike incidents. Major improvements are needed in the information collected in these data-sets, if their value is to be increased and used for injury prevention purposes.     

Child injury prevention in Vietnam: achievements and challenges

As with other South Asian countries, injury is becoming a leading cause of death and morbidity among children in Vietnam. In response to the increasing burden of child injury, government and non-government agencies in Vietnam have combined efforts during the last decade to develop and implement various child injury prevention strategies and programmes. This article provides, through a review of relevant documents and interviews with major stakeholders, an overview of these efforts and highlights major challenges to child injury prevention in the country. The findings point to notable achievements in terms of increasing awareness of injury facing children at all levels in the community and developing a sound injury prevention policy framework in a relatively short period of time. However, much needs to be done to implement necessary environmental and legislative changes, strengthen child injury surveillance and injury prevention research; and to improve access to health services. The insight into the experience of Vietnam could benefit other low- and middle-income countries with a high burden of child injury.     

Child injury prevention in Vietnam: achievements and challenges

As with other South Asian countries, injury is becoming a leading cause of death and morbidity among children in Vietnam. In response to the increasing burden of child injury, government and non-government agencies in Vietnam have combined efforts during the last decade to develop and implement various child injury prevention strategies and programmes. This article provides, through a review of relevant documents and interviews with major stakeholders, an overview of these efforts and highlights major challenges to child injury prevention in the country. The findings point to notable achievements in terms of increasing awareness of injury facing children at all levels in the community and developing a sound injury prevention policy framework in a relatively short period of time. However, much needs to be done to implement necessary environmental and legislative changes, strengthen child injury surveillance and injury prevention research; and to improve access to health services. The insight into the experience of Vietnam could benefit other low- and middle-income countries with a high burden of child injury.     

Computer-aided human factors analysis of the industrial vehicle driver cabin to improve occupational health

Industrial vehicle operator's solace and safety have gained significant consideration because of the increment in occupational health issues and accidents. The purpose of this work was to amend the design of the excavator driver cabin through human factor analysis. Thirty operators of excavators who were serving as subjects, were interviewed and identified that their wrist, upper arm and trunk were at a higher risk level while operating. Photograph of the operators was taken and the work environment was simulated. RULA (Rapid Upper Limb Assessment) and REBA (Rapid Entire Body Assessment) scoring was made on different simulated work posture of operators using CATIA V5 and UEAT1.8 softwares. Based on overall RULA and REBA scoring, it was found nearly 46% of the operators were operating at a high hazard level and needed investigation immediately, whereas 35% of operators were at a medium risk level and only 19% of operators were operating safely. The individual RULA and REBA scoring proved prevalence of discomfort in wrist, upper arm and trunk while operating. Identifying the optimized conditions to hold the control levers will help to reduce the operator strain. From the design optimization in excavators, the optimal conditions to hold the control lever is found to be 40cm for popliteal height, 60.51 cm for distance from elbow to ground and 15.07º for reach angle from the seat reference point.     

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.     

Unintentional child home injury incidence and patterns in six countries in Europe

This study investigates the incidence and patterns of child home injuries in six European Union countries. Emergency department and inpatient injury data on injuries to children aged 0-18 years in the home (n = 88,567) for the years 2003-2004 were extracted from the European Injury Database in Austria, Denmark, France, Netherlands, Portugal and Sweden. The incidence of child home injuries was 44.9/1000 inhabitants Six age-dependent injury patterns were identified using cluster analysis: 1) open wound head injuries; 2) hospital admissions for bruises, contusions, abrasions; 3) falls on stairs indoors; 4) fractures and sprains of the upper extremities; 5) crush/cut/piercing of the fingers; 6) miscellaneous injuries. Child home injuries are a considerable public health problem, particularly in the ages 0 to 4 years. The findings are useful for injury surveillance at the European level yet do not allow for designing testable countermeasures for prevention within home safety initiatives.     

Risk factors and geographical heterogeneity in unintentional home injuries incidence rate: new evidence based on Multiscopo survey in Italy

Home injuries together, with road traffic accidents, are estimated to be the third cause of death in Italy (Arokiasamy and Krishnan 1994). However, as in most other countries, in Italy there is a lack of information on home injuries and on how differences in geographical patterns may influence the scope and magnitude of this phenomenon. By analysing a multipurpose large survey (Multiscopo) carried out annually, geographical heterogeneity in home injuries incidence rate can be investigated. The aim of this study is the assessment of possible differences in geographical patterns among the Italian regions making use of a re-analysis of Multiscopo home injury data. The study results show that Italian regions differ greatly in the number of home injuries. The geographical heterogeneity may be due to the unemployment rate and the incidence of poverty that is greater in the Southern and Insular regions than in other zones. Other socio-economic variables such as alcohol consumption can increase the risk of injury in the home. To prevent them it could be useful to organize campaigns aimed at increasing the awareness among people about this problem.     

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.     

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.